Pediatric Ophthalmic Infections and Injuries
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Summary Benchmarks for Preferred Practice Pattern® Guidelines
SUMMARY BENCHMARKS FOR PREFERRED PRACTICE PATTERN® GUIDELINES TABLE OF CONTENTS Summary Benchmarks for Preferred Practice Pattern Guidelines Introduction . 1 Glaucoma Primary Open-Angle Glaucoma (Initial Evaluation) . 3 Primary Open-Angle Glaucoma (Follow-up Evaluation) . 5 Primary Open-Angle Glaucoma Suspect (Initial and Follow-up Evaluation) . 6 Primary Angle-Closure Disease (Initial Evaluation and Therapy) . 8 Retina Age-Related Macular Degeneration (Initial and Follow-up Evaluation) . 10 Age-Related Macular Degeneration (Management Recommendations) . 11 Diabetic Retinopathy (Initial and Follow-up Evaluation) . 12 Diabetic Retinopathy (Management Recommendations) . 13 Idiopathic Epiretinal Membrane and Vitreomacular Traction (Initial Evaluation and Therapy) . 14 Idiopathic Macular Hole (Initial Evaluation and Therapy) . 15 Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Initial and Follow-up Evaluation) . 17 Retinal and Ophthalmic Artery Occlusions (Initial Evaluation and Therapy) . 18 Retinal Vein Occlusions (Initial Evaluation and Therapy) . 19 Cataract/Anterior Segment Cataract (Initial and Follow-up Evaluation) . 20 Cornea/External Disease Bacterial Keratitis (Initial Evaluation) . 22 Bacterial Keratitis (Management Recommendations) . 23 Blepharitis (Initial and Follow-up Evaluation) . 24 Conjunctivitis (Initial Evaluation) . 25 Conjunctivitis (Management Recommendations) . 26 Corneal Ectasia (Initial Evaluation and Follow-up) . 27 Corneal Edema and Opacification (Initial Evaluation) . 28 Corneal Edema -
Repair of Open Globe Injury
Advances in Ophthalmology & Visual System Case Report Open Access Case report: repair of open globe injury Abstract Volume 3 Issue 1 - 2015 Globe rupture is a common sight-threatening ophthalmic emergency. We present a twelve-year-old girl with ocular trauma by sharp object resulting in corneal laceration, Nader Hussein Fouad Hassan Department of Ophthalmology, Benha University Hospital, hyphema, traumatic cataract and iris prolapse. This case illustrates the importance of early Egypt diagnosis, proper wound repair of ruptured globe as well as management of post-operative complications and value of early post-operative visual rehabilitation. Correspondence: Nader Hussein Fouad Hassan, Ophthalmology department, Benha University Hospital, Keywords: globe rupture, open globe injury, corneal laceration Kaliyobeya, Egypt, Tel +201224727982, Email Received: October 16, 2015 | Published: October 19, 2015 Abbreviations: FB, foreign body; VA, visual acuity; CT scan, patient then was given tetanus immunization, antiemetics, analgesics computerized tomography; RD, retinal detachment; INR, international and intravenous broad spectrum antibiotics and prepared for globe normalized ratio; GA, general anesthesia; D, diopter rupture repair under GA. Laboratory tests included a full blood count, liver function tests, INR, prothrombin time, partial thromboplastin Introduction time, kidney function tests, all were within normal. Ruptured Globe is a common ophthalmic emergency. It is a leading cause of blindness. Early examination with high level of suspicion is recommended in any patient with ocular trauma. Many signs may obscure detection of globe rupture, so the ophthalmologist should examine the patient thoroughly and treat the patient as early as impossible including early visual rehabilitation for young patients to prevent amblyopia. Globe rupture may be associated with traumatic hyphema, traumatic cataract, lens dislocation, vitreous hemorrhage, retinal detachment, uveal prolapse, scleral wound, orbital wall fractures, or optic nerve damage. -
URGENT/EMERGENT When to Refer Financial Disclosure
