Adult Eye Conditions: Common Eye Conditions.

In primary care practices and emergency departments, approximately 2% to 3% of visits are related to eye conditions. The most common diagnoses are corneal abrasion, corneal foreign body, conjunctivitis, external hordeolum (stye), and subconjunctival hemorrhage. This section addresses hordeolum, chalazion, conjunctivitis, corneal abrasion, and corneal foreign body. A thorough history and physical examination are crucial for patients with these conditions, and frequently are sufficient for diagnosis. Conservative therapies are first-line treatments for hordeolum and chalazion, including application of warm compresses, eyelid scrubs, and eyelid massage. Conjunctivitis is the most common etiology of red eye and has infectious and noninfectious causes. Bacterial conjunctivitis typically resolves in 1 to 2 weeks, but can be managed with topical antibiotic solutions or ointments. Viral conjunctivitis management involves frequent handwashing and use of cool compresses and artificial tears. Corneal abrasion is the most common eye injury seen in emergency departments, and corneal foreign body is the second most common. Topical antibiotics and cycloplegics are mainstay therapies for corneal abrasion, with consideration of topical nonsteroidal anti-inflammatory drugs for pain management. Follow-up visits are recommended for select patients. Management of corneal foreign body requires prompt removal of the object, pain management, consideration of prophylactic antibiotics, and follow-up when appropriate.

Eye irrigation as a first-line treatment and diagnostic method for emergency department patients who complain of ocular foreign bodies.

This prospective study aimed at determine whether eye irrigation removes ocular foreign bodies (FBs) and whether ocular pain predicts FBs. Emergency department patients complaining of ocular FBs were enrolled. In the irrigation group (n = 52), pain was evaluated with a visual analog scale before and after irrigation, and the presence of FBs was determined under a slit-lamp. In the nonirrigation group (n = 27), the evaluations were performed upon arrival. The corneal FB retention rate was found significantly lower in the irrigation (13/52, 25%) than in the nonirrigation groups (13/27, 48%; P = 0.04). After irrigation, those without FBs had more patients experiencing pain reduction (67%) compared to those with retained FBs (46%; P = 0.14) and had a greater magnitude of change in pain score (mean ± SD, - 2.6 ± 2.7 vs. - 0.7 ± 1.4; P = 0.02). An improvement in ocular pain score ≥ 5 points after irrigation predicted the absence of FBs with a negative predictive value of 100%. Eye irrigation significantly lowered corneal FB retention; if ocular pain decreased considerably, the probability of retained FBs was low, making irrigation-associated pain score reduction a feasible diagnostic method to exclude FB retention without needing specialized ophthalmic examinations.

Skull base osteomyelitis with secondary cavernous sinus thrombosis: a rare presentation of an animate foreign body in the ear.

A 42-year-old woman presented with fever, left ear pain, restricted mouth opening, difficulty in swallowing and inability to open her left eyelid for a period of 10 days. She was treated with antibiotics for the same at a local medical facility; however, a sudden decrease in her left eye vision prompted her to visit our tertiary centre. Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. On examination, she had ptosis of the left eye with chemosis, dilated pupil with only perception of light and restricted ocular mobility. Oral examination revealed trismus and bulge in the left peritonsillar region. Left ear examination revealed a large central perforation with mucopurulent discharge. CT of the neck with contrast demonstrated a collection in the left peritonsillar space with left internal carotid artery thrombosis. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. An emergency incision and drainage of the left peritonsillar abscess was performed. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness.

[Ocular foreign bodies: Epidemiological, clinical and therapeutic aspects in Lubumbashi: About 98 cases]. / Corps étrangers oculaires : aspects épidémiologiques, clinique et thérapeutique à Lubumbashi : à propos de 98 cas.

