Atopic Keratoconjunctivitis
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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 -
Keratoconjunctivitis Sicca (“Dry Eye”) Stephanie Shrader, DVM and John Robertson, VMD, Phd
Keratoconjunctivitis sicca (“Dry Eye”) Stephanie Shrader, DVM and John Robertson, VMD, PhD Introduction and Overview How Tears Are Produced Keratoconjunctivitis sicca (KCS) is a disease of the eyes, The tear film that covers the eyes is made up of three distinct characterized by inflammation of the cornea and conjunctiva. layers. The outermost layer is made up of oils, which are This condition occurs secondary to a deficiency in formation secreted by the Meibomian glands. This lipid layer provides of the tear film that normally protects the cornea (Best et al, protection against evaporation, binds the tear film to the 2014), which leads to dry, irritated eyes. As a result, KCS is cornea, and prevents tears from simply pouring out over the commonly known as “dry eye” or in veterinary terminology, lower eyelid onto the face. The middle layer of the tear film is xerophthalmia. This disease occurs often in West Highland the aqueous layer, which is produced by the lacrimal glands. As White Terriers, but is also common in many other breeds, its name would suggest, the aqueous layer consists primarily including Lhasa Apso, English Bulldog, American Cocker of water, along with important proteins and enzymes that help Spaniel, English Springer Spaniel, Pekingese, Pug, Chinese Shar remove bacteria and cellular waste material, and lubricate the Pei, Yorkshire Terrier, Shih Tzu, Miniature Schnauzer, German surface of the cornea. The innermost layer of the tear film is the Shepherd, Doberman Pinscher, and Boston Terrier. While the mucin layer, which is is produced by tiny secretory cells in the reported incidence of KCS across all dog breeds ranges from conjunctiva known as goblet cells. -
Cytokine Profiles of Tear Fluid from Patients with Pediatric Lacrimal
Immunology and Microbiology Cytokine Profiles of Tear Fluid From Patients With Pediatric Lacrimal Duct Obstruction Nozomi Matsumura,1 Satoshi Goto,2 Eiichi Uchio,3 Kyoko Nakajima,4 Takeshi Fujita,1 and Kazuaki Kadonosono5 1Department of Ophthalmology, Kanagawa Children’s Medical Center, Yokohama, Japan 2Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan 3Department of Ophthalmology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan 4Department of Joint Laboratory for Frontier Medical Science, Faculty of Medicine, Fukuoka University, Fukuoka, Japan 5Department of Ophthalmology and Micro-technology, Yokohama City University, Yokohama, Japan Correspondence: Nozomi Matsu- PURPOSE. This study evaluated the cytokine levels in unilateral tear samples from both sides in mura, Department of Ophthalmolo- patients with pediatric lacrimal duct obstruction. gy, Kanagawa Children’s Medical Center, 2-138-4 Mutsukawa, Minami- METHODS. Fifteen cases of unilateral lacrimal duct obstruction (mean, 26.9 6 28.7 months old) ku, Yokohama 232-8555, Japan; were enrolled in this study. Tear samples were collected separately from the obstructed side [email protected]. and the intact side in each case before surgery, which was performed under general Submitted: September 8, 2016 anesthesia or sedation. The levels of IL-2, IL-4, IL-6, IL-10, TNF, IFN-c, and IL-17A then were Accepted: December 2, 2016 measured in each tear sample. A receiver operating characteristic (ROC) curve was constructed for the IL-6 levels in the tears. We also measured the postoperative tear fluid Citation: Matsumura N, Goto S, Uchio levels of IL-6 in those cases from which tear fluid samples could be collected after the surgery. -
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. -
Reiter's Syndrome
