FELINE CLAMYDIOSIS IN DOMESTIC CATS

A common conjunctival disease in kittens is Chlamydiosis. Chlamydia bacteria invade and infect the cells of the conjunctiva causing inflammation and eye discharge. Clinical signs develop within a few days of infection and begin with eye discharge. The aim of this article is to improve the knowledge of veterinary colleagues in managing cases of conjunctivitis in kittens caused by chlamydial bacterial infection. A 5-month-old female local cat weighing 1.6 kg named Chips had complaints of eye swelling, eye redness and continuous tear and eye discharge since it was adopted. The cat showed signs of difficulty opening the eyes. The diagnosis was confirmed by haematology and cytology examination. Cytological examination of the eye discharge swab was positive for Chlamydophila felis. Haematological examination showed leukocytosis, lymphocytosis and thrombocytopenia. The cat was diagnosed with Feline Chlamydiosis. The cat was treated with Erlamycetin Plus Eye Drop (Chloramphenicol and Dexamethasone) one drop twice daily for 14 days. Supportive therapy with immunomodulator Echinacea purpurea (Imboost Kids Syrup 60 ml) was given twice daily for 2.5 ml for 14 days. The therapy showed satisfactory results. On day 14 the cat was declared cured after therapy and routine eye cleaning. It can be concluded that cats with Chlamydiosis can be treated until cured using topical antibiotics and immunomodulators. The importance of early detection and owner understanding of good and healthy environmental conditions to prevent recurrent infections.

Breast milk (BM) contains various protective components, such as immunoglobulins, lactoferrin, lysozyme, oligosaccharides and immune cell subsets. We evaluated the effectiveness of BM eye drops in infants with eye discharge in a randomised controlled study. Subjects were breastfed infants aged ≤180days, with eye discharge. We randomly assigned patients to receive eye drops of BM or sodium azulene sulphonate hydrate 0.02% ophthalmic solution (OS). The patients received drop of BM or OS for 7days. Improvement score of eye discharge in the groups was compared using a non-inferiority test. The number of patients improved eye discharge was 119/155 (76.8%) and 119/157 (75.8%) in BM and OS groups, respectively. There were no significant differences between groups. The improvement score in eye discharge was 1.76±0.91 in the BM group and 1.71±0.96 in the OS group. The BM group was considered non-inferior to the OS group. This study demonstrated that BM is no less effective than OS in infants with eye discharge aged ≤6months. The results suggested that the use of breast milk as eye drops could be considered as a first-line treatment for infants aged ≤6months with eye discharge.

Vernal keratoconjunctivitis (VKC) is an unusually severe sight-threatening allergic eye disease, occurring mainly in children. Conventional therapy for allergic conjunctivitis is generally not adequate for VKC. Pediatricians and allergists are often not familiar with the severe clinical symptoms and signs of VKC. As untreated VKC can lead to permanent visual loss, pediatric allergists should be aware of the management and therapeutic options for this disease to allow patients to enter clinical remission with the least side effects and sequelae. Children with VKC present with severe ocular symptoms, that is, severe eye itching and irritation, constant tearing, red eye, eye discharge, and photophobia. On examination, giant papillae are frequently observed on the upper tarsal conjunctiva (cobblestoning appearance), with some developing gelatinous infiltrations around the limbus surrounding the cornea (Horner-Trantas dot). Conjunctival injections are mostly severe with thick mucus ropy discharge. Eosinophils are the predominant cells found in the tears and eye discharge. Common therapies include topical antihistamines and dual-acting agents, such as lodoxamide and olopatadine. These are infrequently sufficient and topical corticosteroids are often required for the treatment of flare ups. Ocular surface remodeling leads to severe suffering and complications, such as corneal ulcers/scars. Other complications include side effects from chronic topical steroids use, such as increased intraocular pressure, glaucoma, cataract and infections. Alternative therapies for VKC include immunomodulators, such as cyclosporine A and tacrolimus. Surgery is reserved for those with complications and should be handled by ophthalmologists with special expertise. Newer research on the pathogenesis of VKC is reviewed in this article. Vernal keratoconjunctivitis is a very important allergic eye disease in children. Complications and remodeling changes are unique and can lead to blindness. Understanding of pathogenesis of VKC may lead to better therapy for these unfortunate patients.

