ABSTRACT
In vivo scanning slit confocal microscopy was performed in a patient with Fusarium solani keratitis. Morphologically distinctive abundant filamentous structures were observed intrastromally. Confocal microscopy of the culture plate growing F solani from the patient's corneal scraping revealed filaments morphologically similar to the filaments observed in vivo. After 1 week of medical therapy, subsequent confocal microscopy showed an increased load of filaments, supporting the decision to perform a penetrating keratoplasty. Confocal microscopy confirmed that all of the fungus was eradicated. This aided in the decision to administer corticosteroids and quickly discontinue antifungal agents.
Subject(s)
Corneal Ulcer/diagnosis , Eye Infections, Fungal/diagnosis , Fusarium/isolation & purification , Microscopy, Confocal/methods , Mycoses/diagnosis , Adolescent , Antifungal Agents/therapeutic use , Corneal Stroma/microbiology , Corneal Stroma/pathology , Corneal Ulcer/microbiology , Corneal Ulcer/therapy , Eye Infections, Fungal/etiology , Eye Infections, Fungal/therapy , Humans , Keratoplasty, Penetrating , Male , Mycoses/etiology , Mycoses/therapyABSTRACT
Nonarteritic anterior ischemic optic neuropathy (AION) is a well-described entity that is believed to be caused by abnormal anatomy of the optic disc and to be precipitated by several stressors or disease states. Activated protein C resistance (APCR) is a recently described mutation of factor V (FV) gene that renders FV resistant to cleavage by activated protein C. APCR predisposes to thrombotic events. The case of a 61-year-old woman with AION and activated protein C resistance is presented, and the management is discussed. We thoroughly review the literature on these two conditions. We propose that a prospective analysis of the potential role of APCR in some cases of AION is needed and suggest that physicians consider this and other prothrombotic states when evaluating patients with AION.
Subject(s)
Optic Disk/blood supply , Optic Neuropathy, Ischemic/complications , Protein C/metabolism , Factor V/genetics , Female , Humans , Middle Aged , Optic Neuropathy, Ischemic/metabolism , Optic Neuropathy, Ischemic/physiopathology , Partial Thromboplastin Time , Thrombosis/complications , Thrombosis/metabolism , Thrombosis/physiopathologyABSTRACT
BACKGROUND: Orbital signs and symptoms occur in approximately one half of children with Graves disease, but the symptoms are usually minor and limited to the eyelids. Prominent proptosis is uncommon in children with this disorder. METHODS: Review of eight children with prominent proptosis associated with thyroid eye disease. Four patients were treated at the Children's Hospital of Philadelphia, the other four at the Columbia Presbyterian Medical Center. RESULTS: At initial presentation, children ranged in age from 3 to 16 years. There were five girls and three boys. Seven of eight children had hyperthyroidism at ophthalmic presentation. Four patients had restrictive myopathy, and all of the seven patients who underwent neuroimaging had extraocular muscle enlargement. Five patients were treated with lubrication. Two underwent orbital fat decompression. One patient had thyroid eye disease and myasthenia gravis. CONCLUSIONS: Proptosis in childhood thyroid eye disease usually is associated with a hyperthyroid state. The proptosis may be dramatic, but corneal exposure and restrictive myopathy are seen in only some of the patients. Neuroimaging shows enlarged extraocular muscles. Most children with this complication can be treated conservatively with topical lubrication, but orbital fat decompression may be considered in patients with more advanced conditions.
Subject(s)
Exophthalmos/etiology , Eye Diseases/complications , Thyroid Diseases/complications , Adolescent , Child , Child, Preschool , Eye Diseases/diagnosis , Eye Diseases/therapy , Female , Graves Disease/complications , Graves Disease/diagnosis , Graves Disease/therapy , Humans , Hyperthyroidism/complications , Hyperthyroidism/diagnosis , Hyperthyroidism/therapy , Hypertrophy/diagnosis , Magnetic Resonance Imaging , Male , Oculomotor Muscles/pathology , Thyroid Diseases/diagnosis , Thyroid Diseases/therapy , Tomography, X-Ray ComputedSubject(s)
Optic Nerve Diseases/etiology , Orbital Fractures/surgery , Adult , Bone Plates/adverse effects , Bone Transplantation/adverse effects , Enophthalmos/surgery , Humans , Hypertension/complications , Male , Middle Aged , Optic Nerve Injuries/etiology , Optic Neuropathy, Ischemic/etiology , Orbital Fractures/complications , Risk FactorsABSTRACT
PURPOSE/METHODS: The cause of Mooren's ulcer is unknown. We examined a patient with chronic hepatitis C who had a corneal ulceration that resembled Mooren's corneal ulcer. RESULTS/CONCLUSION: The corneal ulceration progressed despite appropriate medical and surgical interventions. Recombinant interferon alpha 2b finally led to resolution of the process. The resolution correlated with normalization of the patient's liver function tests. Corneal ulcerations that resemble Mooren's ulcer may be associated with hepatitis C. Recombinant interferon alpha 2b seems to induce remission in the corneal as well as the systemic condition.
