| Two hundred and forty-six patients with signs of acute bacterial conjunctivitis and/or blepharitis were randomised to receive either norfloxacin or chloramphenicol for one week in this double-masked parallel group study. Ninety-two per cent of the norfloxacin-treated patients and 93% of the chloramphenicol-treated patients were rated as either clinically improved or cured at the end of the treatment period. Based upon pre-treatment bacteriological cultures, 31.3% of the patients had significant bacterial infection of the lids and/or conjunctiva. All of these culture-positive patients were rated as either clinically improved or cured. Based upon post-treatment cultures, 72 of 82 strains of Gram-positive and gram-negative bacteria were eradicated or suppressed following treatment with either norfloxacin or chloramphenicol. However six of 41 strains persisted for norfloxacin and four of 41 for chloramphenicol. Two norfloxacin-treated patients and three chloramphenicol-treated patients had adverse experiences, predominantly ocular discomfort, which required cessation of drug therapy. norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the lids and/or conjunctiva. In this study, norfloxacin was clinically and microbiologically similar in activity to chloramphenicol. ( info) |
12/90. Uncommon ocular changes in Down's syndrome (mongolism). A one-year-old White female mongoloid child was seen with typical palpebral fissures, esotropia, myopic astigmatism, and nystagmus. Additional uncommon ocular findings included ganglionic neuroretinal hypoplasia (hypoplasia of the optic nerve) and bilateral congenital impatency of the nasolacrimal duct. An active search for these ocular changes is recommended in cases of Down's syndrome. ( info) |
13/90. Detection by impression cytologic analysis of conjunctival intraepithelial invasion from eyelid sebaceous cell carcinoma. OBJECTIVE: To demonstrate that conjunctival impression cytologic analysis can detect conjunctival intraepithelial invasion from sebaceous cell carcinoma of the eyelid. DESIGN: Observational case series with cytopathologic correlation. PARTICIPANTS: Four patients with unilateral blepharoconjunctivitis and biopsy-proven sebaceous cell carcinoma. methods: Impression cytologic analysis specimens were taken from the suspicious area of the bulbar conjunctiva of each patient. Staining of the specimens was performed with a modified Papanicolaou stain. MAIN OUTCOME MEASURE: observation of the abnormal tumor cells in the collected specimens by bright field microscope. RESULTS: The technique of impression cytologic analysis allowed collection and identification of abnormal tumor cells with characteristic cytoplasmic vacuoles. CONCLUSIONS: Conjunctival impression cytologic analysis successfully detected the ocular surface sebaceous carcinoma cells from the eyelid. However, full-thickness biopsies are necessary to confirm the diagnosis. Judicious use of impression cytologic analysis may facilitate the detection and diagnosis of this invasive tumor. ( info) |
14/90. Severe allergic blepharoconjunctivitis induced by a dye for eyelashes and eyebrows. PURPOSE: To report a case of severe allergic blepharoconjunctivitis induced by a dye for eyebrows and eyelashes. methods: A 38-year-old healthy female was examined one day after dyeing her eyebrows and eyelashes with a black cream dye intended for this purpose (FDA-approved). The patient complained of severe eye itching, redness, and epiphora. RESULTS: Vision was 20/40 in both eyes; a moderate edema of the eyebrows and eyelid margins was noted. The conjunctiva was severely hyperemic with papillary reaction and chemosis. The corneas, anterior chambers, irides, lenses, and posterior segments were normal. The patient was treated with dexamethasone 0.1% and ocular lubrication. After five days of treatment, the ocular symptoms improved, her vision returned to 20/20 in both eyes, and the ocular examination was within normal limits. CONCLUSION: FDA-approved dyes for eyebrows and eyelashes can sometimes irritate the ocular surface. ( info) |
15/90. Monthly recurrent herpes simplex virus blepharitis in a boy for more than 10 years. Ocular herpes simplex virus (HSV) infection is generally accepted to be a unilateral disease and simultaneous bilateral recurrent ocular HSV disease is uncommon. Recurrent ocular herpes was generally thought to be characterized by corneal involvement. We here report an 11-year-old boy with monthly bilateral recurrent HSV type 1 blepharitis for more than 10 years. He had a general normal immunological examination. Only supportive or topical acyclovir ointment treatment proved adequate for controlling the monthly recurrent disease without corneal involvement or other sequelae to date. The case highlights the unusual presentation, general normal immune function, clinical course and treatment opinion for recurrent HSV blepharitis. ( info) |
