1/38. Mycotic keratitis in non-steroid exposed vernal keratoconjunctivitis.PURPOSE: To report a patient with vernal keratoconjunctivitis who developed mycotic keratitis in absence of known risk factors. methods: A 17-year-old male suffering from vernal keratoconjunctivitis presented with infective keratitis. The patient had been treated in the past with topical antihistaminics and vasoconstrictors. The patient had not been exposed to topical steroids in 2 years of follow-up. He did not have dry eye or corneal micro or macroerosions prior to the development of infective keratitis. Corneal scrapings were obtained and subjected to KOH wet mount smear, calcofluor and Grams stain as well as bacterial culture sensitivity and fungal culture. RESULTS: Clinical diagnosis of mycotic keratitis in association with vernal conjunctivitis was supported by microbiological investigations. KOH wet mount and calcofluor staining showed presence of filamentous septate hyphae while fungal culture showed growth of aspergillus fumigatus. Antifungal therapy was initiated in the form of topical natamycin 5% suspension to which the patient responded and recovered 6/6 final visual acuity. CONCLUSION: The authors wish to conclude that patients suffering from vernal keratoconjunctivitis, even in the absence of corneal involvement, steroid exposure and trauma, may be at increased risk of developing keratomycosis.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/38. Chronic dacryoadenitis misdiagnosed as eyelid edema and allergic conjunctivitis.PURPOSE: To report the case of a 53-year-old woman with a 2-year history of episodic upper eyelid swelling and nonspecific complaints, who was diagnosed as having allergic conjunctivitis. methods: A complete ocular examination, orbital computerized tomographic (CT) scans followed by complete physical and systemic examinations. RESULTS: The results of physical and systemic examinations were unremarkable for systemic lymphoma and a primary focus of cancer. The results of the ocular examination were normal. CT scans demonstrated well-defined lesions bilaterally with a homogeneous internal structure in the lacrimal gland fossa, which suggested a diagnosis of chronic dacryoadenitis. The differential diagnosis included lymphoma and orbital metastases. The patient refused a biopsy and was started on a tapering dose of 60 mg oral prednisolone daily. The follow-up CT scans 1 month after cessation of 6-week oral corticosteroid treatment showed near complete resolution of the orbital lesions. CONCLUSION: This case demonstrates that orbital inflammation can be misdiagnosed as refractory allergic conjunctivitis.- - - - - - - - - - ranking = 0.0047429737415273keywords = ocular (Clic here for more details about this article) |
3/38. Bilateral keratoconus associated with Hashimoto's disease, alopecia areata and atopic keratoconjunctivitis.keratoconus is a progressive non-inflammatory corneal ectasia. alopecia areata is complete loss of hair patches on the hairy areas of the body in association with some ocular manifestations such as cataract, or disorders of the conjunctiva, iris, lens, choroid and retina pigment epithelium. A ten-year-old patient with atopic keratoconjunctivitis, keratoconus and alopecia areata is presented. This patient has also been receiving treatment for Hashimoto thyroiditis (chronic lymphocytic thyroiditis) for more than three years. The possible association of keratoconus with multisystem autoimmune disease is discussed.- - - - - - - - - - ranking = 0.0023714868707637keywords = ocular (Clic here for more details about this article) |
4/38. Acute hydrops in the corneal ectasias: associated factors and outcomes.PURPOSE: To identify factors associated with the development of hydrops and affecting its clinical outcome. methods: Chart review of all patients with acute hydrops seen by a referral cornea service during a 2.5-year period between June 1996 and December 1998. RESULTS: Twenty-one patients (22 eyes) with acute hydrops were seen. Nineteen patients had keratoconus, 2 had pellucid marginal degeneration, and 1 had keratoglobus. Twenty-one of 22 (95%) eyes had seasonal allergies and 20 of 22 (91%) eyes had allergy-associated eye-rubbing behavior. Six of 22 (27%) had a diagnosis of Down's syndrome. Six patients were able to identify a traumatic inciting event: vigorous eye rubbing in 4 and traumatic contact lens insertion in 2. The affected area ranged from 7% to 100% of the corneal surface area and was related to disease duration and final visual acuity. Proximity of the area of edema to the corneal limbus ranged from 0 to 2.3 mm and was also related to prognosis. Three serious