| bartonella henselae was recovered from the conjunctival scraping of a 38-year-old woman who presented with a 2-week history of tender preauricular lymphadenopathy and a 1-day history of a red left eye. Dry adherent colonies were observed on agar plates at 21 days of incubation, and the isolate was identified through conventional and molecular tests. polymerase chain reaction (PCR) amplification of a specific region of the 16S rRNA gene and confirmation by a separate PCR reaction with hybridization of the product with a B. henselae-specific probe confirmed the isolate as B. henselae. This is the first reported isolation of the causative agent of cat scratch disease from ocular tissue in a patient with Parinaud's oculoglandular syndrome. ( info) |
| A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay. ( info) |
| The atypical, or nontuberculous, mycobacteria are opportunistic pathogens that usually cause infection following accidental trauma or surgery. These organisms are ubiquitous in nature but have been found with increasing frequency in other environments that include medical offices and surgical suites. Management of atypical mycobacterial ocular infections can be difficult because in vitro antibiotic activity does not always correlate with in vivo efficacy and because normal immune defenses against mycobacteria may work too slowly to prevent irreversible damage to infected ocular tissues. This report describes a patient who developed a severe ocular infection due to mycobacterium chelonae after vitrectomy. Despite eradication of the infection, the eye became blind and painful. Arch Ophthalmol. 2000;118:1125-1128 ( info) |
4/48. Group-C meningococcal conjunctivitis in a neonate. Meningococcal conjunctivitis, although rare, may be complicated by ocular damage and systemic spread. Identification of the infecting organism is important for appropriate management. Meningococcal infection needs treatment of both the patient and the contacts. We report the use of meningococcal group-C vaccine in the prophylaxis of adult contacts of a neonate with meningococcal conjunctivitis. This measure, we believe, has not been reported before in the management of meningococcal conjunctivitis. ( info) |
5/48. Acute conjunctivitis associated with biofilm formation on a punctal plug. BACKGROUND: Punctal plugs are used for the treatment of tear-deficient type dry eye. We recently examined a case of acute conjunctivitis associated with bacterial biofilm formation on a punctal plug. CASE: A 63-year-old woman diagnosed as having tear-deficient type dry eye came to our hospital with a complaint of soreness in her right eye. Punctal plugs had been inserted into this eye 5 1/2 months previously. On the day of her visit, she presented with acute conjunctivitis. OBSERVATIONS: In biomicroscopical examination, the top of the punctal plug was seen to be covered with a whitish soft material. Microbiological analysis performed on a part of this material was positive for staphylococcus haemolyticus and candida tropicalis. Scanning electron microscopy of the removed punctal plug revealed widespread bacterial colonization embedded within an extensive extracellular matrix. Treatment consisted of the replacement of the plug, and administration of a combination of antibacterial eyedrops and preservative-free artificial solution. As a result, the acute conjunctivitis cleared up within 1 month. CONCLUSIONS: This case suggests that a punctal plug poses a potential risk of causing the formation of bacterial biofilm. In such a case, replacement of the plug and/or removal of the accumulated materials should be considered. ( info) |
6/48. Ligneous conjunctivitis in a girl with severe type I plasminogen deficiency. BACKGROUND: Ligneous conjunctivitis is a rare form of chronic recurrent pseudomembranous disease and may be associated with systemic membranous pathological changes. Recently ligneous conjunctivitis has been linked to severe type I plasminogen deficiency. We report on a patient with plasminogen deficiency and severe bilateral ligneous conjunctivitis. A new treatment approach and its outcome in this patient are described. CASE REPORT: We present the case of a 9-month-old Turkish girl with massive swelling of the eyelids and hard white pseudomembranes on both lids. The conjunctival smear was positive for streptococcus pneumoniae. The clinical diagnosis was: ligneous conjunctivitis with superinfection. Histological investigation showed fibrin as major component of the pseudomembranes. The coagulation analyses revealed decreased plasminogen activity (<5%; normal 80-120%) and decreased plasminogen antigen (<0.4 mg/dl; normal 6-25 mg/dl). The failure of surgical therapy led to the attempt at treatment with intravenous lys-plasminogen. A significant improvement of the ocular symptoms occurred; stabilization with no recurrent pseudomembranes could be achieved for 6 months after treatment. DISCUSSION: The initial amelioration of symptoms in our patient after systemic replacement therapy confirms the etiological importance of plasminogen deficiency in the development of ligneous conjunctivitis. Curative treatment of ligneous conjunctivitis is still not available. However, intravenous application of plasminogen offers new possibilities in therapy, although long-term treatment seems necessary. ( info) |
7/48. An unusual transmission of neisseria meningitidis: neonatal conjunctivitis acquired at delivery from the mother's endocervical infection. BACKGROUND: Primary meningococcal conjunctivitis is assumed to be due to the direct inoculation of neisseria meningitidis into the conjunctival sac from an exogenous source. According to a literature review, no case of neonatal conjunctivitis infection acquired at delivery from maternal endocervicitis has been published. GOAL: To report a case of meningococcal neonatal conjunctivitis acquired at delivery because of the mother's endocervical infection and cross-transmission of the strain with her partner. STUDY DESIGN: Strains were characterized by bacteriologic and serologic methods including grouping (agglutination), typing, and subtyping (enzyme-linked immunoabsorbent assay). Molecular analysis was done by pulsed-field gel electrophoresis. RESULTS: The three strains (newborn infant, mother, partner) were of the same antigenic formula (C:NT:P1.NT) and exhibited similar NheI and SpeI pulsed-field gel electrophoresis patterns. CONCLUSION: The identical phenotypic and genomic analysis of strains is the evidence for N meningitidis transmission at delivery from a maternal endocervical infection to the newborn infant and cross transmission between sexual partners. ( info) |
8/48. Parinaud's oculoglandular syndrome attributable to an encounter with a wild rabbit. PURPOSE: To describe the clinical and histopathologic findings in a patient with Parinaud's oculoglandular syndrome attributable to francisella tularensis obtained from an encounter with a wild baby rabbit. methods: In an 18-year-old man, the clinical course, laboratory findings, and histopathologic findings are described. RESULTS: Parinaud's oculoglandular syndrome should be considered in the differential diagnosis of a patient presenting with unilateral granulomatous conjunctivitis, painful preauricular, and submandibular lymphadenopathy combined with systemic symptoms of general malaise and fever. CONCLUSION: tularemia is one etiology of Parinaud's oculoglandular syndrome. It is caused by francisella tularensis and is usually transmitted to humans via infected animal blood or through an insect bite, most often a tick. For treatment, intramuscular streptomycin is the drug of choice. ( info) |
9/48. Central necrotic lamellar inflammation after laser in situ keratomileusis. PURPOSE: To report four cases of corneal interface complications that occurred after excimer laser in situ keratomileusis (LASIK). methods: Four eyes of three patients underwent technically uneventful LASIK. RESULTS: One day after LASIK, patients presented with severe pain, blurred vision, conjunctival infection, and diffuse opacity at the interface. Two days after LASIK, significant features were central opacity, striae in the flap, loss of uncorrected and best spectacle-corrected visual acuity, and corneal sensitivity. The findings did not improve by using drugs or by lifting the flap and irrigating the bed. The central opacity partially resolved over 8 to 12 months, leaving a hyperopic shift (one patient), striae (one patient), and loss of two or more lines of best spectacle-corrected visual acuity (three patients). CONCLUSION: This severe central inflammation after LASIK could be an extreme manifestation of diffuse lamellar keratitis. ( info) |
| A case of keratitis and conjunctivitis in an 86-year-old man caused by corynebacterium pseudodiphtheriticum is reported. Corynebacteria are uncommon causes of ocular surface infections. However, the presence of corneal and conjunctival epithelial defects in an immunocompromised patient can result in severe infection by a commensal organism such as C. pseudodiphtheriticum. The significance of a positive culture in these settings should not be overlooked. ( info) |