URGENT/EMERGENT When to Refer Financial Disclosure Speaker, Amy Eston, M.D. has a financial interest/agreement or affiliation with Lansing Ophthalmology, where she is employed as a ophthalmologist. 58 yr old WF with 6 month history of decreased vision left eye. Ache behind the left eye for 2-3 months. Using husband’s contact lens solution made it feel better. Seen by two eye care professionals. Given glasses & told eye exam was normal. No past ocular history Medical history of depression Takes only aspirin and vitamins 20/20 OD 20/30 OS Eye Pressure 15 OD 16 OS – normal Dilated fundus exam & slit lamp were normal Pupillary exam was normal Extraocular movements were full Confrontation visual fields were full No red desaturation Color vision was slightly decreased but the same in both eyes Amsler grid testing was normal OCT disc – OD normal OS slight decreased RNFL OCT of the macula was normal Most common diagnoses: Dry Eye Optic Neuritis Treatment - copious amount of artificial tears. Return to recheck refraction Visual field testing Visual Field testing - Small defect in the right eye Large nasal defect in the left eye Visual Field - Right Hemianopsia. MRI which showed a subacute parietal and occipital lobe infarct. ANISOCORIA Size of the Pupil Constrictor muscles innervated by the Parasympathetic system & Dilating muscles innervated by the Sympathetic system The Sympathetic System Begins in the hypothalamus, travels through the brainstem. Then through the upper chest, up through the neck and to the eye. The Sympathetic System innervates Mueller’s muscle which helps to elevate the upper eyelid. -
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 -
A Case of Uveitis-Hyphema-Glaucoma Syndrome Due to Express Miniature Implantation
Henry Ford Health System Henry Ford Health System Scholarly Commons Case Reports Medical Education Research Forum 2020 5-2020 A Case of Uveitis-Hyphema-Glaucoma Syndrome due to ExPRESS Miniature Implantation Andrew Hou Henry Ford Health System, [email protected] Madeline Hasbrook Henry Ford Health System David A. Crandall Henry Ford Health System, [email protected] Follow this and additional works at: https://scholarlycommons.henryford.com/merf2020caserpt Recommended Citation Hou, Andrew; Hasbrook, Madeline; and Crandall, David A., "A Case of Uveitis-Hyphema-Glaucoma Syndrome due to ExPRESS Miniature Implantation" (2020). Case Reports. 135. https://scholarlycommons.henryford.com/merf2020caserpt/135 This Poster is brought to you for free and open access by the Medical Education Research Forum 2020 at Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Case Reports by an authorized administrator of Henry Ford Health System Scholarly Commons. A Case of Uveitis-Hyphema-Glaucoma Syndrome due to ExPRESS Miniature Implantation Andrew Hou MD, Madeline Hasbrook MD, David Crandall MD Department of Ophthalmology, Henry Ford Health System, Detroit, Michigan Purpose Results Discussion To report a case of a 69-year-old patient We believe etiology for the UGH who developed uveitis-glaucoma- syndrome the significant iridodonesis seen hyphema (UGH) syndrome after an on gonioscopy. In the interim between uneventful ExPRESS (Alcon, Fort Worth, surgery and presentation, the patient had TX) mini shunt surgery for advanced been prescribed tamsulosin for his benign primary open-angle glaucoma. To our prostatic hyperplasia. knowledge, this is the first case report Tamsulosin has been well established as describing glaucoma device induced UGH the cause of intraoperative floppy iris syndrome and its successful treatment syndrome secondary to iris dilator atrophy. -
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. -
Adult Patients Common Eye Infections
Common Eye Dermatitis: HZV and HSV Infections: Adult • Redness of periocular skin can be allergic Patients (if associated with prominent itching) or bacterial (if associated with open sores/wounds) Julie D. Meier, MD Assistant Professor of Ophthalmology • Both HZV and HSV can have devastating ocular sequelae if not treated promptly OSU Eye and Ear Institute General Categories of Herpes Zoster Eye Infections Ophthalmicus • Symptoms: Skin rash and pain, may be • Dermatitis of Lids (HZV, HSV) preceded by headache, fever, eye pain or • Cellulitis of Lids (pre- vs post-septal) blurred vision • Blepharitis • Signs: Vesicular skin rash involving CN V • Conjunctivitis distribution; Involvement of tip of nose can predict higher rate of ocular involvement • Keratitis 1 Herpes Zoster Herpes Simplex Virus Ophthalmicus • Symptoms: • Work-up 9 Duration of rash; Immunocompromised? 9 Red eye, pain, light sensitivity, skin rash 9 Complete ocular exam, including slit 9 Fever, flu-like symptoms lamp, IOP, and dilated exam • Signs: • Can have conjunctival or corneal involvement, elevated IOP, anterior 9 Skin rash: Clear vesicles on chamber inflammation, scleritis, or erythematous base that progress to even involvement of retina and optic crusting nerve. Herpes Zoster Herpes Simplex Virus Ophthalmicus • Work-up: • Treatment: 9 Previous episodes? 9 If present within 3 days of rash’s 9 Previous nasal, oral or genital sores? appearance: oral Acyclovir/ Valacyclovir 9 Recurrences can be triggered by fever, stress, trauma, UV exposure 9 Bacitracin ointment to skin lesions 9 External exam: More suggestive of HSV 9 Warm compresses if lesions centered around eye and no involvement of forehead/scalp 9 TOPICAL ANTIVIRALS (e.g. -
