DOCSLIB.ORG

Ocular Manifestations in Lepromatous and Tuberculoid Leprosy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ocular Manifestations in Lepromatous and Tuberculoid Leprosy Maltese Medical Journal ~ Volume IT Issue I 1990 Ocular Manifestations in Lepromatous and Tuberculoid Leprosy Milan Blagojevic, Richard Soler, George Depasquale, Mario Bonnici, Denis Schiro. countries, but it is believed to be present themselves with the first ABSTRACT between 10 and 12 million. Among signs of disease in late adult life. these about 750,000 have visual Ocular manifestations of leprosy in impairment, even blindness. This 3. Family History - In 39% it was 100 patients examined were fact is even more tragic if one keeps proved that the patient has or has reported on; - 80% were suffering in mind that blindness is almost had another member of the from the lepromatous type of the alwa:r.s associated with other immediate family (i.e. parent, disease. disabIlities: e.g. loss of sensations, sibling, or offspring) suffering from deformities of hands, feet, face, etc. leprosy. The most frequent change was loss of eyebrows (40%) which was seen From all publications it is evident 4. Classification of Patients - The mainly in lepromatous patients. The that patients suffering from the types of disease were represented sclera and cornea were rarely lepromatous type of leprosy are more thus: affected separately, but sclero­ prone to develop ocular kerato- iridocyclitis was found in Lepromatous (LL) 57 complications, involving primarily 80% 3%. On the other hand, the iris was the eyelids and the anterior segment, Borderline lepromatous (BL) 23 involved rather more often - 16% while the fundus is rarely affected Borderline (BB) 5 5% (atrophy of the iris - 4, atrophy of the Borderline tuberculoid (BT) 11 (2,3,4). 15% pupillary margin - 3, miosis - 1, Tuberculoid (TT) 4 posterior synechiae - 6, keratic There are regional, climatic, racial precipitates - 1, and iris "pearls" - 1). and other factors which have an It is evident that the lepromatous The iritis always had an insidious influence on the type of leprosy and and borderline lepromatous types chronic evolution. The origin of the on its complications in general. We constitute the most common form of iritis is probably multifactorial: have therefore undertaken this leprosy encountered in Malta, with survey to examine 100 leprosy a prevalence of 80%. a) neuroparalytic due to patients and find out the prevalence involvement of the autonomic nerves of ocular manifestations as well as 5. Treatment. All patients examined supplying the iris muscles, primarily the relation of these to the type of had been treated with multiple drug dilator; leprosy - lepromatous or tuberculoid. therapy, consisting of "Isoprodian ­ b) direct effect of Mycobacterium RMP" (a fixed combination of leprae on the iris tissue; and ME'IHODS AND MATERIAL Rifampicin 60Omg., Prothionomide c) immune or auto-immune 35Omg., Isoniazide 35Omg., Dapsone mechanisms. In the period February to August 100mg. daily for 6 days a week) for 1987 we have performed the a period of approximately 20 months, The posterior uvea was rarely ophthalmological examination of following a previous variable period . affected (2%). No case of primary 100 leprosy, who were currently of dapsone monotherapy - in some glaucoma was detected, but under the care of the Leprosy cases up to 15 years and over. At the secondary glaucoma due to Eradication Programme. time of examination the vast sclerokerato-iridocyclitis was found majority had been released from in 2 cases. Cataract seems to occur Ophthalmological examination treatment more than 10 years more frequently in leprosy patients included the condition of the external previously and since then had been (20%) than in the general population. part of the eye, examination of the kept under strict post-treatment anterior segment with slit lamp, control. The anterior segment was mostly fundoscopy, tonometry, and visual affected (21%), and all these cases acuity. Dapsone in a daily dose of lOOrng. belonged to the lepromatous (16) or borderline lepromatous (5) type. 1. Sex- Males were represented by M Blagojevic, MD Dr Se. 62% and females by 38%. R Soler, MD FRCS. INTRODUCTION M Bonnici, MD. and 2. Age Distribution - The m~ority Although leprosy has completely D Schiro,MD. of the patients - 75% - are older than Department of Ophthalmology, disappeared from many countries, 50 years due to the facts that: the number of patients suffering St. Luke's Hospital, from this chronic, disfiguring a) the incidence of new cases has G Depasquale MD. condition, is still rather high world declined drastically in the last two wide. The exact number of leprosy Dept of Dermatology decades, and Boffa Hospital patients is not available from all b) a considerable number of patients Maltese Medical Journal 39 Volume IT Issue I 1990 does not usually cause any serious complicated with secondary while sphincter muscle was only side effects. However, a massive glaucoma (fig.3,4). atrophic in 7%. This was seen always dose of 7.5gm taken in a suicidal in lepromatous leprosy while, on attempt has produced bilateral ·5. Iris. Involvement of the iris was the other hand, both muscles were retinal necrosis, haemolytic anemia, encoWltered relatively often - 16% normal in tuberculoid and borderline methaemoglobinaemia, and acute of all cases (12 cases in the LL group leprosy. Because of the atrophy of renal failure (5). and 4 cass in BL). In these cases the iris muscle, particularly the different changes could be noticed dilator, mydriatics have a very poor 6. SeQuelae. A number of patients in the iris: atrophy of iris stroma effect in lepromatous iritis. showed stigmata of the disease. (4%) (Fig.5), atrophy of the iris "Leonine facies" was seen in 3 margin (3%), miosis (1%). Besides We believe that the neuroparalytic patients while a considerable these, one could find posterior factors play a very important but number had abnormalities relating synechiae (6%), keratic precipitates not the only role in the pathogenesis to their upper and/or lower limbs. (1%), and iris "pearls" (1%). of chronic iritis. A second important These included: anesthesia (14%), role belongs to the direct effect of muscle . atrophy (4%), trophic In all cases the eyes were white, the Hansen bacilli on the iris tissue. ulceration (6%), and deformity (7%). quiet and no signs of active iris This is sometimes manifested in the inflammation could be detected. The form of iris "pearls" which consist of OCULAR MANIFESTATIONS involvement of the iris had the tightly packed li· bacilli within features of the chronic iritis or mononuclear cells~ey are located The ocular changes observed in the insidious anterior uveitis seen in in the middle or deeper layers of the 100 patients examined were leprosy. The most striking iris, usually between the collarette recorded according to the type of appearance in this chronic form of and ciliary margin, but can also be leprosy, and the findings are iritis is the atrophy of iris stroma free in the anterior chamber. represented in Table 1. From the and/or iris margin (total 7%). The data the following observations are atrophy is very intensive, involving The above mentioned alterations of evident: large areas of the iris and sometimes the iris muscles and iris tissue may having an appearance similar to generate some autoantigen, which 1. Eyebrows. The most frequent essential iris atrophy, with the can trigger immWle or auto-immWle changes are fOWld on the eyebrows presence of holes in the iris reactions. To prove this and eyelashes. In 40% we could ("Fenestrae iridis"). Inverse immunological mechanism further notice hair loss ranging .from heterochromia could also be seen. investigations are necessary, rarefication to complete loss of the Pronounced iris atrophy, lack of because Wltil now there is no definite eyebrows. The lateral parts of the irritative symptoms and a very evidence concerning the immWlo­ eyebrows were frequently and chronic evolution, differentiate the biological changes in the sera and severely affected. The majority of iritis in lepromatous leprosy from aqueous humor. However, the the patients with these changes other clinical entities of chronic presence of plasma cells, as shown (31%) belonged to lepromatous (ll..) anterior uveitis. For this reason, it by Ffytche in histological specimens, group. is interesting to know which are the indicate the participation of aetiopathogenic factors that play a immunological phenomena in 2. Eyelashes. Changes were only role in the Wlderlying iritis. From leprosy uveitis. seen in the LL and BL groups. our experience and from data from Ciliary Madarosis was present in the literature, we think that there Among our patients we did not 8% while trichiasis was detected in are three pathogenic factors: observe any case of acute serous 4% of cases. It should be noted that nongranulomatous iritis, which regrowth of hairs on the eyebrows a) involvement of the autonomic represents bacterial allergy, similar and eyelashes can occur after nervous system supplying the fibres to acute erythema nodosum starting anti-leprosy treatment in of sphincter and dilator muscles; those cases where the hair loss had 6. Chlorioretinal changes. The not been of long standing. b) direct effect of Mycobacterium leprae on the iris tissue; and 3. Sclera 1 case showed involvement of the sclera in the form of c) immune or auto-immune episcleritis. manifestations; 4. Cornea Two cases showed the Ffytche (6) estimates that chronic sequelae of stromal keratitis in the iritis in lepromatous leprosy is not a form of corneal leucoma (Fig.2). true inflammation, but is a form of Superficial keratitis, pannus, or the neuroparalytic iritis, caused by early typical white opacities having involvement of autonomic nerve "chalk-white" appearance, fibres. Direct involvement of neuroparalytic keratitis, exposure nonmyelinated autonomic nerve keratitis, or band-shaped fibres results in damage to the iris keratopathy were not observed. muscles, particularly the dilator. Meanwhile, the cornea was very Ffytche demonstrated histologically much involved in the cases of sclero­ that the dilator muscle was absent kerato-iritis, in 3% of all patients, or very markedly atrophied in 73%, M.alteee Medical Journal 40 Volume IT Issue I 1990 8.