PURPOSE: The purpose of this study was to determine the epidemiological, clinical and therapeutic features of ocular foreign bodies in our practice setting. METHODS: We conducted a cross-sectional descriptive study with retrospective data collection at the Sainte Ivonne ophthalmology center in Lubumbashi. We studied 98 medical records of patients seen from January through December 2016 for an ocular foreign body. The parameters used for this study were: age, gender, profession, circumstances of the injury, nature of the foreign body, complications, location, entry site, management and prognosis. RESULTS: The frequency of ocular foreign bodies was 2.4%. We saw predominantly young subjects; the mean age was 33.18±17.98 years. Males predominated, with a frequency of 78.57% of the cases, for a gender ratio of 3.7 men to women. The circumstances of the injuries were primarily work-related (36.46% of cases). The type of foreign body was most commonly wood (41.8% of cases). The FB was corneal in 81.7% of cases, conjunctival (bulbar and tarsal) in 13.3% of cases, and limbal in 5% of cases. Treatment consisted of either simple removal (86.61% of cases) or removal with suturing for deeper foreign bodies (13.27% of cases). The functional results obtained were encouraging; 90.82% of patients recovered well with preservation of visual acuity. The majority of the complications consisted of superficial punctate keratopathy in 27.53% of cases and corneal ulcer in 26.53% of cases. The results of our study are consistent with those in the literature in terms of the frequent corneal location of FB's. CONCLUSION: Ocular foreign bodies represent a situation of non-negligable severity and thus require proper early management in order to prevent progression to visual loss or blindness.

Conjunctival tattoo with inadvertent ocular globe penetration and vitreous involvement: Clinico-pathological correlation and scanning electron microscopy X-ray microanalysis.

PURPOSE: The aim is to report a case of conjunctival tattooing with inadvertent injection of tattoo ink into the vitreous cavity and its consequences, the scanning electron microscopy X-ray microanalysis of the ink components, and the microscopic findings of the affected conjunctiva and vitreous. METHODS: Descriptive case report. RESULTS: A 32-year-old man complained of ocular pain and blurred vision after undergoing a subconjuctival red ink tattoo in his left eye. Ophthalmologic examination revealed best corrected visual acuity of 20/80 and intraocular pressure of 26 mmHg. Pain was elicited with eye movements. The bulbar conjunctiva was colored intense red. In the anterior chamber, pigment granules and filaments were suspended on the aqueous humor, and lens capsule was also stained red. Ultrasonography showed high-density non-mobile echoes in the conjunctiva; anterior chamber and vitreous cavity revealed high-density mobile echoes corresponding to pigment particles. Conjunctival tattoo with inadvertent globe penetration was the clinical diagnosis. The patient received medical and surgical treatment. Histopathological examination of the conjunctiva showed red pigment globular deposits within the stroma, and neutrophils and sparse histiocytes with similar intracytoplasmic pigment granules were seen. No granulomatous foreign body reaction was noticed. Vitreous material contained pigment granules; no inflammatory cells were observed. Scanning electron microscopy X-ray microanalysis of the tattoo red ink revealed significant signals of iron, barium, and copper. CONCLUSION: Conjunctival tattoo is a new form of body decoration gaining worldwide popularity. This procedure is performed by untrained professionals causing severe ocular complications including blindness. Safety regarding tattoo ink needs further study as the composition varies among colors. Strict regulations on this matter should be considered.

[Corneal perforation due to 'lost' contact lenses]. / Corneaperforatie door 'zoekgeraakte' contactlenzen.

An 87-year-old woman with Alzheimer's disease was referred to our eye clinic with a large corneal perforation of her right eye. On further examination a total of 15 contact lenses were found under the upper eyelid of her right eye; several lenses were also found in her left eye. During further evaluation we learned that our patient had experienced severe, recurrent and painful blepharoconjunctivitis for the past 3 years, for which she had consulted several ophthalmologists and other medical practitioners. The last time our patient had inserted a contact lens was more than 3 years previously. We therefore concluded that the retained contact lenses had caused an infectious ulcer which led to a corneal perforation. The patient underwent a perforating keratoplasty, which restored the eyesight in her right eye. Removal of the retained contact lenses gave our patient relief from her severe chronic eye pain.

Oftalmia nodosa por pelos de oruga (procesionaria) / Ophthalmia nodosa due to caterpillar setae

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Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes.

PURPOSE: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. METHODS: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. RESULTS: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. CONCLUSION: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.

A Hairy Affair: Ophthalmia nodosa Due to Caterpillar Hairs.

PURPOSE: To study different clinical presentations, course, and final outcomes of ophthalmia nodosa, a rare disease caused by hairs of the caterpillar. METHODS: A total of 29 eyes of 17 patients with the disease presenting to our institute in 2013 were included. RESULTS: Patients presented with foreign body sensation (94%), photophobia (88%), lacrimation (82%), redness (94%), and eyelid edema (82%). Hairs were found in the conjunctiva (89.6%), cornea (65.5%), and even anterior chamber (3.4%). There was a conjunctival nodule in two eyes (6.8%). Resolution of symptoms occurred in 3-21 days. Treatment included topical steroids, cycloplegia, and removal of hairs with forceps. More than one sitting was required in 17 eyes (62.9%) due to reactional inflammation, precluding visualization of all the hairs. CONCLUSIONS: Ophthalmia nodosa is a relatively rare condition with subtle findings, which can be missed, causing considerable discomfort to the patient if the hairs are not removed.

