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Corneal Ulcer/Keratitis
Published in Charles Theisler, Adjuvant Medical Care, 2023
A corneal ulcer is an open sore on the cornea of the eye. Although there are many different causes, keratitis is frequently caused by a virus or bacterial infection. The cornea covers the iris and the round pupil. Symptoms can include red, watery, or itchy eye with a burning or stinging sensation, sensitivity to light, and a pus-like discharge. The infection can lead to loss of vision or blindness, and so requires immediate medical care.1
Ophthalmic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Review the patient within 2 days to exclude infection, but ask them to return earlier if pain increases or vision deteriorates. Refer the patient immediately to the ophthalmology team if there is then evidence of an infected corneal ulcer.
Corneal Ulcers and Contact Lens Keratitis
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Adequate history and careful examination of the anterior segment of the eye is crucial, which will help identify if it is infectious or not and the risk factors or aetiology. Infectious corneal ulcers can be caused by bacteria, virus, fungi or acanthamoeba, and in some cases concurrent microbes may exist. Common non- infectious corneal ulcers include marginal keratitis, peripheral ulcerative keratitis (PUK), sterile corneal infiltrates associated with contact lens wear and toxic keratitis (contact lenses/solution or eye drops for example).
Rates of Herpes Simplex Virus Types 1 and 2 in Ocular and Peri-ocular Specimens
Published in Ocular Immunology and Inflammation, 2023
A 34-year-old male with a history of ankylosing spondylitis, keratoconus and hard contact lens wear, presented with a two day history of redness and soreness of the right eye. Examination revealed a central corneal ulcer without an infiltrate. A corneal swab was sent for culture and HSV-2 was isolated. The patient was diagnosed with herpetic keratitis and treated over the following month with topical acyclovir ointment, topical methylprednisolone, topical fucithalmic, and oral doxycycline which successfully healed the epithelium. A month following closure of the epithelium, corneal ulceration recurred and an infiltrate was visible. Confocal microscopy confirmed the appearance of cysts consistent with acanthamoeba keratitis. Treatment with polyhexamethylene biguanide (PHMB) and brolene resulted in closure of the epithelium and a vascularized corneal scar over the subsequent 2 months and medications were continued for a further 6 months. Over the subsequent 12 years, one episode of stromal keratitis recurred at 8 years following the initial episode and resolved with topical fluorometholone treatment combined with oral acyclovir.
Smartphone-based Anterior Segment Imaging: A Comparative Diagnostic Accuracy Study of a Potential Tool for Blindness Prevalence Surveys
Published in Ophthalmic Epidemiology, 2022
Ashish Kumar, Ferhina S. Ali, Valerie M. Stevens, Jason S. Melo, N. Venkatesh Prajna, Prajna Lalitha, Muthiah Srinivasan, Gopal Bhandari, Sadhan Bhandari, Robi N. Maamari, Daniel A. Fletcher, Thomas M. Lietman, Jeremy D. Keenan
Low-cost smartphone attachments have been developed to image the anterior segment, but the diagnostic accuracy of such types of attachments has not been well characterized for specific corneal pathologies.5–9 In the present study, the diagnostic accuracy of a 3D-printed smartphone attachment, the Corneal CellScope, was compared to handheld digital single lens reflex (SLR) photography to assess the potential for smartphone photography in large-scale blindness prevalence surveys. A handheld SLR was chosen as a comparator camera since it was the highest-quality camera that could plausibly be used for field studies. The SLR was thought a priori to be the closest thing to a reference standard for corneal photography, although formal diagnostic accuracy studies are lacking. The device was investigated previously for diagnosis of active corneal ulcers and found to have acceptable sensitivity and specificity.10 However, corneal scars that remain after an ulcer has healed are fainter and thus more challenging to detect with an anterior segment imaging device. We performed the present study to establish the diagnostic performance of smartphone-based corneal photography specifically for corneal scars.
Hypofractionated stereotactic photon radiotherapy of choroidal melanoma: 20-year experience
Published in Acta Oncologica, 2021
Katharina Eibenberger, Roman Dunavoelgyi, Andreas Gleiss, Aleksandra Sedova, Dietmar Georg, Richard Poetter, Karin Dieckmann, Martin Zehetmayer
In this study radiogenic side effects were divided according to the time of appearance. Our patients experienced seldom early radiogenic side effects such as dermatitis, alopecia or eyelash loss after 3, 12 and 36 months and showed reversible manner. Only problems of the corneal epithelium occurred more often in the late phase of follow up after 36 months. 23 out of the 49 patients with corneal epithelium effects concomitantly developed corneal ulcers. In most patients local therapy was sufficient, except in three patients who received enucleation due to therapy-resistant corneal ulcer. Radiogenic keratitis with or without corneal ulcers was observed in up to 11.5% after radiation therapy of the eye [31]. The etiology of corneal damage following irradiation is yet unknown but irreversible long-term damage to corneal endothelium or innervation resembling neurotrophic ulcer is being discussed [42].