16/90. Ocular vaccinia following exposure to a smallpox vaccinee. PURPOSE: To describe the presentation and management of the first identified case of ocular vaccinia infection associated with the current smallpox vaccination program. DESIGN: Case report. methods: vaccinia virus was isolated by cell culture of a conjunctival swab. Direct staining with fluorescein isothiocyanate-labeled vaccinia antibody and polymerase chain reaction testing confirmed the diagnosis. RESULTS: In February 2003, a 26-year-old woman developed right preseptal cellulitis and blepharoconjunctivitis following contact with a vaccinated member of the military. The preseptal cellulitis resolved with antibacterial therapy, and the conjunctival infection was treated successfully with a 14-day course of topical trifluridine and a single dose of intravenous vaccinia immune globulin. CONCLUSIONS: To facilitate rapid diagnosis and appropriate treatment, clinicians must maintain a high index of suspicion for ocular smallpox vaccine-associated adverse reactions in vaccine recipients and their close contacts. ( info) |
17/90. glaucoma from topical corticosteroids to the eyelids. Raised intraocular pressure and glaucoma have rarely been associated with use of periorbital corticosteroids for dermatological conditions such as blepharitis and eczema. Three cases are described in which periorbital topical corticosteroids appear to have resulted in raised intraocular pressure or glaucoma. Topical corticosteroids used for dermatological conditions around the face and eyes are often regarded as being fairly innocuous with regard to ocular side-effects. This case series demonstrates that secondary open-angle glaucoma can be a sight-threatening consequence, and periorbital steroids should therefore be used cautiously and sparingly, particularly in those with a family history of glaucoma. intraocular pressure may not always return to normal upon cessation of the drug. ( info) |
| OBJECTIVE: To report the association of kaposi varicelliform eruption (KVE) with 0.1% tacrolimus ointment treatment of atopic blepharitis in a patient with atopic dermatitis (AD). METHOD: We encountered KVE in a 20-year-old male patient with atopic blepharitis and AD who developed generalized herpetic lesions on his face 28 days after commencement of treatment. RESULT: The lesions resolved quickly with intravenous acyclovir treatment. CONCLUSION: Ophthalmologists should be well aware of KVE as a complication of immunosuppressive treatment in patients with atopic blepharitis. ( info) |
19/90. Masquerade syndrome: sebaceous carcinoma presenting as an unknown primary with pagetoid spread to the nasal cavity. Sebaceous carcinoma of the eyelid is an uncommon tumour with unusual modes of presentation. It can remain occult at the primary site, without producing any mass, masquerading as chronic blepharoconjunctivitis, while setting up metastases in the regional lymph nodes especially in the pre-auricular group. We report here a case that not only masqueraded as chronic blepharoconjunctivitis with nodal metastases from an 'unknown primary' in the neck, but whose tumour spread in a pagetoid manner along the nasolacrimal duct producing a nasal tumour that was believed to be the 'unknown primary'. This case emphasizes the need for ophthalmologists, ENT surgeons and pathologists to keep sebaceous carcinoma in mind while evaluating patients with chronic blepharoconjunctivitis and cervical node metastases from 'unknown primary'. Histological clues for picking up a sebaceous carcinoma at a metastatic site include a tumour with comedo or ductal growth pattern and intracytoplasmic lipid. ( info) |
20/90. Bilateral lid margin ulcers as the initial manifestation of crohn disease. PURPOSE: To report an unusual bilateral ulcerative lid involvement as the presenting manifestation of a severe crohn disease. DESIGN: Observational case report. METHOD: Description of an otherwise healthy woman who initially presented with bilateral ulcerative lid involvement before the discovery of an extensive ulcerative intestinal inflammatory disease. RESULTS: A 32-year-old woman presented with bilateral ulcerative blepharitis. She also complained of aphthous oral lesions and diarrheic episodes for the previous 3 days. Impression cytology of the lid ulcers showed conjunctival cells, together with the presence of lymphocytes and macrophages. colonoscopy and colonic biopsy were characteristic of crohn disease. The treatment with systemic corticosteroids healed bowel, oral, and lid margin ulcerative lesions. CONCLUSION: The simultaneous appearance of ulcerative lesions in the intestinal mucosa and in the mucocutaneous lid margin and the comparable features encountered in the cytologic studies indicate that ulcerative lid margin disease could be an ocular manifestations of crohn disease. ( info) |