Load more

Recommended publications
  • Eyelid Conjunctival Tumors
    EYELID &CONJUNCTIVAL TUMORS PHOTOGRAPHIC ATLAS Dr. Olivier Galatoire Dr. Christine Levy-Gabriel Dr. Mathieu Zmuda EYELID & CONJUNCTIVAL TUMORS 4 EYELID & CONJUNCTIVAL TUMORS Dear readers, All rights of translation, adaptation, or reproduction by any means are reserved in all countries. The reproduction or representation, in whole or in part and by any means, of any of the pages published in the present book without the prior written consent of the publisher, is prohibited and illegal and would constitute an infringement. Only reproductions strictly reserved for the private use of the copier and not intended for collective use, and short analyses and quotations justified by the illustrative or scientific nature of the work in which they are incorporated, are authorized (Law of March 11, 1957 art. 40 and 41 and Criminal Code art. 425). EYELID & CONJUNCTIVAL TUMORS EYELID & CONJUNCTIVAL TUMORS 5 6 EYELID & CONJUNCTIVAL TUMORS Foreword Dr. Serge Morax I am honored to introduce this Photographic Atlas of palpebral and conjunctival tumors,which is the culmination of the close collaboration between Drs. Olivier Galatoire and Mathieu Zmuda of the A. de Rothschild Ophthalmological Foundation and Dr. Christine Levy-Gabriel of the Curie Institute. The subject is now of unquestionable importance and evidently of great interest to Ophthalmologists, whether they are orbital- palpebral specialists or not. Indeed, errors or delays in the diagnosis of tumor pathologies are relatively common and the consequences can be serious in the case of malignant tumors, especially carcinomas. Swift diagnosis and anatomopathological confirmation will lead to a treatment, discussed in multidisciplinary team meetings, ranging from surgery to radiotherapy.
    [Show full text]
  • A Rare Presentation of Lower Conjunctival Fornix Eyelashes Cyst Dr Mohammad Aldroos (MD)* *Department of Ophthalmology, Jordanian Royal Medical Services
    Int J Biol Med Res.2018 ;9(1):6259-6260 Int J Biol Med Res www.biomedscidirect.com Volume 6, Issue 2, April 2015 Contents lists available at BioMedSciDirect Publications International Journal of Biological & Medical Research Journal homepage: www.biomedscidirect.com BioMedSciDirect International Journal of Publications BIOLOGICAL AND MEDICAL RESEARCH Case report A rare presentation of lower conjunctival fornix eyelashes cyst Dr Mohammad Aldroos (MD)* *Department of Ophthalmology, Jordanian Royal Medical Services A R T I C L E I N F O A B S T R A C T Keywords: Purpose: To describe a rare presentation of a right lower conjunctival fornix eyelashes cyst. Case Report: A 56 year-old lady presented to our clinic complaining of blackish mass in the lower conjunctival fornix of the right eye ( see fig.1), with mild conjunctival hyperemia around the mass. There was no history of discharge and difficulty in extraocular muscles movements also there was no history of trauma. A gradually enlarging mass over the past few years with recurrent conjunctivitis. Slit lamp examination of the mass showed normal appearing eyelashes surrounded by capsule only. The mass was surgically excised with good cosmetic appearance and without any complications c Copyright 2010 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved. Introduction Fig.2 Eyelashes grow on the edge of the eyelid. A normal eyelid has a single row of eyelashes located along its anterior margin. The posterior portion of the lid contains a row of Meibomian glands orifices, which secrete the oily component of the tear film (1). There are approximately 100 eye lashes on the upper lid and approximately 50-75 on the lower lid, they protect the eyeball.
