Fingerprick Autologous Blood in the Treatment of Severe Dry Eyes and Ocular Surface Disease.

PURPOSE: To evaluate the efficacy of autologous blood eye drops in patients diagnosed with severe ocular surface disease and dry eye who were unresponsive to conventional therapy and who would otherwise be considered for autologous serum eye drops. METHODS: A total of 38 eyes of 19 patients (15 women and 4 men) with ocular surface disease and severe dry eye refractory to conventional treatment were treated with fingerprick autologous blood 4 times daily for 6 months. Follow-up visits occurred at 1-, 3-, and 6-month intervals. At each visit, visual acuity, Oxford Grading Scheme score, tear film break-up time, Schirmer test, and ocular surface disease index were measured. RESULTS: There was a significant improvement in the ocular surface staining score at all time gates. The mean score at presentation was 2.13, and this improved to 1.50 at 1 month (P < 0.001), 1.29 at 3 months (P < 0.01), and 1.42 at 6 months (P < 0.01). There was an improvement in tear film break-up time from 4.75 seconds at baseline to 6.79 seconds at 3 months (P < 0.01) and 7.0 seconds at 6 months (P < 0.001). An improvement in the Schirmer test was only found at 6 months with an improvement from 3.67 mm to 13.33 mm (P < 0.05). There was no statistical change in visual acuity at any time gate or ocular surface disease index score, although 83% of patients reported an improvement in their symptoms at 6 months. There were no adverse events reported. CONCLUSIONS: Fingerprick autologous blood is an effective, readily accessible, and safe therapy for the treatment of recalcitrant cases of severe ocular surface disease and dry eye unresponsive to conventional therapy.

Atypical conjunctival CD5 positive mucosa-associated lymphoid tissue (MALT) lymphoma.

A 61-year-old woman with intermittent ocular irritation redness and swelling of her eyes was followed up and investigated. The diagnosis was conjunctival CD5 positive mucosa-associated lymphoid tissue (MALT) lymphoma, which is an atypical and rare type of pathology of the eye, in which the clinical course/behavior is not fully understood. Our experience showed that this disease is indolent and responds well to radiotherapy. It can recur in the fellow eye, even after as many as eight years of successful treatment with no evidence of recurrences in the previously affected eye. Therefore, long-term periodic follow-up is mandatory to detect recurrences in such patients. Further studies are also required to elucidate a more conclusive clinical behavior of this disease so that a clearer therapeutic and management plan can be devised for future patients with this disease.

Variable angle of strabismus related to timing of opiate ingestion.

Heroin (diamorphine) is a highly addictive opiate with potential for misuse. A small number of reports have linked the commencement of heroin misuse to acute exotropia with diplopia and subsequent withdrawal to esotropia in individuals without previous symptoms.(1-5) We describe a young adult who sought strabismus surgery to correct a large-angle exotropia. Detailed patient history and orthoptic measurements at different times of the day revealed a fluctuating angle of divergence relating to the timing of opiate ingestion, rendering surgery inappropriate. We suggest that opiate misuse, which may not willingly be disclosed by patients, should be specifically asked about before acquired-strabismus surgery is undertaken in adults.

Leucocytoclastic vasculitis presenting as bilateral marginal keratitis.

Leucocytoclastic vasculitis is an immune-mediated, neutrophil-induced small vessel disease. Clinically, it presents with cutaneous palpable painless purpuric papules on the extremities. Ocular manifestation reported in the literature is rare and includes peripheral ulcerative keratitis, panuveitis and multifocal retinitis all preceded by cutaneous lesions. Herein a fatal case of leucocytoclastic vasculitis initially presenting with bilateral marginal keratitis without any cutaneous lesions is reported.