1/20. Tarantula keratouveitis.PURPOSE: To report a case of chronic bilateral keratouveitis, which was initiated after contact with a pet tarantula. methods: A 16-year-old male presented with a photophobia and redness of his eyes two days after handling a tarantula. He was found to have a number of linear corneal foreign bodies with subepithelial infiltrates. The infiltrates were found at varying levels of the corneal stroma with deposits on the endothelium. The anterior chamber had a mild cellular reaction. RESULTS: He was treated with topical steroid drops, which made him asymptomatic. However, he continued to have a mild persistent keratitis and iritis four months after the onset. CONCLUSION: Tarantula hairs may be associated with a chronic keratouveitis, which is usually self-limiting and responds well to treatment with topical steroids. Tarantula pet owners should be forewarned of the ocular dangers associated with handling these spiders.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/20. Recurrent fungal keratitis and endophthalmitis.PURPOSE: To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection. methods: A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin b were necessary to eradicate the fungal infection. RESULTS: visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK. CONCLUSION: The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.- - - - - - - - - - ranking = 8keywords = keratitis (Clic here for more details about this article) |
3/20. Red coral keratitis.PURPOSE: We describe a 39-year-old woman who was seen for pain and blurred vision in the right eye that presented immediately after scuba diving several inches from a red coral reef. methods: The patient was found to have multiple superficial corneal foreign bodies with adjacent infiltrates on slit-lamp examination. She was treated with long-term topical corticosteroids. RESULTS: The infiltrates and symptoms gradually resolved after nearly 3 months of treatment. CONCLUSION: This case represents a form of keratitis caused by exposure to red coral. Possible mechanisms for the keratitis include type I and 4 hypersensitivities, resulting from the release of vasoactive substances. This is triggered by the red coral's nematocysts, or toxin-releasing organelles. Long-term corticosteroid treatment was effective in resolving the lesions.- - - - - - - - - - ranking = 6keywords = keratitis (Clic here for more details about this article) |
4/20. Diffuse lamellar keratitis induced by trauma 6 months after laser in situ keratomileusis.This case report illustrates an unusual presentation of diffuse lamellar keratitis triggered by a foreign body striking the eye 6 months after laser in situ keratomileusis (LASIK). The etiology of diffuse lamellar keratitis is unclear. The infiltrate within the plane of the flap after removal of the foreign body supports the theory that diffuse lamellar keratitis is an inflammatory reaction.- - - - - - - - - - ranking = 7keywords = keratitis (Clic here for more details about this article) |
5/20. anterior chamber tap: diagnostic and therapeutic indications in the management of ocular infections.PURPOSE: To report three cases in which an anterior chamber tap was useful in the management of infection of the eye confined to the anterior segment. methods: In the first case, the patient presented with diffuse conjunctival congestion and thick anterior chamber exudates adhering to the back of the cornea. The second case involved fungal keratitis, and the patient was not responding to topical natamycin and systemic ketoconazole. In this patient, infiltrate and thick hypopyon persisted despite medical therapy. The patient in the third case had a persistent thick endothelial exudate, and a retained intracameral foreign body, fungal infection, and a cataract were suspected. In all three cases, an anterior chamber tap was performed. In case 1, the exudate was removed and sent for microbiologic investigation. In case 2, the hypopyon was evacuated and intracameral amphotericin b (5 microg) was injected. In case 3, the exudate contained a wooden foreign body that was sent for culture. Intracameral amphotericin b (5 microg) was injected. RESULTS: In the first case, the culture of the exudate grew staphylococcus aureus. The eye quieted, and the exudate resolved following treatment with topical fortified cefazolin, fortified gentamicin, and systemic cefazolin. In the second case, smears of corneal scrapings revealed fungal filaments and the culture grew aspergillus species. The infection resolved following an anterior chamber tap, but the patient developed a cataract. After cataract surgery, visual recovery was limited because of the corneal scar. In the third case, the culture of the foreign body grew an unidentified hyaline fungus. Following an anterior chamber tap, the infection resolved, but the cataract progressed. The patient did well after cataract surgery. CONCLUSIONS: An anterior chamber tap is an extremely useful procedure in the management of ocular infections confined to the anterior segment. The procedure should be performed under strict aseptic conditions. If the infection involves the anterior capsule of the lens, care should be taken to avoid injury to the lens, and the possibility of progression of the cataract should be explained to the patient.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
