Conjunctival Swelling Research Articles

A Rare Case of Congenital Bilateral Upper Eyelids Ectropion in Down’s Syndrome : Conservative or Operative?

Introduction : Congenital upper eyelids ectropion, is a very rare congenital condition characterized by everted upper eyelids associated with Ichthyosis, Blepharophymosis Syndrome, birth trauma and prominently appears in Down’s syndrome. This case aimed to report a rare case of congenital ectropion in an Down’s syndrome with further management considerations, conservative or operative.
 Case Illustration : A three-month-old baby with bilateral red upper eyelids swelling since birth with conjunctival swelling followed by yellowish discharge. Born through section caesarean from a mother with history of pre-eclampsia and being incubated for 24 days. Ophthalmic examination revealed bilateral upper eyelids eversion, minimal conjunctival chemosis, epicantal fold. The upper eyelids able to be repositioned in relaxed state and re-everted with forced lid closure. Treatment of the eyelids eversion was conservative, combining antibiotics, topical steroids and lubricants. We referred to the pediatrician for the management of Down’s Syndrome, the further management for the eyelids eversion still debatable.
 Discussion : Most infants with congenital ectropion showed excellent anatomic and functional results with conservative treatment if managed timely and promptly. However, infants with Down’s syndrome have a more complicated course due to complex periorbital anatomy and facial anomalies such as flattened face, almond shaped eyes and large nose’s bridge. If congenital ectropion accompanied by lagophthalmos and exposure keratopathy, surgical management should be considered.
 Conclusion : Congenital eyelids ectropion can be managed conservatively or surgically depend on the clinical courses. Mild case able to be managed conservatively with excellent results if managed timely but surgical management supposed to be considered in complicated case.

Successful outcome with injection bleomycin in primary lymphangioma of the conjunctiva – Clinical and anterior segment optical coherence tomography-based approach

Primary conjunctival lymphangioma is characterized by abnormal enlargement of the lymphatic vessels and usually presents as a diffuse or localized conjunctival swelling. We present a case of a conjunctival lymphangioma managed successfully with intralesional bleomycin. There was no recurrence of the lesion both clinically and on anterior segment optical coherence tomography (AS-OCT) at 1-year follow-up. We are unaware of any case in literature like ours which highlights the role of AS-OCT both to complement clinical findings and as an adjuvant in understanding response to treatment in primary conjunctival lymphangioma.

Coronavirus disease 2019: Repeated immersion of chlorine-containing disinfectants has adverse effects on goggles.

During COVID-19, some front-line personnel experienced varying degrees of eye discomfort due to the use of goggles repeatedly disinfected with chlorine-containing disinfectant. The eye damage information of 276 front-line personnel who used goggles in a hospital from October 1, 2021, to December 1, 2021, was collected by filling out a questionnaire. To study the effect of chlorinated disinfectants on goggles, we immersed the goggles in the same volume of water and chlorinated disinfectant buckets. We tested the light transmittance, color and texture, and airtightness of the goggles at different times (1, 3, 12, 24, 36, 48, 60, 72, 96, 120, 144, 168, 192, 216, 240, and 268 h). In addition, we detected where chlorinated disinfectant remained in the goggles by using disinfectant concentration test paper. 60 (21.82%) people experienced dry eyes, stinging pain, photophobia and tearing, conjunctival congestion, eyelid redness, and swelling. After treatment or rest, the patient's ocular symptoms were significantly relieved within 3 days. With the extension of disinfection time, the light transmission of the lenses gradually decreased, and the light transmission reduced when immersion occurred at 216 h. After 72 h of disinfection, the color of the goggle frame began to change to light yellow, the texture gradually became hard and brittle, and the color became significantly darker at 268 h of disinfection. The airtightness of the goggles began to decrease after 168 h of disinfection, the airtightness decreased substantially at 268 h, and the shape changed significantly. In addition, the concentration test paper results show that the disinfection solution mainly resides in the goggle frame seam and goggles' elastic bands' bundle. Repeated chlorine disinfectant disinfection will reduce the effectiveness of goggles protection and damage front-line personnel's eye health.

Production profile of lipid mediators in conjunctival lavage fluid in allergic and infectious conjunctivitis in guinea pigs.

