Two Soft Contact Lenses Retained in the Superior Fornix for 15 Years in a Patient With Unique Orbital Anatomy.

A 70-year-old white woman presented to her ophthalmologist with bacterial conjunctivitis resistant to treatment. The relationship between the patient's globe and superior orbital rim prompted high clinical suspicion of an occult foreign body as the cause. The following article describes the office visits preceding the discovery of two adhered soft contact lenses lodged in the superior fornix of the right eye that had been hidden for 15 years. We discuss the role her unique orbital anatomy played in successfully concealing these foreign bodies for over a decade. In addition, we present an algorithm to practice when an occult foreign body is suspected, which includes effective clinical techniques.

Chronic Conjunctivitis From a Retained Contact Lens.

PURPOSE: To help clinicians diagnose and manage unilateral recalcitrant chronic bacterial conjunctivitis secondary to a retained soft contact lens and describe the first report of Gram-negative bacteria causing this condition. METHODS: Chart review of successive cases presenting with unilateral chronic conjunctivitis with positive cultures and a retained contact lens. RESULTS: Three cases were identified and described. Culturing of the retained contact lenses grew Pseudomonas aeruginosa in the first case, Achromobacter xylosoxidans in the second, and Staphylococcus epidermidis in the third. All three patients were successfully treated with removal of the retained lens and targeted antibiotic eyedrop therapy. CONCLUSIONS: Unilateral chronic recurrent or recalcitrant purulent papillary conjunctivitis is rare, and a retained contact lens should be suspected in patients with a history of wearing contact lenses. Careful examination with double eversion of the upper eyelid and sweeping of the fornices can recover the offending lens. Although only Gram-positive organisms have been isolated in previous reports, two of our three cultures grew Gram-negative organisms, highlighting the importance of broad-spectrum antibiotic usage for these cases.

Lentes de contato provocando conjuntivite por Ralstonia Pichettii / Contact lenses causing conjunctivity by Ralstonia Pichettii

Resumo O presente relato apresenta o caso de conjuntivite causada por Ralstonia pichettii em paciente imunocompetente usuária de lente de contato. A bactéria isolada da solução utilizada para desinfecção das lentes R. pichettii não pertente a microbiota humana mas infecta pacientes imunodeprimidos e está presente em soluções aquosas. Não há padronização de sensibilidade para esta bactéria e poucos antibióticos foram testados para bactérias não fermentadoras da glicose. Devido ao reduzido perfil de sensibilidade aos antimicrobianos demonstrado pela R. pichettii, torna-se importante a identificação correta deste agente etiológico em quadros de conjuntivite e ceratites. Este relato de caso ilustra que R. Pickettii é um patógeno mais importante do que se pensava anteriormente.

Abstract The present report reports a case of conjunctivitis caused by Ralstonia pichettii in an immunocompetent patient wearing a contact lens. The bacterium isolated from the solution used to disinfect R. pichettii does not belong to the human microbiota but infects immunodepressed patients and is present in aqueous solutions. There is no standardization of sensitivity for this bacterium and few antibiotics have been tested for non-fermenting glucose bacteria. Due to the reduced antimicrobial sensitivity profile demonstrated by R. pichettii, it is important to correctly identify this etiologic agent in conjunctivitis and keratitis. This case report illustrates that R. Pickettii is a more important pathogen than previously thought.

Atypical presentation of cat scratch disease: Parinaud's oculoglandular syndrome with facial nerve paresis.

A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive Bartonella henselae IgG level and diagnosed him with cat scratch disease presenting as Parinaud's oculoglandular syndrome. He was treated with a 5-day course of Azithromycin 250 mg with definitive improvement.

Incidence, Etiology and Risk Factors Associated with Neonatal Healthcare-Associated Conjunctivitis: A Prospective Study from a Tertiary Care Hospital in India.

INTRODUCTION: Healthcare-associated conjunctivitis (HAC) can lead to serious sequelae including blindness. We conducted a one-year prospective study to determine the epidemiology of neonatal HAC at a tertiary-care hospital in India. METHODS: From the neonates fulfilling a set of predefined inclusion criteria, cases of HAC were diagnosed based on CDC guidelines. Conjunctival swabs, obtained from neonates with suggestive clinical signs, were processed using standard protocols. Twenty-eight potential risk factors were analyzed. RESULTS: We detected 24 cases of HAC among 591 enrolled neonates, with Escherichia coli being the most frequently isolated microorganism. On multivariate analysis, intubation at birth (p = 0.046) and orogastric feeding (p = 0.029) had a statistically significant association with neonatal HAC. Average hospitalization increased from 9.6 to 20.8 days for neonates diagnosed with HAC. CONCLUSION: A standardized case-definition and physician awareness of potential serious sequelae would help improve detection rates and timely institution of therapy. Hand hygiene could help control the menace of neonatal HAC.

