1/33. The spectrum of ocular inflammation caused by euphorbia plant sap.OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from euphorbia species. DESIGN: Clinical case series. SETTING: ophthalmology emergency referrals in the United Kingdom. patients: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
2/33. A case of keratoconjunctivitis due to Ewingella americana and a review of unusual organisms causing external eye infections.We report the isolation of Ewingella americana from the conjunctivae of a 38 year old female physician with keratoconjunctivitis associated with the use of soft contact lens. The patient was treated successfully with topical ciprofloxacin. The source of the infection remains unknown. All contact lens cleaning materials used by the patient were sterile. Since the patient was a physician, and this organism has been recorded as a cause of nosocomial infections, we checked whether cases of Ewingella americana had been reported, but none were identified. We have identified 39 bacterial species, 27 fungi, 4 viruses, 7 protozoa, 4 helminths, and 2 arthropods which rarely have been associated with keratitis or conjunctivitis. Infectious diseases specialists and ophthalmologists must be aware of the many different causes of this illness, including Ewingella americana. This organism is a rare bacterial cause of keratoconjunctivitis not previously reported in brazil. It should be added to the list of unusual cases of external eye infections.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
3/33. Coexistent adenoviral keratoconjunctivitis and acanthamoeba keratitis.A 17-year-old youth presented with bilateral follicular conjunctivitis and nummular subepithelial corneal infiltrates. Failure of this to settle in an outpatient setting led to corneal scraping with microscopy and culturing for bacteria, fungi, herpes simplex, adenovirus and Acanthamoeba as an inpatient. polymerase chain reaction analysis of corneal cells was positive for adenovirus, and culture on live escherichia coli-coated agar plates was positive for Acanthamoeba by phase contrast microscopy on day two. We conclude that Acanthomoeba infection can complicate adenoviral keratoconjunctivitis. This observation is in keeping with previously reported modes of infection by Acanthamoeba, whereby any epithelial breach seems to allow inoculation of the eye by this opportunistic organism.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
4/33. Microsporidial keratoconjunctivitis in a healthy contact lens wearer without human immunodeficiency virus infection.PURPOSE: To present a rare case of microsporidial keratoconjunctivitis in an otherwise healthy contact lens wearer without human immunodeficiency virus infection who responded to treatment with systemic albendazole and topical fumagillin. DESIGN: Interventional case report. METHOD: A cornea epithelial scraping from a man with unilateral keratoconjunctivitis previously treated with topical steroids was evaluated by modified trichome staining. MAIN OUTCOME MEASURES: The patient was evaluated for his symptoms, visual acuity, clinical observations, and pathologic examination of corneal scrapes. RESULTS: Modified trichome staining of an epithelial corneal scraping revealed pinkish to red organisms characteristic of microsporidia. Results of a human immunodeficiency virus (hiv) enzyme-linked immunosorbent assay test were negative. The symptoms of ocular discomfort and clinical signs of keratoconjunctivitis resolved after 2 months of treatment with albendazole and topical fumagillin. CONCLUSIONS: Ocular infection with microsporidia, although classically occurring in patients with hiv infection, may occur rarely in healthy individuals, especially if previously treated with systemic immune suppression or topical steroids. Microsporidial keratoconjunctivitis should be considered in the differential diagnosis of a contact lens wearer with atypical multifocal diffuse epithelial keratitis.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
5/33. pseudomonas aeruginosa keratitis treated with ticarcillin and tobramycin.A corneal ulcer, infected with pseudomonas aeruginosa and complicated by conjunctivitis and endophthalmitis, was treated successfully with systemic administration of ticarcillin and topical application of tobramycin. It is unlikely that carbenicillin, to which the organism was much less sensitive, would have attained sufficient tissue levels to control the infection.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
6/33. Reactivation of presumed adenoviral keratitis after laser in situ keratomileusis.We report a patient with reactivation of presumed adenoviral keratoconjunctivitis after laser in situ keratomileusis (LASIK) to correct high myopia. The preoperative refraction was -13.00 diopters (D) in the right eye and -14.00 D in the left eye, and the best corrected visual acuity was 20/20 in both eyes. On the first postoperative day, mild conjunctival hyperemia and multiple subepithelial infiltrations localized in the flap zone consistent with adenoviral keratoconjunctivitis were seen. After prompt treatment, the lesions resolved. As a consequence, LASIK successfully corrected the high myopia. Adenoviral keratoconjunctivitis can be reactivated after LASIK, unlike after photorefractive keratectomy, despite the absence of symptomatic and clinical findings before the procedure.- - - - - - - - - - ranking = 4keywords = keratitis (Clic here for more details about this article) |