Ophthalmia neonatorum is generally defined as conjunctivitis occurring within one month of life. The sources of this infection are environmental organisms or the organisms colonized in the birth canal. Untreated infection can cause blindness, especially if the corresponding organisms are Neisseria gonorrhoeae, or Chlamydia trachomatis. Povidone-iodine ophthalmic solution is an effective antibacterial agent with broad antibacterial and antiviral activity to which no bacterial resistance has been known. It is less expensive and less toxic than the agents currently used to prevent neonatal conjunctivitis. It turns the conjunctiva brown for a few minutes, a characteristic that can serve as an indicator of being properly applied. Because this preparation is not available in Iran, its formulation can be valuable. In this study, the povidone-iodine ophthalmic solution was prepared in concentration of 2.5%, and then required control parameters such as pH, self-preservation effect, tonicity, sterility, and chemical stability were studied. In this clinical study, one drop of povidone-iodine ophthalmic solution was instilled in each eye of 475 neonates within 30 minutes of birth. This study demonstrated that povidone-iodine in concentration of 2.5% is self-preservative against microbial contamination. The pH of solution was adjusted about 5 near to the pH of tear using sodium hydroxide 0.1 N and citric acid 0.5%, because in this pH povidone-iodine was more stable. Tonicity was measured according to an in vitro hemolytic method. Povidone-iodine 2.5% solution was packaged in amber color bottles, and after ensuring from its sterility, it was used in clinical study. Among the population studied, eye discharge was observed in 2.94 percent in comparison to the control group in which eye discharge was observed in 10.9 percent. In conclusion because of availability, low cast, and good clinical results, a 2.5% ophthalmic solution of povidone-iodine is desirable to use as a prophylactic agent against ophthalmia neonatorum.

Eye Problems in Mountain and Remote Areas: Prevention and Onsite Treatment—Official Recommendations of the International Commission for Mountain Emergency Medicine ICAR MEDCOM

Among new hormone receptor positive and HER2-negative breast cancer cases, less than 4% of patients aged 41-60 are diagnosed with metastatic disease at presentation. Of this small percentage, very few cases of orbital metastasis as the first presenting finding have been identified. We present the case of a 44 year old female who initially presented with redness and discharge of the left eye and was diagnosed with conjunctivitis. Despite treatment with courses of moxifloxacin eye drops, fluoromethalone eye drops, and oral amoxicillin, her symptoms persisted after 2 months prompting an ED visit. A CT scan demonstrated an osseous mass of the left sphenoid bone with a soft tissue mass involving the left superolateral orbit, anterior and middle cranial fossa with associated proptosis. MRI scan of the orbits revealed an aggressive mass of the left frontal bone and left sphenoid wing with extraosseous soft tissue components. Further full-body imaging showed 2 small masses measuring 1.9 and 1.8 centimeters in the lower outer quadrant of the left breast and an enhancing lesion of the left parietal bone concerning for metastatic lesion but otherwise no convincing evidence of metastasis within the intradural parenchyma of the brain, abdomen, pelvis, or spine. She underwent left orbitofrontal craniotomy for resection and biopsy without complications; pathology revealed metastatic adenocarcinoma of breast primary. Tumor markers were found to be estrogen receptor and progesterone receptor positive and HER2 receptor negative. Subsequent breast biopsy confirmed consistent tumor markers within the breast masses. She received gamma knife radiation to the left periorbital region. At the time of gamma knife, 17 Gy was prescribed to the 59% isodose line to cover the high-risk post-operative peri-orbital dura. MRI 8 weeks later showed no evidence of local recurrence or new intracranial metastases. Radiation was followed by first line medical therapy for metastatic breast cancer with abemaciclib, an aromatase inhibitor and ovarian function suppression with goserelin. In conclusion, we present a rare case of metastatic breast cancer with the presenting feature of orbital mass; this case will contribute to earlier diagnosis and treatment in subsequent cases as well as add to the small body of known cases to further characterize long term prognosis of this specific type of organ involvement of metastatic breast cancer. Citation Format: Haley Westervelt Mabry, Katherine Ansley, Christina Cramer. De Novo Metastatic Breast Cancer to the Orbit: A Case Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-12-28.

