Accelerated high fluence photoactivated chromophore for infectious keratitis-corneal cross-linking (PACK-CXL) at the slit lamp: a pilot study.

Introduction: Photoactivated Chromophore for Infectious Keratitis-Corneal Cross-Linking (PACK-CXL) has garnered substantial interest among researchers and ophthalmologists due to its high promise as a potential treatment for infectious keratitis. The aim of this study is to evaluate the efficacy and safety of high fluence PACK-CXL, using 10.0 J/cm2 (30 mW/cm2, 5 min, and 33 s) at the slit lamp. Methods: This prospective interventional, nonrandomized cohort study included 20 eyes of 20 patients with bacterial, fungal, or mixed origin keratitis who underwent high fluence PACK-CXL treatment as an adjunct therapy to conventional antimicrobial therapy per American Academy of Ophthalmology treatment guidelines. The re-epithelization time was recorded, and corneal endothelial cell density was counted before and after treatment. Results: The average re-epithelization time was 8.2 ± 2.8 days (range 3-14 days). After PACK-CXL treatment, eight patients (40%) were directly discharged, while the remained patients stayed in the hospital for an average of 5.6 ± 3.5 days. No eyes required keratoplasty. Endothelial cell density counts before and after the PACK-CXL procedure were 2,562.1 ± 397.3, and 2,564.8 ± 404.5 cells/mm2, respectively (p = 0.96). Conclusion: although it was not a randomized control trial, we conclude that high fluence PACK-CXL as an adjuvant therapy is safe with no complications observed, and efficient as time to re-epithelization was less than 14 days for all patients and no patients underwent tectonic keratoplasties. Further research is needed to compare it to the current standard of care.

Assessment of the iCare HOME2, a New Intraocular Pressure Self-Measurement Tonometer.

PRCIS: The iCare HOME2 tonometer generally can be considered reliable for most eyes and clinical settings, although it may produce slightly overestimated or underestimated intraocular pressure (IOP) readings in thicker and thinner corneas, respectively. PURPOSE: To evaluate the accuracy, correlation, and analysis of differences in IOP measurements between the gold standard Goldmann applanation tonometer (GAT) and the new, self-measurement iCare HOME2 tonometer (icare). PATIENTS AND METHODS: In this retrospective study, patients were randomly selected from those who attended a routine examination in our clinic. After a complete ocular examination, each patient's IOP was measured and recorded with GAT and iCare HOME2. Central corneal thickness was measured. Eyes with any corneal morbidity were excluded. Pearson correlation coefficient was used to determine the correlation between paired IOP measurements. Bland-Altman plots were graphed for the analysis of differences in IOP between the instruments. RESULTS: One hundred thirty-five eyes of 70 patients were included in the study. The mean IOP measured with GAT was 16.3 ± 6.5 mm Hg (range: 3-56). The mean IOP measured with iCare HOME2 was 16.5 ± 7.3 mm Hg (range: 3-55), ( P = 0.47). A strong, significant positive correlation was found for paired IOP measurements by the 2 instruments ( r = 0.94; P < 0.0001). A small systematic proportional bias was seen for the paired IOP measurements, meaning that with higher IOPs the iCare HOME2 yielded higher IOP readings than GAT, but this difference was clinically insignificant. The instrument underestimated IOPs with corneas thinner than 522 µm, whereas it overestimated IOPs when corneas were thicker than this. CONCLUSION: The iCare HOME2 could be a reliable tonometer for most eyes and clinical settings. Central corneal thickness measurement is recommended in patients who use the instrument.

Airsoft gun-related ocular injuries: long-term follow-up.

PURPOSE: To describe the long-term ocular effects of airsoft gun pellet injuries. METHODS: The present study extends by 7-10 years the results of a 2010 study on the acute ocular findings related to airsoft gun pellet injuries in 59 patients, wherein we found a variety of anterior and posterior segment injuries, including hyphema (66%), corneal edema (61%), corneal erosions (59%), and traumatic mydriasis (25%), as well as retinal edema in (22%), retinal hemorrhages and mild vitreous hemorrhage in (2.1%), and, in 1 patient, elevated intraocular pressure and traumatic cataract. RESULTS: Of the 59 patients in the original study, up-to-date medical records were available for 26 (44%; 20 males). The mean follow-up time was 8 years (range, 7.2-10.3 years); the mean age, 17.1 years. Persistent abnormal findings included traumatic cataract in 3 cases (11.5%) and iris dialysis in 1 case (3.8%). In all traumatic cataract cases, cataract was not present at the time of initial examination after injury. Final mean best-corrected visual acuity was 0.92 (range 0.67-1.0), logMAR 0.03 (range 0.18-0). CONCLUSIONS: While most acute airsoft gun-related ocular injuries are transient, some patients may develop significant and potentially sight-threatening ocular damage, even in the absence of significant pathologic findings at the time of the injury. Long-term follow-up on these patients is advisable.