iMedPub JOURNALS ARCHIVES OF MEDICINE | 2009 | Vol. 1 | No. 1:1 | doi: 10.3823/032 Review Reiter's Syndrome Digna Llorente Molina, Susandra Cedeño Facultad de Ciencias Médicas 10 de Octubre. Ciudad Habana, Cuba. E-mail: [email protected] Reiter’s syndrome is a systemic disorder characterized by ocular conjunctivitis or uveitis, reactive arthritis, and urethritis manifestations. The exact cause of reactive arthritis is unknown. It occurs most commonly in men before the age of 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella or Yersinia. Certain genes may make you more prone to the syndrome. The diagnosis is based on symptoms. The goal of treatment is to relieve symptoms and treat any underlying infection. Reactive arthritis may go away in 3 - 4 months, but symptoms may return over a period of several years in up to a half of those affected. The condition may become chronic. Preventing sexually transmitted diseases and gastrointestinal infection may help prevent this disease. Wash your hands and surface areas thoroughly before and after preparing food. © Archives of Medicine: Accepted after external review ■ The first description of Reiter’s syndrome was attributed in occasionally, cutaneous-mucosal lesions such as keratodermia 1916 to the re-known German physician Hans Reiter, linked to blennorrhagica and balanitis circinata; yellow papule lesions Nazi powers, and to his experiments in the concentration on the soles, palms and with less frequency on the nails, camps. In 1918, Junghanns described the first case in a young scrotum, scalp and trunk, amongst others (3), (4), (5).. The patient (1), (2). earliest manifestation of joint disorder is entesitis, normally in the Achilles tendon and in the plantar fascia of the calcaneus, Due to the syndrome’s abnormal immunological reactivity to causing shortening or lengthening of fingers and toes certain pathogens as a result of the interaction between resembling "sausage fingers and toes". -
Chronic Conjunctivitis
9/8/2017 Allergan Pharmaceuticals Speaker’s Bureau Bio-Tissue BioDLogics, LLC Katena/IOP Seed Biotech COA Monterey Symposium 2017 Johnson and Johnson Vision Care, Inc. Shire Pharmaceuticals Nicholas Colatrella, OD, FAAO, Dipl AAO, ABO, ABCMO Jeffrey R. Varanelli, OD, FAAO, Dipl ABO, ABCMO Text NICHOLASCOLA090 to 22333 to join Live Text Poll Nicholas Colatrella, OD, FAAO, Dipl AAO, Jeffrey Varanelli, OD, FAAO, Dipl ABO, ABO, ABCMO ABCMO Text NICHOLASCOLA090 to 22333 once to join Then text A, B, C, D, E or write in your answer Live Immediate Accurate Chronic conjunctivitis is one of the most frustrating reasons that patients present to the office (1) Time course Often times patients will seek multiple providers searching for a solution The chronicity of their symptoms is extremely frustrating to the (2) Morphology patient and treating physician alike Some conditions can seriously affect vision and create ocular morbidity (3) Localization of disease process Many of these diseases do not respond to commonly used topical antibiotics, topical steroids, artificial tears, and other treatments for external ocular disease (4) Type of discharge or exudate Our hope during this one-hour lecture is to present a process to help aid in the diagnosis of chronic conjunctivitis help you determine the most likely etiology 1 9/8/2017 Three weeks is the dividing point as it is the upper limit for cases of viral infection and most bacterial infections to resolve without treatment. Acute Conjunctivitis Conjunctivitis that has been present for less than 3 weeks -
The Uveo-Meningeal Syndromes
ORIGINAL ARTICLE The Uveo-Meningeal Syndromes Paul W. Brazis, MD,* Michael Stewart, MD,* and Andrew G. Lee, MD† main clinical features being a meningitis or meningoenceph- Background: The uveo-meningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. alitis associated with uveitis. The meningeal involvement is Review Summary: We review the clinical manifestations of uveitis often chronic and may cause cranial neuropathies, polyra- and describe the infectious, inflammatory, and neoplastic conditions diculopathies, and hydrocephalus. In this review we define associated with the uveo-meningeal syndrome. and describe the clinical manifestations of different types of Conclusions: Inflammatory or autoimmune diseases are probably uveitis and discuss the individual entities most often