The Definition and Classification of Dry Eye Disease
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Endogenous Brucella Endophthalmitis: a Case Report
Saudi Journal of Ophthalmology (2017) xxx, xxx–xxx Case Report Endogenous Brucella endophthalmitis: A case report ⇑ Merih Oray a, ; Zafer Cebeci a; Nur Kir a; Banu Turgut Ozturk b; Lutfiye Oksuz c; Ilknur Tugal-Tutkun a Abstract Brucellosis may be associated with a wide range of ophthalmic manifestations including endophthalmitis, which is a sight- threatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. A 26-year-old female with a 6-month history of vision loss in the left eye was treated with high dose systemic corticosteroids and azathioprine with an initial misdiagnosis elsewhere. A dense vitreous haze with opacities at the posterior hyaloid and a wide area of retinochoroiditis led to the diagnosis of endogenous endophthalmitis at presentation to us. The vitreous sample and blood cultures demonstrated growth of Brucella melitensis. She received 6 months of systemic antibiotherapy, which resulted in resolution of inflammation; however, visual acuity remained poor due to irreversible damage. Infectious etiology, including brucellosis in endemic countries, has to be considered in the differential diagnosis before administering immunomodulatory therapy in patients with panuveitis of unknown origin. Keywords: Endogenous endophthalmitis, Ocular brucellosis, Panuveitis Ó 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of Saudi Ophthalmological Society, King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.sjopt.2017.03.002 Introduction We herein present an unusual case of endogenous endophthalmitis due to B. melitensis. Brucellosis (Malta fever) is a zoonotic systemic disease caused by Brucella melitensis or Brucella abortus. -
Binocular Vision Disorders Prescribing Guidelines
Prescribing for Preverbal Children Valerie M. Kattouf O.D. FAAO, FCOVD Illinois College of Optometry Associate Professor Prescribing for Preverbal Children Issues to consider: Age Visual Function Refractive Error Norms Amblyogenic Risk Factors Birth History Family History Developmental History Emmetropization A process presumed to be operative in producing a greater frequency of occurrence of emmetropia than would be expected in terms of chance distribution, as may be explained by postulating that a mechanism coordinates the formation and the development of the various components of the human eye which contribute to the total refractive power Emmetropization Passive process = nature and genetics 60% chance of myopia if 2 parents myopic (Ciuffrieda) Active process = mediated by blur and visual system compensates for blur Refractive Error Norms Highest rate of emmetropization – 1st 12-17 months Hyperopia Average refractive error in infants = +2 D > 1.50 diopters hyperopia at 5 years old – often remain hyperopic Refractive Error Norms Myopia 25% of infants are myopic Myopic Newborns (Scharf) @ 7 years 54% still myopic @ 7 years 46% emmetropic @ 7 years no hyperopia Refractive Error Norms Astigmatism Against the rule astigmatism more prevalent switches to with-the-rule with development At 3 1/2 years old astigmatism is at adult levels INFANT REFRACTION NORMS AGE SPHERE CYL 0-1mo -0.90+/-3.17 -2.02+/-1.43 2-3mo -0.47+/-2.28 -2.02+/-1.17 4-6mo -0.00+/-1.31 -2.20+/-1.15 6-9mo +0.50+/-0.99 -2.20+/-1.15 9-12mo +0.60+/-1.30 -1.64+/-0.62 -
Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Development of in Vitro Corneal Models: Opportunity for Pharmacological Testing
Review Development of In Vitro Corneal Models: Opportunity for Pharmacological Testing Valentina Citi 1, Eugenia Piragine 1, Simone Brogi 1,* , Sara Ottino 2 and Vincenzo Calderone 1 1 Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; [email protected] (V.C.); [email protected] (E.P.); [email protected] (V.C.) 2 Farmigea S.p.A., Via G.B. Oliva 6/8, 56121 Pisa, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-050-2219-613 Received: 24 October 2020; Accepted: 30 October 2020; Published: 2 November 2020 Abstract: The human eye is a specialized organ with a complex anatomy and physiology, because it is characterized by different cell types with specific physiological functions. Given the complexity of the eye, ocular tissues are finely organized and orchestrated. In the last few years, many in vitro models have been developed in order to meet the 3Rs principle (Replacement, Reduction and Refinement) for eye toxicity testing. This procedure is highly necessary to ensure that the risks associated with ophthalmic products meet appropriate safety criteria. In vitro preclinical testing is now a well-established practice of significant importance for evaluating the efficacy and safety of cosmetic, pharmaceutical, and nutraceutical products. Along with in vitro testing, also computational procedures, herein described, for evaluating the pharmacological profile of potential ocular drug candidates including their toxicity, are in rapid expansion. In this review, the ocular cell types and functionality are described, providing an overview about the scientific challenge for the development of three-dimensional (3D) in vitro models. -
