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1.
Eye Contact Lens ; 46(2): e13-e16, 2020 Mar.
Article in English | MEDLINE | ID: mdl-30985489

ABSTRACT

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.


Subject(s)
Conjunctivitis, Bacterial/etiology , Contact Lenses, Hydrophilic/adverse effects , Eye Foreign Bodies/etiology , Eyelid Diseases/etiology , Keratitis/etiology , Orbit/anatomy & histology , Aged , Conjunctivitis, Bacterial/diagnosis , Conjunctivitis, Bacterial/surgery , Device Removal , Eye Foreign Bodies/diagnosis , Eye Foreign Bodies/surgery , Eyelid Diseases/diagnosis , Eyelid Diseases/surgery , Female , Humans , Keratitis/diagnosis , Keratitis/surgery , Slit Lamp Microscopy
2.
Orbit ; 38(1): 84-86, 2019 Feb.
Article in English | MEDLINE | ID: mdl-29565715

ABSTRACT

Adnexal and periocular involvement in Neisseria gonorrhoeae (NG) infection is rare. This report describes the case of a patient with a delayed diagnosis of gonococcal dacryoadenitis with contiguous conjunctivitis and corneal involvement. She underwent extensive inpatient laboratory and infectious workup but rapidly progressed to corneal perforation requiring emergent penetrating keratoplasty prior to a positive culture confirming the diagnosis. To date, this is the first reported case of ophthalmologic NG infection with associated conjunctivitis, dacryoadenitis, and corneal perforation.


Subject(s)
Conjunctivitis, Bacterial/microbiology , Corneal Perforation/microbiology , Dacryocystitis/microbiology , Eye Infections, Bacterial/microbiology , Gonorrhea/microbiology , Neisseria gonorrhoeae/isolation & purification , Anti-Bacterial Agents/therapeutic use , Conjunctivitis, Bacterial/diagnosis , Conjunctivitis, Bacterial/surgery , Corneal Perforation/diagnosis , Corneal Perforation/surgery , Dacryocystitis/diagnosis , Dacryocystitis/surgery , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/surgery , Female , Gonorrhea/diagnosis , Gonorrhea/surgery , Humans , Keratoplasty, Penetrating , Tomography, X-Ray Computed , Young Adult
5.
Article in English | MEDLINE | ID: mdl-23187819

ABSTRACT

PURPOSE: To describe a novel surgical treatment for patients with chronic relapsing conjunctivitis, corneal epitheliopathy, and ptosis secondary to giant fornix syndrome. METHODS: A retrospective case series was performed looking at the presence or absence of preoperative symptoms of eye irritation, tearing, blurry vision, and discharge in 6 patients diagnosed with giant fornix syndrome. Their examination findings were noted, and all patients underwent an extensive conjunctivoplasty with resection of redundant forniceal conjunctiva with subconjunctival antibiotics. Final visual acuity, symptoms, and examination findings were noted with a minimum follow up of 9 months. RESULTS: Six patients were treated from November 2009 to November 2011. Duration of symptoms ranged from 3 to 40 months. Four patients were women while 2 were men, with age ranging from 61 to 85 years. Common symptoms were severe mucopurulent discharge, eye redness, tearing, and irritation with examination findings of severe conjunctival discharge and injection, corneal epitheliopathy, upper eyelid ptosis, and a deep upper and lower eyelid fornix. Most patients had undergone previous treatments with topical and/or oral antibiotics or steroids. All patients underwent surgical intervention using the surgical technique to be described with resolution of their symptoms, and even an improvement of 2 or more lines of best corrected visual acuity (3 of 5 patients). CONCLUSIONS: The authors' novel surgical technique helps restore the abnormal anatomy found in patients with giant fornix syndrome and thus, helps resolve chronic relapsing conjunctivitis and surface disease associated with this often underdiagnosed condition. Further studies are needed to evaluate the risk of entropion and dry eye syndrome due to the modification of the posterior lamella.


Subject(s)
Conjunctivitis, Bacterial/surgery , Eyelid Diseases/surgery , Ophthalmologic Surgical Procedures , Staphylococcal Infections/surgery , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Cefazolin/therapeutic use , Chronic Disease , Combined Modality Therapy , Conjunctivitis, Bacterial/drug therapy , Conjunctivitis, Bacterial/microbiology , Cornea/physiology , Electrocoagulation , Eyelid Diseases/drug therapy , Eyelid Diseases/microbiology , Female , Humans , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Middle Aged , Recurrence , Retrospective Studies , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Syndrome , Visual Acuity/physiology
6.
Am J Ophthalmol ; 154(3): 527-33, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22609049

ABSTRACT

PURPOSE: To describe 3 patients with chronic mucopurulent conjunctivitis found to have an unrecognized sequestration of bacteria within tarsoconjunctival crypts of the upper eyelid. DESIGN: Review of 3 noncomparative cases. METHODS: settings: Institutional. study population: Three consecutive patients with tarsoconjunctival crypts. intervention procedure: Marsupialization of the individual crypts. main outcome measures: Resolution of chronic discharge and resolution of signs and symptoms. RESULTS: One patient with Stevens-Johnson syndrome and 2 patients with floppy eyelids had chronic mucopurulent conjunctivitis that was refractory to multiple medical and surgical interventions. Retention of a yellowish coagulum within the fistulous tracts of the tarsal conjunctiva was the site of pathologic features in all patients. The diagnosis was confirmed by squeezing out of the coagulum from the fistulous tracts by pinching the eyelid horizontally. Pseudomonas aeruginosa was isolated in 1 patient and Staphylococcus aureus was isolated in the other 2 patients. A Bowman probe could be passed through the fistulous opening to unveil the full extent of the conjunctival tunnels on the epitarsal surface. Each tract was marsupialized, and no relapse was found during a follow-up period of 12 to 96 months. CONCLUSIONS: Patients with chronic, relapsing, purulent conjunctivitis should have their upper eyelid everted to search for tarsoconjunctival crypts as the source of bacteria-laden coagulum. The formation of the crypts is likely the result of tarsal conjunctiva trauma with lamellar de-epithelialization, followed by re-epithelialization to form an epithelialized tunnel as a potential space for harboring bacteria. Marsupialization of the crypts obliterates the potential space and is curative.