6/20. Atypical mycobacterium keratitis.We present two cases of mycobacterium chelonae keratitis, both of which followed minor corneal trauma. One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty. The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy.- - - - - - - - - - ranking = 5keywords = keratitis (Clic here for more details about this article) |
7/20. Fungal keratitis caused by paecilomyces lilacinus associated with a retained intracorneal hair.OBJECTIVE: To report a case of fungal keratitis caused by paecilomyces lilacinus (P. lilacinus) associated with a retained intracorneal hair. methods: A 61-year-old man developed pain, decreased vision, hyperemia, and corneal infiltrates in his right eye without any predisposing factor. An intracorneal hair had migrated superiorly in the corneal stroma, giving rise to 3 separate stromal infiltrates. The patient demonstrated a waxing and waning course over several months despite antimicrobial and steroid therapy. RESULTS: Histopathologic examination of a corneal biopsy specimen disclosed the presence of fungal elements, and intensive antifungal therapy was initiated. verticillium sp. was initially identified as the causative organism, but after failure to improve on topical natamycin, subsequent investigations demonstrated the pathogen to be P. lilacinus that was resistant to routine antifungal agents. The patient was then initiated on systemic voriconazole and terbinafine. He responded well to treatment and ultimately recovered a best-corrected visual acuity of 6/15 in the affected eye. CONCLUSION: This is the first case of P. lilacinus keratitis associated with a retained intracorneal hair. hair in the cornea could be a predisposing factor for this infection. Early corneal biopsy should be considered to properly diagnose and manage atypical keratitis and to prevent further complications.- - - - - - - - - - ranking = 7keywords = keratitis (Clic here for more details about this article) |
8/20. Spontaneous resorption of an insect hair in the corneal stroma: a case report.A case of keratitis, due to an insect hair penetrating into the deep cornea, was reported. The patient felt right ocular pain while riding a motorcycle, as an insect struck into his eye. On examination, an insect hair was seen embedded into the corneal stroma with severe corneal edema, which caused a visual acuity of the right eye decreased to hand motion. The patient was treated by a topical antibiotics, cycloplegics, and anti-inflammatory drugs, without removing the hair. After a 6-week follow-up period, there was a spontaneous resorption of the hair. There was no apparent toxic sign during 6-months of follow up, and the visual acuity improved to 6/6. The insect hair could be left in the deep cornea with careful observation, and spontaneous resorption can occur.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
9/20. Deep stromal mycobacterial keratitis: viable bacteria after six months of treatment: case report and literature review.To report the presence of viable mycobacteria in a patient with keratitis treated for 6 months. Species identification was performed using the PRA method (polymerase chain reaction followed by restriction endonuclease analysis). Clonality was evaluated with RAPD (randomly amplified polymorphic dna) and ERIC-PCR (enterobacterial repetitive intergenic consensus-polymerase chain reaction) methods. The patient reported trauma due to a metallic foreign body 3 weeks prior to presentation. Initial corneal scraping cultures revealed Mycobacterium abscessus. After 6 months of topical and systemic treatment the patient presented with no active inflammation and was considered clinically cured. An optic penetrating keratoplasty was performed. culture of the excised cornea revealed Mycobacterium abscessus. Both isolates had the same clonal origin. The most interesting finding of this case report was the positive culture of the excised cornea after 6 months of intensive specific topical therapy. To our knowledge, this is the first report in the literature showing this possibility in the treatment of Mycobacterial keratitis. Thus, Mycobacterium abscessus may present viable bacteria after long-term treatment and should be followed carefully for a long period of time after tapering the medication.- - - - - - - - - - ranking = 6keywords = keratitis (Clic here for more details about this article) |
10/20. Bee sting of the cornea: a case study and review of the literature.Bee stings of the cornea are rarely reported, but have the potential for causing serious ophthalmological injuries. We present a case of corneal bee sting with retained stinger apparatus. A 35-year-old patient presented with an acute, corneal bee sting of the right eye 12 hours after he was stung. The patient suffered from pain, blurred vision, and epiphora. The right eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, and striate keratitis of the paracentral cornea by biomicroscopic examination. The stinger was identified in the depth of the corneal infiltration. visual acuity was 5/10. It was removed surgically. After 2 months, the eye only showed a minimal residual corneal opacification. visual acuity was 10/10. We present a case of bee sting to the cornea with retained stinger apparatus and treatment of this unusual presentation.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
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