-
Clinical Medicine Insights. Case Reports 2023Small artery disease caused by neutrophils and immune-mediated is known as leucocytoclastic vasculitis (LCV). Clinically, it manifests as palpable, asymptomatic purpuric...
INTRODUCTION
Small artery disease caused by neutrophils and immune-mediated is known as leucocytoclastic vasculitis (LCV). Clinically, it manifests as palpable, asymptomatic purpuric papules on the limbs. Ocular manifestation is rare. Here, we describe a case of peripheral ulcerative keratitis (PUK) associated with LCV.
CASE PRESENTATION
A 59-year-old man was referred to the hospital with blurred vision due to corneal perforation in his left eye. He complained of itchy nodules on his hands and lower legs for 15 years and the skin biopsy of the back of his hand revealed LCV 6 years ago, which suggested erythema elevatum diutinum. The patient was under treatment with anti-inflammatory and immunosuppressive drugs and physical features of LCV seen in him included erythema on his hands and legs. After receiving conjunctival flap covering surgery, the corneal perforation was resolved. Conjunctival flaps covered cornea that limited his vision to hand motion. Six months later, he was referred to our clinic again because of pain, redness, photophobia, and tearing in the right eye, presenting with PUK. Necrotic tissue was removed during surgery, which also included a conjunctival flap covering procedure. Following surgery, the symptoms were reduced, and the postoperative eye condition remained stable.
CONCLUSION
To our knowledge, it is the first case of PUK secondary to LCV which was diagnosed 6 years ago. This case demonstrates that PUK associated with LCV can be successfully treated by surgical interventions.
PubMed: 37808226
DOI: 10.1177/11795476231204358 -
Cureus Dec 2023Aim The acute red eye or conjunctival injection is the most common ophthalmic presentation in primary care. The aim of this audit was to improve red eye consultations...
Aim The acute red eye or conjunctival injection is the most common ophthalmic presentation in primary care. The aim of this audit was to improve red eye consultations by increasing the number of red flag features documented in the history of patients. Method The National Institute of Clinical Excellence (NICE) Clinical Knowledge Summary (CKS) outlines red flag features, which should be documented for an acute red eye consultation. Two interventions were implemented to attempt to improve consultations. The first involved creating a template in the Egton Medical Information Systems. The second involved training doctors in the recognition of red flag features and identifying sight-threatening conditions. Red eye consultations and red flag features documented were recorded in the two months before and after the interventions. Results All documentation of red flag features assessed in this project increased post intervention. However, lateralisation, visual changes, and eye pain were commonly asked prior to the intervention and did not show a statistically significant difference. They showed an increase from 90% (19/21) to 100% (19/19), 71% (15/21) to 84% (16/19), and 67% (14/21) to 79% (15/19), respectively. After the interventions, significant increases in asking about headaches (14% (3/21) to 74% (14/19), pupil changes (5% (1/19) to 58% (11/19)), and method of injury (high velocity 10% (2/21) to 84% (16/19), foreign body 14% (3/21) to 84% (16/19), chemical 10% (2/21) to 84% (16/19) were observed (p<0.05). Photophobia inquiries also significantly increased (14% (3/19) to 79% (15/19), P<0.05). Conclusion The number of red flag features identified and documented for acute red eye consultations increased with the introduction of an online template and a teaching session.
PubMed: 38205501
DOI: 10.7759/cureus.50344 -
Cephalalgia : An International Journal... Jun 2024This study aimed to identify the potential subgroups of migraines based on the patterns of migraine associated symptoms, vestibular and auditory symptoms using latent...
OBJECTIVE
This study aimed to identify the potential subgroups of migraines based on the patterns of migraine associated symptoms, vestibular and auditory symptoms using latent class analysis and to explore their characteristics.
METHOD
A total of 555 patients with migraine participated in the study. Symptoms such as nausea, vomiting, photophobia, phonophobia, osmophobia, visual symptoms, vestibular symptoms (dizziness, vertigo), and auditory symptoms (tinnitus, hearing loss, aural fullness) were assessed. Latent class analysis was performed to identify subgroups of migraines. Covariates such as gender, age of migraine onset, frequency of migraine attacks per month, and family history were also considered.