    [Show full text]
  • Ophthalmic and Adnexal Complications of Radiotherapy
    Acta Ophthalmologica Scandinavica 2007 Review Article Ophthalmic and adnexal complications of radiotherapy Shane R. Durkin,1 Daniel Roos,2 Braden Higgs,2 Robert J. Casson1,3 and Dinesh Selva1,3 1Department of Ophthalmology and Visual Sciences, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia 2Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia 3Department of Medicine and Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide South Australia, Australia ABSTRACT. The efficacy of radiotherapy is The role of radiotherapy in ophthalmic practice continues to grow. This determined by aspects of radiation growth has seen an expansion of indications for radiotherapy, a refinement of delivery and the biological conse- the modalities that can be used and a reduction in the ocular and adnexal com- quences to the tumour and normal tis- plications that result from this form of therapy. The compendium of indica- sues. By giving radiation doses over a tions for radiotherapy in ophthalmology continues to grow and now includes number of fractions, damage to nor- many conditions such as the treatment of lid and adnexal disease, ocular sur- mal tissues can be reduced due to the repair of sublethal damage between face disorders and both benign and malignant disease of the posterior segment fractions and repopulation of cells and optic pathways. The radiotherapeutic modalities employed to manage during the course of treatment. these conditions are numerous and include
    [Show full text]
  • Pediatric Pharmacology and Pathology
    7/31/2017 In the next 2 hours……. Pediatric Pharmacology and Pathology . Ocular Medications and Children The content of th is COPE Accredited CE activity was prepared independently by Valerie M. Kattouf O.D. without input from members of the optometric community . Brief review of examination techniques/modifications for children The content and format of this course is presented without commercial bias and does not claim superiority of any commercial product or service . Common Presentations of Pediatric Pathology Valerie M. Kattouf O.D., F.A.A.O. Illinois College of Optometry Chief, Pediatric Binocular Vision Service Associate Professor Ocular Medications & Children Ocular Medications & Children . Pediatric systems differ in: . The rules: – drug excretion – birth 2 years old = 1/2 dose kidney is the main site of drug excretion – 2-3 years old = 2/3 dose diminished 2° renal immaturity – > 3 years old = adult dose – biotransformation liver is organ for drug metabolism Impaired 2° enzyme immaturity . If only 50 % is absorbed may be 10x maximum dosage Punctal Occlusion for 3-4 minutes ↓ systemic absorption by 40% Ocular Medications & Children Ocular Medications & Children . Systemic absorption occurs through….. Ocular Meds with strongest potential for pediatric SE : – Mucous membrane of Nasolacrimal Duct 80% of each gtt passing through NLD system is available for rapid systemic absorption by the nasal mucosa – 10 % Phenylephrine – Conjunctiva – Oropharynx – 2 % Epinephrine – Digestive system (if swallowed) Modified by variation in Gastric pH, delayed gastric emptying & intestinal mobility – 1 % Atropine – Skin (2° overflow from conjunctival sac) Greatest in infants – 2 % Cyclopentalate Blood volume of neonate 1/20 adult Therefore absorbed meds are more concentrated at this age – 1 % Prednisone 1 7/31/2017 Ocular Medications & Children Ocular Medications & Children .
    [Show full text]
  • Oculoplastic Aspects of Ocular Oncology
    Eye (2013) 27, 199–207 & 2013 Macmillan Publishers Limited All rights reserved 0950-222X/13 www.nature.com/eye Oculoplastic aspects C Rene CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM of ocular oncology Abstract represents a significant proportion of the oculoplastic surgeon’s workload. In this review, It is estimated that 5–10% of all cutaneous the features of periocular skin cancer are malignancies involve the periocular region presented together with a discussion of the and management of periocular skin cancers treatment modalities. account for a significant proportion of the oculoplastic surgeon’s workload. Epithelial tumours are most frequently encountered, Diagnosing malignant eyelid disease including basal cell carcinoma, squamous cell carcinoma, and sebaceous gland Although malignant eyelid disease is usually carcinoma, in decreasing order of frequency. easy to diagnose on the basis of the history and Non-epithelial tumours, such as cutaneous clinical signs identified on careful examination melanoma and Merkel cell carcinoma, rarely (Table 1), differentiating between benign and involve the ocular adnexae. Although malignant periocular skin lesions can be non-surgical treatments for periocular challenging because malignant lesions malignancies are gaining in popularity, occasionally masquerade as benign pathology. surgery remains the main treatment modality For instance, a cystic basal cell carcinoma (BCC) 4,5 and has as its main aims tumour clearance, can resemble a hidrocystoma or sebaceous restoration of the eyelid function, protection gland carcinoma (SGC) classically mimics a 6,7 of the ocular surface, and achieving a good chalazion. Conversely, a benign lesion such as cosmetic outcome. The purpose of this article a pigmented hidrocystoma may be mistaken for 8 is to review the management of malignant a malignant melanoma.