Two Cases of Endogenous Endophthalmitis That Progressed To
rine to more distal vessels may have led to vasoconstric- References tion and subsequent vasospasm. In conclusion, epinephrine can lead to OAO following 1. Niemi G. Advantages and disadvantages of adrenaline in accidental intra-arterial injection of subcutaneously ad- regional anaesthesia. Best Pract Res Clin Anaesthesiol ministered local anesthetics. Hence, physicians should 2005;19:229-45. carefully administer local anesthesia while considering the 2. Park KH, Kim YK, Woo SJ, et al. Iatrogenic occlusion of possibility that such a complication may occur. the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Byung Gil Moon Ophthalmol 2014;132:714-23. Retina Center, Department of Ophthalmology, HanGil Eye 3. Lazzeri D, Agostini T, Figus M, et al. Blindness following Hospital, Incheon, Korea cosmetic injections of the face. Plast Reconstr Surg 2012;129:995-1012. June-Gone Kim 4. Savino PJ, Burde RM, Mills RP. Visual loss following intra- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea nasal anesthetic injection. J Clin Neuroophthalmol E-mail: [email protected] 1990;10:140-4. 5. Webber B, Orlansky H, Lipton C, Stevens M. Complica- tions of an intra-arterial injection from an inferior alveolar Conflict of Interest nerve block. J Am Dent Assoc 2001;132:1702- 4. No potential conflict of interest relevant to this article was reported. Korean J Ophthalmol 2017;31(3):279-281 litus presented with blurred vision of the right eye for 10 https://doi.org/10.3341/kjo.2017.0002 days. Abdominal and chest computed tomography showed an emphysematous prostatic abscess with multiple pulmo- nary lesions. -
Common Eye Condition Management
Common eye condition management Introduction by Moorfields’ medical director Thank you for taking the time to read this concise advice booklet about common eye conditions. It has been produced by clinicians and other staff CONTENTS at Moorfields to help you to make informed clinical decisions about your Introduction by Moorfields’ patients’ eye conditions locally, and medical director ......................... 3 avoid them having to attend hospital unnecessarily. Schematic diagram of the human eye ........................ 4 For each of the most common conditions you might see in your practice, we have listed signs and symptoms, General information Equipment and drugs to keep the equipment you will need to examine the patient, and at hand in the surgery ............ 4 the procedure to follow in undertaking that examination. General good practice advice ..................................... 5 Towards the end of the booklet, we have included a Eye examination .................... 5 table divided into four levels of urgency for onward referral – immediate, within 24 hours, within one week Care pathways for common and routine – with a list of relevant circumstances and eye conditions: conditions for each. Conjuntivitis ........................... 6 Dry eyes ............................... 7 We have also provided a table of the several locations Blepharitis ............................. 8 in which Moorfields provides care in and around Chalazion (meibomian cyst) ...10 London, and the sub-specialty services we offer in Stye .......................................11 each place. Corneal abrasion ....................12 Corneal foreign body ..............13 Subtarsal foreign body ..........14 I hope you find this guide helpful, and welcome your Subconjunctival views on how we might improve future editions. Please haemorrhage .........................15 contact our GP liaison manager on 020 7253 3411, Episcleritis .............................16 ext 3101 or by email to [email protected] with your comments. -
STYES and CHALAZION
