1/11. Linear IgA disease.PURPOSE: A case of linear IgA disease is reported to alert ophthalmologists and physicians to this unusual cause of chronic cicatrizing conjunctivitis. methods: Clinical records of a patient suffering from linear IgA disease were reviewed. RESULTS: A 65-year-old woman with a complicated medical history experienced rapidly progressive chronic cicatrizing conjunctivitis leading to corneal perforation. Undiagnosed gingivitis and palatal ulceration had been present for 5 years prior to the onset of ocular symptoms and vitamin C deficiency had followed the consequent dietary restrictions. A diagnosis of linear IgA disease was made on conjunctival biopsy, which demonstrated linear deposits of IgA along the epithelial basement membrane. The perforation was managed successfully with a conjunctival pediculate flap. Control of the inflammation was achieved with systemic prednisolone and cyclophosphamide but at the expense of serious systemic side-effects. CONCLUSIONS: Linear IgA disease causes progressive conjunctival cicatrization in many affected individuals.Although dapsone generally controls the inflammation, heavier systemic immunosuppression was required in this case. Involvement of skin or other mucosal surfaces may become symptomatic before the conjunctivitis, and physicians must be educated to refer patients for ophthalmological review on diagnosis. Conversely, ophthalmologists encountering ocular linear IgA disease should be aware of the possibility of other mucosal involvement requiring physician intervention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Chronic cicatrizing conjunctivitis in a patient with ocular cicatricial pemphigoid and fatal wegener granulomatosis.PURPOSE: To describe a case of chronic cicatrizing conjunctivitis in a patient with ocular cicatricial pemphigoid and wegener granulomatosis. methods: Observational case report. A retrospective study. RESULTS: An 80-year-old man presented with chronic cicatrizing conjunctivitis, peripheral corneal thinning, and wegener granulomatosis, which were diagnosed by his referring physician based on clinical (recurrent epistaxis, sinus congestion) and histopathologic features of nasal mucosa (granulomatous inflammation, vasculitis). A conjunctival biopsy performed by us disclosed features of active wegener granulomatosis and ocular cicatricial pemphigoid, which indicate lack of control of both diseases with methotrexate treatment. The patient died of pulmonary complications from Wegener granulomatosis 1 week after our evaluation. CONCLUSION: Ocular cicatricial pemphigoid and wegener granulomatosis are both potentially fatal autoimmune diseases. Ocular involvement in wegener granulomatosis indicates poor control of the underlying systemic condition and is a marker for active vasculitis, which indicates the need for treatment with cyclophosphamide.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/11. Chemical injury to the eye from trichloroacetic acid.BACKGROUND: trichloroacetic acid (TCA) is frequently utilized for chemical peeling by physicians practicing dermatologic surgery. Ocular complications from TCA have not been reported previously. OBJECTIVE: The purpose of this article is to underscore the irritating and corrosive effects of TCA on the eye. methods: A patient is described who experienced seepage of 35% TCA into the eye during a chemical peel. RESULTS: The patient developed marked conjunctivitis of the affected eye and abrasions involving 25% of the cornea. CONCLUSION: TCA must be applied carefully around the eyes to avoid ocular complications, which albeit rare, can be quite grave if not addressed in a timely manner.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/11. Phthiriasis palpebrarum: an unusual blepharoconjunctivitis.Phthiriasis palpebrarum is an unusual cause of blepharoconjunctivitis and may easily be overlooked because of the failure of physicians to recognize phthirus pubis. We report a case of a 30-year-old woman with persistent itching in the left eyelid which was unsuccessfully treated under the diagnosis of allergic blepharoconjunctivitis. Careful ophthalmic examination revealed seven bugs with multiple red pinpoint excretions and numerous small translucent oval eggs (nits) coating the eyelashes. The patient was successfully treated with mechanical removal of all the lice and nits from the eyelashes. The specimen proved histopathologically to be the phthirus pubis infestation. The phthirus pubis infestation is usually associated with poor hygiene in overcrowded or undeveloped country. However, it may become a notable problem because of frequent traveling and commercial activities across the different countries.