RESULTS
The analysis revealed four latent classes: the Prominent Vestibular; Prominent Nausea; Presenting Symptoms but not prominent or dominant; and Sensory Hypersensitivity groups. Various covariates, such as gender, age of migraine onset, and frequency of migraine attacks, demonstrated significant differences among the four groups. The Sensory Hypersensitivity group showed the presence of multiple sensory symptoms, earlier age of migraine onset, and higher proportion of females. The Prominent Vestibular group had the highest probability of dizziness or vertigo but lacked the presence of auditory symptoms. The Prominent Nausea group exhibited prominent nausea. The Presenting Symptoms but not prominent or dominant group comprised individuals with the highest migraine attacks per month and proportion of chronic migraine.
CONCLUSION
This study identifies four subgroups of migraines based on the patterns of symptoms. The findings suggest potential different but overlapped mechanisms behind the vestibular and auditory symptoms of migraine. Considering the different patterns of migraine-related symptoms may provide deeper insights for patients' prognosis and clinical decision-making.
Topics: Humans; Migraine Disorders; Female; Male; Adult; Middle Aged; Latent Class Analysis; Vertigo; Young Adult; Nausea; Dizziness; Aged; Adolescent; Vestibular Diseases
PubMed: 38887813
DOI: 10.1177/03331024241262488 -
The Journal of International Medical... Nov 2023Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a... (Review)
Review
BACKGROUND
Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented. A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined.
CONCLUSION
Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.
Topics: Male; Humans; Child; Brain Abscess; Headache; Magnetic Resonance Imaging; Physical Examination; Drainage
PubMed: 38006608
DOI: 10.1177/03000605231213751 -
Journal of Ophthalmic Inflammation and... Dec 2023To describe a complex case of ocular tuberculosis reactivation with anterior uveitis, choroiditis and inflammatory choroidal neovascular membrane (CNVM) following immune...
Tuberculosis reactivation demonstrated by choroiditis and inflammatory choroidal neovascular membrane in a patient treated with immune checkpoint inhibitors for malignant mucosal melanoma.
PURPOSE
To describe a complex case of ocular tuberculosis reactivation with anterior uveitis, choroiditis and inflammatory choroidal neovascular membrane (CNVM) following immune checkpoint inhibitor (ICPI) treatment of malignant mucosal melanoma.
METHODS
A retrospective collection of medical history, clinical findings and multimodal imaging with literature review of the topic was conducted.
RESULTS
A 52-year-old Romanian female developed reduced vision and photophobia after three cycles of ICPI therapy comprised of ipilimumab and nivolumab. Bilateral anterior uveitis, multiple left eye choroidal lesions and a CNVM were confirmed using slit-lamp examination with ancillary multimodal imaging. Retinal changes in the right eye as well as a history of previously treated posterior uveitis and high-risk ethnicity increased clinical suspicion for ocular tuberculosis (TB) reactivation. The diagnosis was confirmed by TB positivity on polymerase chain reaction (PCR) analysis of lung aspirate followed by significant clinical improvement on systemic anti-tubercular therapy (ATT), systemic steroids and anti-vascular endothelial growth factor (VEGF) therapy.
CONCLUSIONS
ICPIs can cause a myriad of ocular issues, both by primary immunomodulatory effects as well as secondary reactivation of latent disease.
PubMed: 38110833
DOI: 10.1186/s12348-023-00374-x -
Revista Argentina de Microbiologia 2024Blepharitis is a very common disease in ophthalmology, dermatology and allergy practice. It generally follows a chronic course and is frequently associated with...
Blepharitis is a very common disease in ophthalmology, dermatology and allergy practice. It generally follows a chronic course and is frequently associated with objective and/or subjective symptoms such as epiphora, red eye, dandruff, gritty sensation, itching, burning, photophobia, and blurred vision. The purpose of this study is to analyze the prevalence of Demodex spp. in patients with symptoms of chronic blepharitis. An analytical cross-sectional study was conducted in the period between 2016 and 2020. All patients with symptoms of chronic blepharitis who underwent a parasitological test of eyelashes (Rapitest) in the Dermatology Department of the Hospital Italiano de Buenos Aires were included. Those with previously established blepharitis due to another infectious cause were excluded. We analyzed 972 patients. Sixty percent (n=585) underwent a positive Rapitest for the presence of Demodex spp. Seventy five percent (n=728) were women. There were no significant differences in the prevalence associated with sex (p=0.38). Among the patients positive for Demodex spp., 65% (n=628) were older than 60 years old. The most frequently associated symptom was itching, present in 35% (n=342). A statistically significant decrease in the number of consultations was observed during the cold months of the year (May-June-July-August). Our results show a high prevalence of Demodex spp. in patients with chronic blepharitis. As its presence reveals a direct association with age, we recommend looking for this parasite in this age group.
