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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Bitot’s spots, which may be caused by vitamin A deficiency, appear as a white or gray spongy spot on the white of the eye (see Figure 7.2).2,4,5 Possible non-nutrient causes include pinguecula (a benign growth that develops on the eye, commonly found in the elderly), Gaucher disease (rare, inherited metabolic disorder) and pterygium (“Surfer’s eye”) which is a raised fleshy growth filled with blood vessels that originates in the conjunctiva and spreads over the cornea.4
Infiltrative Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aniruddha Agarwal, Sabia Handa, Vishali Gupta
The most common manifestation in the leukemic infiltration of optic nerve head is blurring of vision. The loss of vision may be acute, though rarely patients may remain asymptomatic despite optic nerve infiltration.51 Profound vision loss including no light perception is common. Other symptoms and signs include ocular pain, conjunctival congestion and photophobia. Signs of increased ICP such as sixth cranial nerve palsy may indicate a diffuse meningeal involvement. Ophthalmoscopic examination may reveal optic disc edema with or without hemorrhages. Occasionally, the optic disc may appear normal.52 Presence of leukemic infiltrates results in the disc to appear creamy white with infiltrates, elevated, with peripapillary dot and blot or flame-shaped hemorrhages, along with serous macular detachment (Figure 10.3). Occlusion of the central retinal artery and vein is common association. Retinal hemorrhages may also be associated with anemia or pancytopenia (Figure 10.4).52–56
Comparative Anatomy and Physiology of the Mammalian Eye
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
The conjunctiva is a modified integumental mucous membrane that aids in the anterior suspension of the eye. It is vascular, possesses lymphatics, glands, and nerves. The conjunctiva can be divided into two layers, the epithelium and the substantia propria. The epithelium originates from surface ectoderm and is composed of nonkeratinizing, cuboidal, epithelial cells. Between these cells are also found focal areas of goblet cell differentiation. The goblet cells are mucous secretors, supplying the layer of the precorneal tear film adjacent to the cornea, which covers the glycocalyces of the corneal epithelial cells. They are most plentiful in the inferior, nasal fornix.173 Goblet cells appear to be absent from the bulbar conjunctiva.173 The substantia propria is found immediately beneath the basement membrane of the epithelium and can be subdivided into the superficial adenoid layer and the deeper fibrous layer. The adenoid layer contains lymphocytes, a few mast cells, and plasma cells, lymphatics, and blood vessels. The deep layer is a thick meshwork of collagenous and elastic fibers in the bulbar conjunctiva and fornices. The majority of vessels and nerves supplying the conjunctiva are found in this layer.
Bilateral Anterior Uveitis Following Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 – Case Report and Focused Review
Published in Ocular Immunology and Inflammation, 2023
Aliénor Vienne-Jumeau, Antoine P. Brézin, Amina Debieb
Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), also referred as Multi Inflammatory Syndrome in Children (MIS-C) in the USA, is a systemic hyperinflammatory state newly described in children recently infected with SARS-CoV-21 Clinical criteria include fever, disease severity and dysfunction of two or more organ systems.2–4 It shares common characteristics with Kawasaki disease.1,2,5 From the ophthalmologist perspective, non-purulent conjunctival injection is the most common symptom, which is found in both diseases.2,6–9 Anterior uveitis is another typical symptom of Kawasaki disease, which has raised interest as a potential help for early diagnosis.10,11 Here, we present a case of an anterior uveitis in a pre-adolescent boy diagnosed with PIMS-TS, whom we followed for six-month. We also review studies reporting uveitis in children with PIMS-TS to outline common history and evolution.
COVID-19-related Conjunctivitis Review: Clinical Features and Management
Published in Ocular Immunology and Inflammation, 2023
William Binotti, Pedram Hamrah
Therefore, the real incidence of ocular findings in SARS-CoV-2 infection remains unclear since most of the published studies were on hospitalized patients. Nonetheless, our pooled meta-analysis data showed a weighted mean incidence of 11.4% (95% CI = 6.4–17.2%) for all ocular manifestations in COVID-19.7,9,11 The main symptoms and signs related to the infection were ocular pain 31.2% (95% CI = 23.7–38.7%), conjunctival redness or congestion 10.8% (95% CI = 3.0–18.7%), follicular conjunctivitis 7.0% (95% CI = 2.1–11.8%), and itching 6.55% (95% CI = 0.2–12.8%).7 The average duration of conjunctival congestion was 5.9 ± 4.5 days.10 Interestingly, in a study assessing clinical symptoms in health-care workers with mild COVID-19 symptoms, ocular pain showed an incidence of 34.4% among confirmed cases and a significant association with COVID-19 (odds ratio = 4.5, 95% CI = 2.7–7.4; p < .001).33
RhoA/ROCK Signaling Regulates TGF-β1-Induced Fibrotic Effects in Human Pterygium Fibroblasts through MRTF-A
Published in Current Eye Research, 2022
Jiajun Xie, Qingyao Ning, Huina Zhang, Shuang Ni, Juan Ye
Pterygium is a triangular-shaped and invasive overgrowth of fibrovascular conjunctiva over the cornea, which can cause visual impairment, astigmatism, ocular irritation, and cosmetic issues.1,2 Although pterygium is a benign disease, it shows characterizations such as uncontrolled proliferation, migration, inflammatory infiltrates, angiogenesis, fibrosis, and extracellular matrix (ECM) remodeling.3 Surgical excision with tissue grafting, such as conjunctival autograft, or amniotic membrane transplants is the mainstream method for pterygium treatment.4 However, recurrence is a major challenge for both surgeons and patients, as it worsens the prognosis. To reduce postsurgical recurrences, adjuvant therapies such as mitomycin C (MMC), 5-fluorouracil (5-FU), glucocorticoids, and radiotherapy have been attempted,5,6 but numerous adverse effects including stromalysis, corneal melting, and secondary ocular hypertension have limited their use.7–9 Therefore, it is necessary to investigate the mechanisms of pterygium and to develop more targeted therapies to prevent recurrence.