Subject(s)
Conjunctivitis, Bacterial/microbiology , Eye Infections, Bacterial/microbiology , Eyelid Diseases/microbiology , Pseudomonas Infections/microbiology , Staphylococcal Infections/microbiology , Aged , Aged, 80 and over , Chronic Disease , Conjunctivitis, Bacterial/diagnosis , Conjunctivitis, Bacterial/surgery , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/surgery , Eyelid Diseases/diagnosis , Eyelid Diseases/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pseudomonas Infections/diagnosis , Pseudomonas Infections/surgery , Pseudomonas aeruginosa/isolation & purification , Staphylococcal Infections/diagnosis , Staphylococcal Infections/surgery , Staphylococcus aureus/isolation & purification
7.
Ophthalmology ; 119(1): 193-6, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22133798

ABSTRACT

OBJECTIVE: To describe the clinical characteristics and management of a group of patients who had chronic mucopurulent conjunctivitis that was probably due to Actinomyces infection of the lacrimal gland ductules. DESIGN: A retrospective, interventional case series. PARTICIPANTS: Seven patients (2 male; 29%) between 34 and 52 years of age (mean, 48.7 years; median, 49 years) who presented to the lacrimal clinic. INTERVENTION: Surgical excision of the infective focus (6 cases) or fenestration and expression of infective debris (1 case) from the affected lacrimal gland ductule--typically the most inferolateral of the ductules. MAIN OUTCOME MEASURES: The clinical features of this previously unrecognized cause of chronic conjunctivitis and its response to treatment. RESULTS: All cases settled rapidly after surgery. There was often a major delay in diagnosis, with the patients having symptoms for between 2 and 42 months before referral (mean, 13.3 months; median, 9 months); 5 patients received prolonged or ineffectual topical medical therapy before referral. CONCLUSIONS: Infective lacrimal gland ductulitis, commonly from Actinomyces infection, should be considered in patients with unexplained chronic mucopurulent conjunctivitis; the condition settles rapidly with surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.


Subject(s)
Actinomyces/isolation & purification , Actinomycosis/microbiology , Conjunctivitis, Bacterial/microbiology , Lacrimal Apparatus Diseases/microbiology , Actinomycosis/pathology , Actinomycosis/surgery , Adult , Chronic Disease , Conjunctivitis, Bacterial/pathology , Conjunctivitis, Bacterial/surgery , Female , Humans , Lacrimal Apparatus Diseases/pathology , Lacrimal Apparatus Diseases/surgery , Male , Middle Aged , Ophthalmologic Surgical Procedures , Retrospective Studies , Treatment Outcome
8.
Klin Monbl Augenheilkd ; 224(4): 234-6, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17458781

ABSTRACT

BACKGROUND: This study reports the one-year success rate of a new surgical approach to treat symptoms of chronic epiphora and/or mucopurulent discharge refractive to at least six months of medical treatment in patients with permeable lacrimal drainage system (irrigation test). DESIGN: retrospective chart review analysis. PARTICIPANTS: seventeen consecutive patients referred from a private praxis to an eye clinic to treat, by surgery, symptoms of either chronic epiphora (8/17), mucopurulent discharge (7/17), or both (2/17). INTERVENTION: Piffaretti's non-laser transpunctal endoscopic diagnostic/surgical lacrimal drainage procedure (17/17), lacrimal punctoplasty (16/17), conjunctivochalasisplasty (5/17), lateral canthoplasty (1/17), and/or both conjunctivochalasisplasty and lateral canthoplasty (3/17). In the majority of these patients (13/17) partial obstructions within the lacrimal canaliculus (3/17), the ductus nasolacrimalis (7/17), or both (3/17) were observed endoscopically and removed with Piffaretti's lacrimal trephines. MAIN OUTCOME MEASURES: patient's self-assessment of symptom improvement one year after surgery. RESULTS: One year after surgery, 88 % (15/18) of patients had a marked improvement of their symptoms, 64 % (11/17) of them even reporting as being symptom free. When conducted (14/17), irrigation always revealed a permeable lacrimal system (test not performed in a lost-to-follow-up and in two symptom-free patients). CONCLUSIONS: Surgery can be an alternative therapeutic option for patients who have a permeable lacrimal drainage system and suffer from chronic epiphora and/or mucopurulent discharge that do not respond to conventional conservative medical therapies.


Subject(s)
Conjunctivitis, Bacterial/complications , Conjunctivitis, Bacterial/surgery , Dry Eye Syndromes/surgery , Lacrimal Apparatus Diseases/complications , Lacrimal Apparatus Diseases/surgery , Ophthalmologic Surgical Procedures/instrumentation , Ophthalmologic Surgical Procedures/methods , Adult , Chronic Disease , Conjunctivitis, Bacterial/diagnosis , Dry Eye Syndromes/complications , Female , Humans , Lacrimal Apparatus Diseases/diagnosis , Male , Middle Aged , Retrospective Studies , Treatment Outcome
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