ABSTRACT
Purpose: Deeply embedded corneal foreign bodies and intrastromal foreign body removal can often be a challenge. The aim of this report was to describe the utility of endoscopy in visualization and removal of an embedded corneal bee stinger. Methods: A 44-year-old male patient developed toxic keratopathy after injury from a bee stinger. On examination, the bee stinger was noted to be deeply embedded in the corneal stroma. A superficial keratectomy was initially attempted; however, the stinger was noted to be intrastromal and protruding into the anterior chamber and could not be removed. An Endoscopy-assisted visualization was used to remove the stinger. Results: The bee stinger was successfully removed and the patient's vision improved to 20/100 from an initial CFCF (counting fingers close to face) at time of presentation. At the end of 3 months follow-up, there was residual corneal edema along with cataractous changes in the lens as a sequelae of the initial bee sting injury. The patient subsequently underwent an endothelial keratoplasty along with phacoemulsification with intraocular lens implantation and the final BCVA improved to 20/40. Conclusion: Endoscopyassisted visualisation of anterior chamber and angle structures can be valuable in removal of retained and deeply embedded corneal or intracameral foreign bodies.
Subject(s)
Corneal Injuries , Eye Foreign Bodies , Insect Bites and Stings , Animals , Bees , Cornea , Corneal Injuries/diagnosis , Corneal Injuries/etiology , Corneal Injuries/surgery , Endoscopy , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/etiology , Eye Foreign Bodies/surgery , Humans , MaleSubject(s)
Corneal Injuries/diagnosis , Endothelium, Corneal/injuries , Eye Foreign Bodies/diagnosis , Insect Bites and Stings/diagnosis , Keratitis/diagnosis , Administration, Ophthalmic , Adult , Anti-Bacterial Agents/administration & dosage , Corneal Injuries/drug therapy , Eye Foreign Bodies/drug therapy , Glucocorticoids/administration & dosage , Humans , Insect Bites and Stings/drug therapy , Keratitis/drug therapy , Male , Moxifloxacin/administration & dosage , Prednisolone/administration & dosage , Prednisolone/analogs & derivatives , Slit Lamp MicroscopyABSTRACT
PURPOSE: To report corneal toxicity following intentional inoculation of the juice of crushed leaves of datura (Datura Inoxia). CASE REPORT: A 70-year-old male presented with diminished vision, redness, watering, and photophobia in his right eye one day before his presentation. The patient had instilled the juice of datura leaves in his right eye to treat his ocular problems. Slit lamp examination revealed mild conjunctival and circumcorneal congestion, corneal edema, and folds in Descemet's membrane. The left eye was pseudophakic with an otherwise unremarkable examination. The patient was treated with dexamethasone, cycloplegics, and lubricants. The cornea did not sufficiently recover after one month of treatment leaving him with permanent corneal decompensation that required a referral for keratoplasty. The patient was followed up for six months. We hypothesize damage to the corneal endothelial Na+/K+-ATPase pump by tropane alkaloids as a cause for corneal decompensation. CONCLUSION: Awareness about toxicity of this commonly grown plant in the tropics and subtropics is essential in order to avoid blindness due to accidental or deliberate use.
ABSTRACT
Purpose/Aim of the study: Chlorhexdine has been shown to provide excellent and cost-effective presurgical antisepsis. However, standard presurgical concentrations of chlorhexidine (2-4%) are known to cause ocular injury, even in cases in which a bio-occlusive dressing (Tegaderm™) was applied beforehand to the closed eye. MATERIALS AND METHODS: Three experiments were conducted to assess the barrier performance of Tegaderm™ to chlorhexidine skin prep in vitro and on non-ocular skin. The experiments used water as a control group. RESULTS: In the first in vitro experiment, the chlorhexidine group showed penetration at the edges of the Tegaderm™ at 5 minutes while the water (control) group never penetrated the Tegaderm™. A subsequent experiment testing the central permeability of the tegaderm showed it to be impermeable to both chlorhexidine and water after 90 minutes. In the in vivo experiment, the chlorhexidine group showed penetration at 10 minutes, while the water (control) group never penetrated the Tegaderm™. CONCLUSIONS: These data suggest Tegaderm™ is permeable at the edges to chlorhexidine but not water. Based on this, along with reports of ocular injury from chlorhexidine skin preparation of the head despite prior application of Tegaderm™ over the eyes, we advise against using bio-occlusive adhesive dressing to protect the ocular surface from chlorhexidine exposure. We suggest an alternative presurgical antiseptic agent such as povidone-iodine be employed whenever possible.
Subject(s)
Anti-Infective Agents, Local/toxicity , Antisepsis/methods , Chlorhexidine/analogs & derivatives , Occlusive Dressings , Skin, Artificial , Chlorhexidine/toxicity , Humans , Hydrogen-Ion Concentration , Keratitis/prevention & control , Preoperative Care , Skin/drug effectsABSTRACT
PURPOSE: To report a case of toxic keratitis due to chronic use of sodium hyaluronate eyedrops. CASE SUMMARY: A 74-year-old female visited our clinic with severe ocular pain and decreased vision in both eyes. She had received refractive surgeries in both eyes 10 years prior. She had been using sodium hyaluronate eyedrops for the treatment of dry eye symptoms for 10 years. Slit-lamp examination revealed inferior punctate erosions in the inferior part of the cornea in both eyes. With her history of chronic use of sodium hyaluronate and after ophthalmologic examination, we suspected keratitis medicamentosa due to sodium hyaluronate eyedrops. We discontinued the eyedrops she was using and prescribed autologous serum. One month later, ocular discomfort and decreased vision were improved and corneal erosions were decreased. CONCLUSIONS: In the present case, toxic keratitis was assumed to be associated with the use of sodium hyaluronate eyedrops and corneal erosions improved after the eyedrops were discontinued. We suggest sodium hyaluronate eyedrops are potentially hazardous and recommend a regular follow-up should be performed by a qualified ophthalmologist.