complications were observed: a leak, an infectious keratitis, and an infectious keratitis and coincidental neovascular glaucoma. Various medical therapies did not differ significantly in their effect on outcome, and ultimately 4 (18%) of 22 patients underwent penetrating keratoplasty. Best-corrected visual acuity was equal to or better than prehydrops visual acuity in 5 of the 6 patients in whom prehydrops visual acuity was known, without corneal transplantation. CONCLUSIONS: Allergy and eye-rubbing appear to be important risk factors in the development of hydrops. Visual results are acceptable in some patients without surgery. Close observation allows for the early detection and treatment of complications such as perforation and infection.- - - - - - - - - - ranking = 0.25keywords = keratitis (Clic here for more details about this article) |
5/38. skin tests and cutaneous anergy in children with ocular allergy.PURPOSE: To evaluate skin tests with clinical ocular allergy and to compare cutaneous hypersensitivity and seasonal allergic conjunctivitis in children. CASE-REPORT: A 10-year-old girl presented a typical seasonal allergic conjunctivitis, never treated and the onset occurred one year before. She was skin tested for the allergy. Complete blood tests were also performed. An ocular treatment was given: olopatadine over 45 days. RESULTS: She showed a complete cutaneous anergy including histamine and codeine controls. Radioallergosorbent tests (RAST) found numerous great positivity to different allergens. Within 30 days under ocular treatment, she recovered completely from symptoms and clinical signs. CONCLUSION: Clinical typical seasonal ocular allergy in children with cutaneous anergy should be explored further or at least treated. Cutaneous hypersensitivity should be evaluated more precisely with a larger study comparing results in general allergy and in ocular allergy where the anergy seems to be more frequent.- - - - - - - - - - ranking = 0.021343381836873keywords = ocular (Clic here for more details about this article) |
6/38. Contact dermatitis.BACKGROUND: Anatomically, the eyelid can be divided microscopically into (1) skin, which is made up of epidermis and dermis; (2) submucosa (3) muscular layer; (4) submuscular layer (dense connective tissue); (5) fibrous layer; and (6) palpebral conjunctiva. The thin nature of the eyelid makes it susceptible to inflammation resulting from allergy. Minimum levels of irritants contacting the adnexal area can penetrate the skin to initiate the allergic cascade. Allergic reactions that involve the eye may begin via contact to the skin, but often involve the conjunctiva. eczema is the general term that describes the superficial inflammatory process involving the epidermis. Contact eczema is characterized by varying elements of epidermal erythema, papules, and vesicles. Allergic dermatoconjunctivitis connotes involvement of both the skin and conjunctiva. CASE REPORT: A 24-year-old man came to the clinic with a red, swollen left eye. Based on the history, the constellation of signs and symptoms (lack of diffuse or focal pain, presence of periorbital and conjunctival edema, absence of fever), and failed resolution after treatment with injectable antibiotics, the diagnosis of type IV delayed hypersensitivity reaction secondary to toxic/chemical exposure was made. Speedy resolution was accomplished using a sequenced therapy, which included oral antihistamines, topical cycloplegics, topical antibiotics, topical steroids, and palliative therapies. CONCLUSION: Optometrists should be familiar with the signs and symptoms of contact eczema and allergic dermatoconjunctivitis. Treatment includes management of the skin and adnexae, as well as the ocular manifestations.- - - - - - - - - - ranking = 0.0023714868707637keywords = ocular (Clic here for more details about this article) |
7/38. Atopic dermatitis: a case report and current clinical review of systemic and ocular manifestations.PURPOSE: Atopic dermatitis is a relatively common hereditary dermatologic condition. Ocular sequellae are commonly seen in this disorder and may include involvement of both the anterior and posterior segments of the eye. Clinical symptoms and presentation may vary, as well as visual prognosis. METHOD: A 48-year-old black woman came to us with a sudden exacerbation of atopic disease with ocular complications-most notably, the classic "shield-like" anterior subcapsular cataract seen in patients with this disease. Extensive diagnostic and management considerations specific to this disorder are highlighted. RESULTS: A careful history and clinical examination will help direct appropriate diagnosis and management in this population. Although chronic in nature, acute exacerbations of the disease may require specific management. Proposed pathophysiologic mechanisms, including new aspects of treatment, are discussed. CONCLUSION: Ocular manifestations of atopic disease may be visually debilitating. Therefore, specific consideration relating to clinical course, effective diagnosis, and medical and surgical management of this disorder are discussed.- - - - - - - - - - ranking = 0.011857434353818keywords = ocular (Clic here for more details about this article) |