A Novel Method for Laser Suture Lysis Using Multispot Laser System.

Although often uncomplicated, the current technique for laser suture lysis after filtration surgery requires patient cooperation and appropriate care taken by the surgeon. In cases with suboptimal cooperation, steadying the 50-µm laser aiming beam exactly over a thin 10-0 nylon suture, can be exhausting, difficult for both the patient and the surgeon; it may prove to be ineffective or even precipitate complications. We describe a novel method for laser suture lysis using a multispot laser system, which requires less patient cooperation and surgeon skills and yields excellent results.

Optic nerve head assessment: comparison of Cirrus optic coherence tomography and Heidelberg Retinal Tomograph 3.

BACKGROUND: The purpose of this study was to analyse the relationship between optic nerve head (ONH) parameters measured by spectral domain optical coherence tomography and confocal scanning laser ophthalmoscope. DESIGN: Prospective, cross-sectional study. Hospital setting. PARTICIPANTS: One hundred seventy-three subjects (85 glaucoma and 88 normal subjects). METHODS: One eye from each individual was selected randomly for ONH imaging by the spectral domain Cirrus OCT and Heidelberg Retinal Tomograph 3 (HRT3). MAIN OUTCOME MEASURES: Four ONH parameters that are measured by both technologies (average cup-to-disc ratio [CDR], rim area, disc area and cup volume) were analysed and compared for differences, agreement of the categorical classification, diagnostic sensitivities and specificities and the area under the receiver operating characteristic curves (AUC). RESULTS: ONH parameters, as determined by the two technologies were significantly different but strongly correlated. Proportional bias was demonstrated for all measurements. The agreement of categorical classification was excellent for CDR (κ = 0.94) and good for rim area and cup volume (κ = 0.63 and 0.71, respectively). The highest sensitivities at fixed specificities were achieved by Cirrus OCT. AUCs for CDR, rim area, disc area and cup volume were not significantly different between the two technologies. CONCLUSIONS: The diagnostic capability of ONH measurements by both technologies is similar. Paired ONH measurements by Cirrus OCT and HRT3 are strongly correlated but significantly different and proportionally biased. The results preclude interchangeable use of the absolute values, but categorical classification of ONH parameters may be interchangeable in clinical practice.

Pars plana vitrectomy versus combined pars plana vitrectomy-scleral buckle for secondary repair of retinal detachment.

BACKGROUND AND OBJECTIVE: To investigate the optimal technique for repairing recurrent rhegmatogenous retinal detachments. PATIENTS AND METHODS: A 2-year retrospective review of recurrent rhegmatogenous retinal detachments by 23-gauge pars plana vitrectomy (PPV) or combined 23-gauge PPV with encircling scleral buckling was performed. The primary outcome was anatomical success. The secondary outcome was the likelihood of achieving a final best corrected visual acuity of 6/12 or better at 6-month follow-up. RESULTS: Anatomical success was achieved in 65.2% (95% CI, 53.4% to 75.4%) of the PPV group versus 74.3% (95% CI, 57.9% to 85.8%) of the PPV-scleral buckling group with one additional procedure (not statistically significant). There was no significant difference in the likelihood of achieving a final acuity of at least 6/12 between groups at 6-month follow-up. CONCLUSION: The results of our study do not demonstrate a superiority of method of primary repair, or of one method of secondary repair, over another.

Retinal nerve fibre layer imaging: comparison of Cirrus optical coherence tomography and Heidelberg retinal tomograph 3.