Topics: Animals; Humans; Female; Middle Aged; Male; Mites; Mite Infestations; Prevalence; Cross-Sectional Studies; Blepharitis; Pruritus
PubMed: 37541821
DOI: 10.1016/j.ram.2023.05.005 -
Ophthalmology. Retina Mar 2024To examine the molecular causes of Schubert-Bornschein (S-B) congenital stationary night blindness (CSNB), clinically characterize in detail, and assess...
OBJECTIVE
To examine the molecular causes of Schubert-Bornschein (S-B) congenital stationary night blindness (CSNB), clinically characterize in detail, and assess genotype-phenotype correlations for retinal function and structure.
DESIGN
Retrospective, longitudinal, single-center case series.
PARTICIPANTS
One hundred twenty-two patients with S-B CSNB attending Moorfields Eye Hospital, United Kingdom.
METHODS
All case notes, results of molecular genetic testing, and OCT were reviewed.
MAIN OUTCOME MEASURES
Molecular genetics, presenting complaints, rates of nystagmus, nyctalopia, photophobia, strabismus, color vision defects and spherical equivalent refraction (SER). Retinal thickness, outer nuclear layer (ONL) thickness, and ganglion cell layer + inner plexiform layer (GCL+IPL) thickness from OCT imaging.
RESULTS
X-linked (CACNA1F and NYX) and autosomal recessive (TRPM1, GRM6, GPR179 and CABP4) genotypes were identified. The mean (± standard deviation) reported age of onset was 4.94 ± 8.99 years. Over the follow-up period, 95.9% of patients reported reduced visual acuity (VA), half had nystagmus, and 64.7% reported nyctalopia. Incomplete CSNB (iCSNB) patients more frequently had nystagmus and photophobia. Nyctalopia was similar for iCSNB and complete CSNB (cCSNB). Color vision data were limited but more defects were found in iCSNB. None of these clinical differences met statistical significance. There was no significant difference between groups in VA, with a mean of 0.46 logarithm of the minimum angle of resolution, and VA remained stable over the course of follow-up. Complete congenital stationary night blindness patients, specifically those with NYX and TRPM1 variants, were more myopic. CACNA1F patients showed the largest refractive variability, and the CABP4 patient was hyperopic. No significant differences were found in OCT structural analysis during the follow-up period.
CONCLUSIONS
Retinal structure in CSNB is stationary and no specific genotype-structure correlates were identified. Visual acuity seems to be relatively stable, with rare instances of progression.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
PubMed: 38522615
DOI: 10.1016/j.oret.2024.03.017 -
Aesthetic Plastic Surgery Dec 2023The purpose of this study was to summarize the misdiagnosis and treatment of corneal complications associated with suture exposure in cases of buried-suture...
PURPOSE
The purpose of this study was to summarize the misdiagnosis and treatment of corneal complications associated with suture exposure in cases of buried-suture double-eyelid blepharoplasty.
METHODS
This study retrospectively analyzed 14 patients with palpebral conjunctival and corneal complications due to suture exposure after buried-suture double-eyelid blepharoplasty at the First Affiliated Hospital of Harbin Medical University from January 2020 to July 2022. The patients' clinical symptoms included photophobia, lacrimation, pain, foreign body sensation, swelling of the eyelids, conjunctival hyperemia, secretion, etc. We recorded the patient's sex, age, surgical method, length of exposed suture, suture type, number of double-eyelid surgeries, surgical site, timepoint when eye discomfort occurred, misdiagnosed disease and treatment.
RESULTS
Three patients were misdiagnosed with dry eye, nine patients were misdiagnosed with viral keratitis, and two patients were misdiagnosed with allergic conjunctivitis. All 14 patients had manifestations of photophobia, lacrimation, pain, foreign body sensation and conjunctival hyperemia. Eight patients had manifestations of swelling of the eyelids. Five patients had manifestations of eye secretions. There were 8 patients with corneal epithelial injuries and 6 patients with corneal ulcers. All patients underwent suture removal without further progression. Ten patients were treated with artificial tears, and 4 patients were treated with calf serum deproteinized gel after suture removal.
