1/10. 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 = 1keywords = upper (Clic here for more details about this article) |
2/10. Floppy eyelid syndrome: a diagnostic dilemma.BACKGROUND: Floppy eyelid syndrome may be the underlining cause of papillary keratoconjunctivitis. patients initially report a nonspecific irritation, redness, or a foreign body sensation. methods: As a result of its vague presentation, floppy eyelid syndrome is frequently misdiagnosed. A careful slit-lamp evaluation and a complete history aids in the diagnosis. CONCLUSIONS: The most distinctive feature of floppy eye syndrome is a pliant upper tarsus that is easily everted without excess manipulation. Histopathology has attributed the laxity of the lid to a decreased amount of elastin within the tarsus. Treatment includes prevention of the upper lid from everting during sleep or surgical procedures such as horizontal eyelid shortening. Our case report illustrates a patient with a classic case of floppy eyelid syndrome.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
3/10. 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 = 1keywords = upper (Clic here for more details about this article) |
4/10. Toxic eosinophil granule protein deposition in corneal ulcerations and scars associated with atopic keratoconjunctivitis.PURPOSE: Recurrent or persistent corneal erosions and ulcerations are typical complications of atopic keratoconjunctivitis. Toxic eosinophil granule proteins such as major basic protein (MBP) and eosinophil cationic protein (ECP) may be involved in this pathogenetic process. This study was designed to demonstrate the presence of toxic eosinophil granule proteins in corneal tissue from a patient with corneal complications of atopic keratoconjunctivitis. DESIGN: Observational case report. methods: Three corneal buttons of a patient with atopic keratoconjunctivitis associated ulcerations or scarring were examined by light microscopy and by immunofluorescence technique. RESULTS: A linear deposition of eosinophil granular substance was detected subepithelially above Bowman's membrane in all corneal buttons. Indirect immunofluorescence identified this material as MBP and ECP. The deposits were not limited to the area of ulceration, but were also found underneath intact corneal epithelium. Multiple eosinophils were present in the upper corneal stroma. Normal corneas and negative control sections of the pathologic buttons revealed only minimal nonspecific staining at the surface of the epithelium. CONCLUSIONS: Both MBP and ECP are known to affect human corneal epithelial cell viability and morphology in vitro. Moreover, MBP was shown to inhibit epithelial migration and protein synthesis. These toxic eosinophil proteins may also be responsible for corneal instability, recurrent and persistent corneal epithelial defects and ulcerations in patients with atopic keratoconjunctivitis.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
5/10. Fungal keratitis associated with vernal keratoconjunctivitis.PURPOSE: To report a case of fungal keratitis associated with vernal keratoconjunctivitis. CASE REPORT: A 22-year-old man with a history of vernal keratoconjunctivitis since October 1999 developed a shield ulcer in the left eye in June 2000, which resolved with intensive topical steroid therapy. He presented in August 2001 with onset of acute pain, redness, and decreased vision. The tarsal conjunctiva in the left eye showed large papillae. The cornea showed a white plaque-like lesion with an underlying stromal infiltrate involving the upper half of the cornea. The overlying epithelial defect measured 4.5 x 2.5 mm. The anterior chamber showed 1 flare and cells and hypopyon measuring about 1 mm. RESULTS: Corneal scrapings were performed for microbiologic investigations. Smears of corneal scrapings revealed septate fungal filaments, and the culture showed a significant growth of aspergillus flavus. CONCLUSIONS: Fungal keratitis may be associated with vernal keratoconjunctivitis. Though rare, fungal keratitis should be considered in the differential diagnosis of infections associated with vernal keratoconjunctivitis.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
6/10. Nonoccupationally induced allergy to monkey.BACKGROUND: A previous study described 2 patients with occupationally induced asthma caused by exposure to monkey. We describe a patient who developed asthma, rhinitis, and conjunctivitis owing to sensitivity to a pet monkey. The patient had a long history of upper and lower allergic airway disease. When 2 pet macaque monkeys were introduced into the home, the patient noticed increasing coughing, wheezing, and shortness of breath. During a particularly long exposure to the monkey in a car, the patient developed severe wheezing, rhinitis, and conjunctival edema. OBJECTIVE: To demonstrate that a nonoccupational exposure to monkey can lead to allergic sensitivity. methods: Commercially obtained macaque monkey hair was defatted in acetone and extracted. A total of 5 microg/mL of extract protein was adsorbed onto microtiter plates, and an alkaline phosphatase enzyme-linked immunosorbent assay was performed on serum samples from 4 individuals: 2 controls, 1 individual with suspected sensitivity, and the patient. A positive result was an optical density greater than twice that of the control. RESULTS: The patient's serum had an optical density greater than twice that of the control. The antibody levels of 2 control subjects-the patient's wife and one of the investigators-were elevated but not positive. The investigator had manifested asthma after exposure. CONCLUSIONS: This is the first report of sensitivity to monkey occurring in a nonoccupational setting.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
7/10. Floppy eyelid syndrome: a case report and clinical review.Floppy eyelid syndrome is a clinical entity associated with a chronic papillary conjunctivitis which is resistant to topical therapeutic agents. The disorder is usually found in older, obese males with upper eyelids which are loose, rubbery, and easily everted. This paper is a review of the clinical characteristics and treatment of the syndrome and includes a case of a 16-year-old male with floppy eyelid syndrome, one of the youngest reported.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
8/10. Floppy eyelid syndrome associated with keratoconus.keratoconus has been associated with various ocular and systemic disorders. It has been linked, in a few cases, with floppy eyelid syndrome (a disorder characterized by a soft rubbery upper tarsus, papillary conjunctivitis and obesity). A 40-year-old male presented with a complaint of gradually decreasing vision in the right eye. An intermittent right exotropia had become constant and he was unable to maintain fixation voluntarily. Corneal findings were consistent with keratoconus. Floppy eyelid syndrome was also diagnosed. An underlying connective tissue disorder may link these two disorders.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
9/10. Vernal keratoconjunctivitis and trachoma.Both vernal keratoconjunctivitis and trachoma affect young people, occur in hot, dry climates, and have a predilection for the limbus and upper tarsal conjunctiva. These two conditions may occur simultaneously and present the ophthalmologist with a diagnostic and therapeutic dilemma.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/10. Papillary conjunctivitis induced by an epithelialized corneal foreign body.This report of papillary conjunctivitis induced by a corneal foreign body suggests that papillogenesis may result from physical/mechanical tissue trauma. A case is presented with an epithelialized corneal foreign body in the peripheral cornea during a 9-month period. The overlying corneal epithelial surface was elevated, and corresponding upper tarsal conjunctiva revealed localized, elevated papillae. One month after the foreign body was excised, the papillae resolved. An epithelialized foreign body, elevated cornea, and coincidental papillae support the role of physical trauma for the development of papillae--a feature of the syndrome of contact-lens-associated giant papillary conjunctivitis.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
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