1/20. Cochleovestibular impairment in pediatric Cogan's syndrome.Cogan's syndrome is a rare, chronic inflammatory disorder that typically targets the eyes and vestibuloauditory apparatus, but it may also involve other organs. Three pediatric cases of Cogan's syndrome (ages 5, 13, and 18 years) are reported with long-term follow-up and complete and regular cochleovestibular functional evaluation and ophthalmologic and neurologic examinations. One case was a typical form (characterized by an interstitial keratitis and cochleovestibular impairment), whereas the other 2 cases were atypical forms with uveitis and polyarthritis. In all 3 cases, the first clinical sign was nonspecific eye redness misdiagnosed as a banal conjunctivitis, initially or secondarily associated with bilateral endocochlear sensorineural hearing loss and complete bilateral peripheral vestibular deficit. During the acute phase, early steroid treatment (prednisone, 1 mg/kg/day) was effective in treating the ocular lesions (3 of 3 cases) and improving hearing (2 of 3 cases) but less effective for the vestibular loss (2 of 3 cases). Adverse effects and dependence on the steroid occurred in 2 cases, and immunosuppressive drugs were necessary to avoid recurrences in 1 case. Over the long-term, the disease was controlled in 2 cases but continued to progress in the other. Cogan's syndrome in childhood should be suspected in cases of conjunctivitis associated with inner-ear symptoms; a prompt steroid treatment can avoid progressive impairment of multiple sensorineural functions (vision, balance, hearing). Long-term management involves limiting disease recurrences by adaptive therapies, screening for complications (aortitis in particular), and planning rehabilitation for the sensorial deficits.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/20. Bilateral spontaneous corneal perforation associated with complete external ophthalmoplegia in mitochondrial myopathy (kearns-sayre syndrome).PURPOSE: Mutations of mitochondrial dna can lead to a variety of pheno- and genotypically heterogeneous diseases. kearns-sayre syndrome is caused by the deletion of several mitochondrial genes. The syndrome is characterized by chronic progressive external ophthalmoplegia, tapetoretinal degeneration, and severe generalized myopathy. CASE REPORT: We report on a 36-year-old female patient with kearns-sayre syndrome, confirmed by biochemistry, histology, and genetics. Over a period of 10 years, progressive ophthalmoplegia led to recurrent conjunctivitis, keratitis, and corneal ulceration. Almost total external ophthalmoplegia including involvement of the orbicularis oculi muscles was observed. Despite advanced ptosis, there was lagophthalmos of 2 mm with near complete extinction of globe motility in both eyes. The left eye showed a peripheral corneal perforation parallel to the lower limbus. After successful penetrating keratoplasty in the left eye, despite preventive measures, a peripheral corneal perforation also occurred in the right eye. Penetrating keratoplasty was therefore also performed on the right eye. To achieve a satisfactory functional result, large-diameter transplants were necessary in both eyes. To prevent immune reactions, cyclosporine therapy was initiated prophylactically. Sixteen and 9 months after penetrating keratoplasty, the corrected visual acuity was 20/60 in the right eye and 20/100 in the left eye, with clear transplants on both sides. DISCUSSION: patients with progressive ophthalmoplegia require thorough neurologic investigation and evaluation. Lagophthalmos in the presence of almost absent globe motility requires extensive preventive measures to avoid exposure keratitis. In spite of this, in the presented case, corneal perforation of the second eye could not be prevented.- - - - - - - - - - ranking = 2keywords = keratitis (Clic here for more details about this article) |
3/20. Inadvertent conjunctival trauma related to contact with drug container tips: a masquerade syndrome.PURPOSE: To report the diagnosis, clinical course, and management of acute painful red eye syndrome associated with unintentional tube- or bottle-tip-induced conjunctival trauma. DESIGN: A small, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 12 patients (8 female and 4 male, aged 21-84 years) who were urgently reported or referred with a variety of diagnoses resulting from acute onset of red, painful eye. Four eyes had corneal transplants, two were recovering from herpetic keratitis, two had undergone cataract surgery or a laser in situ keratomileusis procedure, one had a corneal neurotrophic ulcer, and one used a contact lens. All the