Background: Research analyzing COVID-19 symptom screening has primarily focused on adult patients. In efforts to safely reopen schools, symptom screeners are being widely utilized. However, pediatric-specific outpatient data on which symptom combinations best identify children with COVID-19 are lacking. Such data could refine school symptom screening by improving screener sensitivity and specificity. In this study, we assessed the frequency of symptoms and symptom combinations in children tested for SARS-CoV-2 in outpatient settings. We aim to contribute to the optimization of pediatric COVID-19 screening questionnaires, to ultimately minimize both COVID-19 transmission in schools and missed school days. Methods: We conducted a retrospective analysis of outpatient symptoms screens, SARS-CoV-2 test results, and demographics of children (≤18 years) tested for SARS-CoV-2 between March 30 and November 30, 2020, at 3 UCSF-affiliated COVID-19 outpatient screening clinics in northern California. Those with incomplete symptom screens, >7 days between symptom documentation and test, and invalid test results were excluded. Results: Of 473 children tested at 1 site, 21 children had positive SARs-CoV-2 results and 452 children had negative results (4.4% positivity rate). Moreover, 85.7% of SARS-CoV-2–positive children had a known exposure to COVID-19 (Table 1). Of SARS-CoV-2–positive children, 61.9% had >1 symptom. Also, 52.4% of SARS-CoV-2–positive children had at least 1 symptom (fever, cough, or loss of taste or smell) versus 62.8% of SARS-CoV-2–negative children (Table 2). Runny nose or nasal congestion was the most frequently reported symptom in the SARS-CoV-2–positive group (47.6%) as well as the SARS-CoV-2–negative group (58.6%). Also, 14.3% of SARS-CoV-2–positive children had eye redness or discharge versus 3.1% of SARS-CoV-2–negative children. Isolated runny nose presented in 10.8% of SARS-CoV-2–negative versus 9.5% of SARS-CoV-2–positive children. All children with isolated diarrhea (n = 5), isolated headache (n = 3), and isolated rash (n = 2) tested negative. Preliminary symptom data based on 176 children from a second site showed that 9.9% of symptomatic children had a positive test result. Conclusions: Runny nose or nasal congestion was the most frequently reported symptom in all children tested for SARS-CoV-2. However, isolated runny nose or nasal congestion identified 2 cases of COVID-19 in our cohort. Eye redness or discharge may be an important symptom to screen for COVID-19 in children. Further research with a larger number of positive cases is needed to make conclusions about improving efficiency and efficacy of symptom screeners for COVID-19 in children.Funding: NoDisclosures: None

To assess the impact of open versus masked adherence monitoring on adherence with topical brimonidine using two different dosing schedules. Thirty-seven patients with glaucoma or ocular hypertension were enrolled in a prospective, observational cohort study. Patients were randomly assigned to open or masked adherence monitoring and to brimonidine twice daily (BID) or three times daily (TID). Patients received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks with weekly intraocular pressure measurements. Adherence calculations comprised dosing intervals, adherence rate and time covered. Subgroup analysis with anova included the factors masking, regimen, diagnosis and age. Among 36 individually analysed patients, 12 (33%) had adherence rates above 75%, therein two (5%)>90%. The mean adherence rate in 19 patients aware of adherence measurements was 70 ± 17% for brimonidine BID and 65 ± 14% for TID, not significantly different to the rates of 17 patients not informed about adherence measurements (77 ± 6% BID, 62 ± 9% TID, p = 0.24). On average, patients with brimonidine TID achieved significantly lower adherence rates (64 ± 12%) than patients on BID (73 ± 13%, p = 0.02). Still, patients on TID applied brimonidine more often (TID 1.9 ± 0.3, BID 1.5 ± 0.1 mean applications per day). The median coverage was 70% and showed no statistically significant difference between patients on BID and TID (p = 0.36). The study findings suggest that adherence measurements are not significantly altered by open adherence monitoring, which may simplify future adherence studies. Adherence with brimonidine eye drops was insufficient for most patients. These results demonstrate the necessity to develop new strategies to improve compliance in glaucoma therapy.