associ- the most common clinically recognized causes of true uveo-menin- ated with the uveo-meningeal syndrome. We review the geal syndromes. These entities often cause inflammation of various distinctive signs in specific causes for uveo-meningeal dis- tissues in the body, including ocular structures and the meninges (eg, ease and discuss our evaluation of these patients. Wegener granulomatosis, sarcoidosis, Behc¸et disease, Vogt-Koy- anagi-Harada syndrome, and acute posterior multifocal placoid pig- ment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a The uveo-meningeal syndromes are a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in heterogeneous group of disorders that share patients 40 years of age or older with bilateral uveitis, especially involvement of the uvea, retina, and meninges. -
Management of Chronic Anterior Uveitis Relapses: Efficacy of Oral Phospholipidic Curcumin Treatment. Long-Term Follow-Up
Clinical Ophthalmology Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up Pia Allegri1 Abstract: Curcumin has been successfully applied to treat inflammatory conditions in Antonio Mastromarino1 experimental research and in clinical trials. The purpose of our study is to evaluate the efficacy Piergiorgio Neri2 of an adjunctive-to-traditional treatment with Norflo tablets (curcumin-phosphatidylcholine complex; Meriva) administered twice a day in recurrent anterior uveitis of different etiologies. The 1Uveitis Center, Ophthalmological Department of Lavagna Hospital, study group consisted of 106 patients who completed a 12-month follow-up therapeutic period. Genova, Italy; 2Uveitis Unit, The We divided the patients into three main groups of different uveitis origin: group 1 (autoimmune Eye Clinic, Azienda Ospedaliero- uveitis), group 2 (herpetic uveitis), and group 3 (different etiologies of uveitis). The primary Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy end point of our work was the evaluation of relapse frequency in all treated patients, before and after Norflo treatment, followed by the number of relapses in the three etiological groups. Wilcoxon signed-rank test showed a P , 0.001 in all groups. The secondary end points were the evaluation of relapse severity and of the overall quality of life. The results showed that Norflo was well tolerated and could reduce eye discomfort symptoms and signs after a few weeks of treatment in more than 80% of patients. In conclusion, our study is the first to report the potential therapeutic role of curcumin and its efficacy in eye relapsing diseases, such as anterior uveitis, and points out other promising curcumin-related benefits in eye inflammatory and degenerative conditions, such as dry eye, maculopathy, glaucoma, and diabetic retinopathy. -
Immune Defense at the Ocular Surface
Eye (2003) 17, 949–956 & 2003 Nature Publishing Group All rights reserved 0950-222X/03 $25.00 www.nature.com/eye Immune defense at EK Akpek and JD Gottsch CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM the ocular surface Abstract vertebrates. Improved visual acuity would have increased the fitness of these animals and would The ocular surface is constantly exposed to a have outweighed the disadvantage of having wide array of microorganisms. The ability of local immune cells and blood vessels at a the outer ocular system to recognize pathogens distance where a time delay in addressing a as foreign and eliminate them is critical to central corneal infection could lead to blindness. retain corneal transparency, hence The first vertebrates were jawless fish that preservation of sight. Therefore, a were believed to have evolved some 470 million combination of mechanical, anatomical, and years ago.1 These creatures had frontal eyes and immunological defense mechanisms has inhabited the shorelines of ancient oceans. With evolved to protect the outer eye. These host better vision, these creatures were likely more defense mechanisms are classified as either a active and predatory. This advantage along with native, nonspecific defense or a specifically the later development of jaws enabled bony fish acquired immunological defense requiring to flourish and establish other habitats. One previous exposure to an antigen and the such habitat was shallow waters where lunged development of specific immunity. Sight- fish made the transition to land several hundred threatening immunopathology with thousand years later.2 To become established in autologous cell damage also can take place this terrestrial environment, the new vertebrates after these reactions. -