Nonsurgical Management of Retained Needlefish Jaw.

While scuba diving, the left medial canthus of a 53-year-old man was pierced by a needlefish. He immediately lost vision in his left eye. An orbital computed tomographic scan showed the needlefish jaw in the left optic canal. The left medial orbit was explored surgically but no foreign object was removed. One month later, MRI confirmed the presence of the retained needlefish jaw. A conservative approach was taken and the patient remained stable over 3 months of follow-up.

[Classical Medical Mistakes - Lack of Appreciation of Psychological Components]. / Klassische ärztliche Fehlleistungen ­ die Verkennung psychologischer Komponenten.

Detailed evidence for psychogenic effects after an accident: evidence from 3 expert reports.

First identification of Gordonia sputi in a post-traumatic endophthalmitis patient - a case report and literatures review.

BACKGROUND: We present a case of post-traumatic endophthalmitis with relatively good prognosis caused by Gordonia sputi, which, to our knowledge is the first case in the literature. CASE PRESENTATION: A 24 year old man, who underwent an intraocular foreign body extraction half a month before presentation in the left eye, was referred to us complaining of blurred vision and slight pain for 5 days. His first presentation showed moderate intracameral and intravitreous purulent inflammation with a best corrected vision of counting fingers. After gram staining of the intravitreous samples revealed a gram-positive bacilli infection, a combination of amikacin and vancomycin was initially injected intravitreously. The left eye kept stable for three days but deteriorated on the 4th day. On the 5th day after presentation conventional culture characterized the bacterium as an Actinomyces sp. while 16S ribosomal RNA gene sequencing confirmed it as Gordonia sputi. Thereby a complete pars plana vitrectomy combined with lensectomy and silicone oil tamponade was performed. During the surgery an intraocular irrigation with penicillin G was adopted, followed by administration of intravenous penicillin G twice one day for a week. A relatively normal fundus with slight intracameral inflammation was observed a week after the operation, and the best corrected vision recovered to 0.15. One year later his vision remained 0.1. CONCLUSION: Gordonia sputi should be taken into consideration in patients with post-traumatic endophthalmitis especially due to foreign body penetration. Compared to conventional laboratories, molecular methods are recommended for an accurate diagnosis. A comprehensive strategy of antimicrobial agents and vitrectomy may render a satisfactory result.

Lawn mower injuries as a cause of serious visual acuity impairment - Case reports.

[b]Abstract Objective.[/b] The aim of the study is to present four cases of lawn mowers injuries as a cause of serious visual acuity impairment. [b]Materials and Method[/b]. A retrospective study of four patients admitted in 2013-2015 to the Department of Vitreoretinal Surgery in Lublin with severe open or closed globe injury, one with an intraocular foreign body (IOFB). The presence of eye protective equipment was assessed, as well as visual acuity, eye tissue condition before and after treatment, and applied therapy. RESULTS: In all cases an improvement was achieved in local conditions. The intraocular foreign body was removed, wounds sutured and damaged tissues placed in position. All eyeballs were saved. In three cases, visual acuity was improved to a usable level. Three patients underwent pars plana vitrectomy, one with IOFB removal from the vitreous cavity. [b]Conclusions[/b]. Lawn mower induced eye injuries are a significant cause of serious visual acuity impairment or blindness. The presented study shows that lawn mower eye injuries are still a therapeutic, social and economic problem, yet are very preventable with proper eye protection and patients' education. Current prevention strategies are inadequate, and therefore should be updated.

Ocular Emergencies: Red Eye.

"Red eye" is used as a general term to describe irritated or bloodshot eyes. It is a recognizable sign of an acute/chronic, localized/systemic underlying inflammatory condition. Conjunctival injection is most commonly caused by dryness, allergy, visual fatigue, contact lens overwear, and local infections. In some instances, red eye can represent a true ocular emergency that should be treated by an ophthalmologist. A comprehensive assessment of red eye conditions is required to preserve the patients visual function. Severe ocular pain, significant photophobia, decreased vision, and history of ocular trauma are warning signs demanding immediate ophthalmological consultation.