A case of orbital emphysema as an ocular emergency.

Orbital emphysema is radiologically apparent in 50% of cases of orbital fractures, but it is generally a benign, self-limited condition. However, visual loss may occur if a fracture produces orbital compression via a ball-valve effect, allowing air to enter but not leave the orbit. A case of compressive orbital emphysema complicated by ischemic optic neuropathy is reported. Intraorbital needle aspiration relieved the compression with improvement of visual acuity and normalization of intraocular pressure.

Cataract development and removal. How to answer the questions a patient asks.

Cataract surgery with implantation of an intraocular lens is a safe procedure that, when indicated, can quickly and effectively improve vision. Indications vary with patients, but surgery is generally needed when vision has deteriorated to a level that interferes with the patient's life-style. The procedures of choice for cataract extraction are extracapsular surgery by conventional large incision and phacoemulsification by small incision with placement of a posterior chamber lens. Patients with macular degeneration do not benefit from cataract surgery as much as those with normal macular function, but they may enjoy brighter vision after surgery. Tests that can ascertain whether the macula is functioning allow the physician to inform the patient as to the likelihood of improvement. Ultimately, the patient must judge whether the benefit of surgery is worth the risk. If the patient elects to undergo surgery, sending flowers is a nice gesture, but the physician's real task is to let the patient see--as well as smell--the roses.

Contact lenses and refractive surgery. Addressing patient problems and concerns.

Contact lenses, used by millions of people throughout the United States, are a safe, effective way to correct refractive errors and to improve the vision of patients with diseased corneas. Proper care and cleaning of contact lenses is very important; at the first sign of eye irritation, the lenses should be removed and a physician should be consulted. New advances include improved gas-permeable materials, new hypoallergenic solutions, and planned replacement systems. Excimer laser treatment and radial keratotomy are more invasive methods of correcting refractive problems and must be approached with great care and caution.

Subepithelial infiltrates in Acanthamoeba keratitis.

Six patients had Acanthamoeba keratitis that manifested an unusual type of subepithelial corneal infiltrate late in the course of the disease. These infiltrates occurred in the anterior corneal stroma, often in a location removed from the site of infection. In four of these patients the infiltrates occurred with no other clinical signs of inflammation. Two patients had mild foreign-body sensation that resolved despite the persistence of the subepithelial infiltrates. The infiltrates resolved with topical corticosteroid therapy in three patients; however, in two of these three patients the infiltrates recurred when corticosteroid therapy was tapered or discontinued. The subepithelial infiltrates appeared and behaved similarly to those associated with viral and chlamydial corneal infections. An immunologic mechanism may be responsible for these unusual delayed-in-onset infiltrates.