patients had received new medications (ophthalmic ointments in nine patients, topical drops in three patients) within 1 week before onset of symptoms. INTERVENTION: Assessment of method of self-administration of topical medication, evaluation of the ocular surface lesion, and patient education. MAIN OUTCOME MEASURES: association of patient behavior with ocular surface lesions. RESULTS: All 12 patients presented red, painful eyes, congested lower palpebral conjunctiva, epithelial conjunctival erosions, and episcleritis. In all patients, direct contact of the tube or bottle-tip with the affected area of the conjunctiva was ascertained by inspection. Instructions on proper method of drug administration and eye patching with lubrication were followed, within 2 weeks, by healing of conjunctival lesions. CONCLUSIONS: Drug containers may cause nonintentional conjunctival trauma and simulate severe ocular disorders. physicians should be aware of this diagnosis in any case of prolonged and unexplained ocular irritation and should instruct patients as to the proper instillation of topical ophthalmic medications.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
4/20. Pseudomembranous and membranous conjunctivitis. Immunohistochemical features.A 63-year-old man, who had for one month been on sulfasalazine therapy, developed general malaise, high fever, severe stomatitis, and bilateral necrotizing pseudomembranous conjunctivitis with corneal erosion, identical to that seen in the stevens-johnson syndrome. Topical therapy with antibiotics and aprotinin rapidly healed the corneal surfaces, while densely adherent true membranes developed on the conjunctiva, and were removed surgically several times during the next week. After the acute stage, subtle subepithelial conjunctival scarring, superficial punctate keratitis, dry eye syndrome and fluctuating irregular corneal astigmatism became evident, but good visual acuity, lid function and ocular motility were retained. Histopathologic study of conjunctival membranes from two cases of membranous conjunctivitis revealed polymorphonuclear leukocytes within a matrix composed of fibrin, tenascin and fibronectin. In older membranes, histiocytes were additionally found. Surgical debridement of such membranes removes a substratum of inflammatory debris that is likely to promote secondary infection, fibrosis and symblepharon formation, and may decrease rather than increase subsequent scarring of the necrotized conjunctiva.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
5/20. Persistent superficial punctate keratitis after resolution of chlamydial follicular conjunctivitis.Two cases of follicular conjunctivitis due to chlamydia trachomatis followed by punctate epithelial keratitis are described. Both cases were initially treated with either oral tetracycline or doxycycline with resolution of the follicles. These two patients subsequently had recurrent, bilateral grayish lesions at various levels in the corneal epithelium that stained in a punctate fashion with fluorescein. There was anterior stromal edema associated with some of these lesions in one case. The lesions were confined mostly to the central cornea. These recurrent lesions were unassociated with a conjunctival reaction, were unresponsive to oral tetracycline, but were exquisitely responsive to low doses of topical steroids. Chlamydial conjunctivitis and the associated keratitis typically shows no response or actual exacerbation of symptoms with topical steroids, and the keratitis shows a predilection for the upper half of the cornea. These patients demonstrate that chlamydial keratoconjunctivitis might result in a clinical appearance consistent with Thygeson's superficial punctate keratitis.- - - - - - - - - - ranking = 8keywords = keratitis (Clic here for more details about this article) |
6/20. Atypical Cogan's syndrome mimicking encephalitis.Cogan's syndrome is a rare autoimmune multisystem disease. The main clinical features of typical Cogan's syndrome are vestibuloauditory dysfunction and interstitial keratitis. The authors present a case of atypical Cogan's syndrome with headache, fever, deafness, trigeminal neuralgia and electroencephalographic abnormality which mimicked viral encephalitis.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
