Trauma to the Eyelids and Periorbital Region
Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen in Practical Emergency Ophthalmology Handbook, 2019
The history will allow you to determine the potential site of injury and more importantly the likelihood of foreign body or ocular penetration. These patients often present with sharp pain, increased lacrimation, and a foreign body sensation with severe irritation. Although for the vast majority of these cases the clinician will be able to locate the culprit, it is nonetheless vital to rule out an intraocular foreign body (IOFB), especially with a history of explosion or when hammering and chiselling. Simple foreign bodies located within the ocular surface should be suspected when punctate epithelial erosions or linear vertical corneal abrasions are seen on the cornea. Quite often a subtarsal perpetrator is found embedded on lid eversion. When a conjunctival laceration is identified it is important to be suspicious of an injury affecting the deeper structures. Quite often this can mask an open globe injury and sometimes even an IOFB. The conjunctiva may appear to be folded within itself with surrounding chemosis and subconjunctival haemorrhage. When confronted with these cases, the wound should be imaged and explored appropriately to ensure an accurate diagnosis to guide subsequent management. Signs that suggest an IOFB include an irregular shaped (peaked) pupil (see Figure 4.1), reduced IOP, vitreous haemorrhage, and intraocular inflammation. All structures of the eye should be examined systematically, with emphasis on the position and integrity of the lens and drainage angle.
Ophthalmologic Side Effects
Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish in Retinoids in Dermatology, 2019
Punctate epithelial erosions or superficial punctate keratitis (Figure 12.2) is a finding associated with dry eye disease, reflecting the damaged ocular surface with dryness on the corneal epithelium. Although the association of keratitis with isotretinoin use was previously listed as certain (4), these older reports probably represented dryeye disease–associated punctate epithelial erosions, not the full-blown clinical picture of keratitis (24). There is no detailed study describing the association of these corneal findings with other retinoids; however, the package inserts of other retinoid compounds (acitretin, bexarotene, and alitretinoin) also describe corneal involvement and visual disturbances among rare side events (21,22,25).
Palytoxin
Dongyou Liu in Handbook of Foodborne Diseases, 2018
A 45-year-old Caucasian female coral farmer presented to the emergency eye department with ocular pain, redness, and eyelid swelling [49]. She denied any ophthalmic history. One day earlier, a coral she was holding (Palythoa sp.) expressed a toxin directly into her left eye from the distance of around 20 cm causing immediate pain. She performed immediate eye irrigation. On examination, visual acuity was 6/5 in the affected eye. Slit lamp examination showed eyelid swelling, conjunctival chemosis and injection, diffuse punctate epithelial erosions, and a circumferential marginal ulcer. There was no limbal ischaemia or anterior chamber inflammation. The pH level of her tears was neutral (pH = 7), and no foreign bodies were detected.
Evaluation of the Efficacy and Safety of A Novel 0.05% Cyclosporin A Topical Nanoemulsion in Primary Sjögren’s Syndrome Dry Eye
Published in Ocular Immunology and Inflammation, 2020
Min-Ji Kang, Youn-Hee Kim, Miyoung Chou, Jehyung Hwang, Eun-Jeong Cheon, Hyun-Jung Lee, So-Hyang Chung
Ocular staining scores including corneal and conjunctival staining scores were determined in accordance with the SICCA registry ocular examination protocol.26 Corneal punctate epithelial erosions (PEEs) were enumerated and scored after staining with fluorescein. Corneal scores were assigned as follows: PEEs absent received zero points; between one and five PEEs received one point; between six and 30 PEEs received two points; and more than 30 PEEs received three points. An additional point was awarded in cases in which more than one patch of confluent staining was observed in the pupillary area of the cornea or if filaments located on the cornea were stained. The maximum possible score for each cornea was six points. For assessment of conjunctival staining scores, fluorescein was washed out with nonpreserved saline solution, after which 1% lissamine green dye (Leiter’s Pharmacy, San Jose, CA, USA) was administered at the inferior conjunctival fornix (one drop in each eye). Following several blinks, conjunctival staining scores in the temporal and nasal bulbar conjunctivae were determined separately, as follows: between zero and nine dots received 0 points; between 10 and 32 dots received one point; between 33 and 100 dots received two points; and more than 100 dots received three points. Therefore, the maximum possible score for the conjunctiva (temporal and nasal regions) was six points.
Pembrolizumab-induced Stevens–Johnson Syndrome with Severe Ocular Complications
Published in Ocular Immunology and Inflammation, 2022
Soyoung Ryu, Ikhyun Jun, Tae-Im Kim, Kyoung Yul Seo, Eung Kweon Kim
The patient was admitted to the oncology division of our hospital, and the dermatologist and ophthalmologist continued to monitor the progress. Along with 12 mg oral methylprednisolone and 125 mg intravenous methylprednisolone per day, the patient was treated aggressively with topical steroids (dexamethasone ointment 4 times/day), lubrication (0.1% hyaluronic acid every hour), and prophylactic topical antibiotics (0.5% moxifloxacin 4 times/day). The pseudo-membrane was removed in the first two visits (second visit was scheduled one day after the first visit). Therapeutic contact lenses were prescribed and all four lacrimal puncta were plugged in both eyes. After 2 weeks of treatment, corneal epithelial defects and pseudo-membranes disappeared, minimal punctate epithelial erosions remained in the inferior part of both cornea, and skin lesions had improved. No definite sign of acute stage ocular SJS pathology was noted, and intravenous methylprednisolone was stopped. Oral steroid dose was gradually tapered from 2 weeks after the first administration, and completely tapered off after 3 months. In addition, topical steroid was altered from dexamethasone ointment 4 times/day to prednisolone 4 times/day after a week of treatment and subsequently tapered off.
Transient vision loss: a neuro-ophthalmic approach to localizing the diagnosis
Published in Expert Review of Ophthalmology, 2018
Helen Chung, Jodie M. Burton, Fiona E. Costello
Many medications can contribute to dry eye symptoms in patients, including antihistamines, decongestants, antidepressants, birth control pills, hormone replacement therapy, and anti-anxiety agents [7]. Similarly, systemic disorders including Sjogren syndrome, systemic lupus erythematosus, diabetes, Parkinson’s, thyroid disease, and vitamin A deficiency can cause patients to experience dry eyes [8]. Affected individuals may report intermittent visual blurring and pain in this context. In these cases, we recommend looking for signs of ocular surface irregularity, such as punctate epithelial erosions after instillation of fluorescein. In cases of suspected aqueous tear deficiency, Schirmer’s testing can be performed to measure tear production. Evaluation of tear film instability can identify evaporative dry eye disease, where an abnormal tear break-up time is under 10 s [9]. Another corneal disease typified by TVL upon awakening is Fuchs’ endothelial dystrophy: endothelial cells responsible for active transport of water out of the cornea are dysfunctional or low in number, resulting in overhydration and corneal edema overnight when evaporation from the surface is prevented. Once awake and eyes are open, it may take several hours for the corneas to detumesce and vision to recover. Signs of this condition on slit lamp exam include corneal guttae (Table 1) [10].
Related Knowledge Centers
- Blepharitis
- Cornea
- Epithelium
- Photophobia
- Trichiasis
- Slit Lamp
- Signs & Symptoms
- Dry Eye Syndrome
- Exposure Keratopathy
- Entropion