Dacryoliths causing intermittent epiphora associated with a patent lacrimal system / Dacriolitíase causando epífora intermitente associada a um sistema lacrimal de patente

ABSTRACT We present two patients with dacryoliths and patent lacrimal drainage with intermittent tearing and without infection. Dacryoliths can be present in the lacrimal sac or lacrimal duct without acute or chronic inflammation. In these cases, we believe dacryolith formation was a causative factor of intermittent epiphora even with a patent drainage system, and we propose that dacryoliths and even fungal colonization formation may be the first event before dacryocystitis and should be considered as a cause of epiphora.

RESUMO Apresentamos dois pacientes com dacriolitíase e drenagem lacrimal patente com lacrimejamento intermitente, sem infecção. Os dacriolitos podem estar presentes no saco lacrimal ou duto lacrimal, sem inflamação aguda ou crônica. Neste caso nós acreditamos que a dacriolitíase foi um fator causador da epífora intermitente mesmo com sistema de drenagem patente e propomos que dacriolitíase e até mesmo a colonização fúngica pode ser o primeiro evento antes dacriocistite, e deve ser adicionada como uma das causas de epífora.

Parinaud's oculoglandular syndrome and possibly causing cortical cataract / Síndrome oculoglandular de Parinaud como possível causa de catarata cortical

According to the World Health Organization, cataract is the leading cause of blindness and visual impairment throughout the world. However, the etiology of cataracts often remains unknown. This report describes the development of cortical cataract in a patient after Parinaud's oculoglandular syndrome caused by the fungus Sporothrix schenckii.

De acordo com a Organização Mundial de Saúde, a catarata é a principal causa de cegueira e deficiência visual em todo o mundo. No entanto, a etiologia das cataratas frequentemente permanece desconhecida. Este relato descreve o desenvolvimento de catarata cortical em um paciente após Síndrome oculoglandular de Parinaud causada pelo fungo Sporothrix schenckii.

Ocular mycosis at a referral center in Saudi Arabia: a 20-year study

To review the clinical experience of fungal keratitis cases at King Khaled Eye Specialist Hospital [KKESH] in Riyadh, Saudi Arabia. Retrospective observational review and analysis of 124 patient charts with confirmed diagnosis of fungal keratitis between 1984 and 2004. One hundred and twenty four eyes of 124 patients had proven fungal infection; 101 eyes had fungal keratitis and 23 eyes had fungal endophthalmitis complicating keratitis. Estimated proportion of fungal keratitis and endophthalmitis was 10.3%. Mean age was 55 years with male predominance [79.0%]. Commonly associated factors were previous intraocular surgery [38.7%] and trauma [20.9%]. Major risk factor for progressing to endophthalmitis was previous intraocular surgery [65.2%], p < 0.001. Initial laboratory results were fungal positive only in 30.6% [p < 0.001]. Commonest organisms isolated were Aspergillus spp. [29.8%] followed by Trichophyton sp. [16.1%], then Candida and Fusarium sp. Comparison of both phases of the study showed improvement in the rate of successfully treated cases from 34.6% to 58.3%, and a decline in cases progressing to endophthalmitis from 25.0% to 13.9%. Therapeutic penetrating keratoplasty increased from 26.9% to 73.6% [p < 0.001]. Thirteen eyes required enucleation or evisceration. In contrast to other studies on fungal keratitis, Aspergillus spp. and Trichophyton sp. were the most commonly isolated fungal pathogens; the former carries the worst prognosis. Risk factors included previous intraocular surgery and trauma. Poor outcome was associated with Aspergillus spp., delayed presentation, previous intraocular surgery and late surgical intervention. This study recommends early surgical intervention to improve the outcome

A Congruous Superior Quadrantanopsia Following a Junctional Scotoma Induced by Asperogillosis