Conjunctivitis is a major ocular disease classified into allergic or infectious. The pathological features of conjunctivitis are not fully understood despite its high morbidity rate; thus, its differentiation can be difficult. We used ovalbumin-induced allergic conjunctivitis and lipopolysaccharide-induced infectious conjunctivitis models of guinea pigs. Both models showed conjunctival swelling. Histological studies revealed that numerous eosinophils infiltrated the conjunctiva in the allergic model, whereas neutrophils infiltrated the conjunctiva in the infectious model. We collected conjunctival lavage fluid (COLF) and comprehensively analyzed lipid production using liquid chromatography-tandem mass spectrometry. COLF showed increase of 20 and 12 lipid species levels in the allergic and infectious models, respectively. Specifically, the levels of a major allergic mediator, prostaglandin D2 and its three metabolites and several cytochrome P450-catalyzed lipids increased in the allergic model. In the infectious model, the levels of prostaglandin E2 and 8-iso-prostaglandin E2 increased, indicating tissue inflammation. Moreover, the level of 12-oxo-eicosatetraenoic acid, a lipoxygenase metabolite, increased in the infectious model. These differences in lipid production in the COLF reflected the pathological features of allergic and infectious conjunctivitis.

The effectiveness of additional medical management of patients in the early stages after reconstructive interventions on the auxiliary apparatus of the eye: assessment of changes in the tissues of the ocular surface and eyelids

Purpose: to evaluate the effectiveness and safety of combination therapy using the moisturizing ophthalmic solution, Hyloparin-Comod®, and the lubricating ophthalmic agent Parin-Pos® in complex medical management in the early stages after reconstructive interventions on the auxiliary apparatus of the eye.Material and methods. The clinical group consisted of 30 patients (40 eyes) aged 18 to 75 (m = 58.46 ± 7.31), of which 7 (23.3 %) were men; and 23 (74.7 %) women. Of these, 18 patients had ptosis of the upper eyelid (of which 10 had bilateral ptosis), 8 had inversion of the eyelids and 4 had eversion. All patients underwent reconstructive plastic surgery on the auxiliary apparatus of the eye: ptosis of the upper eyelid was treated by various methods depending on its type: 18 patients received plastic surgery of the levator aponeurosis (in 8 cases on both eyes; simultaneously, blepharochalasis resection was performed), 4 patients underwent levator shortening, 4 patients underwent eyebrow suspension (of these, 2 patients had the procedure on both eyes, hanging to the eyebrow – 4 operations (both eyes were operated on in two patients), 2 had tarzomyectomy; 8 had elimination of inversion, and 4 had elimination of eversion. In the postoperative period, instillations of antiseptics and antibiotics were supplemented by tear replacement and keratoprotective therapy: Hyloparin-Comod® was instilled 3 times during the day, while Parin-Pos® ointment was placed under and on the eyelids before going to bed. The course of treatment lasted 1 month. All patients underwent a standard ophthalmological examination before surgery as well as 2 weeks, 1 month and 3 months after surgery. The criteria for evaluating the effectiveness of treatment were the condition of the eyelid skin on a pointwise scale (Manchester scar scale), the result of biomicroscopy / biomicroscopy with fluorescein staining of the conjunctiva and cornea, Norn test.Results. In all cases of the use of Hyloparin-Comod® and Parin-Pos® combination, good subjective tolerability was noted, the patients had no complaints of discomfort due to the use of drops or ointment.Conclusion. The results obtained demonstrate that the proposed combination of drugs contributes to improving the favorable condition of eyelid skin and wound healing with the formation of a delicate scar, rapid resolution of conjunctival and eyelid swelling, prevention of corneal microerosions, minimization of corneal epithelial edema and tear film stability.

Fungal Endophthalmitis in a Case of Rhino-Orbito-Cerebral Mucormycosis: Successfully Treated With Amphotericin B Colloidal Dispersion.