TRE ATM ENT TRE ATM ENT FOR STYES FOR CHALAZION While most styes will drain on their The primary treatment for chalazion is own, the application of a hot or warm application of warm compresses for 10 compress are the most effective to 20 minutes at least 4 times a day. means of accelerating This may soften the hardened oils STYES drainage. The blocking the duct and promote drain- warmth and damp- age and healing. ness encourages the stye to drain. Just like any infection try not to touch it with your fingers. A Chalazion may be treated with compress can be made by putting hot any one or a combination of (not boiling) water on a wash cloth, or antibiotic or steroid drops pre- by using room temperature water and scribed by your healthcare a plastic heat pack. Warm compress- provider. es should be applied for 10—20 and minutes, four (4) times a day. There are occasions when sur- There is also a specialized topical gical drainage is required. ointment for styes, that may be pre- scribed. “Do not use eye makeup Styes may also cause a bruised feel- or wear contact lenses ing around the eye which is treated by application of a warm cloth to the eye. until the stye or chalazion CHALAZION With treatment, styes typically resolve have healed.” within one week. Lancing of a stye is not recommended. Revised: August 2011 WHAT ARE THEY? Signs and Symptoms Signs & Symptoms O f S t ye s of Chalazions The first signs of a stye are: A stye is an infection of the The symptoms of chalazions differ from tenderness, sebaceous glands at the base of the styes as they are usually painless. -
Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular
perim Ex en l & ta a l ic O p in l h Journal of Clinical & Experimental t C h f a o l m l a o Ke et al., J Clin Exp Ophthalmol 2017, 8:6 n l o r g u y o Ophthalmology J DOI: 10.4172/2155-9570.1000694 ISSN: 2155-9570 Case Report Open Access Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular Massage Following Trabeculectomy Hongmin Ke, Chengguo Zuo and Mingkai Lin* State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie Nan Road, Guangzhou, China *Corresponding author: Mingkai Lin, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, 54 Xianlie Nan Road, Guangzhou, China, 510060, E- mail: [email protected] Received date: November 13, 2017; Accepted date: November 21, 2017; Published date: November 23, 2017 Copyright: © 2017 Ke H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Purpose: To report a case of acute keratoconus-like corneal hydrops in a patient with long-term ocular massage following trabeculectomy. Methods: Case report and review of medical literature. Results: A rare complication of acute keratoconus-like corneal hydrops occurred in a patient following the use of ocular massage to maintain satisfactory aqueous humor filtration after trabeculectomy. The patient had a history of high myopia but denied previous ocular trauma, allergic disease and a family history of keratoconus. Slit-lamp examination demonstrated keratoconus-like corneal hydrops with formation of epithelial microcystic, and intrastromal cleft. -
Eye Infections
CLINICAL Approach Taking a Look at Common Eye Infections John T. Huang, MD, FRCSC and Peter T. Huang, MD, FRCSC he acutely red eye is often seen first by the primary-care physician. The exact Tcause may be difficult to determine and may cause some concern that a serious ocular condition has been missed. Thorough history and clinical examination will help delineate the final diagnosis. When there are doubts, prompt referral to an oph- thalmologist can prevent serious consequences. Often, the most likely diagnosis of an acutely red eye is acute conjunctivitis. In the first day, an acute bacterial infection may be hard to differentiate from viral, chlamydial and noninfectious conjunctivitis and from episcleritis or scleritis. Below is a review of the most commonly seen forms of eye infections and treat- ments. Failure to improve after three to five days should lead to a re-evaluation of the patient and appropriate referral where necessary. CHRONIC BLEPHARITIS Clinical: Gritty burning sensation, mattering, lid margin swelling and/or scaly, flaky debris, mild hyperemia of conjunctiva; may have acne rosacea or hyperkeratotic dermatitis (Figure 1). Anterior: Staphylococcus aureus (follicles, accessory glands); posterior (meibomian glands). Treatment: • Lid scrubs (baby shampoo, lid-care towellettes, warm compresses). Figure 1. Chronic blepharitis. There may be localized sensitivity to the shampoo or the components of the solution in the towellettes (e.g., benzyl alcohol). • Hygiene is important for the treatment and management of chronic blepharitis. Topical antibiotic-corticosteroid combinations (e.g., tobramycin drops, tobramycin/dexamethasone or sulfacetamide sodium-prednisolone acetate). Usage of these medications is effective in providing symptomatic relief, as the inflammatory component of the problem is more effectively dealt with.