A 69-year old man presented to us with decreased vision in his right eye and a relative afferent pupillary defect. Under the presumption that he was suffering from retrobulbar optic neuritis or ischemic optic neuropathy, visual field tests were performed, revealing the presence of a junctional scotoma. Imaging studies revealed tumorous lesions extending from the sphenoid sinus at the right superior orbital fissure, with erosion of the right medial orbital wall and optic canal. Right optic nerve decompression was performed via an endoscopic sphenoidectomy, and histopathologic examination confirmed the presence of aspergillosis. The patient did not receive any postoperative antifungal treatment; however, his vision improved to 20 / 40, and his visual field developed a left congruous superior quadrantanopsia 18 months postoperatively. A junctional scotoma can be caused by aspergillosis, demonstrating the importance of examining the asymptomatic eye when a patient is experiencing a loss of vision in one eye. Furthermore, damage to the distal optic nerve adjacent to the proximal optic chiasm can induce unusual congruous superior quadrantanopsia.

Fungal keratitis in Lattice dystrophy.

We report a case of fungal keratitis occurring in a patient with lattice dystrophy. A 57-year-old farmer presented with a corneal ulcer following probable entry of paddy husk in the right eye, of one month duration. Corneal scraping revealed pigmented fungal filaments while culture grew Alternaria alternata. Treatment with 5% natamycin eye drops and 1% atropine healed the infection in four weeks. We would like to draw attention to the fact that the cornea in lattice dystrophy is prone to frequent erosions and is a compromised epithelial barrier to invasion by microorganisms. Patients must be made aware of this fact and should seek attention at the earliest following any trivial trauma. Management of minor corneal abrasions in them should be directed at healing the epithelium with adequate lubricants and preventing infection with topical antibiotic prophylaxis.

Liver cirrhosis and rhino-orbital mucormycosis, a possible but rare association: description of a clinical case and literature review

Only few cases of rhino-orbital mucormycosis in patients with liver cirrhosis are described in the literature and most of these patients showed an associated diabetes mellitus. We describe a case of rhino-orbital mucormycosis in a patient with liver cirrhosis without other risk factors.

Queratitis infecciosa no viral: factores predisponentes, agentes etiológicos y diagnóstico de laboratorio / Non viral infectious keratitis: predisposing factors, etiologic agents and laboratory diagnosis

Las queratitis infecciosas poseen una elevada morbilidad, poniendo en riesgo la visión en casos graves. Dada la eficaz protección que brinda el epitelio corneal, para que ocurra una infección se requiere la presencia de factores condicionantes. El principal predisponente para las queratitis infecciosas es el uso de lentes de contacto, seguido por traumatismos y cirugías oculares y luego diversas afecciones locales o generales. Los agentes etiológicos abarcan una enorme diversidad de microorganismos, incluyendo bacterias, micobacterias, virus, hongos y parásitos. Para poder instaurar un tratamiento acotado se necesita un diagnóstico etiológico, lo que requiere una correcta toma de muestra y un exhaustivo análisis microbiológico.

Infectious keratitis cause significant morbidity and, if it is not promptly and appropriately treated, can lead to severe ocular disability. Almost all cases of keratitis are associated to predisposing conditions. In occident, the main risk factor is contact lens wear, but previous ocular surgery or trauma are also important, as well as various ocular surface diseases. An enormous diversity of etiologic agents for infectious keratitis exist, including virus, bacteria, mycobacteria, fungi and parasites. This review provides literature and personal based information about main predisposing factors, etiologic agents and pathophysiology of infectious keratitis, excluding those of viral origin. Focus is made on microbiologic procedures, describing stains and media that should be used, and highlighting their utility. A special mention on particular situations is made, including laboratory diagnosis of Acanthamoeba keratitis, utility of lens cases analysis, keratitis in patients with previous treatment, as well as molecular biology techniques described in ophthalmology.