Rickettsial infection caused by accidental conjunctival inoculation.

The most common transmission route of tick-borne Rickettsia is through tick bite; nevertheless, other transmission routes should also be considered. We report a case of rickettsial infection in a 15-year-old boy caused by accidental contamination of the conjunctiva through the infected fluid of a crushed engorged tick removed from a dog. Right eye pain, conjunctival hyperaemia with mucopurulent exudate, chemosis and eyelid oedema were the first signs and symptoms. Two days later, the boy developed fever, myalgia, headache, abdominal pain and was vomiting; physical examination showed multiple cervical adenopathies but no rash. He was treated with doxycycline (200 mg/day) for 7 days with progressive resolution of clinical signs. Rickettsial infection was confirmed by immunofluorescence assay with serological seroconversion in two consecutive samples. Rickettsia conorii or Rickettsia massiliae were the possible causal agents since they are the Rickettsia spp found in the Rhipicephalus sanguineus dog tick in Portugal.

Conjunctivitis: a systematic review of diagnosis and treatment.

IMPORTANCE: Conjunctivitis is a common problem. OBJECTIVE: To examine the diagnosis, management, and treatment of conjunctivitis, including various antibiotics and alternatives to antibiotic use in infectious conjunctivitis and use of antihistamines and mast cell stabilizers in allergic conjunctivitis. EVIDENCE REVIEW: A search of the literature published through March 2013, using PubMed, the ISI Web of Knowledge database, and the Cochrane Library was performed. Eligible articles were selected after review of titles, abstracts, and references. FINDINGS: Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks. Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis. Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy. Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help; itching is the most consistent sign in allergic conjunctivitis, and treatment consists of topical antihistamines and mast cell inhibitors. CONCLUSIONS AND RELEVANCE: The majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases. However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics. Treatment for viral conjunctivitis is supportive. Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis.

Effect of hemodialysis duration on conjunctival bacterial flora and susceptibility of conjunctival bacterial isolates to fluoroquinolones.

PURPOSE: To determine the differences between conjunctival bacterial flora of hemodialysis patients and healthy subjects, the effect of duration of hemodialysis on conjunctival bacterial flora, and in vitro antibiotic susceptibility patterns of conjunctival bacterial flora to fluoroquinolones. METHODS: Sixty healthy subjects (32 male, 28 female) and 60 hemodialysis patients (33 male, 27 female) who had renal failure due to reasons other than diabetic nephropathy and with no previous history of intraocular surgery participated in this study. Statistical analysis of the difference between the culture positivity of hemodialysis patients and a control group was determined using the chi-square test. Pearson's correlation test was used to quantify the correlations among culture positivity and duration of hemodialysis. RESULTS: Conjunctival culture positivity of the hemodialysis patients and the control group was 58.3 and 45.0%, respectively, and there was no statistically significant difference between these groups (p = 0.144). Pearson's correlation test revealed that there was a weak but statistically significant positive correlation between culture positivity and duration of hemodialysis (r value was 0.378 [p = 0.003]). Staphylococcus aureus (28.3%) and Staphylococcus epidermidis (20.0%) were the most frequently isolated organisms in the hemodialysis patients, Staphylococcus epidermidis (26.7%) and Staphylococcus aureus (6.7%) were the most frequently isolated organisms in the control group. Resistance of most frequently isolated organisms (Staphylococcus aureus and Staphylococcus epidermidis) from control group and hemodialysis patients to ofloxacin, levofloxacin, moxifloxacin, and gatifloxacin were 20, 15, 5, and 5%, and 34.5, 20.7, 6.9, and 6.9%, respectively. CONCLUSIONS: As distinct from the control group, S. aureus colonization was isolated more from the hemodialysis patients. Culture positivity of the hemodialysis patients was positively correlated with the duration of hemodialysis. Antibiotic susceptibility of isolates from conjunctival bacterial flora of hemodialysis patients were less than healthy control group.

Síndrome oculoglandular de parinaud como primera manifestación de la enfermedad por arañazo de gato / Parinaud oculoglandular síndrome as first manifestation of cat scratch disease

Caso clínico: Se presenta el caso de un varón mestizo de 33 años, con cuadro de conjuntivitis aguda purulenta en ojo izquierdo, lesión granulomatosa sobreelevada en el tercio externo de la conjuntiva tarsal y adenopatías preauricular y submandibular izquierdas. Se detectó serología IgM positiva para B. henselae. Se consiguió remisión completa con azitromicina oral y ciprofloxacino tópico. Conclusión: El síndrome oculoglandular de Parinaud (SOGP) es la manifestación ocular más frecuente de la enfermedad por arañazo de gato (EAG). La EAG debe considerarse entre los diagnósticos diferenciales ante cuadros de conjuntivitis unilateral asociada a adenopatías regionales (AU)