    [Show full text]
  • FDA Briefing Document Dermatologic and Ophthalmic Drugs Advisory
    FDA Briefing Document Dermatologic and Ophthalmic Drugs Advisory Committee Meeting December 13, 2019 The committee will discuss biologics license application (BLA) 761143, teprotumumab solution for intravenous use, submitted by Horizon Pharma Ireland, Ltd., proposed for the treatment of active Thyroid Eye Disease (TED). FDA Advisory Committee Briefing Material for BLA 761143 (b) (4) (teprotumumab- (b) (4) The attached package contains background information prepared by the Food and Drug Administration (FDA) for the panel members of the advisory committee. The FDA background package often contains assessments and/or conclusions and recommendations written by individual FDA reviewers. Such conclusions and recommendations do not necessarily represent the final position of the individual reviewers, nor do they necessarily represent the final position of the Review Division or Office. We have brought the biologics license application (BLA) 761143, teprotumumab solution for intravenous use, submitted by Horizon Pharma Ireland, Ltd. and proposed for the treatment of active Thyroid Eye Disease (TED) to this Advisory Committee in order to gain the Committee’s insights and opinions, and the background package may not include all issues relevant to the final regulatory recommendation and instead is intended to focus on issues identified by the Agency for discussion by the advisory committee. The FDA will not issue a final determination on the issues at hand until input from the advisory committee process has been considered and all reviews have been finalized. The final determination may be affected by issues not discussed at the advisory committee meeting. 2 FDA Advisory Committee Briefing Material for BLA 761143 (b) (4) (teprotumumab- (b) (4) Table of Contents 1.
    [Show full text]
  • Ocular Manifestations in Systemic Lupus Erythematosus
    Cur gy: ren lo t o R t e a s e Boonsopon et al., Rheumatology (Sunnyvale) m a u r c e h h 2015, 5:1 R Rheumatology: Current Research DOI: 10.4172/2161-1149.1000150 ISSN: 2161-1149 Review Article Open Access Ocular Manifestations in Systemic Lupus Erythematosus Sutasinee Boonsopon1,2, Armin Maghsoudlou1,2 and Charles Stephen Foster1,2,3* 1Massachusetts Eye Research and Surgery Institution (MERSI), Cambridge, MA, USA 2Ocular Immunology and Uveitis Foundation, USA 3Harvard Medical School, Cambridge, MA, USA *Corresponding author: Charles Stephen Foster, Massachusetts Eye Research and Surgery Institution, 355 Main Street, 8th Floor, Cambridge, MA 02142 USA, Tel: 617-621-6377; Fax: 617-494-1430; E-mail: [email protected] Received date: February 20, 2015; Accepted date: March 24, 2015; Published date: March 30, 2015 Copyright: © 2015 Boonsopon S, 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 Systemic lupus erythematosus (SLE) is an autoimmune disease manifest with multiple organ system involvement. Even though the eye is not part of the diagnostic criteria, once it gets affected, it will alter patients’ quality of life. The purpose of this review is to point out the significance of ocular manifestations in SLE and to emphasize the importance of possible blinding complications such as peripheral ulcerative keratitis, scleritis, and SLE retinopathy/ choroidopathy. The condition can be even worse when SLE is accompanied with antiphospholipid syndrome. In addition to the disease itself, several treatment agents that are used in SLE are responsible for vision threatening conditions; thus they have to be given with caution because of potential side effects, including cataract, glaucoma, and chloroquine maculopathy.