Characteristics of Allergy in Autoimmune Thyroid Diseases Ildikó
Characteristics of allergy in autoimmune thyroid diseases Ildikó Molnár MD, PhD, EndoMed, Hungary ImmunSum, Baltimore, 2014 Relationship between allergic responses and thyroid autoimmunity IgE levels IgE deposits are present in Graves’ thyroid and orbital tissues (Werner SC et al., N Engl Med, 1972;287:421-425.; Raikow RB et al., Ophthalmol. 1990; 97:629-635.) Elevated IgE levels associated with hyperthyroid Graves’ disease (Akira S et al., J Clin Endocrinol Metab 1999; 84:3602-3605.; Takashi Y et al., J Clin Endocrinol Metab 2000; 85:2775- 2778.) Evidence of immunglobulin E autoantibodies to thyrotropin receptor (TSH rec) and thyroid peroxidase (TPO) (Metcalfe R et al., J Clin Endocrinol Metab 2002;87:1754-1761.; Gou J et al., Clin Immunol Immunopathol 1997; 82: 157-162.) Th2-derived cytokine profils Elevated serum levels of IL-5 and IL-13 cytokines. (Hidaka Y et al., Thyroid 1998; 8:235-239.; Ichiro K et al., J Clin Endocrinol Metab 2001; 86:3540-3544.) Allergic rhinitis associated frequently with Graves’ disease (Amino N et al., Thyroid 2003; 13:811-814.; Hidaka Y et al., Thyroid 1996; 6: 349-351.) Common key factors regulate the immune responses in both allergic and autoimmune conditions (Rottem M et al., Dev Immunology 2002; 9: 161-167.) ImmunSum, Baltimore, 2014 Previous results Graves’ ophthalmopathy associated with increased total IgE serum levels. Molnár I et al., Eur J Med Rev 1996; 1:543-546. Hyperthyroid Graves’ ophthalmopathy demonstrated elevated serum IL-5 levels compared to patients who had no eye signs. Molnár I , Abstract: ACT International Suppl., 2000; 2: 220. Decreased serum levels of nerve growth factor (NGF) associated with hyperthyroid Graves’ ophthalmopathy compared to those who had no eye signs. -
Oral Contraception and Eye Disease: findings in Two Large Cohort Studies
538 Br J Ophthalmol 1998;82:538–542 Oral contraception and eye disease: findings in two large cohort studies M P Vessey, P Hannaford, J Mant, R Painter, P Frith, D Chappel Abstract over.4 Given the sparsity of the epidemiological Aim—To investigate the relation between evidence available, we have undertaken an oral contraceptive use and certain eye dis- analysis of the data on eye disease in the two eases. large British cohort studies of the benefits and Methods—Abstraction of the relevant data risks of oral contraception—namely, the Royal from the two large British cohort studies College of General Practitioners’ (RCGP) Oral of the eVects of oral contraception, the Contraception Study5 and the Oxford-Family Royal College of General Practitioners’ Planning Association (Oxford-FPA) contra- (RCGP) Oral Contraception Study and ceptive study.6 We summarise our findings the Oxford-Family Planning Association here. (Oxford-FPA) Contraceptive Study. Both cohort studies commenced in 1968 and were organised on a national basis. Be- Material and methods tween them they have accumulated over ROYAL COLLEGE OF GENERAL PRACTITIONERS’ 850 000 person years of observation in- ORAL CONTRACEPTION STUDY volving 63 000 women. During a 14 month period beginning in May 1968, 1400 British general practitioners re- Results—The conditions considered in the analysis were conjunctivitis, keratitis, iri- cruited 23 000 women using oral contracep- tives and a similar number who had never done tis, lacrimal disease, strabismus, cataract, 5 glaucoma, retinal detachment, and retinal so. The two groups were of similar age and all vascular lesions. With the exception of subjects were married or living as married.