Painful Acute Corneal Ulceration and Anterior Stromal Keratitis in an Adolescent With Reactive Arthritis.

Reactive arthritis is occasionally associated with conjunctivitis and uveitis, but rarely keratitis. The authors describe a patient with paracentral anterior stromal keratitis with overlying epithelial erosion and multiple satellite subepithelial infiltrates. The initial appearance and the severe pain were suggestive of an infectious process. Recovery was rapid following introduction of topical steroid, with features suggesting an immune process in the recovery phase. The authors suggest that a history of arthritis and/or recent enteritis should be sought in the work-up of an atypical keratitis with or without epithelial defect. [J Pediatr Ophthalmol Strabismus. 2016;53:e61-e63.].

Causes of Severe Visual Impairment and Blindness: Comparative Data From Bhutanese and Laotian Schools for the Blind.

PURPOSE: To determine and compare the major causes of childhood blindness and severe visual impairment in Bhutan and Laos. DESIGN: Independent cross-sectional surveys. METHODS: This survey consists of 2 cross-sectional observational studies. The Bhutanese component was undertaken at the National Institute for Vision Impairment, the only dedicated school for the blind in Bhutan. The Laotian study was conducted at the National Ophthalmology Centre and Vientiane School for the Blind. Children younger than age 16 were invited to participate. A detailed history and examination were performed consistent with the World Health Organization Prevention of Blindness Eye Examination Record. RESULTS: Of the 53 children examined in both studies, 30 were from Bhutan and 23 were from Laos. Forty percent of Bhutanese and 87.1% of Laotian children assessed were blind, with 26.7% and 4.3%, respectively, being severely visually impaired. Congenital causes of blindness were the most common, representing 45% and 43.5% of the Bhutanese and Laotian children, respectively. Anatomically, the primary site of blinding pathology differed between the cohorts. In Bhutan, the lens comprised 25%, with whole globe at 20% and retina at 15%, but in Laos, whole globe and cornea equally contributed at 30.4%, followed by retina at 17.4%. There was an observable difference in the rates of blindness/severe visual impairment due to measles, with no cases observed in the Bhutanese children but 20.7% of the total pathologies in the Laotian children attributable to congenital measles infection. CONCLUSIONS: Consistent with other studies, there is a high rate of blinding disease, which may be prevented, treated, or ameliorated.

Treatment of conjunctival and corneal epithelial neoplasia with retinoic acid and topical interferon alfa-2b: long-term follow-up.

OBJECTIVE: To evaluate the long-term recurrence rate of conjunctival and corneal intraepithelial neoplasia (CIN) treated with retinoic acid and topical interferon alfa-2b. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: A total of 89 eyes of 89 patients from 1 institution who were treated between September 2003 and February 2010 for CIN lesions used topical interferon alfa 1 million IU/ml drops 4 times daily and retinoic acid 0.01% once every second day. METHODS: Diagnosis was made by biopsy and impression cytology. Patients' notes and clinical photographs were reviewed, and data were analyzed. All eyes were monitored for the possibility of recurrence with a minimum of 1 year of follow-up from the time of documented clinical resolution. MAIN OUTCOME MEASURES: All eyes were monitored for the possibility of recurrence with a minimum of 1 year of follow-up from the time of documented clinical resolution. RESULTS: Complete clinical resolution of the CIN lesions was achieved in 87 of the 89 eyes treated (97.75%). Two of the 89 eyes treated (2.25%) had only a partial response to treatment; of these 2 patients, 1 was taking cyclosporine for keratitis sicca. For the 87 eyes with complete response, resolution occurred after a mean of 1.69 months (range, 19 days to 6.5 months). Mean follow-up after clinical resolution (tumor-free period) was 51.5 months (range, 11-84 months). Four of the 87 patients with complete response developed a mild allergic papillary conjunctivitis that settled on halving the interferon dose to 0.5 million IU drops and reducing the frequency to 3 times daily. Side effects were limited to 1 case of epithelial microcysts and 1 case of marginal keratitis. CONCLUSIONS: In this group of patients observed with CIN lesions, combination treatment of topical retinoic acid and interferon alfa-2b was effective in treating lesions with minimal self-limited side effects with faster and greater resolution and a longer tumor-free period compared with studies using interferon alfa-2b alone. We hypothesize that topical all-trans retinoic acid and interferon alfa-2b may act synergistically. We believe that combination treatment of interferon alfa-2b and retinoic acid may offer a superior alternative to interferon alfa-2b alone in treating CIN.

Laser corneal biofilm disruption for infectious crystalline keratopathy.

Crystalline keratopathy can be successfully treated by the Nd:YAG laser. We present two cases of crystalline keratopathy managed this way. A 36-year-old female contact lens wearer presented with crystalline keratopathy following recent treatment with topical steroids and antibiotics for a corneal abscess. In this case crystalline keratopathy developed despite the intensive topical antibiotic treatment. A 55-year-old man with a history of acne rosacea, chronic myelomonocytic leukaemia, asthma and Crohn's disease presented with crystalline keratopathy following an episode of infectious keratitis. Treatment with the Nd:YAG laser to the area of involvement was instituted in both cases. Noticeable resolution occurred within days, with subsequent full recovery. No side-effects from the use of the Nd:YAG laser were noted. There have been only two cases previously reported using this treatment modality.

Treatment of recurrent corneal erosion syndrome using the combination of oral doxycycline and topical corticosteroid.

Recurrent corneal erosion syndrome is a debilitating condition for which there are many treatment options with varying rates of success. One treatment of interest in recent years is the combination of oral doxycycline and topical corticosteroids, both of which have been shown to inhibit key metalloproteinases important to disease pathogenesis. To assess the efficacy of this treatment, we conducted a retrospective single-observer case series involving all patients with recurrent corneal erosion syndrome who were treated at a community-based clinic with oral doxycycline and topical corticosteroid between January 2000 and July 2007. Twenty-one patients were identified. All received oral doxycycline 50 mg twice daily and topical fluoromethalone 0.1% three times daily for at least 4 weeks. At 8 weeks post commencement of treatment, 15/21 patients (71%) were symptom free. All but one of these patients reported an improvement in symptoms. Of those patients not lost to follow up, 15/18 patients (83%) and 11/15 patients (73%) denied any symptoms suggestive of relapse at 6 and 12 months, respectively. Among the patients in remission was one who had responded poorly to other treatments including ocular lubricants, epithelial debridement, serum eyedrops, anterior stromal puncture, and phototherapeutic keratectomy. Treatment of recurrent corneal erosion syndrome with the combination of oral doxycycline and topical corticosteroid is effective. It may help patients with recurrent corneal erosion syndrome who have failed other forms of treatment. This non-invasive treatment modality should also be considered as the first treatment option when conservative management with ocular lubricants fails.

Topical therapy with imiquimod for eyelid lesion.

Herein a case of clinically diagnosed lower eyelid lesion treated with topical imiquimod is reported. Macroscopic resolution of the lesion occurred 4 weeks after treatment with good cosmetic result. This is the first reported successful case of using this drug in treating eyelid lesion involving the lid margin.