ABSTRACT
PURPOSE: The aim of this study is to describe the technique of subpalpebral antibiotic lavage (SAL), which is a highly therapeutic, efficient, and cost-effective method for managing severe bacterial keratitis. METHODS: This case report describes a 26-year-old woman with severe bacterial keratitis in the right eye due to contact lens overwear, with progressive corneal thinning, a hypopyon, impending perforation, and marked visual loss to perception of light despite treatment with intensive topical antibiotics. This was managed with SAL that involves the insertion of a cannula transcutaneously into the upper conjunctival fornix to provide continuous antibiotic irrigation of the ocular surface. RESULTS: By 11 weeks after presentation, the cornea and anterior chamber appeared clinically quiescent, and visual acuity improved to 20/40 corrected in the right eye. CONCLUSIONS: Bacterial keratitis is a potentially blinding condition for which contact lens wear is an important risk factor. Most cases are successfully managed with topical medications; however, in cases of treatment failure, a second-line approach such as SAL can be sight-saving. SAL uses readily available equipment for the delivery of high concentrations of antibiotics to the ocular surface, thus increasing therapeutic efficacy and reducing nursing staff workload. Despite its advantages, the literature reveals apparent underutilization of this technique.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Contact Lenses, Hydrophilic/microbiology , Cornea/microbiology , Eye Infections, Bacterial/drug therapy , Keratitis/drug therapy , Pseudomonas Infections/drug therapy , Visual Acuity , Adult , Contact Lenses, Hydrophilic/adverse effects , Cost-Benefit Analysis , Eye Infections, Bacterial/economics , Eye Infections, Bacterial/microbiology , Female , Humans , Keratitis/economics , Keratitis/microbiology , Ophthalmic Solutions , Pseudomonas Infections/economics , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Therapeutic IrrigationSubject(s)
Charles Bonnet Syndrome , Posterior Leukoencephalopathy Syndrome , Charles Bonnet Syndrome/complications , Charles Bonnet Syndrome/diagnosis , Hallucinations , Humans , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnosis , Vision Disorders/diagnosis , Vision Disorders/etiologyABSTRACT
The ocular tilt reaction is a rare neuro-ophthalmological phenomenon commonly occurring due to an injury to the vestibulo-ocular pathway, or a thalamic, brainstem, or cerebellar lesion. Most ocular tilt reactions are transient and demonstrate spontaneous recovery. This report documents the immediate resolution of diplopia and the patient's ocular tilt reaction following visual recovery from left yttrium aluminum garnet laser capsulotomy.
ABSTRACT
Patients with loose zonular apparatus after acute angle closure may require phacoemulsification cataract surgery. The authors' experience from management of such patients provides excellent instruction on the surgical intervention for their cataracts. This is because patients who have recovered from acute angle closure glaucoma may not have evident zonular laxity preoperatively, as the iris may be taut secondary to the effects of associated ischaemia. If the surgeon's preoperative planning is directed to the possibility of loose zonular apparatus, then appropriate preoperative, intraoperative, and postoperative planning and management can be effected. This may permit preoperative patient counselling regarding the potentially increased complexity of the case. Intraoperatively, deliberately gentle capsulorrhexis, the use of iris hooks or a pupil expander to dilate the pupil, iris hooks to support the capsular bag, and the employment of a capsular tension ring may be helpful. Postoperatively, due to the previous ocular ischaemia, intraocular pressure elevation may ensue, and should be actively managed. The authors provide a summary of factors that require consideration in patients undergoing cataract surgery following acute angle closure.
Subject(s)
Central Serous Chorioretinopathy , Sleep Apnea, Obstructive , Central Serous Chorioretinopathy/complications , Central Serous Chorioretinopathy/diagnosis , Central Serous Chorioretinopathy/epidemiology , Humans , Risk Factors , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosisSubject(s)
Hemianopsia , Optic Tract , Hemianopsia/diagnosis , Hemianopsia/etiology , Humans , Retinal Ganglion Cells , Visual Field TestsSubject(s)
Conjunctival Diseases/etiology , Corneal Diseases/etiology , Eye Foreign Bodies/etiology , Eye Pain/etiology , Phacoemulsification , Physician-Patient Relations , Surgical Tape/adverse effects , Conjunctival Diseases/diagnosis , Conjunctival Diseases/surgery , Corneal Diseases/diagnosis , Corneal Diseases/surgery , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/surgery , Eye Pain/diagnosis , Female , Humans , Lens Implantation, Intraocular , Middle Aged , Postoperative Complications , Visual Acuity/physiologySubject(s)
COVID-19/prevention & control , COVID-19/transmission , Pressure , Sneezing , Facial Muscles , Humans , LipABSTRACT
Management of multiple exposed eyelid concretions can be performed successfully in an anesthetized eyelid with gentle curettage of the concretions using a small chalazion curette. It has the advantage of managing the patient supine, providing better eyelid stability and visibility, and minimizing risk in the event of patient movement. This curettage technique was used to facilitate the successful resolution of a patient's ocular surface irritative symptomatology due to multiple exposed concretions.