8/38. Bilateral conjunctival mucosa-associated lymphoid tissue lymphoma misdiagnosed as allergic conjunctivitis.PURPOSE: This report aimed to discuss two nearly identical cases of primary conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma mimicking allergic conjunctivitis. methods: Two patients were referred for intractability to conventional treatment of initial diagnoses of allergic conjunctivitis. On ocular examination, normally pigmented, giant papilla-like lesions were found bilaterally in the upper conjunctiva. Excisional biopsies were performed. RESULTS: Histopathologic and immunohistochemical examination of the conjunctival biopsies indicated MALT lymphoma in both patients. The patients subsequently received radiation therapy and achieved complete remission with no evidence of recurrence during follow-up periods of 13 and 11 months. CONCLUSION: Conjunctival low-grade lymphoma may share similar clinical features with allergic conjunctivitis. Ophthalmologists should be concerned that primary conjunctival low-grade malignant lymphoma can be misdiagnosed as allergic conjunctivitis- - - - - - - - - - ranking = 0.0023714868707637keywords = ocular (Clic here for more details about this article) |
9/38. Allergic contact dermatitis to latanoprost.An 85-year-old male with glaucoma presented with a 1-1/2 year history of tearing; red eyes; and pruritic, edematous, eczematous eyelids. Treatment for presumed ocular rosacea and seborrhea was unhelpful. Patch testing to our standard 64 antigens yielded a positive reaction to Balsam of peru. Notably, benzalkonium chloride, thimerosal, and other preservatives elicited negative reactions. Repeat open application testing elicited positive results to Xalatan (latanoprost) 0.005% ophthalmic solution (Pharmacia & Upjohn, Kalamazoo, MI). A second session of patch tests to 10 personal products, in addition to Xalatan 0.005% solution and the Xalatan vehicle (provided by the manufacturer), elicited a strong positive reaction only to the full preparation of Xalatan 0.005% solution. This report describes the first known case of ACD to latanoprost, a new prostaglandin analog that is widely prescribed for treatment of glaucoma.- - - - - - - - - - ranking = 0.0023714868707637keywords = ocular (Clic here for more details about this article) |
10/38. Limbal stem cell transplantation in chronic inflammatory eye disease.OBJECTIVE: The goal of this study was to describe the outcome of limbal stem cell transplantation (LSCT) in patients with severe ocular surface disease caused by underlying chronic inflammatory eye disease. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Nine patients with limbal stem cell deficiency caused by an underlying ocular inflammatory disease who underwent LSCT. methods: The authors reviewed the records of 11 eyes of 9 patients with immunologically mediated ocular surface disease that underwent LSCT. MAIN OUTCOME MEASURES: The main outcome measures were reepithelialization of the corneal surface, restoration of corneal surface, and improvement in visual acuity. RESULTS: A total of 11 eyes underwent either autologous (n = 1) or HLA-matched living related donor (n = 10) LSCT for ocular surface disease secondary to inflammatory disease. Reepithelialization of the corneal surface in the immediate postoperative period occurred in 10 eyes (91%) within an average of 10 days (range, 3-21 days). Long-term restoration of the corneal surface was achieved in six (55%) eyes. visual acuity improved in six eyes (55%). Reasons for poor outcomes included microbial infection, limbal stem cell graft rejection, and corneal ulceration. No donor eyes had complications. CONCLUSIONS: patients with underlying immunologically mediated diseases, such as stevens-johnson syndrome, toxic epidermal necrolysis, or ocular cicatricial pemphigoid, who undergo LSCT have lower success rates than do those patients with noninflammatory ocular surface diseases.- - - - - - - - - - ranking = 0.014228921224582keywords = ocular (Clic here for more details about this article) |
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