7/33. Bilateral microsporidial keratoconjunctivitis in an immunocompetent non-contact lens wearer.PURPOSE: To describe an immunocompetent male with bilateral microsporidial keratoconjunctivitis who responded to treatment with albendazole, propamidine, and fumagillin. methods: Corneal and conjunctival epithelial scrapings from a man with bilateral keratoconjunctivitis previously treated with topical corticosteroids were evaluated by Gram stain and by fluorescence microscopy. RESULTS: Gram stain and fluorescence microscopy of corneal epithelial scraping revealed organisms characteristic of microsporidia. Results of human immunodeficiency virus antibody testing were reported as nonreactive. Symptoms of ocular discomfort and clinical signs of keratoconjunctivitis resolved after five weeks of treatment that included systemic albendazole and topical propamidine isethionate 0.1% and fumagillin bicyclohexylammonium salt. A follow-up conjunctival scraping failed to detect any residual organisms 2 weeks after cessation of all treatment. CONCLUSION: Microsporidial ocular infection occurred in an immunocompetent non-contact lens wearer. Microsporidial keratoconjunctivitis should be considered in any individual with atypical multifocal diffuse epithelial keratitis, regardless of immune status or recent history of contact lens wear.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
8/33. Microsporidial keratoconjunctivitis in healthy individuals: a case series.PURPOSE: To present a series of 6 cases of microsporidial keratoconjunctivitis in healthy, nonimmunocompromised individuals. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Six individuals with unilateral keratoconjunctivitis. methods: Cornea epithelial scrapings were taken and evaluated by modified trichome staining. blood was taken for human immunodeficiency virus (hiv) enzyme-linked immunosorbent assay in all cases and for CD4 and CD8 T-lymphocyte counts in 5 cases. MAIN OUTCOME MEASURES: The individuals were evaluated based on symptoms, visual acuity, slit-lamp biomicroscopy, and pathologic examination of the corneal scrapings. RESULTS: All cases occurred in men whose ages ranged from 16 to 37 years. Initial symptoms included unilateral pain and redness. All experienced subsequent worsening of symptoms and blurring of vision after using topical steroids prescribed by general practitioners. Slit-lamp biomicroscopy revealed coarse, multifocal, punctate epithelial keratitis in all 6 cases, anterior stromal infiltrates in 2 cases, with accompanying conjunctivitis in all cases. Modified trichrome staining of corneal epithelial scrapes revealed pinkish to red spores characteristic of microsporidia in all cases. Results of an hiv enzyme-linked immunosorbent assay were negative in all cases, and CD4 and CD8 T-lymphocyte counts and ratios were normal in all 5 tested cases. On diagnosis, topical steroid therapy was stopped in all cases. Treatment with topical Fumidil B (bicyclohexylammonium fumagillin; Leiter's Park Ave pharmacy, San Jose, CA) together with oral albendazole was given in 3 cases, oral albendazole alone in a single case, and broad-spectrum antibiotic treatment with topical norfloxacin or chloramphenicol in two cases. Two cases had keratic precipitates with mild cellular activity in the anterior chamber and one such case was restarted subsequently on topical steroids. All six cases showed resolution of epithelial keratitis but with residual visually inconsequential subepithelial scars by the end of 1 month of treatment. CONCLUSIONS: Microsporidial keratoconjunctivitis can occur more commonly than expected in healthy, nonimmunocompromised individuals. Topical steroids seem to contribute to the persistence of this infection and may be a predisposing factor in these cases by creating a localized immunocompromised state. The clinical course is variable and may be self-limiting with cessation of topical steroid use.- - - - - - - - - - ranking = 2keywords = keratitis (Clic here for more details about this article) |
9/33. Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis.PURPOSE: To report the early success of the use of topical cyclosporine A 0.5% drops to treat Theodore's superior limbic keratoconjunctivitis (SLK). DESIGN: A retrospective noncomparative case series. PARTICIPANTS: Five patients diagnosed with SLK. INTERVENTION: All five patients were treated with topical cyclosporine A 0.5% drops as primary or adjunctive therapy after treatment failure in some of prednisolone acetate 1% drops and topical silver nitrate 0.5% application. Topical cyclosporine A 0.5% drops were used four times a day in both eyes. MAIN OUTCOME MEASURES: Resolution of symptoms (foreign body sensation and irritation) and signs (rose bengal staining, tarsal papillary reaction, and injection). RESULTS: All five patients had long-term (6 months to 3 years) improvement of irritation and foreign body sensation, as well as improvement of injection and filamentary keratitis. Aside from burning on instillation, there were no complications related to this therapy. CONCLUSIONS: Topical cyclosporine A 0.5% is helpful as primary or adjunctive therapy for SLK. It may also be used as a maintenance drug to prevent recurrence. Further study may delineate the specific role and treatment parameters for the use of topical cyclosporine A 0.5% in the treatment of SLK.- - - - - - - - - - ranking = 1keywords = keratitis (Clic here for more details about this article) |
10/33. 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) |
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