Topical Serum for Treatment of Keratomalacia
PROCEDURES PRO > OPHTHALMOLOGY > PEER REVIEWED Topical Serum for Treatment of Keratomalacia Amy Knollinger, DVM, DACVO Eye Care for Animals Salt Lake City, Utah Corneal Anatomy An understanding of corneal anatomy is vital to determine if serum therapy for the treatment of keratomalacia should be initiated. The cornea makes up the anterior por- tion of the globe and provides multiple functions for vision: it is transparent (despite originating from surface ectoderm), thereby allowing for clear vision; it acts as the major refractive (bending of light) surface of the globe; and it provides a protective barrier between the globe and the environment The cornea consists of 4 layers in domestic species, being approximately 0.45–0.55 mm thick in the normal dog. The corneal epithelium is the most external layer overly- What You Will Need ing the stromal layer, which accounts for 90% of the total corneal thickness. The cor- n Sterile gloves neal epithelium in the dog and cat is 5–11 cells thick and has a turnover rate of n approximately 7 days.1 The stroma is made up of collagen fibers, which are precisely Clean #40 clipper blade arranged in parallel sheets running the entire diameter of the cornea, allowing for its n Chlorhexidine scrub and solution transparency. The third layer is an acellular membrane (ie, Descemet’s membrane), n Sterile needle and syringe which forms the basement membrane for the innermost layer, the endothelium. The n corneal endothelium is a single layer of hexagonally shaped cells forming the internal Red top sterile blood collection or barrier between the anterior chamber and the cornea.2 serum separator tube n Centrifuge Corneal Disease n Sterile pipette Corneal ulcers are classified by underlying cause. -
Ocular Surface Changes Associated with Ophthalmic Surgery
Journal of Clinical Medicine Review Ocular Surface Changes Associated with Ophthalmic Surgery Lina Mikalauskiene 1, Andrzej Grzybowski 2,3 and Reda Zemaitiene 1,* 1 Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; [email protected] 2 Department of Ophthalmology, University of Warmia and Mazury, 10719 Olsztyn, Poland; [email protected] 3 Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61553 Poznan, Poland * Correspondence: [email protected] Abstract: Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combina- tion with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface. Keywords: dry eye disease; ocular surface dysfunction; cataract surgery; phacoemulsification; refractive surgery; trabeculectomy; vitrectomy Citation: Mikalauskiene, L.; Grzybowski, A.; Zemaitiene, R. Ocular Surface Changes Associated with Ophthalmic Surgery. J. Clin. 1. Introduction Med. 2021, 10, 1642. https://doi.org/ 10.3390/jcm10081642 Dry eye disease (DED) is a common condition, which usually causes discomfort, but it can also be an origin of ocular pain and visual disturbances. -
Scleral Faqs
www.scleralcenter.com SCLERAL FAQS CONTACT US: Office: 501 E. Palm Valley Blvd. WHY ARE SCLERAL LENSES SO Round Rock, TX 78664 COMFORTABLE? Website: www.scleralcenter.com Scleral lenses vault over the cornea and rest on Phone: 512.248.2424 the white portion of the eye (sclera), which is less sensitive. They fit under the eyelid, resulting in comfort & stability. JAVIER R. ZAMORA, OD Dr. Zamora is the co-founder of Advanced Eye Care & Surgery and has been fitting specialty contact lenses since 1998. He is a graduate of the University of Texas at Austin and the University of Houston College of Optometry. FIRM LENSES LARGER LENSES Sharp Vision Comfort & Stability DEBBIE A. ZAMORA, OD Dr. Zamora is the co- founder of Advanced Eye WHY DO SCLERAL LENSES OFFER Care & Surgery and has SUPERIOR VISION? been fitting specialty contact lenses since They are manufactured in Gas Permeable (GP) 2001. She is a graduate HOW material which provides a smooth optical surface of Tulane University and the University of Houston and excellent vision even if your cornea has an College of Optometry. SCLERAL LENSES irregular shape. Scleral lenses treat astigmatism and are available with bifocal options. CAN HELP YOU DEBRA A. WARE, OD WHAT IS THE ‘LIQUID BANDAGE’ Dr. Ware has been fitting EFFECT? specialty contact lenses since 1998. She is Scleral lenses provide extra moisture for healthy a graduate of Baylor eyes, as well as for patients with severe dry eyes. University and the The space between your eye and the back of the University of Houston scleral lens acts as a fluid reservoir that provides College of Optometry. -
