Unilateral Punctate Keratitis Secondary to Wallenberg Syndrome

We studied three patients who developed left unilateral punctate keratitis after suffering left-sided Wallenberg Syndrome. A complex evolution occurred in two of them. In all cases, neurophysiological studies showed damage in the trigeminal sensory component at the bulbar level. Corneal involvement secondary to Wallenberg syndrome is a rare cause of unilateral superficial punctate keratitis. The loss of corneal sensitivity caused by trigeminal neuropathy leads to epithelial erosions that are frequently unobserved by the patient, resulting in a high risk of corneal-ulcer development with the possibility of superinfection. Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of trigeminal nerve damage. In some of these patients, oculofacial pain is a distinctive feature.

A Case of Supratarsal Injection of Triamcinolone in Management of Chronic Thygeson's Superficial Punctate Keratitis

PURPOSE: To report a case of supratarsal injection of triamcinolone for the management of chronic, steroid-dependent Thygeson's superficial punctate keratitis. CASE SUMMARY: A 37-years-old woman complained of redness, photophobia, and tearing in both eyes, which lasted for 6 years. The slit lamp examination revealed multiple intraepithelial and subepithelial, punctated corneal lesions which were elevated and scattered diffusely upon staining with fluorescein dye in both eyes. The patient was diagnosed with Thygeson's superficial punctate keratitis and treated with 0.1% fluorometholone, 0.05% cyclosporin, and 0.15% ganciclovir in both eyes. After 10 months of follow-up, recurrences were reported twice in the right eye, and 7 times in the left eye. The patient was treated with a supratarsal injection of triamcilonone in both eyes and after injection, the patient was treated only with artificial tears. Four months later, the patient did not complain of any symptoms and her cornea was clear. CONCLUSIONS: A supratarsal injection of triamcinolone may be an effective method to prevent recurrence of chronic, steroid-dependent Thygeson's superficial punctate keratitis.

Superficial Punctate Keratopathy after LASIK

PURPOSE: To evaluate the clinical characteristics of superficial punctate keratopathy following LASIK and to estabilish the management and prevention of superficial punctate keratopathy. METHODS: We retrospectively analyzed the medical records of 476 eyes followed up for more than 6 months after LASIK. RESULTS: Of the 476 eyes, the SPK has deveolped in 118 eyes (24.8%). The incidence was higher when there was a history of dry eye symptoms or contact lens intolerance (p<0.05%). In 68 eyes (57.6%), SPK has developed within 1 month after LASIK and the inferior cornea (85.6%) was the most frequently involved site. Most cases were asymptomatic and treated with preservative-free artificial tear solution. There were no visually significant complications. CONCLUSIONS: Corneal sensitivity decreases after LASIK by cutoff of the sensory innervation. As LASIK-induced neurotrophic epitheliopathy has an influence on tear film dynamics, it may be a possible cause of dry eye syndrome or epithelial keratopathy after LASIK. Careful attention should be taken into the contributing factors such as pre-existing dry eye syndrome, contact lens intolerance, previous history of blepharoplasty, lagopthalmos and so on. Adequate hydration of cornea preoperatively, careful manipulation during procedure, conservative treatment with artificial tears may be helpful in reducing symptoms and preventing further complications.

Corneal Complications in Contact Lens Wearer

With the widespread introduction of contact lenses as a convenient alternative to spectacles, corneal complications in contact lens wearers has also increased. We undertook this study to assess the risk of contact lens use, and other major causes of corneal complications. We have experienced 95 contact lens wearer(133 eyes) with corneal complications at the Chung Ang University Hospital from Jan. 1991 to May 1994. Among the corneal complications, abrasion and erosion occupied the most part of them(57.9%). Other complications were punctate keratitis(36.8%) and ulceration(5.3%). The causes of corneal lesion were extended wearing, foreign body or scratching of lens, poor fitting, sleeping with contact lens wear, and unknown. In order to decrease the corneal complications in contact lens wearers, phthalmologists should warn their patients using or considering contact lenses of this potential problems and stress the necessity of meticulous hygiene and prompt evaluation of an uncomfortable eye.

The Clinical Study of the Effective Treatment of Blepharospasm and Hemifacial Spasm with Botulinum toxin A (Oculinum(R))(II)

Two hundred sixty two patients of the essential blepharospasm and hemifacial spasm were treated with Botulinum toxin A (Oculinum(R)). A total of 620 treatments was given injections over a 3-year period. A reduction in spasm intensity was noted in most patients, and the mean response time of the essential blepharospasm and hemifacial spasm were 144.2 days and 172.3 days, respectively, There was no clear relationship between age, sex, toxin dose or preinjected spasm intensity, the amount of spasm reduction, and the mean response time. The mean respone time had no difference from the first through the fourth treatments; but in hemifacial spasm, the mean response time of the second treatment was longer than that of first, third and fourth treatments. The lagophthalmos and superficial punctate keratitis were the most frequent complications. As a result of the injection to avoid the center of the upper and lower eyelids, the frequency of complications could be minimized. There was no clear difference in the beneficial effect and the mcidence of complication (lagophthalmos) between toxin stored in the vaccum and in the non-vaccum state. Patients who were treated with lidocaine mixed toxin had a less effective result than those with saline-mixed toxin.

Corneal Complications of Contact Lens Wearer

We have experienced the corneal complications of contact lens wearer in 102 eyes from March 1986 to Nov. 1988. Among the corneal complications, the corneal erosion and abrasion occupied the most part of them(65.7%). Punctate keratitis and corneal ulcer were noted in 22 eyes(21.5%) and 12 eyes (11.8%), respectively. The causes of corneal lesion were foreign body or scratching of contact lens(17.6%), sleeping while wearing contact lens(23.1%), poor fitting(l3.8%), extended wearing(30.4%) and unknown(17.6%). It was interesting that 45.3% of the corneal lesions occurred on Saturday and Sunday. This is probably due to extended wearing or sleeping while wearing contact lens on the weekend.

Corneal Complications of Contact Lens Wearer

We have experienced the corneal complications of contact lens wearer in 102 eyes from March 1986 to Nov. 1988. Among the corneal complications, the corneal erosion and abrasion occupied the most part of them(65.7%). Punctate keratitis and corneal ulcer were noted in 22 eyes(21.5%) and 12 eyes (11.8%), respectively. The causes of corneal lesion were foreign body or scratching of contact lens(17.6%), sleeping while wearing contact lens(23.1%), poor fitting(l3.8%), extended wearing(30.4%) and unknown(17.6%). It was interesting that 45.3% of the corneal lesions occurred on Saturday and Sunday. This is probably due to extended wearing or sleeping while wearing contact lens on the weekend.