Ophthalmology
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan in Essential Notes for Medical and Surgical Finals, 2021
Beware that eyesight may be threatened and action may be required immediately. Causes include conjunctivitis, keratitis, episcleritis, scleritis, anterior uveitis and acute glaucoma. It is important to distinguish between painless versus painful (identified in brackets) causes. Inflammation of the uveal tract, i.e. the iris, ciliary body and choroid. A hypopyon may be present and there may be keratic precipitates (clumps of inflammatory cells) and synechiae (adhesions of the iris to the lens). Damage to the optic nerve secondary to raised intraocular pressure. Classified as primary or secondary (associated with ocular disease); acute or chronic; and closed-angle (iris in contact with the trabecular meshwork) or open-angle (iris not in contact with the trabecular meshwork): Chronic and acute closed angle. Hereditary condition with clinical features of night blindness, tunnel vision and classical fundus appearance.
Intravitreal triamcinolone acetonide in macular edema
A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha in Vitreoretinal Surgical Techniques, 2019
Macular edema is one of the most important causes of impaired vision; it can occur in many diseases, including diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, exudative age-related macular degeneration (ARMD), perifoveal telangiectasias, pseudophakia, uveitis, ischemic ophthalmopathy, and chronic prephthisical ocular hypotony. Intravitreal triamcinolone acetonide has increasingly been used as a treatment option for exudative ARMD because of the neovascular and edematous nature of the disease and the possible antiangiogenic, antiproliferative, and antiedematous effects of the drug. Intravitreal triamcinolone acetonide has several side-effects, one of the two most common of which is steroid-induced elevation of intraocular pressure. Eyes with intravitreal triamcinolone acetonide and infectious endophthalmitis show a marked destruction of the whole globe. Triamcinolone acetonide crystals that are washed from the vitreous cavity into the anterior chamber usually settle down in the inferior anterior chamber angle, mimicking a hypopyon.
Anterior uveitis
Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio in Practical Uveitis, 2017
Anterior uveitis makes up the vast majority of uveitis cases seen in eye casualty. The most common mistake made in treating anterior uveitis is when the patient does not have anterior uveitis, but anterior signs from a posterior uveitis. Attacks of anterior uveitis are typically limited and recurrent as opposed to persistent and chronic. A hypopyon is an inferior collection of inflammatory material at the bottom of the anterior chamber which is a sign of severity. Cells are actual observed leucocytes in the anterior chamber, a testament to the magnification ability of the slit lamp. When measuring the severity of anterior uveitis the main two measures used are therefore cells and flare. Patients with recurrent anterior uveitis are more likely to develop cataract and when they undergo cataract surgery they are more likely to develop a flare-up of anterior uveitis as a result of the surgery.
Evaluation of Intracameral Amphotericin B in the Management of Fungal Keratitis: Randomized Controlled Trial
Published in Ocular Immunology and Inflammation, 2016
Namrata Sharma, Preeti Sankaran, Tushar Agarwal, Tarun Arora, Bhavna Chawla, Jeewan S Titiyal, Radhika Tandon, Gita Satapathy, Rasik B Vajpayee
Purpose: To evaluate the efficacy and safety of intracameral amphotericin B (ICAMB) in the management of fungal keratitis. Methods: In total, 45 eyes with smear-confirmed fungal keratitis with hypopyon were randomized into three treatment groups: Group I (topical antifungal treatment + oral antifungal); Group II (topical antifungal treatment + ICAMB + oral antifungal); and Group III (topical antifungal treatment + drainage of hypopyon + ICAMB + oral antifungal). The main outcome measures were treatment success rate, time to heal, visual acuity gain, and presence of complications. Results: There were no differences in the treatment success rates (p = 0.66), time to healing (p = 0.18), or mean final visual acuity (logMAR) (p = 0.8) between the three groups. The major complication observed was increased incidence of cataract in group III (40%), though it was statistically insignificant. Conclusions: ICAMB does not offer any benefit over topical antifungal therapy when performed alone or associated with drainage of hypopyon.
Bilateral Hypopyon as the Presenting Feature of Chronic Myeloid Leukemia
Published in Ocular Immunology and Inflammation, 2008
Sridharan Sudharshan, Anjana Kumari, Jyotirmay Biswas
Purpose: To report bilateral hypopyon as an unusual presenting feature of chronic myeloid leukemia (CML). Design: Observational case report. Methods: A 68-year-old male presenting with bilateral hypopyon uveitis underwent hematological investigations and cytology of hypopyon. Results: Blood smear revealed increased leucocyte count with presence of abnormal cells (myelocytes, band forms, and promyelocytes) suggestive of CML. Cytopathology of hypopyon revealed predominance of lymphocytes and few plasma cells. CML was confirmed by hematological investigations. Patient was initiated on chemotherapy under the care of an oncologist and is stable. Conclusions: Elderly patients presenting with hypopyon uveitis should be investigated to rule out masquerade syndrome.
Subretinal Hypopyon in Sympathetic Ophthalmia
Published in Ocular Immunology and Inflammation, 2009
Rongping Dai, Meifen Zhang, Fangtian Dong, Zhiqiao Zhang, Weijing Chao
Purpose: To describe a rare case of sympathetic ophthalmia with subretinal hypopyon. Methods: Observational case report. Results: A 41-year-old man was diagnosed with sympathetic ophthalmia in his left eye. Oral prednisone was started. Three days later, he developed an inferior exudative retinal detachment with an underlying hypopyon. The exudative retinal detachment and hypopyon resolved completely within 48 hours. Conclusions: A subretinal hypopyon in sympathetic ophthalmia is a rare clinical finding. It is probably the result of acute inflammation in the subretinal space.
Related Knowledge Centers
- Anterior Chamber
- Conjunctiva
- Eye
- Uveitis
- Uvea
- Episclera
- Iris