To the Editor: While ocular manifestations like conjunctival injection are well described in Kawasaki disease (KD) [1], acute anterior uveitis as the initial manifestation is distinctly uncommon. We describe a girl who presented to the eye clinic with red eyes and was later diagnosed with KD. A 9-y-old girl presented with fever for 15 d, red eyes and photophobia. She developed an erythematous macular rash 4 d after fever. There was no eye discharge, pain or blurred vision. Both eyes showed keratic precipitates, cells and flare in the aqueous suggesting anterior uveitis. As she had fever and systemic manifestations, she was referred for a pediatric consultation. Examination revealed fissured lips, red tongue, bilateral conjunctival injection and swollen hands. Investigations showed hemoglobin of 106 g/L, total leucocyte count 12.47 × 10/L (76 % neutrophils and 20 % lymphocytes), platelets 4.57 × 10/L, C-reactive protein 55.15 mg/L and erythrocyte sedimentation rate 20 mm in the first hour (Westergren). Blood culture was sterile. Echocardiogram was normal. A clinical diagnosis of KD was made. Intravenous immunoglobulin (2 g/kg) was given along with prednisolone, aspirin, topical atropine and betamethasone. Redness improved dramatically. Eye examination after 3 mo was normal. Bilateral nonexudative bulbar conjunctivitis typically sparing the limbus is seen inmore than 85% children with KD and is one of the major diagnostic criteria of KD [1]. Other ocular manifestations like superficial punctate keratitis, vitreous opacities, choroidal and retinal changes, papilledema and subconjunctival hemorrhage are less commonly described [2]. Anterior uveitis has been seen in upto 66 % of patients with KD a mean of 8.6 d after the onset of fever [3]. It commonly manifests as redness and photophobia and has a good prognosis [4]. Photophobia and redness of eyes were so prominent in this case that this child was first taken to an ophthalmologist who in turn sent the child for pediatric review because of underlying systemic features. Both ophthalmologists and pediatricians should be aware of this clinical presentation as delayed diagnosis could be responsible for delay in treatment and consequently for adverse cardiovascular outcomes.

In children there is a paucity of data in recent literature on the prevalence of infective conjunctivitis and almost it is absent from an area like Sudan. This research was aimed to study the point prevalence of a cute bacterial conjunctivitis in Sudanese children and put light on causative bacterial pathogens. Acute bacterial conjunctivitis is a common infection in children and it may be extremely contagious and easily spread in day care centres and school class rooms leading to absences or lost time from work for parents, outbreaks may occur. Common presenting symptoms are red eye and eye discharge. Commonly involved bacteria are Staphylococcus aureus and Haemophilus influenzae. Generally it is a mild disease but more serious complications may occur. Methods: Hundred children with clinical presentation of acute conjunctivitis were included in this study. For each patient a sample for bacterial culture and sensitivity to commonly used antibiotics was obtained by a thin cotton micro swab, isolation and identification of pathogens was done by conventional methods. Antimicrobial susceptibility testing was performed according to method standardized by CLSI. Data was analyzed by SPSS computer program. Results: The most common presenting symptom is the red eye. Bacterial pathogens were detected in 65% of the studied sample. Predominant bacterial pathogens were Staphylococcus aureus and Haemophilus influenzae, Klebsiella pneumoniae is a cause in small number of patients. All isolates are sensitive to Gentamycin. Conclusion: Acute bacterial conjunctivitis is a common infection in children, muco purulent discharge points to bacterial cause in acute infective conjunctivitis. Staphylococcus aureus is a common pathogen and it is sensitive to Gentamycin.

Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder presenting in childhood. Dupilumab is the first approved biologic agent for the treatment of moderate-to-severe AD in pediatric populations. While generally well-tolerated, dupilumab-associated ocular surface disease (DAOSD) is a known complication. In severe cases, this may necessitate discontinuation of treatment. We aim to describe DAOSD in our cohort of Asian pediatric patients with moderate-to-severe AD on dupilumab. We performed a single-center retrospective review of children and adolescents on dupilumab for moderate-to-severe AD who developed ophthalmological complications from 2019 to 2024. Most patients had prophylactic lubricant eyedrops. Data collected and analyzed included demographics, ophthalmologic findings, treatment, and outcomes of eye condition. Of 216 patients treated with dupilumab, 16 (7.4%) developed ophthalmologist-diagnosed DAOSD. All patients had co-existing eyelid or head and neck eczema while 31.3% of these patients had pre-existing eye conditions. Eye redness (87.5%) was the most common presenting symptom, followed by pruritus (43.8%) and eye discharge (25%). The most common eye finding was conjunctivitis (87.5%), followed by limbitis (62.5%) and papillary reaction (62.5%). Two patients required temporary interruption of dupilumab. No patients required discontinuation of dupilumab treatment. The median time to resolution of eye complications was 14 weeks. In a real-world setting, the incidence and severity of DAOSD in pediatric patients appears to be lower than that of adults. Prophylactic use of lubricant eye drops, close monitoring and early referral to pediatric ophthalmologists can help reduce the incidence of severe eye disease requiring discontinuation of dupilumab.

