ABSTRACT
BACKGROUND: Ocular herpes simplex is usually diagnosed by its typical clinical presentation. It is generally accepted to be a unilateral disease, with lid eruptions typically occurring in primary ocular herpes simplex, while absent or mild in recurrent disease. Recurrent ocular herpes simplex is generally thought to be characterized by corneal involvement. CASE REPORT: A 35-year-old woman had a 2-day history of a progressive bilateral, erythematous, vesicular rash of the upper and lower eyelids and associated preseptal cellulitis. She had a history of a recurrent, unilateral eyelid rash that was previously diagnosed as herpes zoster. The eyelid involvement was unusual because it was bilateral, severe, recurrent, vesicular, and isolated, with no additional ocular manifestations of herpes simplex. These atypical features are in contrast to the generally accepted manifestations of recurrent ocular herpes simplex. A cytologic evaluation and a viral culture confirmed infection by HSV Type 1. CONCLUSION: Lid involvement occurs in recurrent ocular herpes simplex disease more often than generally accepted, while simultaneous bilateral disease is uncommon. As in this case, when atypical presentations occur, critical review of the differential diagnosis and use of laboratory tests are helpful.
Subject(s)
Eye Infections, Viral/etiology , Eyelid Diseases/virology , Eyelids/virology , Herpes Simplex/etiology , Acyclovir/administration & dosage , Acyclovir/therapeutic use , Administration, Oral , Adult , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , Eye Infections, Viral/diagnosis , Eye Infections, Viral/drug therapy , Eyelid Diseases/diagnosis , Eyelid Diseases/drug therapy , Female , Follow-Up Studies , Herpes Simplex/diagnosis , Herpes Simplex/drug therapy , Herpesvirus 1, Human/isolation & purification , Humans , RecurrenceABSTRACT
BACKGROUND: A study was performed to compare the clinical effectiveness of a nondilated fundus examination to a dilated fundus examination. METHODS: The population consisted of 90 pediatric patients aged 5 to 16 years. Subjects were randomly selected from patients presenting for a routine eye examination at the Eye Institute of the Pennsylvania College of Optometry. Direct ophthalmoscopy was performed on the subjects before pupillary dilation while direct and binocular indirect ophthalmoscopy were performed post-dilation. RESULTS: Twenty-three patients (25.5 percent) had one or more posterior pole anomalies not detected by the nondilated pupil examination. A total of 30 posterior pole anomalies were not detected by the nondilated pupil examination. Forty-six patients (51 percent) had one or more peripheral anomalies not detected by the nondilated pupil examination. Sixty-nine total peripheral anomalies were not detected by the nondilated pupil examination. CONCLUSIONS: A dilated fundus examination provides a more effective clinical method for evaluating intraocular health in a pediatric population.
Subject(s)
Choroid Diseases/diagnosis , Mydriatics/administration & dosage , Optic Nerve Diseases/diagnosis , Pupil/drug effects , Retinal Diseases/diagnosis , Adolescent , Child , Child, Preschool , Cyclopentolate/administration & dosage , Fundus Oculi , Humans , Ophthalmic Solutions , Ophthalmoscopy/methods , Phenylephrine/administration & dosage , Tropicamide/administration & dosageABSTRACT
BACKGROUND: Familial adenomatous polyposis (FAP) is characterized by the development of multiple adenomatous polyps of the large intestine and gastrointestinal tract. FAP leads to colon malignancy in 100 percent of untreated cases. Congenital hypertrophy of the retinal pigment epithelium (CHREPE) has been identified as a potential early clinical marker for FAP. METHODS: Two generations received ocular examinations. One subject demonstrated CHRPE and was already known to have inherited FAP. His son showed typical CHRPE lesions associated with FAP and has most likely inherited the FAP gene. RESULTS: This case report of a family with autosomal dominant familial adenomatous polyposis (FAP) demonstrates the role of CHRPE as a useful early detector of the inheritance of the FAP gene. CONCLUSIONS: Early intervention (ocular and colorectal examinations) and treatment (colectomy) is advocated to prevent malignancy.