BackgroundRhino-orbito-cerebral mucormycosis (ROCM) is an acute, fulminant, opportunistic fungal infection that usually occurs in diabetes or immunocompromised patients. Amphotericin B combined with surgical debridement remains the standard treatment, although it is controversial due to its lager nephrotoxicity. Thus far, no studies have reported the treatment for ROCM-associated fungal endophthalmitis because the exact pathogenesis and transmission routes in ROCM remain unclear. Here, we reported a case of ROCM complicated with fungal endophthalmitis treated favorably with amphotericin B colloidal dispersion (ABCD) in combination with other antifungals and surgical debridement.Case PresentationA 34-year-old woman with diabetes was admitted to our hospital owing to right-sided headache for 8 days, blindness with swelling in the right eye for 5 days, and blindness in the left eye for 1 day. MRI showed that the patient had sphenoid sinus, sinuses, frontal lobe lesions, and proptosis of the right eye. Metagenomic sequencing revealed that the patient had Rhizopus oryzae infection. During hospitalization, the patient received intravenous ABCD, oral posaconazole, and topical amphotericin B and underwent surgical debridement. After 67 days of treatment, the patient’s condition was significantly improved, and limb muscle strength showed grade V. Rhizopus oryzae showed negative results, and conjunctival swelling decreased. Additionally, no nephrotoxicity occurred during treatment. After discharge, the patient’s treatment was transitioned to oral posaconazole and she was free of complaints during the 30-day follow-up without any additional treatment for ROCM.ConclusionTreatment with ABCD combined with other antifungal drugs and surgical debridement for ROCM complicated with fungal endophthalmitis showed remarkable efficacy and good safety. Hence, this regimen is a promising treatment strategy for this fatal disease.

Strabismus Surgery: A Retrospective Comparison of Different Postoperative Treatment Regimes to Prevent Infections.

As studies have shown postsurgical polyvidone-iodine to be at least equal to postsurgical topical antibiotics, our postsurgical care regime was adjusted accordingly in 2017. Here, we retrospectively compared the postsurgical infection rate in patients who underwent strabismus surgery prior to and following this change in regimen in a routine clinical setting. In this retrospective and explorative study, data from 162 adult patients who had undergone strabismus surgery was extracted from files: 98 patients who had received topical gentamycin in a combination ointment with steroid (postsurgery) followed by 1 week of topical gentamycin with nonsteroidal antiphlogistic eye drops for 1 week (group 1) and 64 who had received polyvidone-iodine once immediately postsurgically instead. We compared both groups' postsurgical healing period regarding occurrence of bacterial conjunctival infection and conjunctival swelling and redness as well as other complications. Data were extracted from the entries of the routine follow-up dates on postsurgical days 1, 7, and at 3 months. Mean age of group 1 was 49 years and 51 years in group 2. There was no significant difference between the kind of surgeries (recessions/resections) or the number of patients who had undergone a reoperation. There was no significant difference between the groups for any of the endpoints analyzed at any of the three regular follow-up dates. From group 1, 12.04% and from of group 2, 6.25% showed bacterial conjunctivitis 1 week postsurgery. There was no endophthalmitis. Topical polyvidone-iodine given once at the end of strabismus surgery is a good alternative to topical antibiotics with a comparable healing progress. It carries a comparable risk of infection as seen with a 1-week course of topical antibiotics. The advantages are less manipulation of the eye, no bacterial resistance caused, and cost efficiency. In addition, the lack of anti-inflammatories given in group 2 did not pose a disadvantage.

Lymphome conjonctival révélant un lymphome systémique: à propos d´un cas

We report the case of a 60-year-old female patient with no specific history, presenting to the emergency ophthalmology with conjunctival mass in left and right eyes that had gradually increased over the past three months. Ophthalmological examination of both eyes showed uncorrected visual acuity 8/10, preserved ocular motility, present and symmetrical pupillary light reflex, bilateral well-vascularized, salmon pink conjunctival swelling filling the upper conjunctival cul-de-sac (A). Examination of the anterior segment showed clear cornea, anterior chamber of good depth and optically empty, normal iris texture and color, grade I nuclear cataract, and filamentous opacity in the vitreous chamber. Fundus examination objectified small optic disc showing clearly visible contour and excavation (3/10), good foveal reflex and normal peripheral retina. Orbital MRI was performed, which showed bilateral palpebral infiltration, predominantly on the upper conjunctival surface with iso-signal on T2 and uniformly enhanced after injection. Lacrimal glands were invaded. Conical fat, eyeball and optic nerve were spared (B). After a multidisciplinary meeting, it was decided to perform conjunctival biopsy with immunohistochemistry, which showed malignant non-Hodgkin B lymphoma of the marginal malt zone CD20 +, CD 10-, CD23- , anti-cyclin D1, with proliferation index 8% (C). The patient was then referred to the hematology department for chemotherapy.