Case report: We report the case of a 33 year old mestizo male, with acute purulent conjunctivitis in his left eye, an elevated granulomatous lesion in the outer third of the tarsal conjunctiva and left preauricular and submandibular lymph nodes. IgM serology was positive for B. henselae. Complete remission was achieved with oral azithromycin and topical ciprofloxacin. Conclusion: Parinaud oculoglandular síndrome is the most common ocular manifestation of cat scratch disease (CSD). The CSD should be considered in the differential diagnosis in the case of unilateral conjunctivitis associated with regional lymphadenopathy (AU)

A case of recalcitrant bacterial conjunctivitis.

It is important to be vigilant for retained foreign bodies as a cause of recalcitrant bacterial conjunctivitis, even in the absence of foreign body sensation. A relapsing-remitting history should prompt referral to an ophthalmology department. All patients presenting with a red eye should be asked specifically about contact lens wear, and causes of conjunctivitis other than those bacterial in nature--such as viral and chlamydial infections or allergy--should be borne in mind. Contact lens wear may cause ocular complications, ranging from mild dry eye symptoms to contact lens-associated microbial keratitis, which is an ophthalmic emergency. Contact lens-associated corneal infections caused by Pseudomonas aeruginosa, which can rapidly penetrate the cornea, or Acanthamoeba can be severe and sight threatening. All patients with a history of contact lens wear and red flag symptoms such as eye pain, redness, reduction or change in vision, corneal epithelial defect, discharge, foreign body sensation or failure to respond to antibiotics should be referred for an urgent ophthalmic review. Retained contact lenses are known to cause several ocular complications, such as giant papillary conjunctivitis and ulcerative keratitis which may threaten corneal penetration. Lid eversion may reveal a hidden sub-tarsal contact lens. Use of fluorescein may also allow visualisation of any corneal epithelial defect. A careful slit lamp examination by an ophthalmologist is required to exclude this critical finding definitively.

Giant fornix syndrome: a case series.

PURPOSE: To describe the demographics, characteristics, and treatment of giant fornix syndrome, a rare cause of chronic purulent conjunctivitis in the elderly. METHODS: Retrospective chart review of five patients with giant fornix syndrome evaluated by the Cornea Service, Oculoplastics and Orbital Surgery Service and the Department of Pathology at the Wills Eye Institute. RESULTS: The median age of the 5 female patients was 75 years (mean 80, range 70-95). The median duration of eye symptoms before presentation was 2 years (mean 2.4, range 1-4). Before referral, the chronic conjunctivitis was treated with topical antibiotics in all 5 cases and with additional dacryocystorhinostomy in one case. The right eye was affected in 2 cases, and the left eye was affected in the other 3 cases. Floppy eyelids were present in 2 cases. The superior fornix was involved in 4 cases, and the inferior fornix was involved in one case. Pseudomembranes and superficial punctate keratitis (SPK) were seen in 3 cases. Diagnosis of giant fornix syndrome was made in all 5 cases. Conjunctival culture grew methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and S. aureus in singular cases. Case 1 was treated with topical moxifloxacin, Case 2 was treated with topical vancomycin and repair of the upper eyelid, Case 3 was treated with topical besifloxacin, and Case 4 was treated with dacryocystorhinostomy and topical vancomycin. Case 5 was treated with reconstruction of the left upper eyelid. The median duration of follow up was 4 months (mean 21.6, range 1-84). CONCLUSIONS: Giant fornix syndrome can lead to chronic relapsing conjunctivitis in the elderly. Deep conjunctival fornices in affected patients can be a site for prolonged sequestration of bacteria causing recurrent infections. Removing the infected debris from the superior fornix and reconstruction of the upper eyelid may prevent the recurrent chronic persistent infection.

Ocular manifestations of meningeal carcinomatosis: a case report and literature review.

BACKGROUND: Meningeal carcinomatosis (MC) is a devastating and frequently fatal complication of cancer, affecting approximately 5% of patients with systemic malignancies. The disease is characterized by diffuse infiltration of the meninges and cerebrospinal fluid by metastatic tumor cells. The disease affects all levels of the central nervous system, with the most common symptoms of the disease being headache, change in mental status, diplopia, hearing loss, facial numbness, and vision loss. Ocular or visual symptoms have been reported in 91% of patients with MC and may progress to total blindness. CASE REPORT: This report presents a case of MC with multiple ocular manifestations and a review of the literature regarding diagnosis and treatment of the disease. CONCLUSION: Eye care professionals can play a critical role in directing care and achieving an early diagnosis of MC and should be educated about this rare condition.