Proparacaine Overuse in Corneal Abrasions at the Emergency Department: A Case Series.

ABSTRACT: Corneal abrasions are among the most common ophthalmic injuries in the emergency department (ED) and primarily present as severe ocular pain. Topical anesthetics provide temporary analgesia, but overuse is associated with complications including further corneal injury, infection, and vision loss. This case series describes three patients who used a 15-mL bottle of 0.05% proparacaine hydrochloride ophthalmic solution after discharge from the ED and returned within three days with corneal injury and pain. Although the use of topical anesthetics is traditionally discouraged by ophthalmologists, publications in the emergency medicine literature support their use. We review the literature surrounding topical anesthetic use in the ED setting and caution against prescribing patients topical anesthetics for corneal abrasions, particularly without patient counseling and significant restriction of anesthetic supply.

Contact Lens Safety for the Correction of Refractive Error in Healthy Eyes.

ABSTRACT: Contact lenses are a safe and effective method for correction of refractive error and worn by an estimated 45 million Americans. Because of the widespread availability and commercial popularity of contact lenses, it is not well appreciated by the public that contact lenses are U.S. Food and Drug Administration (FDA)-regulated medical devices. Contact lenses are marketed in numerous hard and soft materials that have been improved over decades, worn in daily or extended wear, and replaced in range of schedules from daily to yearly or longer. Lens materials and wear and care regimens have impact on the risks of contact lens-related corneal inflammatory events and microbial keratitis. This article reviews contact lens safety, with specific focus on the correction of refractive error in healthy eyes.

Gone Viral: A Cross-Sectional Analysis of Contact Lens-Related Videos on TikTok.

OBJECTIVES: To evaluate the content, sources, and quality of contact lens (CL)-related videos on TikTok, the fastest growing social media platform worldwide. METHODS: TikTok was queried on October 25, 2021 for the top 200 posts with the hashtag "#contactlenses." Posts meeting inclusion criteria were characterized and assessed for quality with DISCERN, a validated scoring instrument for the appraisal of consumer health information (score range 1-5 with a higher score indicating a higher quality video). RESULTS: The included 113 posts showed a mean quality of 1.94±0.44. Content included product displays (42%), patient experiences (23%), educational (22%), and comedy (12%). Most product displays featured decorative lenses (98%). Although videos by eye-care providers (ECPs) accounted for most educational content (52%) and showed significantly higher mean quality compared with posts by non-ECPs (2.57±0.18 vs. 1.85±0.13, P <0.001), they were a minority (12%) and showed poor overall quality. Contact lens representation was greatly skewed toward decorative lenses (74%), whereas only 3.5% of videos promoted seeing an ECP. CONCLUSIONS: Poor quality and skewed representation of posts indicate that CL-related information on TikTok has serious shortcomings. These findings are particularly concerning given that most TikTok users are adolescents and young adults, the same population who tend to be decorative lens wearers and who are at increased risk of CL-related complications. Eye-care providers, professional organizations, and regulatory agencies should be urged to increase their engagement with the platform, especially regarding educational content creation and CL marketing oversight.

Passive Verification: A Flawed System Putting Patients' Sight at Risk.

OBJECTIVE: To assess the rate of erroneous or expired (invalid) contact lens prescriptions submitted for passive verification at two practice sites in Cleveland, OH. METHODS: Passive verification facsimile (FAX) requests were collected from office staff at a county hospital (MetroHealth [MH]), and at a private ophthalmology group office (University Ophthalmology Associates [UOA]) in Cleveland, Ohio, from January 2013 to January 2018. RESULTS: A total of 415 verification requests were evaluated (339 MH, 75 UOA), 28.2% (104 MH, 13 UOA) were expired, 11.8% (48 MH, one UOA) were not under the care of the doctor to whom the request was directed, 8.9% (32 MH, 5 UOA) were incorrect, and 3.9% (16 MH, 0 UOA) did not complete fitting. The total rate of invalid prescriptions was 52.8% (200 MH, 19 UOA). CONCLUSIONS: There is a high rate of invalid prescriptions presented for passive verification. Although the majority of prescriptions are simply expired, there is a fraction of prescriptions that contain incorrect specification of lens parameters or no record of prescription by that doctor. The current mechanism of passive verification, with the burden on the provider for denial within a short time window, makes it likely that such prescriptions would be filled, potentially putting patient comfort and safety at risk.

Corneal Infections Associated with Sleeping in Contact Lenses - Six Cases, United States, 2016-2018.

Contact lenses, when worn and cared for properly, are a safe and effective form of vision correction used by an estimated 45 million Americans. However, contact lens wearers are at risk for contact lens-related eye infections, especially when wearers do not practice proper contact lens wear and care habits. These infections, affecting the cornea and known as microbial keratitis (Figure), can lead to serious adverse health outcomes. Because contact lenses are regulated by the Food and Drug Administration (FDA) as medical devices, contact lens-related corneal infections should be reported to FDA as an adverse event. To illustrate their serious health implications, six cases of contact lens-related corneal infection, in which sleeping in lenses was reported as the main risk factor, are presented. Consequences of infection reported among the identified cases included the need for frequent administration of antibiotic eye drops, multiple follow-up medical appointments, and permanent eye damage. Health education measures directed toward contact lens wearers should emphasize raising awareness of the risks of sleeping in contact lenses as well as adherence to all recommendations for the wear and care of contact lenses. Additional measures are needed to educate eye care professionals about the need to report contact lens-related corneal infections to MedWatch, the FDA Safety Information and Adverse Event Reporting program (https://www.fda.gov/MedWatch/).

