PURPOSE: The aim of this study is to describe the technique of subpalpebral antibiotic lavage (SAL), which is a highly therapeutic, efficient, and cost-effective method for managing severe bacterial keratitis. METHODS: This case report describes a 26-year-old woman with severe bacterial keratitis in the right eye due to contact lens overwear, with progressive corneal thinning, a hypopyon, impending perforation, and marked visual loss to perception of light despite treatment with intensive topical antibiotics. This was managed with SAL that involves the insertion of a cannula transcutaneously into the upper conjunctival fornix to provide continuous antibiotic irrigation of the ocular surface. RESULTS: By 11 weeks after presentation, the cornea and anterior chamber appeared clinically quiescent, and visual acuity improved to 20/40 corrected in the right eye. CONCLUSIONS: Bacterial keratitis is a potentially blinding condition for which contact lens wear is an important risk factor. Most cases are successfully managed with topical medications; however, in cases of treatment failure, a second-line approach such as SAL can be sight-saving. SAL uses readily available equipment for the delivery of high concentrations of antibiotics to the ocular surface, thus increasing therapeutic efficacy and reducing nursing staff workload. Despite its advantages, the literature reveals apparent underutilization of this technique.
Anti-Bacterial Agents/administration & dosage , Contact Lenses, Hydrophilic/microbiology , Cornea/microbiology , Eye Infections, Bacterial/drug therapy , Keratitis/drug therapy , Pseudomonas Infections/drug therapy , Visual Acuity , Adult , Contact Lenses, Hydrophilic/adverse effects , Cost-Benefit Analysis , Eye Infections, Bacterial/economics , Eye Infections, Bacterial/microbiology , Female , Humans , Keratitis/economics , Keratitis/microbiology , Ophthalmic Solutions , Pseudomonas Infections/economics , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Therapeutic Irrigation
Charles Bonnet Syndrome , Posterior Leukoencephalopathy Syndrome , Charles Bonnet Syndrome/complications , Charles Bonnet Syndrome/diagnosis , Hallucinations , Humans , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnosis , Vision Disorders/diagnosis , Vision Disorders/etiology
Central Serous Chorioretinopathy , Sleep Apnea, Obstructive , Central Serous Chorioretinopathy/complications , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/epidemiology , Humans , Risk Factors , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis
Conjunctival Diseases/etiology , Corneal Diseases/etiology , Eye Foreign Bodies/etiology , Eye Pain/etiology , Phacoemulsification , Physician-Patient Relations , Surgical Tape/adverse effects , Conjunctival Diseases/diagnosis , Conjunctival Diseases/surgery , Corneal Diseases/diagnosis , Corneal Diseases/surgery , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/surgery , Eye Pain/diagnosis , Female , Humans , Lens Implantation, Intraocular , Middle Aged , Postoperative Complications , Visual Acuity/physiology
Temporal arteritis (TA), or giant cell arteritis, is a systemic autoimmune vasculitis affecting patients over 50 years of age. It can cause rapid, irreversible bilateral vision loss in older adults and is therefore considered an ophthalmological emergency. Many of the symptoms and signs of TA can be vague, non-specific and gradual in onset, often leading to a delayed or inaccurate diagnosis. As such, it is important for a wide variety of primary optometrists and health practitioners to maintain a robust understanding of the clinical presentation, key investigations and time-sensitive management of this disease, as early initiation of treatment for TA can be vision- and life-saving.
Disease Management , Giant Cell Arteritis/diagnosis , Temporal Arteries/pathology , Biopsy , Diagnosis, Differential , Giant Cell Arteritis/therapy , Humans , Positron Emission Tomography Computed Tomography