CONCLUSION
If there is postoperative eye discomfort caused by eyelid and corneal complications in patients after buried-suture double-eyelid blepharoplasty, clinicians should carefully check whether there is suture exposure and determine the cause in a timely manner. Suture removal is the best way to treat this complication.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Blepharoplasty; Retrospective Studies; Hyperemia; Photophobia; Suture Techniques; Asian People; Eyelids; Sutures; Diagnostic Errors; Pain; Foreign Bodies
PubMed: 37653179
DOI: 10.1007/s00266-023-03606-6 -
Taiwanese Journal of Obstetrics &... Mar 2024Recurrent disseminated coccidioidal meningitis in two subsequent pregnancies is rare and can pose a challenge in ensuring the health of both mother and baby. In this...
OBJECTIVE
Recurrent disseminated coccidioidal meningitis in two subsequent pregnancies is rare and can pose a challenge in ensuring the health of both mother and baby. In this unique case we highlight this rare occurrence and subsequent treatment.
CASE REPORT
A 29-year-old G4P1021 with a history of disseminated coccidioidomycosis in a previous pregnancy presented at 8 weeks gestation with nausea, headache, and neck pain. Cerebrospinal fluid analysis was positive for recurrent coccidioidal infection. She was started on Amphotericin and discharged. She re-presented at 30 week's gestation with phonophobia and photophobia, emesis, neck pain and swelling. MRI showed evidence of ventriculomegaly with communicating hydrocephalus. She was treated with therapeutic lumbar punctures throughout her pregnancy and a ventriculoperitoneal shunt following delivery. She had a spontaneous vaginal delivery at 38 weeks and 3 days with no complications.
CONCLUSION
This unique case highlights the susceptibility of recurrent disseminated coccidioidomycosis in subsequent pregnancies and treatment thereof.
Topics: Humans; Infant; Female; Pregnancy; Adult; Coccidioidomycosis; Neck Pain; Meningitis, Fungal; Amphotericin B; Hydrocephalus
PubMed: 38485323
DOI: 10.1016/j.tjog.2024.01.022 -
Contact Lens & Anterior Eye : the... Feb 2024To compare the clinical efficacy of orthokeratology (ortho-k) and 0.01% atropine for retardation of myopia progression in myopic children.
OBJECTIVE
To compare the clinical efficacy of orthokeratology (ortho-k) and 0.01% atropine for retardation of myopia progression in myopic children.
METHODS
This was a retrospective cohort study. A total of 282 patients, aged 8-17 years, were enrolled, including 100 children treated with ortho-k, 84 with 0.01% atropine, and 98 with single-vision spectacles. During the follow-up of 1 year, ortho-k wearers were examined at 1 day, 1 week, 1 month, 3 months after treatment, and thereafter every 3 months, while the others were examined every 3 months by measurements of uncorrected vision, intraocular pressure, refractive power, slit-lamp microscopy, corneal topography, and the lens fitting when necessary. The axial length was measured every 6 months.
RESULTS
Patients with ortho-k had stable uncorrected vision after 1 month of lens wear, all reaching 0 logMAR. The annual axial elongation was 0.23 ± 0.19 mm, 0.22 ± 0.20 mm, and 0.39 ± 0.27 mm in the ortho-k, atropine, and spectacle groups, respectively, with significant difference (F = 23.251, P = 0.000). The axial length was delayed to increase by 41.03% and 43.59% within a year in patients with ortho-k and atropine, respectively, as compared to patients with spectacles (F = 0.006, P = 0.936). The elongation was ≤ 0.3 mm in 69.0% and 66.7% of patients in the two groups, respectively, versus 38.8% in the spectacle group (χ = 17.251, P = 0.000). During the follow-up, the rate of corneal staining was 11.0% and 2.0% in the ortho-k and spectacle groups, respectively (χ = 8.076, P = 0.003). The use of atropine did not increase corneal staining, but the incidence of related photophobia was 4.8%. No other serious complications were observed.
CONCLUSION
Ortho-k lenses and 0.01% atropine can achieve similar efficacy of myopia retardation, which was significantly better than that obtained with single-vision spectacles, in myopic children. The risk of corneal staining after ortho-k wear may be slightly higher than that with spectacles, but could be well controlled.
Topics: Child; Humans; Atropine; Retrospective Studies; Myopia; Treatment Outcome; Corneal Topography; Refraction, Ocular; Orthokeratologic Procedures; Axial Length, Eye
PubMed: 37985346
DOI: 10.1016/j.clae.2023.102094