Conjunctival necrosis following the administration of subconjunctival corticosteroid.

This report describes an unusual reaction to injected subconjunctival corticosteroid. The authors examined a patient with large areas of conjunctival necrosis at the site of a previous subconjunctival corticosteroid injection. A Gram's strain and culture of the affected conjunctival area and the bottled corticosteroid suspension were negative. Necrosis of the conjunctiva is a heretofore unreported adverse reaction to a subconjunctival corticosteroid injection. These lesions probably represent a localized toxic reaction rather than a sequela of infection.

The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic.

OBJECTIVE: The purpose of the study is to compare the utility of culturing corneal ulcers in a tertiary referral clinic and a general ophthalmology clinic. DESIGN: A retrospective review of medical and microbiologic records was performed. PARTICIPANTS: One hundred fifty-seven patients with corneal ulcers were included in the study. Eighty-two ulcers were treated in the referral clinic and 75 ulcers were treated in the general ophthalmology clinic. MAIN OUTCOME MEASURES: The authors determined the percentage of corneal ulcers in each clinical setting that failed to respond to empiric therapy and required a culture-directed change in treatment. RESULTS: One hundred fifty-seven ulcers were included. Eight (10%) of the 82 patients treated in the Cornea Clinic had treatment altered based on culture and sensitivity results. All 75 patients in the general clinic responded to empiric antibiotics, such that culture data never were required for modification of therapy (0%, P = 0.007). In contrast to patients treated in the Cornea Clinic, patients treated in the general clinic had smaller, more peripheral ulcers, shorter duration of symptoms, and fewer risk factors for corneal ulceration other than contact lens wear. CONCLUSIONS: Cornea specialists, who are referred the most severe cases, should consider culturing most corneal ulcers. However, it appears reasonable for general ophthalmologists to use culturing more judiciously. Patients with significant corneal ulcers should be cultured regardless of the clinic to which they present. However, small, peripheral ulcers respond extremely well to current, broad-spectrum antibiotics. Close follow-up is mandatory to discover the rare patient who will not respond to empiric therapy.

Mucoepidermoid carcinoma of the caruncle.

PURPOSE: To report a case of mucoepidermoid carcinoma, a highly aggressive variant of conjunctival squamous cell carcinoma. METHODS: We examined and treated a 57-year-old man with mucoepidermoid carcinoma of the caruncle, a highly unusual site for this tumor. RESULTS: In the past, simple excision of this tumor has been followed by rapid recurrence. Our patient underwent wide surgical excision of the tumor and has shown no evidence of recurrence after 16 months of follow-up. CONCLUSION: Mucoepidermoid carcinoma may first manifest in the caruncle. Histologically verified, tumor-free surgical margins are necessary for complete excision.