| PURPOSE: To report successful treatment of ocular infection caused by the microsporidium encephalitozoon cuniculi in a person with acquired immunodeficiency syndrome (AIDS) and nasal and paranasal sinus infection. METHOD: Case report. RESULTS: Microsporidial infection in a person with AIDS and with chronic sinusitis and keratoconjunctivitis was diagnosed by Weber modified trichrome stain and transmission electron microscopy. Symptoms completely resolved with itraconazole treatment (200 mg/day for 8 weeks) after albendazole therapy (400 mg/day for 6 weeks) was unsuccessful. CONCLUSION: itraconazole can be recommended in ocular, nasal, and paranasal sinus infection caused by E. cuniculi parasites when treatment with albendazole fails. ( info) |
| Two cases of periorbital dermatitis and one case of keratoconjunctivitis following contact with blister beetle are presented. In tanzania and kenya the commonest blister beetle is known as Nairobi Fly and is of the genus Paederus. Ocular symptoms are common, usually secondary to transfer by the fingers of the toxic chemical involved from elsewhere on the skin. blister beetle keratoconjunctivitis has not previously been described in detail. ( info) |
3/154. Corneal stromal calcification after topical steroid-phosphate therapy. Secondary corneal calcification involving the full thickness of the stroma is a rare potential complication of severe dry eye conditions, recurrent corneal ulcerations, chronic ocular inflammation, or multiple surgical procedures. We describe on a patient with unusual, hitherto unreported calcareous degeneration of the corneal stroma after topical steroid-phosphate therapy for chronic keratoconjunctivitis after stevens-johnson syndrome. The patient's serum levels of calcium and phosphorus were normal. Histopathologic and electron microscopic examination of the corneal button revealed mainly intracellularly located crystalline calcium deposits throughout all layers of the corneal stroma but sparing the Bowman layer. Energy-dispersive x-ray analysis confirmed the presence of calcium phosphate. The calcium deposits were closely associated with intracellular and pericellular accumulations of glycosaminoglycans. Our findings indicate that corneal stromal calcification may develop after topical steroid-phosphate medication, and suggest a possible role of alterations in the glycosaminoglycan metabolism of stromal keratocytes in the calcification process. ( info) |
4/154. The spectrum of ocular inflammation caused by euphorbia plant sap. OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from euphorbia species. DESIGN: Clinical case series. SETTING: ophthalmology emergency referrals in the United Kingdom. patients: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days. ( info) |
5/154. A case of keratoconjunctivitis due to Ewingella americana and a review of unusual organisms causing external eye infections. We report the isolation of Ewingella americana from the conjunctivae of a 38 year old female physician with keratoconjunctivitis associated with the use of soft contact lens. The patient was treated successfully with topical ciprofloxacin. The source of the infection remains unknown. All contact lens cleaning materials used by the patient were sterile. Since the patient was a physician, and this organism has been recorded as a cause of nosocomial infections, we checked whether cases of Ewingella americana had been reported, but none were identified. We have identified 39 bacterial species, 27 fungi, 4 viruses, 7 protozoa, 4 helminths, and 2 arthropods which rarely have been associated with keratitis or conjunctivitis. Infectious diseases specialists and ophthalmologists must be aware of the many different causes of this illness, including Ewingella americana. This organism is a rare bacterial cause of keratoconjunctivitis not previously reported in brazil. It should be added to the list of unusual cases of external eye infections. ( info) |
6/154. Acute haemorrhagic keratoconjunctivitis following laser in situ keratomileusis. We report two cases of acute haemorrhagic keratoconjunctivitis which occurred following laser in situ keratomileusis (LASIK) during an ongoing epidemic. Both cases underwent preoperative investigation and surgery on the same day. The possible sources of contamination include the paramedical staff, the contact instruments used for performing preoperative investigation, surgeon, nurse, surgical instruments and eye drops. However, the flap was intact with no haze or regression and at 1 year follow up, the visual acuity was maintained at 6/6 in both the patients. We recommend greater caution while performing contact investigations and strict surgical asepsis during LASIK surgery, routinely as well as during epidemics of conjunctivitis. ( info) |
| A 17-year-old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, herpes simplex, adenovirus and Acanthamoeba as an inpatient. polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live escherichia coli-coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two. We conclude that Acanthomoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism. ( info) |
| An 18-year-old white man with severe staphylococcal blepharokeratoconjunctivitis of several years' duration developed phylctenules intermittently. At age 22 an active corneal phlyctenule caused perforation of the cornea. Seven days after this occurrence, the perforation closed spontaneously but perforated again ten days later. This occurrence may have been caused by an increase in the patient's hypersensitivity to the staphylococcus as a result of concurrent viral infection, or it may have been due to the patient's failure to return for treatment at the scheduled time. The area of perforation appeared to be healed 10 and one half months later. ( info) |
9/154. Resolution of microsporidial keratoconjunctivitis in an AIDS patient treated with highly active antiretroviral therapy. PURPOSE: To report the outcome of microsporidial keratoconjunctivitis in a patient with acquired immunodeficiency syndrome (AIDS) after highly active antiretroviral therapy without any specific treatment for microsporidiosis. methods: Case report. A 42-year-old woman diagnosed with AIDS and severe immunodepression (CD4 of 9 cells/mm(3) and viral load of 460,000/mm(3)), antiretroviral naive, presented with cerebral toxoplasmosis and microsporidial keratoconjunctivitis in the right eye documented by conjunctival scraping and electron microscopy. RESULTS: The patient was treated with a combination of indinavir, stavudine, and lamivudine, besides sulfadiazine and pyrimethamine. No specific treatment for the microsporidial keratoconjunctivitis was attempted. One month later, the keratoconjunctivitis had disappeared. CONCLUSION: This case suggests that microsporidial keratoconjunctivitis in the setting of AIDS and severe immunodepression can be effectively managed with highly active antiretroviral therapy alone. ( info) |
10/154. Recurrent phlyctenular keratoconjunctivitis: a forme fruste manifestation of rosacea. BACKGROUND: Phlyctenular keratoconjunctivitis represents a delayed type hypersensitivity response to a systemic antigen within the body. methods: We present a case of symptomatic, recurrent, phlyctenular keratoconjunctivitis in an 8-year-old child. The patient's inflammation responded favorably to topical steroids at each episode, but no specific antigen could be identified. CONCLUSION: After observing the father's erythematous facial lesions, we attributed the child's ocular inflammation to rosacea (as a forme fruste manifestation) and treated her with systemic erythromycin. The symptoms were rapidly relieved and the disease process was arrested. ( info) |