    [Show full text]
  • Ocular Manifestations of Graft-Versus-Host Disease
    Saudi Journal of Ophthalmology (2013) 27, 215–222 Original Article Ocular manifestations of graft-versus-host disease ⇑ Amr Nassar, MD a; Khalid F. Tabbara, MD b, ; Mahmoud Aljurf, MD, MPH c Abstract Allogeneic hematopoietic stem cell transplantation (HSCT) has evolved over the past two decades to become the standard of care for hematologic and lymphoid malignancies. Major ocular complications after allogeneic HSCT have been increasing in number and severity. Graft-versus-host disease (GVHD) remains a major cause of ocular morbidity after allogeneic HSCT. The main objec- tive of this review is to elucidate the ocular complications in patients developing GVHD following HSCT. Ocular complications secondary to GVHD are common and include dry eye syndrome, acquisition of ocular allergy from donors with allergic disorders. Eyelid changes may occur in GVHD leading to scleroderma-like changes. Patients may develop poliosis, madarosis, vitiligo, lagophthalmos, and entropion. The cornea may show filamentary keratitis, superficial punctate keratitis, cor- neal ulcers, and peripheral corneal melting which may lead to perforation in severe cases. Scleritis may also occur which can be anterior or posterior. Keratoconjunctivis sicca appears to be the most common presentation of GVHD. The lacrimal glands may be involved with mononuclear cell infiltration of both the major and accessory lacrimal glands and decrease in tear production. Severe dry eye syndrome in patients with GVHD may develop conjunctival scarring, keratinization, and cicatrization of the conjunctiva. Therapy of GVHD includes systemic immunosuppression and local therapy. Surgical treatment in refractory cases includes surgical intervention to improve the manifestation of GVHD of the eye. This may include tarsorrhapy, prose lenses, punctal occlusions and corneal transplantation.
    [Show full text]
  • Meibomian Gland Dysfunction: an Overlooked Eyelid Disease
    Advances in Ophthalmology & Visual System Review Article Open Access Meibomian gland dysfunction: an overlooked eyelid disease Abstract Volume 8 Issue 3 - 2018 Meibomian gland dysfunction is a multifactorial and chronic disease of the eyelids, Burak Turgut,1 Onur Çatak,2 Tamer Demir3 leading to eye irritation, inflammation, evaporative and aqueous-deficient dry eye 1Department of Ophthalmology, Yuksek Ihtisas University, Turkey and negatively affecting the quality of life. MGD is often overlooked clinically. This 2 review presents a general and practical guide for MGD diagnosis and management. Department of Ophthalmology, Firat University, Turkey 3Department of Ophthalmology, Onsekiz Mart University, Keywords: Meibomian gland, dysfunction, dry eye, hypersecretory, hyposecretory, Turkey duct obstruction, lipid layer, tear film, ocular surface diseaset Correspondence: Burak Turgut, Private Etimed Hospital, Ophthalmology Clinic, Elvan Mah. 1934. Sok. No:4 Etimesgut/ANKARA, Turkey, Tel +90 (312) 293 06 06, Email [email protected] Received: May 21, 2018 | Published: May 29, 2018 Introduction evaporative dry eye and also the most common underlying pathology in the cases with the aqueous-deficient dry eye. Additionally, MGD Meibomian glands (MGs) are large sebaceous glands, vertically can negatively affect the quality of life.2–9 arranged in the tarsal plates of the upper and lower eyelids and produce the lipids of the outermost layer of the preocular tear film. Risk factors The tarsal glands are firstly described by Heinrich MEIBOM (1638- The risk factors for MGD identified by the epidemiology and risk 1700), a professor of medicine at the university town of Helmsted, factors identification committee of International Meibomian Gland and afterward, these glands were called as MGs.1 Dysfunction Study group are divided into three group as ophthalmic, Definition systemic and therapeutic (Table 1).
    [Show full text]
  • Role of Demodex Infestation in Blepharitis and Coconut Oil As a Treatment Option
    Indian Journal of Clinical and Experimental Ophthalmology 2020;6(2):270–275 Content available at: iponlinejournal.com Indian Journal of Clinical and Experimental Ophthalmology Journal homepage: www.innovativepublication.com Original Research Article Role of demodex infestation in blepharitis and coconut oil as a treatment option Suresha A R1, Sadhwini M H1,* 1Dept. of Ophthalmology, JJM Medical College, Davangere, Karnataka, India ARTICLEINFO ABSTRACT Article history: Purpose: To assess incidence of demodex species, correlate ocular symptomatology, evaluate efficacy of Received 03-01-2020 coconut oil as treatment method in all types of blepharitis. Accepted 06-02-2020 Materials and Methods: 30 patients with anterior & mixed blepharitis, meibomian gland dysfunction Available online 16-06-2020 & non-specific irritation were enrolled for study. History taken & examined clinically. 2 lashes/lid were sampled & mounted on slides with normal saline & observed under light microscope. Number of mites counted. Patients positive for demodex were treated with coconut oil application over lid margins & Keywords: reviewed after 3 weeks. Anterior blepharitis Results: Incidence of demodex was 40% & it increased with age. Demodex was commonly associated with Demodex infestation meibomian gland dysfunction, non-specific irritation, madarosis, cloudy & toothpaste like meibum quality. Meibomian gland dysfunction Burning sensation and itching were common complaints. At 3rd week, all patients were symptom-free. Non-specific irritation Mite count dropped by 52.8% but were not eliminated. Conclusion: Demodex infestation is often overlooked but it is associated with about half of blepharitis cases. Hence further evaluation should be considered. Coconut oil is an easily available mode of treatment & helps reduce symptoms and mite counts. © 2020 Published by Innovative Publication.
