Oftalmía nodosa en el trópico / Ophthalmia nodosa in the tropics

Antecedentes: La oftalmía nodosa (ON) fue descrita por primera vez por Schön en 1861, y desde entonces ha recibido múltiples nombres, ampliando la identificación de los agentes causales. En Colombia no se tienen referencias precisas sobre dichos agentes. Objetivo: Realizar revisión de tema sobre una enfermedad subdiagnosticada como la ON. Material y métodos: Análisis retrospectivo y narrativo de la literatura, a propósito de la publicación de cinco casos diagnosticados con ON en la Clínica Barraquer, Bogotá, Colombia, de enero de 1983 a diciembre de 2020. Resultados: Los pacientes valorados en nuestra institución presentaron resolución completa de los síntomas una vez que se realizó tratamiento descrito de manera oportuna. Conclusiones: La ON es una enfermedad conocida que requiere alta sospecha clínica para ser diagnosticada. Los corticoesteroides tópicos son la primera línea de tratamiento y se recomienda la retirada del cuerpo extraño siempre que sea posible.

Background: Ophthalmia nodosa (ON) was first described by Schön in 1861, and since then it has received multiple names, broadening the identification of the causal agents. In Colombia there are no precise references to these agents. Objective: To perform a review of an underdiagnosed entity such us ON. Material and methods: To report of five patients diagnosed with ON in Clinica Barraquer, Bogotá, Colombia from January 1983 to December 2020. Retrospective and narrative literature analysis. Results: Patients presented complete resolution once the described treatment was carried out on time. Conclusions: ON is a well-known disease that requires a high clinical suspicion to be diagnosed. Topical corticosteroids are the first line of treatment and removal of the foreign body is recommended.

Severe sequelae in bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin: a case report.

BACKGROUND: Moxifloxacin is a fourth-generation fluoroquinolone used as a second-line treatment for multiple bacterial infections. Uveitis has been described as an adverse effect related to this medication. Although several case reports have been published describing uveitis and bilateral acute iris transillumination syndrome related to moxifloxacin, we present a unique case of a patient with severe sequelae associated with bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin. CASE PRESENTATION: A 45-year-old Colombian hispanic female presented bilateral conjunctival hyperemia, decreased visual acuity, blurred vision, photophobia, and ocular pain after 15 days of treatment with systemic moxifloxacin for an upper tract respiratory infection. The patient presented unilateral anterior chamber pigment dispersion, mydriatic and nonreactive pupils, extensive iris transillumination defects, and secondary glaucoma. Blood and aqueous humor tests were negative for infectious and autoimmune diseases. Moxifloxacin-induced bilateral acute iris transillumination syndrome was diagnosed. Permanent sequelae such as ocular pain, photophobia, and focus difficulty secondary to severe bilateral iridian atrophy and inability of synkinetic reflex were left. Additionally, glaucoma was diagnosed, and Ahmed valve implantation was required. CONCLUSIONS: We should be aware of the possible association between moxifloxacin and bilateral acute iris transillumination syndrome. A detailed anamnesis, adequate examination, and laboratory tests are necessary to reach an early diagnosis and treatment to avoid unnecessary therapies. Larger studies should be carried out to understand the pathophysiology, diagnosis, management, and sequelae of the disease.

A white circular-spot pattern of iridian atrophy associated with Varicella-zoster virus and Toxoplasma gondii coinfection: a case report.

BACKGROUND: We report a case of white circular spots of iridian atrophy, which we will call "polka dots" pattern, as a rare ophthalmological finding associated with uveitis secondary to varicella-zoster virus and Toxoplasma gondii coinfection in a male patient in Bogotá, Colombia. CASE PRESENTATION: We present de case of a 53-year-old Colombian male patient with a diagnosis of anterior uveitis in his left eye due to varicella-zoster virus and Toxoplasma gondii coinfection documented by polymerase chain reaction analysis. He presented with multiple areas of superficial white circular spots of iridian atrophy in 360º, some with deeper atrophy where the stroma fibers were visualized and only a small punctate defect of transillumination was evident. This rare pattern of iridian atrophy has not been previously described in cases of uveitis in the literature. CONCLUSIONS: This is the first case reporting the findings of superficial "polka dots" pattern iridian atrophy in 360° secondary to anterior uveitis due to the coinfection of a virus and a parasite. The identification of similar clinical cases may lead to early initiation of systemic treatment in these patients.

Prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in thyroid eye disease: a systematic review of the literature.

BACKGROUND: Thyroid eye disease is an autoimmune disorder of the orbital retrobulbar tissue commonly associated with dysthyroid status. The most frequent condition is hyperthyroidism, although it is also present in hypothyroid and euthyroid patients. The prevalence of thyroid conditions in patients with thyroid eye disease had been previously evaluated; however, there is no consensus on a global prevalence. The study aims to estimate the prevalence of hyperthyroidism, hypothyroidism, and euthyroidism in patients with TED, through a systematic review of literature. METHODS: We conducted a systematic review of the literature following the PRISMA guidelines, in MEDLINE, COCHRANE, EMBASE, Science Direct, and LILACS databases. Inclusion criteria were primary studies of patients with a diagnosis of thyroid eye disease made by an ophthalmologist or with diagnosis criteria, with measurement of thyroid function (TSH, T3, and free T4), and diagnosis of the primary thyroid condition. A quality assessment was made through the Joanna Briggs Institute Quality tools. Finally, we extracted relevant details about the design, the results, and the prevalence of thyroid disorders in thyroid eye disease. RESULTS: The initial search revealed 916 studies, of which finally thirteen met inclusion criteria. Six studies were performed in Europe (Germany, Wales, and Spain), five in Asia (Iran, South Korea, Japan, and Singapore), one in North America (USA), and one in Africa (Ghana). The global prevalence, in patients of thyroid eye disease, was 10.36% for hypothyroidism, 7.9% for euthyroidism, and 86.2% for hyperthyroidism. CONCLUSIONS: Professionals should be aware that thyroid eye disease can be present in patients with a normal thyroid function. The assessment for these patients is based on orbital images; serum TSH, T3, and free T4; antibody levels as thyrotropin receptor antibodies; and thyroperoxidase levels. Additionally, we want to encourage research in this field in other regions of the world such as Latin America. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42020107167.