Estudo laboratorial das micoses oculares e fatores associados às ceratites / Laboratory study of the mycotic infectious eye diseases and factors associated with keratitis

OBJETIVO: Analisar a freqüência e a etiologia das doenças oculares micóticas diagnosticadas por cultura no Laboratório de Doenças Externas Oculares da Universidade Federal de São Paulo (LOFT-UNIFESP), São Paulo, SP, Brasil e os fatores associados às ceratites fúngicas. MÉTODOS: Estudo retrospectivo de 14.391 solicitações de exames laboratoriais de doenças infecciosas oculares no período compreendido entre 1975 e maio de 2003. Nas comprovações por cultura de micoses oculares foram observados o tipo morfológico do fungo isolado, o sexo e a idade dos pacientes, o local de acometimento da infecção ocular, os anos de identificação e os fatores associados nos casos de ceratite fúngica, conforme o agente etiológico identificado. Considerou-se significante p<0,05. RESULTADOS: Foram verificadas 296 (2,05 por cento) comprovações por cultura de infecção ocular micótica, sendo 265 (89,5 por cento) identificadas como agente etiológico de ceratites, 27 de infecções intra-oculares (9,1 por cento) e 4 de outros locais (1,3 por cento). Fungos filamentosos foram identificados em 233 casos (78,7 por cento), sendo 74,7 por cento dos pacientes do sexo masculino (n=174) e 25,3 por cento do sexo feminino (n=59). Em 63 exames (21,3 por cento) foram isolados fungos leveduriformes, sendo 49,2 por cento dos casos do sexo masculino (n=31) e 50,8 por cento do sexo feminino (n=32).As idades variaram entre 2 e 99 anos no grupo dos fungos filamentosos e entre 14 e 88 anos no grupo dos fungos leveduriformes. Os fungos filamentosos mais freqüentemente encontrados foram Fusarium (n=137 ou 58,8 por cento), Aspergillus (n=28 ou 12,0 por cento) e Penicillium (n=12 ou 5,2 por cento). Entre as leveduras, o gênero mais freqüente foi a Candida (n=59 ou 93,7 por cento). Em relação às ceratites, 95,1 por cento das solicitações apresentadas tiveram pelo menos um fator associado. Trauma ocular foi significativamente associado às ceratites por fungos filamentosos (p=0,0002); e, cirurgias (p=0,0002), doenças oculares prévias (p=0,0002) e sistêmicas (p=0,0002) às infecções por fungos leveduriformes. O uso de antibióticos tópicos mostrou associação com infecção por fungos filamentosos, com menor significância estatística (p=0,0224). CONCLUSÕES: A análise laboratorial mostrou predomínio de infecções por fungos filamentosos sobre os leveduriformes, destacando-se a ceratite micótica como a principal doença verificada. A maioria das ceratites fúngicas apresentou pelo menos um fator associado.

Ciliary staphyloma: very rare sequelae of conjunctival rhinosporiodosis.

The main ocular manifestation of rhinosporiosis is lid or conjunctival infection. Conjunctival rhinosporiodosis is very rately causing sclera necrosis. A patient named Shumi (8 years), D/O.- Rukan Uddin of Rupchandrapur, Atpara, Netrokona admitted on 09/03/2003 in the department of Ophtalmology, Mymensingh Medical College Hospital with complains of mass in right eye looks externally like a growth in upper lid and mild dimness of vision of right eye. On examination, it was found that she got VAR : 6/24 and having a shaphyloma near 12-00 O'clock position with a mass adjacent to it which was identified as rhinosporiodosis after excisional biopsy. No history of ocular trauma or any other ocular disease was found.

Penetrating keratoplasty following scleral patch graft procedure.

PURPOSE: To present the benefit of preserved sclera for immediately repairing perforated corneal ulcer and report the clinical outcome of patients undergoing penetrating keratoplasty after scleral patch graft. PATIENTS AND METHOD: The results of perforated corneal ulcer patients, who underwent penetrating keratoplasty after scleral patch graft between January 1996 and December 2002, were reviewed retrospectively. The causes of the corneal ulcer were also included. RESULTS: Penetrating keratoplasty was performed after scleral patch graft for perforated corneal ulcer on four patients, three males and one female. The culture results from corneal scraping showed Fusarium spp in two cases and Streptococus pneumoniae in one. One patient had a presumed bacterial corneal ulcer. The post-penetrating keratoplasty visual acuity ranged from hand motions to 20/40. CONCLUSION: The scleral patch graft procedure for perforated corneal ulcer may benefit in circumstances of unavailable corneal donors. The results of penetrating keratoplasty after scleral patch graft were favorable.