BACKGROUND: The purpose of this study was to analyze the relationship between retinal nerve fibre layer thickness measured by spectral domain optical coherence tomography and confocal scanning laser ophthalmoscope. DESIGN: Prospective, cross-sectional study. Hospital setting. PARTICIPANTS: One hundred seventy-three subjects (85 glaucoma and 88 normal subjects). METHODS: One eye from each individual was selected randomly for imaging by the spectral domain Cirrus optical coherence tomography and Heidelberg retinal tomograph 3. MAIN OUTCOME MEASURES: Global thickness and measurements at the four quadrants around the optic disc. RESULTS: Measurements as determined by Heidelberg retinal tomograph 3 were significantly larger than measurements done by Cirrus optical coherence tomography (respectively in mm, for global thickness: 200.0 ± 87.2 and 80.7 ± 14.7; for temporal quadrant: 75.3 ± 31.9 and 59.1 ± 13.8; for superior quadrant: 223.2 ± 128.4 and 97.7 ± 20.9; for nasal quadrant: 208.0 ± 102.9 and 66.8 ± 11.8; and for inferior quadrant: 224.4 ± 116.9 and 99.1 ± 26.6, for all P < 0.01). Significant correlation was found for all measurements (P ≤ 0.009), but a pattern of proportional bias was demonstrated. The agreement of categorical classification (within normal limits, borderline or outside normal limits) ranged between poor and fair. CONCLUSIONS: The thickness easurements by the two technologies are strongly correlated but significantly different. The differences are substantial and proportional to the retinal nerve fibre layer thickness. The normative diagnostic classification of the two technologies may not agree. The results preclude interchangeable use of these measurements in clinical practice.

Planned posterior assisted levitation in severe subluxated cataract: surgical technique and clinical results.

We report the surgical technique and outcome of planned posterior assisted levitation (P-PAL) in four cases of subluxated cataract. P-PAL was planned as the preferred approach in all cases. A spatula was inserted via the pars plana, the whole lens was lifted to the anterior chamber and then removed through a scleral tunnel incision. Anterior chamber intraocular lenses were implanted in all cases. All four eyes had severe subluxation of the crystalline lenses with marked phacodonesis. Two eyes had history of blunt trauma, and the other two eyes had severe pseudoexfoliation with spontaneous lens subluxation. Follow-up ranged from 1 to 2 years in three cases. The postoperative visual acuity was 20/80 or better. No intraoperative complications were observed. In conclusion, the P-PAL technique was successfully performed during cataract surgery in four eyes with severe subluxated cataracts. There were no complications over the long-term follow-up.

Contamination of contact lens storage cases of asymptomatic refractive surgery candidates.

PURPOSE: To examine the rates of contamination of contact lens storage cases of refractive surgery candidates and compare the growth yields of the traditional method of culturing and a broth-based method. METHODS: Thirty contact lens storage cases of 16 asymptomatic refractive surgery candidates were studied. Samples from the lens storage case fluid were inoculated into Bactec Peds Plus F broth (Becton Dickinson) and also directly onto blood agar, chocolate agar, and Sabouraud dextrose agar ("traditional method"). Another sample was processed for amoebal contamination. The rate of contamination of cases and the types of pathogens were evaluated for the broth-based and traditional culturing methods. Correlation between right and left storage cases of the same patient was defined as contamination of the two compartments with the same pathogen or pathogens. To avoid statistical bias, only one compartment was included in the study for these patients. RESULTS: Four storage cases were omitted due to growth correlation between right and left storage cases. Of the remaining 26 storage cases, 16 (61.5%) were found to be contaminated using the broth-based method and 10 (38.5%) using the traditional method (P=.011). High contamination rates were observed regardless of the type of disinfecting solution or type of contact lens used. CONCLUSIONS: The broth-based method had significantly greater culture yield than the traditional method. The high rates of contamination of contact lens storage cases of refractive surgery patients may put this cohort at greater risk than non-contact lens wearing candidates for developing postoperative infections.

[Prevalence and risk factors for diabetic retinopathy in type 2 diabetes patients in Jewish and Bedouin populations in southern Israel].