Risk factors for ophthalmic complications in patients with burns.

A retrospective study of patients admitted to MetroHealth Medical Center was performed to identify the risk factors for short- and long-term ophthalmologic complications related to burn injury. From 2000 to 2007, the authors identified 293 patients with the inclusion criteria of facial burns, TBSA ≥20%, or smoke inhalation injury. Seventy (24%) developed ocular complications, and 16 (11%) developed long-term complications. Statistically significant risk factors identified for short-term complications were burn size, chemical burns, depth of facial burns, initial Glasgow Coma Scale, and need for mechanical ventilation/sedation. Risk factors for long-term complications included wound infection with Pseudomonas or Acinetobacter, third-degree burn size, hours to ophthalmology evaluation, LOS, time on mechanical ventilation, and need for STSG. In addition to facial burns, the requirement of mechanical ventilation, prolonged sedation, and presence of infection with Pseudomonas or Acinetobacter increase the risk of injury to the eye after burn injury, and these patients may benefit from serial eye examinations for early identification of ocular complications.

Suture-related keratitis following cataract surgery caused by methicillin-resistant Staphylococcus aureus.

A 54-year old-man presented with a two-day history of severe pain and decreased vision. Examination revealed a corneal ulcer associated with a loose suture from cataract surgery done approximately two years ago. The suture was removed and the patient was started on topic antibiotic treatment with cefazolin and gentamycin. Cultures revealed methicillin-resistant Staphylococcus aureus (MRSA). The antibiotic regimen was changed to include vancomycin but the ulcer continued to progress. Three days later, the ulcer had perforated and an emergent corneal patch graft was performed. To our knowledge, this is the first reported case of suture-related MRSA keratitis after uncomplicated clear corneal cataract surgery.

Over-the-counter decorative contact lenses: Cosmetic or Medical Devices? A Case Series.

PURPOSE: To illustrate the implications of the unauthorized sale and unmonitored wearing of decorative cosmetic contact lenses resulting in ocular complications and to determine the prevalence of the use of cosmetic contact lenses obtained from unlicensed providers by adolescents. METHODS: Observational case report, structured interview, and survey in a retrospective, observational, clinical practice setting. Reported sources of contact lenses were categorized as provider and nonprovider, and associations within the data were reviewed by using a Pearson correlation and chi-square test. RESULTS: Twelve patients (eight female and four male) were seen urgently for acute eye pain and redness after wearing plano decorative contact lenses. None of the patients had previously worn a contact lens. None of the lenses were dispensed by eye care professionals. Four patients developed blinding infections requiring hospital admission. Causative organisms included staphylococci, Pseudomonas, and acanthamoeba. One patient required a penetrating keratoplasty. One hundred fifty-nine patients were surveyed. Thirty-seven (23%) used decorative contact lenses. Lenses were obtained from an unlicensed provider 51% of the time. Education about lens care and handling was significantly associated with acquiring lenses from licensed providers (R = 0.74, P < 0.0001). CONCLUSIONS: Colored noncorrective contact lenses are being dispensed without a prescription or fitting from unlicensed vendors. Patients who acquire lenses from unauthorized providers are significantly less likely to be instructed on appropriate lens use and care. Consequently, uninformed lens wearers are experiencing acute vision-threatening infections and inflammation.

Ocular complications associated with the use of cosmetic contact lenses from unlicensed vendors.

PURPOSE: To call attention to the unauthorized sale of cosmetic contact lenses, resulting in ocular complications. DESIGN Observational case report. METHODS: Retrospective, observational, clinical practice setting. RESULTS: Six patients (five female and one male) were seen urgently for acute eye pain and redness after wearing cosmetic plano contact lenses. None of the patients had previously worn a contact lens or spectacle correction. None of the lenses were dispensed by eye care professionals. One patient developed pseudomonal keratitis, ultimately requiring penetrating keratoplasty for visual rehabilitation. CONCLUSIONS: Colored contact lenses are being dispensed without a prescription or fitting from unlicensed vendors, such as cosmetics, convenience, and accessory stores. Lenses are sold individually and without care instructions. Consequently, uninformed lens wearers are experiencing acute, vision-threatening infections and inflammation.

Short-acting peribulbar anesthesia with 2-chloroprocaine.

A 64-year-old monocular man had uneventful penetrating keratoplasty in his seeing eye for aphakic bullous keratopathy and counting fingers visual acuity. One year later, standard slitlamp suture removal under topical anesthesia was not possible because of sensory nystagmus. In addition, the patient could not have general anesthesia as a consequence of severe coronary artery disease. He requested that the procedure be done with a short-acting local anesthetic agent so a patch would not be necessary. He successfully had the procedure using a peribulbar injection of 2-chloroprocaine (Nesacaine-MPF); vision and ocular motility returned 15 minutes after the surgery was completed. At subsequent examinations, the visual acuity was 20/200 and the graft was clear despite a congenital macular scar.