Background:Visual impairment is one of a major public health problem among elderly people.Object:Aim of this study was determining the prevalence of visual impairment in median and old peoples in Qazvin (Iran).Method:In this cross sectional study, with a simple random sampling, 446 patients older than 5o years who were referred to outpatient ophthalmology clinics at Avecina hospital of Qazvin (a province of Iran) in 2010 were enrolled. Participants first complete a questionnaire with 25 questions toward demographic and past medical history and then were examined by ophthalmologist. These examinations includes direct and indirect ophthalmoscopy, slit lamp examination, measurement of uncorrected visual acuity and visual acuity with current glasses, lensometery of the previous glasses, refraction with and without the use of cycloplegic and determining the best corrected visual acuity. All slit lamp examinations were performed by the same ophthalmologist. Data were analyzed with SPSS16 with use of Chi – Square test with Pvalue <0.05.Results:In this study 446 patients were examined that 54.7% were male. Mean age of study population was 62+-9.3 years old. 96.4% of participants had refractory disorder. Prevalence of myopia, hyperopia and astigmatism were 33.6%, 45.9% and 16.8% respectively. Of patients 17.4% had diabetes. Of participants 28.9% had temporal headache, 37% red eye, 41.2% flashing, 27.3% and 28% had dryness and discharge of eye respectively. 31.1% of participants had eyelide problem, 4.7% Color Vision Deficiency (CVD) and 3.8% had family history of CVD. Of total 4.5% had glaucoma, 3.3% macular degeneration and 21.7% had hypertension. 0.6% of population had macular degeneration, 0.4% of population had glaucoma Of 892 eyes (446 individuals), 36.2% had visual acuity less than 7/10, 1.7% light perception (LP) and 0.22% no light perception (NLP) and 2.7% finger count.Conclusion:Refractory errors, cataract and amblyopia were most important eye disorders in older people in Qazvin.

We describe a patient who was seen with a unilateral red eye and purulent discharge refractory to antibiotic treatment with multiple antibiotic regimens over the previous 4 months. Initially it was believed to be a bacterial conjunctivitis, but when conventional treatments failed it was thought to be a viral conjunctivitis with bacterial superinfection. Cultures yielded only Enterococcus. There was a small mass with a draining fistulous tract at the lateral canthus. Symptoms persisted despite courses of topical and systemic antibiotics followed by a tapering dose of steroids. The patient was taken to the operating room for an orbitotomy through the conjunctiva at the lateral canthus. Findings from pathologic examination of the excised mass demonstrated a dermoid cyst of the conjunctiva. This clinical appearance obscured the diagnosis.

To describe a novel surgical treatment for patients with chronic relapsing conjunctivitis, corneal epitheliopathy, and ptosis secondary to giant fornix syndrome. 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. 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). 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.

Toxocariasis, conjunctivitis, and scabies are common health issues in cats and are caused by nematode worms, viral or bacterial infections, and mites, respectively. This article reports a case involving a two-month-old female domestic cat named Jeni, who was brought to the veterinarian due to complaints of diarrhea, eye discharge, itching, skin lesions, and hair loss. Laboratory examinations revealed the presence of Toxocara cati eggs through faecal analysis using native and flotation methods, bacteria from a cytological examination of conjunctival smears later identified as Staphylococcus sp. through bacterial culture, and Sarcoptes scabiei from superficial skin scraping. A complete blood count showed leukocytosis, lymphocytosis, monocytosis, granulocytosis, thrombocytopenia, and hypochromic anemia. The patient was diagnosed with toxocariasis, conjunctivitis, scabies, and thrombocytopenia, with a guarded prognosis. Treatment included the administration of pyrantel pamoate, kaolin-pectin, chloramphenicol, dexamethasone eye drops, ivermectin, diphenhydramine HCl, and multivitamin syrup. Despite four days of treatment, the cat did not survive and died, after which an autopsy was performed. Gross pathological changes included intestinal and pulmonary hemorrhage, while histopathological examination revealed congestion and necrosis in the bronchioles, as well as hemorrhage and edema in the lungs. Necrosis was also found in the intestinal villi and crypts of Lieberkühn, supporting the diagnosis of toxocariasis, with suspected Toxocara cati larval migration to the lungs.