BACKGROUND: Diabetic retinopathy is the most common microvascular complication of diabetes. In recent years, there is a dramatic increase in the number of diabetic patients in the Bedouin population in the Negev region. PURPOSE: To analyze the clinical features and find out the incidence and risk factors of diabetic retinopathy of type 2 diabetes patients in the Jewish and Bedouin populations. METHODS: Data was collected from the files of 523 patients, who were examined by ophthalmologists at different clinics in southern Israel, and who were not previously diagnosed with diabetic retinopathy until that examination. All the data was analyzed by univariate analysis, and a multivariate model was built to predict the risk to develop diabetic retinopathy, separately for the Jewish and Bedouin population in the Negev. RESULTS: The average age was 64 +/- 10.3 years in the Jewish population and 58.6 +/- 12 years in the Bedouin population (P < 0.001). Treatment with insulin was administered to 14.5% of the Bedouin population, compared to 5.7% of the Jewish population (P < 0.001). Eye complications (diabetic retinopathy and/or maculopathy) were found in 13.4% of Jews, compared to 22% of Bedouins (P < 0.01). In the multivariate analysis we found 6 predicting factors for the development of diabetic retinopathy in the Jewish population: long duration of diabetes, older age, high HbA1c, insulin treatment, high levels of LDL and creatinine; and 4 predicting factors in the Bedouin population: long duration of diabetes, high HbA1c, insulin treatment and smoking. CONCLUSIONS: The Bedouin population in southern Israel suffers more from retinal diabetic complications compared to Jewish patients. Common risk factors for both populations are long duration of diabetes, high HbA1c and insulin treatment.

Clinical manifestations of adult tubulointerstitial nephritis and uveitis (TINU) syndrome.

To describe the clinical manifestations and response to therapy of adult patients with tubulointerstitial nephritis and uveitis (TINU) syndrome and to provide suggested work-up and treatment. We retrospectively examined medical records of all adult patients suffering from TINU at Soroka University Medical Center (SUMC) over the past 15 years. Characteristics of ocular and nephrologic manifestations were investigated with particular attention given to age, presenting signs and symptoms, treatment and course of disease. Five adult patients (median age 44 years) were diagnosed with TINU syndrome and followed from 1991-2006 at SUMC. As renal involvement was present at initial evaluation in all patients, they were all treated with steroids. They all suffered from moderate to severe ocular inflammation and most of them relapsed; they also suffered from TINU-related non-specific symptoms. The uveitis in our adult patients was more severe than previously reported. Renal failure and TINU-related non-specific symptoms were observed in all patients and led to the diagnosis of TINU and to systemic therapy which is more aggressive than the usual therapy for uvetis. Thus, early suspicion and diagnosis of TINU may help to direct the appropriate therapy for the degree of uveitis observed in these patients.

Airsoft gun-related ocular injuries: novel findings, ballistics investigation, and histopathologic study.

PURPOSE: To describe the ocular injuries related to airsoft gun bullets, investigate the ballistics of airsoft bullets, record real-time impact of the bullets on an eye, and investigate the histopathologic changes within the cornea after being hit by an airsoft gun bullet. DESIGN: Retrospective, interventional case series and experimental animal study. METHODS: All consecutive cases of patients with airsoft gun-related ocular injuries during 2006 to 2008 were included in this study. Porcine eyes were used for high-speed video photographs of bullet impacts. Rabbit eyes were used for the histopathologic investigation. All patients were treated in the Department of Ophthalmology at Soroka University Medical Center, Beer-Sheva, Israel. Laboratory investigations were performed at Ben-Gurion University of the Negev, Beer-Sheva, Israel. The main outcome measures were ocular injuries of the patients, ballistics of the airsoft bullets, nature of corneal deformation upon impact, and corneal histopathologic changes after the hit. RESULTS: Fifty-nine patients with a mean age of 9.8 +/- 3.8 years (range, 2.8 to 26 years) were examined; 49 were male (83.1%). The ocular injuries included hyphema, corneal edema, corneal erosion, traumatic mydriasis, and posterior segment involvement. A novel, "donut" form of corneal erosion was seen and also demonstrated by the histopathologic investigation. Substantial anterior segment deformation was recorded in real-time using the high-speed video camera. CONCLUSIONS: Airsoft gun injuries affect mainly young men and can be visually threatening. Typical ocular injuries along with a unique form of corneal erosion can be seen.

The effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations.