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/11. Posterior uveitis: an under-recognized adverse effect of pamidronate: 2 case reports.Ocular adverse effects of pamidronic acid are rare but well documented. Pamidronate, an inhibitor of bone resorption used primarily in the management of tumor-induced hypercalcemia and Paget's disease, is reported to cause conjunctivitis, anterior uveitis, and infrequently episcleritis and scleritis. It is hypothesized that an allergic or immunologic phenomenon caused by drug-indued immune complex formation is at fault. The reason why the uvea is a target organ is unclear. The acute inflammatory response seems unrelated to the dose of the drug, the way of administration, or the activity of Paget's disease or malignancy. We report two cases of pamidronate-induced posterior uveitis, following the WHO causality Assessment Guide of Suspected Adverse Reactions. uveitis and scleritis have been reported in association with a variety of topical, intraocular, periocular, and systemic medications. Seven criteria were proposed to establish causality of adverse events by drugs. Only systemically administered biphosphonates meet all seven criteria. Where pamidronate is currently considered as the drug of choice in diverse strategies, the adverse ocular effects should be well known to physicians in order to make rapid diagnosis and stop the drug causing adverse reaction.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/11. Chronic unilateral external ocular inflammation.To diagnose the cause of chronic unilateral external ocular inflammation, the physician must take into account many factors usually not considered in bilateral cases. We report on the diagnosis and treatment of ten unilateral cases encompassing a variety of ocular and systemic problems. The purpose of this report is to emphasize the importance of systematic consideration of all diagnostic possibilities and to suggest a diagnostic protocol to aid in the study of patients with chronic unilateral external ocular inflammation.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/11. Gonococcal conjunctivitis in a four-month-old infant.Classic neonatal gonococcal ophthalmia usually manifests during the first week of life with a purulent ocular discharge accompanied by periorbital edema and erythema. This case report describes a 4-month-old child with chronic but minimal ocular discharge and intermittent mild conjunctival infection who proved to be infected with neisseria gonorrhoeae. This experience emphasizes the need for the physician to evaluate for gonococcal infection any child with conjunctivitis.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/11. Chemical conjunctivitis caused by the spray of A. buprestoides. Two-striped walkingstick.Most North American walkingsticks are harmless, but one species, A. buprestoides, can defend itself by spraying an irritating chemical. We present the first reported case in the medical literature of a chemical conjunctivitis caused by the spray of the two-striped walkingstick. The insect has the ability to direct a spray at a predator's eyes, inducing a self-limited conjunctivitis. keratitis has been reported in a dog, and this may also be a possible complication in humans. Prudence is dictated in handling this insect, and physicians should be aware of the potential for injury to the eyes.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/11. mucocutaneous lymph node syndrome in Denver.Four children with acute febrile mucocutaneous lymph node syndrome (MLNS) were hospitalized in Denver over a two-year period. The children had most of the principle features of this recently described syndrome, including prolonged fever unresponsive to antibiotics, an erythematous rash, conjunctivitis, pharyngitis, and nonsuppurative cervical lymphadenitis. Three of the children exhibited characteristic desquamation from the fingertips or toes during convalescence. None developed clinical or electrocardiographic evidence of coronary thromboarteritis, the most serious complication of the disease. Additional cases undoubtedly will be reported in the united states as physicians become famililar with this new syndrome and learn to distinguish it from the other acute febrile exanthems.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/11. Treatment of persistent Pfiesteria-human illness syndrome.patients with exposure to Pfiesteria toxin have developed an illness, Pfiesteria-human illness syndrome, characterized by skin lesions, headache, myalgias, conjunctival irritation, bronchospasm, abdominal pain, secretory diarrhea, recent memory loss, and difficulties with number sequencing. Not all patients demonstrated all features of the syndrome. The natural history of Pfiesteria-human illness syndrome shows that most patients' symptoms improve without treatment. This article reports the improvement of symptoms that had persisted for over one month in five patients, which the author attributes to treatment with cholestyramine. These patients were self-referred to the Pocomoke River Rash and Associated Illness Center, a clinic that opened on August 6, 1997, in response to the need for a central facility for diagnosis of human illness acquired from Pfiesteria. Until the Pfiesteria toxin(s) is isolated and characterized, and laboratory diagnostic tests are available, physicians must be able to recognize Pfiesteria-human illness syndrome and intervene when symptoms, particularly memory loss and diarrhea, cause significant impairment in daily activities. There are no precedents for the treatment of Pfiesteria or any dinoflagellate toxin-related human illness reported in the literature. The successful use of cholestyramine reported here may provide a model for understanding dinoflagellate toxin physiology in the human body. This paper reports an uncontrolled observational study. When identification of the toxin is completed, a basis for properly controlled studies will be available.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
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