Onchocerciasis
11 ONCHOCERCIASIS ADRIAN HOPKINS AND BOAKYE A. BOATIN 11.1 INTRODUCTION the infection is actually much reduced and elimination of transmission in some areas has been achieved. Differences Onchocerciasis (or river blindness) is a parasitic disease in the vectors in different regions of Africa, and differences in cause by the filarial worm, Onchocerca volvulus. Man is the the parasite between its savannah and forest forms led to only known animal reservoir. The vector is a small black fly different presentations of the disease in different areas. of the Simulium species. The black fly breeds in well- It is probable that the disease in the Americas was brought oxygenated water and is therefore mostly associated with across from Africa by infected people during the slave trade rivers where there is fast-flowing water, broken up by catar- and found different Simulium flies, but ones still able to acts or vegetation. All populations are exposed if they live transmit the disease (3). Around 500,000 people were at risk near the breeding sites and the clinical signs of the disease in the Americas in 13 different foci, although the disease has are related to the amount of exposure and the length of time recently been eliminated from some of these foci, and there is the population is exposed. In areas of high prevalence first an ambitious target of eliminating the transmission of the signs are in the skin, with chronic itching leading to infection disease in the Americas by 2012. and chronic skin changes. Blindness begins slowly with Host factors may also play a major role in the severe skin increasingly impaired vision often leading to total loss of form of the disease called Sowda, which is found mostly in vision in young adults, in their early thirties, when they northern Sudan and in Yemen. -
A Description of the Clinical Features of Brimonidine- Associated Uveitis Alyssa Louie Primary Care Resident, San Francisco VA
Drug-induced intraocular inflammation: A description of the clinical features of brimonidine- associated uveitis Alyssa Louie Primary Care Resident, San Francisco VA Abstract: A description of the clinical features, diagnostic work-up, and management of acute anterior uveitis caused by brimonidine, a widely used glaucoma medication. I. Case History a. Patient demographics: 74 year-old white male b. Chief complaint: eye pain, redness, irritation for last 2 weeks c. Ocular and medical history: i. Ocular history 1. Primary open angle glaucoma OU, diagnosed 8 years ago 2. Senile cataracts OU, not visually significant 3. Type 2 Diabetes without retinopathy OU 4. No prior history of uveitis ii. Medical history: Diabetes Mellitus Type 2 iii. No known drug allergies d. Medications i. Ocular: dorzolamide BID OU (1.5 years), brimonidine BID OU (11 months), travatan QHS OU (5.5 years) ii. Medical: metformin 500mg tab BID PO II. Pertinent Findings a. Clinical exam i. Visual acuities: OD 20/20-, OS 20/20- ii. Goldmann applanation tonometry: 13 mm Hg OD, 13 mm Hg OS iii. Anterior segment 1. OU: 3+ diffuse conjunctival injection 2. OU: central and inferior granulomatous keratic precipitates 3. OU: Grade 1+ cell, 1+ flare 4. OU: No synechiae or iris changes were present iv. Posterior segment 1. Optic Nerve a. OD: Cup-to-disc ratio 0.70H/V, distinct margins b. OS: Cup-to-disc ratio 0.75H/V, distinct margins 2. Posterior pole, periphery, vitreous: unremarkable OU b. Laboratory Studies i. ACE, Lysozyme, FTA-ABS, VDRL, HLA-B27, Rheumatoid Factor, ANA, PPD, Chest X- ray: all negative/unreactive III. -
MRSA Ophthalmic Infection, Part 2: Focus on Orbital Cellulitis
