1/8. More than tears in your eyes (exophiala jeanselmei keratitis).PURPOSE: To describe a patient with exophiala jeanselmei keratitis. methods. CASE REPORT: One patient with persistent corneal infiltrate that developed several days after a minor ocular trauma from an onion slice. RESULTS: culture plates from corneal scraping showed a growth of the yeast exophiala jeanselmei, a rare causative agent of ocular infection. CONCLUSIONS: Whenever a corneal abscess does not improve with the usual antibiotic treatment, a thorough ophthalmic history should be taken to determine whether there was a recent ocular trauma. If the trauma was caused by a plant material, the physician should raise the possibility of an unusual fungal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Infectious crystalline keratopathy with ring opacity.A 41-year-old physician was treated for 3 months with antiviral medications, antibiotics, and steroids for presumed herpetic keratitis. When seen by us, an annular infiltrate was observed, along with crystalline-like opacities in the superficial one third of the stroma. Cultures of scrapings and of subsequent biopsies were positive for streptococcus mitis of the viridans group; histopathology demonstrated large aggregates of cocci between the stroma lamellae. Tapering of topical corticosteroids and treatment with topical penicillin resulted in resolution of the infiltrates. The clinical appearance and findings in this patient suggest that infectious crystalline keratitis can produce an annular infiltrate. Injection of the organism into rabbit corneas produced a crystalline infiltrate, but no annular opacity was observed. Corticosteroids altered the clinical and histopathologic appearance of the lesions in rabbits.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. An unusual pathogen causing microbial keratitis.INTRODUCTION: We report a rare case of mycobacterium fortuitum affecting the corneal graft of a patient 6 years post-graft, possibly associated with contact lens use. CONCLUSIONS: This case shows the need for careful microbiological techniques when dealing with patients presenting with microbial keratitis. It must be kept in mind that unusual and slow growing organisms may also be responsible for corneal ulceration. If a slow growing organism is suspected, a microbiological diagnosis may not be forthcoming for weeks. Misidentification of the responsible pathogen may further complicate management for the clinicians. Cases such as these, which may not respond to medical therapy as expected, may prove a difficult therapeutic challenge to physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Radial keratotomy complicated by sterile keratitis and corneal perforation. Histopathologic case report and review of complications.A 35-year-old physician had radial keratotomy (RK) for correction of myopia. Combined radial and transecting circumferential incisions were used which resulted in wound gape, persistent epithelial defect, and severe sterile keratitis. Progressive corneal decompensation required an initial patch graft followed by a penetrating keratoplasty four months after RK. Histopathology of the cornea demonstrated epithelial edema and persistent incisional epithelial plug formation, deep and superficial vascularization, variable incision depth (superficial to full thickness), endothelial cell loss, and inflammatory cell infiltration at all levels of the cornea. A review of the reported complications of RK is included in the discussion of this case.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Unsuspected infectious keratitis in host corneal buttons.Infectious keratitis may be unsuspected preoperatively in patients undergoing penetrating keratoplasty. We have diagnosed five cases of previously unknown corneal infection discovered only after post-keratoplasty histopathologic examination using specific stains. These cases of preoperatively unsuspected infectious keratitis illustrate examples where histopathologic examination using specialized stains may alert the physician to the need for appropriate postoperative antimicrobial therapy. Furthermore, these cases illustrate the ability of soft contact lenses to mask symptoms of infectious keratitis. Additionally, the clinical appearance of advanced bullous keratopathy may mask signs of infectious keratitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Posterior scleritis--an unusual manifestation of Cogan's syndrome.Cogan's syndrome is characterized by a non-luetic interstitial keratitis associated with vertigo, tinnitus and profound deafness. Evidence of a systemic vasculitis is found in up to 50% of patients. Atypical forms of Cogan's syndrome have been described in which the ocular inflammatory disease may be more severe. We describe a case of atypical Cogan's syndrome in association with bilateral posterior scleritis. Serial B-scan ultrasound measurements of posterior scleral thickness were found to be useful in assessing disease activity, in combination with clinical findings. Combination therapy with prednisolone and cyclosporin controlled the ocular disease but the deafness was irreversible. The length of follow-up of this case highlights the frequent relapses and difficult management problems which may be faced. This multisystem disease requires the close co-operation of ophthalmologist, physician and otorhinolaryngologist. Aggressive therapeutic intervention with high-dose combined immunosuppressive agents may be necessary to control severe ocular inflammatory disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. cogan syndrome: autoimmune-mediated audiovestibular symptoms and ocular inflammation.BACKGROUND: cogan syndrome is an uncommon disorder that presents with symptoms involving the eyes and ears. At its onset, it can mimic many common entities. family physicians should be aware of cogan syndrome because it can be successfully treated if it is recognized early in its course. It is one of the few treatable causes of deafness. methods: medline files were searched from 1982 to the present for "Cogan's syndrome." Additional references were obtained by cross-referencing bibliographies from available articles. RESULTS AND CONCLUSIONS: As first defined in 1945, cogan syndrome includes nonsyphilitic interstitial keratitis and attacks of vertigo, tinnitus, and hearing loss. Although it usually begins with only one symptom, most patients have both auditory and ocular findings within 1 year of the onset. If untreated, most patients become deaf within 36 months. blindness occurs in about 5 percent of patients, but ocular symptoms relapse during a period of years. The disease eventually involves other organs with clinical and pathologic findings that suggest vasculitis. Aortic insufficiency, the most serious complication, develops in 15 percent of patients. The cause of cogan syndrome remains unknown, but several studies suggest an autoimmune-mediated process. Many reports document an improvement in symptoms with immunosuppressive therapy, particularly if started early in the course of the illness. family physicians should include cogan syndrome in their differential diagnosis when a young adult seeks care with audiovestibular symptoms or ocular inflammation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/8. fusarium keratitis following the use of topical antibiotic-corticosteroid therapy in traumatised eyes.Keratomycosis is a rare sight-threatening infection of the cornea. Important predisposing factors in its pathogenesis include corneal trauma and use of topical corticosteroid or antibiotic-corticosteroid therapy. Some family physicians are unaware of the dangers of unmonitored topical corticosteroid therapy for traumatised eyes. Three cases of fusarium keratitis following the use of topical antibiotic-corticosteroid therapy in traumatised eyes are reported. Despite aggressive anti-fungal therapy, one eye required a therapeutic penetrating keratoplasty for impending corneal perforation, another eye progressed to corneal perforation and required evisceration while the third eye developed endophthalmitis which also required evisceration. The potential danger of fungal infections of the cornea following the unmonitored use of topical antibiotic-corticosteroids in traumatised eyes is highlighted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |