Corneal Involvement in HIV-infected Individuals.

Corneal involvement in HIV-infected individuals may be broadly classified into two categories, namely, infectious and noninfectious with the vast majority of manifestations occurring in the former. In this article, we shall focus on these two categories and strive to highlight those presentations that should alert the clinician to suspect underlying HIV infection. Infectious group mainly consists of Herpitic group of viral infections. Bacterial causes may be due to Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeroginosa, alpha hemolytic Streptococcus, Micrococcus and Bacillus. Fungalf keratitis in HIV-infected individuals depends on the geographic locations from which patient comes. Microsporidia and Acanthamoeba are common Protozoal causes. Non-infective inflammatory causes include peripheral ulcerative keratitis, keratoconjunctivitis sicca, and squamous cell carcinoma of the conjunctiva. Severity which is abnormally severe or very minimally reactive makes the clinician suspect of immunosuppression.

Ocular complications of oak processionary caterpillar setae in the Netherlands; case series, literature overview, national survey and treatment advice.

During early summer 2019, the Netherlands experienced an outbreak of the exotic oak processionary caterpillar. The vast number of caterpillars, which live in large nests on oak trees before they turn into moths, possess thousands of small, barbed hairs (setae) that are disseminated with the wind. The hairs cause a range of primarily dermatologic problems. However, Dutch ophthalmologists started reporting patients with ophthalmologic complaints caused by the penetrating hairs of the oak processionary caterpillar. This paper focuses on the ophthalmologic complications caused by the caterpillar hairs. We collected a series of four cases with reports ranging from a corneal erosion with hairs lodged into the cornea, to a sterile endophthalmitis in which hairs were found in the vitreous. A literature review for similar cases was performed using the PubMed and Embase database. Together with the Dutch Ophthalmic Society (Nederlands Oogheelkundig Gezelschap, NOG), a national survey was issued to determine the scale of this new problem. This showed that oak processionary caterpillar related complaints are primarily limited to the south of the Netherlands. Suggested ophthalmic treatment guidelines are presented. With the next summer at the doorstep, and limited preventative measures against the caterpillar hairs, we expect a new wave of ophthalmologic complaints coming year as well.

First confirmed case of bovine besnoitiosis in Rwanda.

An-eighteen months (one and half years) old heifer was presented with a progressive loss of weight leading to cachexia and was attended to by a team of doctors from the ambulatory clinic of the School of Animal Science and Veterinary Medicine, University of Rwanda. Clinical examination revealed scleroderma of both sides of the neck and pinpoint cysts in the sclera and conjunctiva as well as corneal opacity of the left eye. Histological examination of skin biopsy showed a mononuclear dermatitis with several cysts of 100-300 µm filled up with bradyzoites in the subcutis and dermis. These lesions are consistent with bovine besnoitiosis, a disease caused by Besnoitia besnoiti in cattle. To the best of our knowledge, this is the first confirmed case of bovine besnoitiosis in Rwanda.

Angiostrongylus-a technique for removing a rare parasite from the cornea of a child.

We report a case of an Angiostrongylus parasite in the corneal stroma in an 8-year-old boy and our technique for its removal. The parasite was identified on slit-lamp examination. Its location was confirmed on anterior segment optical coherence topography (AS-OCT). The parasite was found on the superficial corneal stroma in the periphery and was removed after lamellar dissection of the cornea following marking with trephine.

Effect of storage time and temperature on the detection of Pseudomonas aeruginosa, Acanthamoeba and Herpes Simplex Virus from corneal impression membranes.

The effect of storage time and temperature on the recovery of pathogen DNA from polytetrafluorethylene (PTFE) was investigated. PTFE impression membranes were inoculated with Pseudomonas aeruginosa, Herpes Simplex Virus-1 (HSV-1) or Acanthamoeba and stored at -70 °C, -20 °C, +4 °C or +35 °C. PCR was performed on days 0, 1, 2, 3, 7 and months 1, 3 and 10 post-inoculation. We found no reduction in the DNA recovery of any of the studied microorganisms for the first 3 days of storage up to +35 °C. For HSV-1 and P. aeruginosa, storage for 3 months at +35 °C was associated with a significant reduction in DNA recovery (P<0.001), but not at +4 °C, -20 °C or -70 °C for 1 month for P. aeruginosa and for 10 months for HSV-1. Acanthamoeba DNA recovery was not affected by any storage parameters (P=0.203). These results will inform the investigation of microbial keratitis where access to microbiological testing is not readily available.

Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty.

A healthy 22-year-old male presented to Institutional Cornea Clinic with an intracorneal mass overlying the pupil with lobulated edges having many tiny greyish white dots. The patient had a history of trauma while swimming in a pond with subsequent removal of intracorneal foreign body in the left eye approximately a year prior to presentation. Anterior segment optical coherence tomography (OCT) confirmed that an intracorneal mass sparing deep stroma and Descemet's membrane. A deep anterior lamellar keratoplasty (DALK) was performed in left eye and the mass was sent for histology examination. Histology evaluation was suggestive of rhinosporidiosis. The patient achieved 20/60 BCVA with -1.25 Χ× 120° 1 year postoperatively without any evidence of recurrence at the graft-host interface. This unique presentation (as an 'intracorneal mass') of ocular rhinosporidiosis emphasizes that clinicians from our region of the world must consider rhinosporidiosis in the differential diagnosis especially with a history of penetrating injury while swimming in pond or river water.

Cryptosporidium baileyi infection associated with an outbreak of ocular and respiratory disease in otus owls (Otus scops) in a rehabilitation centre.

Cryptosporidiosis has been reported in more than 30 avian species worldwide. Although some cases of cryptosporidiosis have been described in captive birds of prey in the order Falconiformes, to date there have been no reports of the disease in wild raptors. Here we describe for first time an ocular and respiratory disease associated with Cryptosporidium baileyi in wild scops owl (Otus scops, order: Strigiformes). Sixteen otus owl fledglings born in the wild during the summer of 2008 were admitted to the Torreferrussa Wildlife Rehabilitation Centre (Catalonia, northern Spain) in July and August of the same year. In the middle of September, blepharoedema, conjunctival hyperaemia and mucopurulent ocular discharge were diagnosed unilaterally in 75% (12/16) of the birds and bilaterally in 25% (4/16). Moreover, five birds (31%) developed diffuse epithelial corneal oedema, one owl (6%) displayed mild anterior exudative uveitis and another developed rhinitis (6%). Two birds were euthanized because of the severity of disease. The histopathology demonstrated cryptosporidia-like structures in the conjunctival cells and in the nasal respiratory epithelium of one owl. Cryptosporidium spp. oocysts (6.5 to 7.0 x 5.0 to 5.5 microm) were identified by immunofluorescent antibody test (IFAT) in histological sections from eyelids, trachea and respiratory sinuses and in swab samples from the glottis, choanal slit and conjunctival sac. Polymerase chain reaction and DNA sequence analysis confirmed the presence of C. baileyi. Birds were treated orally with azithromycin (40 mg/kg) once a day for 15 days, and by the end of the treatment all owls tested negative for the parasites, by IFAT, and did not display further signs of disease.

Nd:YAG photodestruction of a presumed corneal Toxocara canis larva.

PURPOSE: To describe the technique of Nd:YAG photodestruction of a presumed Toxocara canis corneal larval migrans and to report the unique clinical combination of a corneal nematode and diffuse unilateral subacute neuroretinitis (DUSN). METHODS: Clinical case report. RESULTS: A 63-year-old white male presented with idiopathic neuroretinitis treated empirically with systemic anti inflammatory therapy. Subsequently, he developed keratouveitis with an obvious corneal larva. Serology was positive for T. canis. Laser destruction of the larva combined with topical steroid and oral albendazole therapy led to initial resolution, followed by 1 episode of recurrent keratouveitis without identified ocular surface or intraocular larvae. This was cleared with topical steroids. A second empiric course of oral albendazole was also administered. The patient has shown no ocular recurrences or evidence of systemic involvement 1 year after the second course of treatment. CONCLUSIONS: Corneal larvae can be safely and successfully destroyed by Nd:YAG photodestruction. T. canis may be one of several nematodes responsible for DUSN. A careful examination of the anterior segment is essential in the management of patients with DUSN.

A case of descemet's membrane rupture in a patient affected by Acanthamoeba Keratitis.

OBJECTIVES: We report ultrasound biomicroscopy (UBM) evidence of Descemet's membrane rupture in a patient affected by Acanthamoeba keratitis without corneal perforation. METHODS: A 38-year-old woman who was a habitual wearer of monthly disposable soft contact lens was admitted to our unit for a severe ulcerated corneal abscess. Two days after admission, the patient presented acute stromal hydrops. Ultrasound biomicroscopy examination revealed a Descemet's membrane rupture and an inflammatory reaction in the anterior chamber. Smears with Gram 17 staining and cultural examination revealed the presence of Acanthamoeba. We started specific therapy with propamidine 0.1% and polyhexamethylene biguanide 0.02% eyedrops; we suspended propamidine therapy after 2 weeks form the onset, when the ulcer had recovered, and we continued topical therapy with polyhexamethylene biguanide 0.02% for 6 months. We performed UBM examinations at each control visit during the follow-up that lasted for 18 months. RESULTS: At 1-month's follow-up, the symptoms and corneal alterations had significantly improved, while UBM revealed a spontaneous reattachment of the endothelium-Descemet layer. At 12 months' follow-up, best-corrected visual acuity had improved from hand movements at onset to 20/40, and no sign of intraocular involvement was evidenced. CONCLUSIONS: Acanthamoeba is a ubiquitous protozoan that can affect the cornea, even colonizing the deep layers, causing rupture of the Descemet's membrane. Ultrasound biomicroscopy examination confirmed the severe pathogenicity of this parasite and confirmed that only a prompt diagnosis can limit the damage caused by this affection.

First report of thelaziosis (Thelazia anolabiata) in an Andean Cock of the Rock (Rupicola peruviana) from Peru.

Thelazia anolabiata is a spirurid nematode living in the orbits of birds which can cause lacrimation, keratitis, conjunctivitis, and corneal ulcers. This species is reported for the first time from an Andean Cock of the Rock, Rupicola peruviana (Passeriformes: Cotingidae), from a zoo in Lima, Peru. Clinical signs of keratoconjunctivitis were resolved with the treatment of ivermectin, ciprofloxacin, and an epithelium regenerator, and the host is presently in good health. The nematodes were identified using the primary characteristics used to differentiate the species of this genus as lengths of spicules and other morphologic characteristics.

Ocular lesions associated with attachment of the copepod Ommatokoita elongata (Lernaeopodidae: Siphonostomatoida) to corneas of Pacific sleeper sharks Somniosus pacificus captured off Alaska in Prince William Sound.

Twenty eyes from 10 Pacific sleeper sharks Somniosus pacificus, infected with the copepod Ommatokoita elongata, were collected in Prince William Sound, Alaska, and the eyes of an additional 18 S. pacificus captured in the same area were inspected for copepods. Prevalence of infection by adult female O. elongata was 97% (n = 28); mean intensity of infection was 1.89 (+/-1SD = 0.32) adult female copepods per infected shark and 1.0 (+/- 1SD = 0.0) adult female copepods per infected eye. Five of the 20 collected eyes were infected by O. elongata chalimi, and 9 of 20 eyes had 1 to several remnants of bullae embedded in the cornea. Bullae were each associated with a corneal opacity, and anchoring plugs of chalimi were associated with pinpoint lesions in the cornea or conjunctiva. All eyes exhibited marked edema and erosion of the bulbar conjunctiva, and this torus-shaped lesion corresponded to each O. elongata adult female's presumed feeding and abrasion radius. Histological examinations revealed lesions in the anterior segment of eyes to be generally similar, but graded, in severity, and in all eyes they involved the conjunctiva, cornea, filtration angle, and iris. Epithelial lesions were characterized by corneal ulceration, dysplasia, hyperplasia, and heterophilic keratitis, and by ulcerative conjunctivitis accompanied by epithelial hyperplasia with rete peg formation. Disorganization of fibers, necrosis, mineralization, minimal heterophilic influx, and perilimbic neovascularization were associated with bullae in the corneal stroma. Within the limbus there was diffuse histiocytic and lymphocytic inflammation and marked lymphofollicular hyperplasia. Heterophilic and mononuclear anterior uveitis affecting the filtration angle and anterior surface of the iris was also observed in most eyes. One eye had a partial transcorneal prolapse of a ruptured lens, with degenerative changes in the ruptured lens and severe keratitis associated with the anchoring devices of an adult copepod and several chalimi. Fourteen eyes exhibited 1 to several, randomly distributed, small, round to irregular, corneal opacities or pits that were not associated with copepods, and it is likely that these opacities represented lesions associated with adult female or larval anchoring devices from past infections. The avascular cornea represents a niche that is somewhat shielded from host immune reactions, and this, and the fact that the general body surface of sleeper sharks is covered by tall and sharp placoid scales, may partially explain the corneal attachment of O. elongata adult females. It was concluded that O. elongata infections can lead to severe vision impairment in Pacific sleeper sharks but that these infections do not significantly debilitate hosts because they probably do not need to rely on acute vision for their survival.

Immune mechanisms in Onchocerca volvulus-mediated corneal disease (river blindness).

Infection with the parasitic nematode Onchocerca volvulus can lead to severe visual impairment and blindness. In an effort to characterize the molecular basis for the inflammatory response in the cornea, we have developed a murine model for O. volvulus-mediated keratitis in which parasite antigens are injected into the corneal stroma of sensitized mice. This model reproduces the two main clinical features of human disease, corneal opacification and neovascularization. Histological analysis of corneas from these mice reveals a biphasic recruitment of neutrophils and eosinophils to the central cornea, along with a small, but persistent number of CD3+ cells. In this review, we present evidence that production of antigen-specific T cell and antibody responses are essential for development of O. volvulus keratitis, and we propose a sequence of molecular and cellular events that lead to migration of inflammatory cells to the cornea and to loss of corneal clarity.

Ophthalmomyiasis caused by Sarcophaga crassipalpis (Diptera: Sarcophagidae) in a hospital patient.

Nine sarcophagid larvae were found on the right eyelid, cornea, and bulbar conjunctiva of a debilitated patient in a hospital in Osaka, Japan. Inflammation of the right eyelid and conjunctival congestion, probably initiated or aggravated by the larvae, were found. The larvae were removed and reared for accurate identification, and, on the basis of the characteristics of the 3rd instar and adult flies, the species was identified as Sarcophaga crassipalpis Macquart. This is a report of ophthalmomyiasis caused by this facultative parasite in a human. Patients with diminished consciousness in hospitals need protection from flies.

Zoonotic Onchocerca (Nematoda:Filarioidea) in the cornea of a Colorado resident.

OBJECTIVE: A female patient, resident in the state of Colorado, presented with iritis of the right eye. Slit-lamp examination showed the presence of a thin, threadlike worm entwined in the cornea. The patient was taken to surgery for removal of the parasite. DESIGN: A case report. INTERVENTION: A 3-mm-long supertemporal incision was made in the cornea and further dissected until the worm could be grasped and removed by gentle traction. RESULTS: The worm, a filarial nematode, was identified as a member of the genus Onchocerca, most likely Onchocerca cervicalis, a natural parasite of horses. The patient had an uneventful recovery, and 1 week after surgery, her visual acuity, intraocular pressure, and corneal edema were all resolving. CONCLUSION: In the United States and elsewhere, most cases of zoonotic filarial infection involving the eye are caused by Dirofilaria or Dipetalonema-like worms. However, the current case was caused by a species of Onchocerca. This is the first case of zoonotic Onchocerca from the eye to be reported, only the second case of zoonotic Onchocerca in the United States, and the seventh case worldwide. The worm was removed surgically, and the patient had an uneventful recovery.

New host and ocean records for the copepod Ommatokoita elongata (Siphonostomatoida: Lernaeopodidae), a parasite of the eyes of sleeper sharks.

Seven of 8 Pacific sleeper sharks (Somniosus pacificus Bigelow and Schroeder, 1944) captured in Prince William Sound, Alaska, were actively infected, and all 8 had been at one time infected with the parasitic copepod Ommatokoita elongata (Grant, 1827) (Siphonostomatoida: Lernaeopodidae). Active infections consisted of adult females and chalimus larvae that had attached to the corneas of the sharks' eyes. This report documents a new host record and possibly the only reliable record of this parasite from a host other than the Greenland shark, Somniosus microcephalus (Bloch and Schneider, 1801). It also documents the first time O. elongata has been identified outside of the Atlantic Ocean or its locally adjacent straits and seas.