Clinical Update COMPREHENSIVE MRSA Ophthalmic Infection, Part 2: Focus on Orbital Cellulitis by gabrielle weiner, contributing writer interviewing preston h. blomquist, md, vikram d. durairaj, md, and david g. hwang, md rbital cellulitis is a poten- Acute MRSA Cellulitis tially sight- and life-threat- ening disease that tops the 1A 1B ophthalmology worry list. Add methicillin-resistant OStaphylococcus aureus (MRSA) to the mix of potential causative bacteria, and the level of concern rises even higher. MRSA has become a relatively prevalent cause of ophthalmic infec- tions; for example, one study showed that 89 percent of preseptal cellulitis S. aureus isolates are MRSA.1 And (1A) This 19-month-old boy presented with left periorbital edema and erythema preseptal cellulitis can rapidly develop five days after having been diagnosed in an ER with conjunctivitis and treated into the more worrisome condition of with oral and topical antibiotics. (1B) Axial CT image of the orbits with contrast orbital cellulitis if not treated promptly shows lacrimal gland abscess and globe displacement. and effectively. Moreover, the community-associ- and Hospital System in Dallas, 86 per- When to Suspect ated form of MRSA (CA-MRSA) now cent of those with preseptal cellulitis MRSA Orbital Cellulitis accounts for a larger proportion of and/or lid abscesses had CA-MRSA. Patients with orbital cellulitis com- ophthalmic cases than health care– These studies also found that preseptal monly complain of pain when moving associated MRSA (HA-MRSA). Thus, cellulitis was the most common oph- the eye, decreased vision, and limited many patients do not have the risk fac- thalmic MRSA presentation from 2000 eye movement. -
Special Considerations in Cataract Surgery: Five Cornea Challenges
Clinical Update EXTRA CONTENT AVAILABLE CATARACT Special Considerations in Cataract Surgery: Five Cornea Challenges by linda roach, contributing writer interviewing preston h. blomquist, md, rosa a. braga-mele, md, kimberly a. drenser, md, phd, herbert e. kaufman, md, marguerite mcdonald, md, and roger f. steinert, md s the most common surgical choices, said Marguerite McDonald, IOL Selection procedure in ophthalmol- MD, of Lynbrook, N.Y. The device en- ogy, replacement of a cloudy ables the surgeon to directly measure 1 crystalline lens with an the eye’s aphakic refractive power in intraocular lens (IOL) usu- the operating room. Aally presents the ophthalmologist with Using intraoperative aberrometry is familiar sets of surgical routines. But becoming more commonplace, as “it what about those cases that involve may help in achieving more accuracy comorbidities or other complicating with IOL power selection,” Dr. Mc- factors? Donald said. Several experts shared their per- Tips on IOL selection. The chosen spectives on approaching out-of-the- IOL should be shaped to neutralize After an off-center LASIK procedure ordinary cataract surgeries in ways spherical aberrations, said Rosa A. such as this, the irregularity of the that offer the best chance at optimiz- Braga-Mele, MD, at the University of corneal topography indicates that a ing patient outcomes. This month, Toronto. “In anybody who has had multifocal IOL should be avoided. here’s a look at five challenges involv- myopic LASIK or PRK, I think it’s very ing the cornea. important to use a negatively aspheric prior to cataract surgery. 2) A dysfunc- IOL, because these patients have more tional, unstable tear film will affect the Challenge: Prior Refractive Surgery positively aberrant corneas. -
Dry Eye in Patient with Clinical History of Chronic Blepharitis and Chalaziosis Edited by Dr
year 10 num b e r 2 4 e y e d o c t o r m a r ch- a p r i l 2018 CLINICAL CASES OF LUCIO BURATTO Dry eye in patient with clinical history of chronic blepharitis and chalaziosis edited by Dr. Maria Luisa Verbelli, Dr.Alessia Bottoni Observation and 1 anamnesis Arrives at our observation at CIOS, Italian Center for Dry Eye at CAMO, a 56-year-old patient with blepharitis, redness, ocular burning and abundant mucous secretion present in both eyes. Furthermore, an enlarged lymph node is seen in the right laterocervical site. At ocular anamnesis the patient reports chronic blepharitis from the juvenile age, multiple chalazion in both eyes, an operation for right Fig. 1 Handpiece for the application of the pulsed light of the Eye-Light instrument upper eyelid chalaziosis in 2006 (4 upper eyelid chalazion , 3 in the lower); negative anamnesis for these pathologies in the family. The patient is shortsighted since adolescence, has not had any other eye operations and has no ocular allergies. The general anamnesis does not report major systemic diseases or medication intake. On objective examination of the anterior segment we find bilaterally: reduced lacrimal meniscus, posterior blepharitis, obstruction of all the Meibomian glands of the upper and lower eyelids, conjunctival hyperemia with dry spots, transparent cornea, transparent crystalline. The no contact tonometry is 15 mmHg in RE, 16 mmHg in LE. The OCT of the macula does not show changes in both eyes. The BUT is 4.9 seconds in RE, and 15.6 seconds in LE.