Aggressive conjunctival Kaposi sarcoma as the initial manifestation of acquired immunodeficiency syndrome.

PURPOSE: To report a case of Kaposi sarcoma in a patient with previously undiagnosed Human Immunodeficiency Virus (HIV) infection. OBSERVATIONS: A 23-year-old male patient presented to the eye clinic with complaints of redness of his left eye for the past month. The patient had been seen one day prior to presentation in the emergency department for a neck mass and pneumonia. Exam was notable for a left hemorrhagic, nodular, bulbar conjunctival mass, a right hemorrhagic conjunctival lesion, and violaceous facial skin lesions. Due to suspicion for conjunctival Kaposi sarcoma, HIV and Acquired Immune Deficiency Syndrome (AIDS) serologies were obtained which returned positive. Biopsies of the ocular mass and axillary lymph nodes confirmed Kaposi sarcoma. The patient was started on anti-retroviral therapy and Doxorubicin. The left conjunctival mass initially progressed to cover most of his cornea but eventually regressed by 6 months. CONCLUSIONS AND IMPORTANCE: Ocular involvement of Kaposi sarcoma as the initial manifestation of HIV/AIDS is rare with only a few reported cases. Since the advent of highly active antiretroviral therapy, conjunctival or adnexal Kaposi sarcoma is not commonly encountered by healthcare providers. Concern for Kaposi sarcoma of the conjunctiva in this patient led to the evaluation for HIV/AIDS. It is vital for all healthcare providers to have Kaposi sarcoma in the differential diagnosis of a hemorrhagic conjunctival or adnexal mass and be familiar with its association with HIV/AIDS. If suspected, appropriate counseling and testing should be performed.

Advances in pharmacotherapy for allergic conjunctivitis.

INTRODUCTION: Allergy is the fifth leading group of chronic diseases, affecting as much as 40% of the first-world population. Its pathophysiology has a genetic component, and is driven by the immune system's sensitized response to antigens and environmental factors. As research continues to uncover the mediators responsible for ocular allergy, the development of novel drugs should progress. AREAS COVERED: A literature review of allergic conjunctivitis, ocular allergy and their treatment was performed using PubMed and Medline. Additional information is also included from clinicaltrials.gov and associated web sites for drugs currently in clinical trials. EXPERT OPINION: The initial step of therapy remains identification and avoidance of allergic triggers. The mainstay of treatment is the new generation of dual-acting antihistamines. Drugs that improve the magnitude and duration of relief, with greater subject responder rates, are gradually making their way into the clinic. Allergic conjunctivitis is a relatively easy disease to study because of the availability of models such as the conjunctival allergen challenge. New classes of drugs that target inflammatory pathways or mediators involved in the early and late-phase allergic response are being screened in these models and we are making progress in identifying the next generation of anti-allergic therapy.