OBJECTIVE: To assess the effect of Nd:YAG laser posterior capsulotomy on ocular wave front aberrations. STUDY DESIGN: Retrospective comparative study. PARTICIPANTS: Twenty-four eyes of 24 consecutive pseudophakic patients with symptomatic PCO, who presented for Nd:YAG laser posterior capsulotomy at our clinic, were included in this study. METHODS: The wave front aberrations of the entire optical path of 24 pseudophakic eyes of 24 patients before, and 1 month after, Nd:YAG laser posterior capsulotomy were measured using the Nidek Optical Path Difference (OPD) scan aberrometer. Total, tilt, and high-order aberrations, and total coma, total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were analyzed statistically. Secondary measures included changes in visual acuity and refraction, and repeatability of wave front measurements in the fellow eye. RESULTS: Before Nd:YAG laser posterior capsulotomy, the total higher-order aberrations root mean-square (RMS) wave front aberration was 2.08 (SD 2.20) microm, with total trefoil being a major contributor at 1.19 (SD 1.15) microm. One month after the procedure, significant decreases in total, tilt, and high-order aberrations, and total trefoil, total tetrafoil, total spherical, and total high astigmatism aberrations were noted (p< 0.05). No significant changes in total coma aberrations were found (p > 0.05). Additionally, significant improvement in visual acuity without significant change in refraction was observed. No statistically significant differences were detected in any of the RMS values of wave front measurements taken 1 month later in the fellow eye. CONCLUSIONS: Nd:YAG laser posterior capsulotomy causes significant decrease in ocular wave front aberrations measured using the Nidek-OPD scan aberrometer, which can account for a better optical quality after the procedure. Further research to examine the impact of wave front aberrations in visual function after Nd:YAG laser posterior capsulotomy is needed.

Neglected squamous cell carcinoma of the eyelid.

An 89-year-old woman was referred with several years' history of enlarging lesions on her right eyelid. The patient did not seek medical aid during disease progression. On admission, a large, ulcerated lesion was seen on her right upper eyelid, covering the globe completely, and the eye was completely blind and hypotonous. A fine-needle biopsy of the lesion was performed. Histopathologic evaluation of the eyelid lesion disclosed a poorly differentiated squamous cell carcinoma. The patient refused any surgical intervention and was treated with electron beam radiotherapy (a total of 4000 cGy) with some decrease in the size of the eyelid and skin tumors. After 2 weeks of hospitalization, the patient was followed-up at home and died 2 weeks later of unknown causes. Squamous cell carcinoma of the periocular region can follow a fulminant course in advanced, neglected cases.

Broth culture yield vs traditional approach in the work-up of endophthalmitis.

PURPOSE: To elucidate whether the Bactec Peds Plus F broth traditionally used for culturing body fluids in pediatric departments can also be used for vitreous cultures in cases with clinically suspected endophthalmitis, and to compare yields between this method and the traditional method. DESIGN: Prospective, comparative clinical trial. METHODS: All consecutive cases with clinically suspected endophthalmitis treated in our institution between July 2003 and November 2005 were included in the study. All cases were cultured both in the Bactec Peds Plus F broth and using the traditional method. RESULTS: Thirteen cases were included in this study. The overall growth rate for the Bactec broth was 28.4% higher than the traditional method (69.2% and 53.9%, respectively, P = .48). In two cases, one of acute-onset postoperative endophthalmitis due to Streptococcus mitis and one of delayed-onset postoperative endophthalmitis attributable to Candida albicans, there was positive growth only in the Bactec broth. CONCLUSIONS: The Bactec Peds Plus F broth can be used successfully in the examination of clinically suspected endophthalmitis. The method appears to have several advantages over the traditional method: time-savings, as only one medium needs to be inoculated, transportation to the laboratory is simpler as there is no need for immediate incubation, and there is no need to maintain a supply of fresh agar media. This method is especially suitable for office settings and remote clinics, but also can be used in hospital settings, as an adjunct, to increase the growth yield.

[Ocular injuries related to Independence Day celebrations].

BACKGROUND: Each year, following Israel's Independence Day celebrations, patients are referred to the Soroka University Medical Center as a result of ocular injuries from items such as artificial snow spray, fireworks, plastic hammers and stick-lights (plastic tubes filled with fluorescent liquid). This study aims to describe and characterize the ocular injuries that are directly related to the use of these devices. PATIENTS AND METHODS: The files of all patients who were referred to the Department of Ophthalmology in the Soroka University Medical Center, between the years 1998 and 2005, during the period of Israel's Independence Day, were screened. If a patient sustained an injury from a device used during the celebration, then data relating to the age, sex, injured eye, diagnosis, the device that caused the injury and treatment were collected. RESULTS: A total of 437 patients were included in this study; fifty-two patients had suffered an ocular injury directly due to a celebration device. The patients' mean age was 17.6 years; 61.5% of the patients were male. The three most common ocular injuries were corneal erosions, conjuctival erosions, and superficial punctate keratitis (38.5%, 28.9%, and 23.0%, respectively). Other injuries included corneal and conjuctival foreign bodies, traumatic iritis, elevated intraocular pressure, and subconjuctival hemorrhage. The devices responsible for most of the injuries were artificial snow spray and fireworks. Ocular injuries from stick-light liquid, plastic hammers, and balloon explosions were seen as well. Almost all patients (96.1%) required medical treatment. Patients injured by celebration devices accounted for 27.9% of all patients seen during this period in our Ophthalmology Department; after several years, the rate approached 40%. CONCLUSION: Strict enforcement of rules and legislation regarding the use of celebration devices must be upheld. The public's awareness of the harm that these devices can cause should be strengthened.