    [Show full text]
  • Twelfth Edition
    SUPPLEMENT TO April 15, 2010 www.revoptom.com Twelfth Edition Joseph W. Sowka, O.D., FAAO, Dipl. Andrew S. Gurwood, O.D., FAAO, Dipl. Alan G. Kabat, O.D., FAAO 001_ro0410_hndbkv7.indd 1 4/5/10 8:47 AM TABLE OF CONTENTS Eyelids & Adnexa Conjunctiva & Sclera Cornea Uvea & Glaucoma Vitreous & Retina Neuro-Ophthalmic Disease Oculosystemic Disease EYELIDS & ADNEXA VITREOUS & RETINA Floppy Eyelid Syndrome ...................................... 6 Macular Hole .................................................... 35 Herpes Zoster Ophthalmicus ................................ 7 Branch Retinal Vein Occlusion .............................37 Canaliculitis ........................................................ 9 Central Retinal Vein Occlusion............................. 40 Dacryocystitis .................................................... 11 Acquired Retinoschisis ........................................ 43 CONJUNCTIVA & SCLERA NEURO-OPHTHALMIC DISEASE Acute Allergic Conjunctivitis ................................ 13 Melanocytoma of the Optic Disc ..........................45 Pterygium .......................................................... 16 Demyelinating Optic Neuropathy (Optic Neuritis, Subconjunctival Hemmorrhage ............................ 18 Retrobulbar Optic Neuritis) ................................. 47 Traumatic Optic Neuropathy ...............................50 CORNEA Pseudotumor Cerebri .......................................... 52 Corneal Abrasion and Recurrent Corneal Erosion ..20 Craniopharyngioma ..........................................
    [Show full text]
  • Ectopic Conjunctivalisation in Stevens-Johnson Syndrome
    British Yournal ofOphthalmology 1994; 78: 727-728 727 CASE REPORTS Br J Ophthalmol: first published as 10.1136/bjo.78.9.727 on 1 September 1994. Downloaded from Ectopic conjunctivalisation in Stevens-Johnson syndrome Samuel E Navon, Peter A D Rubin Stevens-Johnson syndrome (erythema multi- Case report forme major) is a severe exfoliative vesiculo- A 37-year-old black woman was referred for bullous dermatitis accompanied by fever, management of a non-healing lesion of her right inflammation of mucous membranes, and a upper lid after suffering a severe bout of Stevens- severe purulent conjunctivitis.' Late ocular com- Johnson syndrome attributable to oral penicillin. plications are most commonly due to conjunc- During the acute phase of her illness she sus- tival cicatrisation resulting in symblepharon tained 90% total body surface are a full thickness formation, trichiasis, conjunctival keratinisa- epidermal desquamation, including her eyelids, tion, and keratoconjunctivitis sicca. This report and required a 3 month hospitalisation in the describes an unreported phenomenon of ectopic burns unit of the Massachusetts General conjunctivalisation of the eyelids in a case of Hospital. Her dermatological recovery was com- Stevens-Johnson syndrome. plete with residual reticulated epidermal scarring except for a persistent lesion on her right upper and lower eyelids, which was very painful (Fig 1). The eyelid lesion appeared grossly as an ulceration and had been managed for 3 months before referral with topical antibiotics, steroids, lubrication, and vitamin A ointment with abso- lutely no change in the symptoms and appear- ance. Her remaining ophthalmic examination was unremarkable except for right upper and lower lid madarosis and occasional trichiasis.
    [Show full text]