7/20. Ocular cicatricial pemphigoid, keratomycosis, and intravenous immunoglobulin therapy.PURPOSE: To report the case of a patient developing fungal keratitis in the context of uncontrolled ocular cicatricial pemphigoid (OCP), which, despite intravenous immunoglobulin (IVIg) and other immunomodulatory therapy, progressed to end-stage pemphigoid, with corneal opacification, ankyloblepharon, and xerosis. Keratoprosthesis (KPro) restored functional vision for the patient. methods: A 39-year-old man presented with uncontrolled CP and corneal ulcer in the left eye. Conjunctival biopsy diagnosed OCP; corneal scraping and biopsy diagnosed the cause of the corneal ulcer. OCP was treated with systemic steroids, immunosuppressive drugs, and IVIg. Visual rehabilitation was accomplished with Ahmed valve and a type II Dohlman KPro. RESULTS: Immunohistology of the biopsied conjunctiva showed IgG at the epithelial basement membrane zone, confirming the clinical diagnosis of OCP. Microbiologic studies of the corneal biopsy specimen were negative for acanthamoeba and herpes but positive for aspergillus niger. The patient's keratomycosis resolved with topical antifungal therapy. Treatment with dapsone, intravenous-pulse steroid, oral cyclophosphamide, and intravenous immunoglobulin (IVIg) failed to control the OCP, with resultant complete conjunctivization of the cornea. Keratoprosthesis improved the patient's visual acuity from hand movements to 20/20. CONCLUSIONS: patients with uncontrolled OCP are at increased risk of corneal infection. The difficulty in diagnosing keratomycosis and the relatively rare occurrence of OCP explain the uniqueness of our reported case. OCP may progress to "end-stage" disease despite therapy. Keratoprosthesis can restore vision in selected otherwise seemingly hopeless cases.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
8/20. Topical tacrolimus ointment for treatment of refractory anterior segment inflammatory disorders.PURPOSE: To report 4 cases of patients treated with topical tacrolimus ointment 0.03% for ocular inflammatory conditions refractory to traditional treatment. methods: Four patients were treated topically with tacrolimus 0.03% ointment twice daily: 2 patients with blepharokeratoconjunctivitis, 1 patient with severe atopic keratoconjunctivitis, and 1 patient with chronic follicular conjunctivitis. RESULTS: Three patients had a dramatic improvement of their ocular condition as early as 2 weeks after starting tacrolimus ointment. One patient developed a herpes simplex virus dendrite after 1 week of tacrolimus use. CONCLUSION: tacrolimus ointment appears to be an effective alternative for certain ocular inflammatory conditions refractory to traditional treatments. There may be an increased risk of herpes simplex virus keratitis associated with topical use. Our results support previous literature of patients benefiting from topical tacrolimus use.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
9/20. Caterpillar-induced keratitis.Caterpillar hairs are responsible for a well-described though infrequent form of ocular trauma and disease sometimes referred to under the term ophthalmia nodosa. Four patients with this condition are presented with a review of the pathology and treatment guidelines.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
10/20. Epidemic keratoconjunctivitis and chronic papillary conjunctivitis in london due to adenovirus type 19.Since July 1973 cases of keratoconjunctivitis resembling epidemic keratoconjunctivitis were observed in the External eye disease Clinic at Moorfields eye Hospital; City Road, london. Adenovirus type 19 was isolated in human embryonic kidney cells from 21 patients. The majority were males between 20 and 40 years old. A small hospital outbreak involving six patients occurred. Clinical features of the disease, consisting of moderate to severe follicular conjunctivitis, major subepithelial punctate keratitis, sometimes with pseudomembrane and scarring, were closely similar to those of epidemic keratoconjunctivitis caused by adenovirus type 8. This similarity, as well as the ability of the agent to cause hospital outbreaks, indicates that adenovirus type 19 is a cause of epidemic keratoconjunctivitis. A case of bilateral chronic papillary conjunctivitis that persisted for 16 months following an acute onset was described. Adeno 19 was isolated from the eye of the patient after 12 months of recrudescent or recurrent illness. Chronic adenovirus infection lacking the usual clinical picture of an acute follicular reaction has not hitherto been described. Such cases are probably important because of the obvious danger of continuing the carriage and shedding of infective adeno 19 from one outbreak to another, by presenting subsequently in eye clinics, and providing an unrecognised source of infection to initiate further outbreaks of hospital transmission.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
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