[Outcome of combined penetrating keratoplasty with vitreoretinal surgery using temporary Eckardt keratoprosthesis].

BACKGROUND: For the adequate management of vitreoretinal pathology, good visualization through a clear cornea is needed to permit proper surgical repair. However, an opaque cornea, precludes this necessary visualization and makes posterior segment surgery impossible. Temporary keratoprosthesis facilitates visualization of intraocular structures in eyes that might otherwise be inoperable due to corneal opacities. AIM: To report the effectiveness of a combined procedure (pars plana vitrectomy with temporary Eckardt keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty) and to assess the functional outcome of eyes undergoing these procedures. METHODS: Six eyes from six consecutive patients operated on between 2001 and 2004 at the Department of Ophthalmology, Soroka University Medical Center, Beer Sheva, and followed-up for at least 6 months, were evaluated retrospectively. The evaluation focused on ocular history, visual acuity (VA), anatomical outcome and complications. RESULTS: The average follow-up period was 26 months. Prior to the operation, the most frequent diagnosis in the anterior segment was corneal scar in 4 eyes (67%). In the posterior segment, the most frequent diagnosis was retinal detachment in 5 eyes (83%). Preoperative VA was full light perception or less in all eyes. In five cases (83%), final postoperative VA was 6/240 or better. The corneal graft remained clear in five cases (83%). The retina remained attached in all cases. CONCLUSIONS: Combined corneal and retinal procedures using temporary keratoprosthesis are a safe and efficacious way of managing complicated corneal and retinal disease. These methods can preserve ambulatory vision and improve the quality of life of patients. Visual prognosis is usually limited due to the primary ocular disease.

Eye injuries due to tractor wheel explosion: report of two cases.

CASE REPORT: We describe 2 patients who sustained eye injuries when tractor wheels exploded while being inflated. Descriptions of ocular involvement from such accidents are rare in the literature. One of our patients experienced severe eye trauma requiring enucleation. In the second case, despite trauma to both eyes, 20/20 vision was recovered. COMMENTS: Injuries from exploding tires are compared to those seen in the context of air-bag deployment, and safety recommendations are discussed.

Controlling bleeding from superficial wounds by the use of topical alpha adrenoreceptor agonists spray. A randomized, masked, controlled study.

In an attempt to determine whether alpha adrenergic agonists sprayed directly over the wound are able to reduce a superficial bleeding, phenylephrine (0.25%), oxymetazoline (0.05 and 0.25%) and saline (0.9%) were tested in a rat model. The study was randomized, controlled and quantitative. A total of four incisions were made in each rat, and each solution was sprayed directly on the incision according to a specific protocol. The bleeding times were measured and summed up. Biases were minimized by the fact that each rat received all four solutions, including the control, in all possible combinations. The mean bleeding time after spraying phenylephrine (0.25%) was significantly shorter than the mean bleeding time after spraying saline (1.90 +/- 0.14 min versus 4.80 +/- 0.43 min, respectively, P < 0.001) and significantly shorter than the mean bleeding time after spraying oxymetazoline (0.05 or 0.25%: 4.46 +/- 0.54 and 5.50 +/- 0.58 min, respectively, P < 0.001). No statistically significant difference was found between the mean bleeding time after spraying oxymetazoline (0.05 or 0.25%) compared with saline. We conclude that sprayed phenylephrine (0.25%) can be used for reducing superficial bleedings. This method is simple, cost-effective, does not cause further trauma to the tissue, and can be used to treat several bleedings simultaneously (especially abrasions and lacerations) with a single application, without the need for direct physical contact with the bleeding sites. The method is apparently safe, but further studies are needed to test the systemic effect of the sprayed solution.