Biocompatibility and feasibility of VisiPlate, a novel ultrathin, multichannel glaucoma drainage device

BackgroundGlaucoma is the leading cause of blindness worldwide. Glaucoma drainage devices and minimally invasive glaucoma surgeries (MIGS) often present with tradeoffs in safety and durability of efficacy. Using a rabbit model, we examined the biocompatibility and feasibility of VisiPlate, a novel, ultrathin, tubeless subconjunctival shunt comprised of a network of microchannels.MethodsSix naive female New Zealand White rabbits received implants (three only in the right eye with contralateral eye untreated and three in both eyes) composed of a 400-nm-thick aluminum oxide core coated with 2 µm of parylene-C, manufactured with microelectromechanical systems (MEMS) techniques. Tonometry, slit lamp exam, clinical exam, fluorescein patency testing, and histopathology were performed.ResultsVisiPlate demonstrated IOP-lowering of 20–40% compared to baseline at each time point over the course of 3 months in the nine implanted eyes. All eyes developed blebs over the implant, and fluorescein testing demonstrated fluid patency at 22 days post-implantation. Slit lamp and clinical observations showed that VisiPlate was well tolerated, with low levels of conjunctival congestion, conjunctival swelling, aqueous flare, hyphema, and iris involvement from surgery that resolved over time. At sacrifice time points of 93 days and 180 days, the only notable observations were mild levels of conjunctival congestion in implanted eyes. Histopathology showed minimal tissue response and no obvious inflammation, fibrosis, or necrosis around the implant.ConclusionsThe results of this in vivo study demonstrate the biocompatibility and IOP-lowering effect of a multichannel, ultrathin subconjunctival shunt in a rabbit model. The data suggest that VisiPlate may safely enhance aqueous outflow and significantly reduce intraocular pressure.

Development of Chronic Conjunctival Swelling in Association with Congenital Lymphedema

Although the association between the conjunctival swelling & lymphedema is rare, but this may occur, most of the cases described are part of the lymphedema distichiasis syndrome, this is the first case reported in North America where patient developed many years after birth (when the patient is 9 years old) an isolated chronic conjunctival swelling (not associated with any syndrome affecting the eyes) in association with congenital lymphedema of the feet.

Evaluation of chickens infected with a recombinant virulent NDV clone expressing chicken IL4

BackgroundThere is evidence that chicken IL4 (chIL4) functions similarly to its mammalian analogue by enhancing type 2 T helper (Th2) humoral immunity and promoting protection against parasitic infections; however, no studies have been performed to assess the effect of chIL4 on the pathogenesis of Newcastle disease (ND). To assess the role of chIL4 in velogenic NDV pathogenesis we created a vNDV infectious clone expressing chIL4. We hypothesized that co-expression of chIL4 during virus replication would result in decreased inflammation caused by the Th1 response and thereby increasing survival to challenge with vNDV. MethodsTo evaluate the effect of chIL4 during early infection with velogenic Newcastle disease virus (NDV) in chickens, recombinant NDV clones expressing either chIL4 (rZJ1-IL4) or a control expressing green fluorescent protein (rZJ1-GFP) were created by inserting an expression cassette in an intergenic region of the NDV genome. The pathogenesis of rZJ1-IL4 was assessed in 4-week-old specific pathogen free chickens. The extent of virus replication was evaluated by titration in mucosal secretions and immunohistochemistry in multiple tissues. Expression of chIL4 was confirmed in tissues using immunohistochemistry. ResultsInfection of birds with the rZJ1-IL4 resulted in successful viral replication in vivo and in vitro and generation of the chIL4 in tissues. All birds were clinically normal 2 DPI, with one bird in each group showing conjunctival swelling and enlarged spleens grossly. At 5 DPI, moderate or severe depression was observed in birds infected with rZJ1-GFP or rZJ1-IL4, respectively. Neurological signs and thymic atrophy were observed in one bird infected with rZJ1-IL4. Grossly, conjunctival swelling, mottled spleen and proventricular hemorrhages were observed at 5 DPI in one bird from each group. At 5 DPI, severe necrosis in the spleen, bursa and cecal tonsils were observed in birds infected with rZJ1-GFP, along with minimal evidence of chIL4 expression. In contrast, splenic atrophy, and moderate necrosis in the bursa and cecal tonsils were observed in birds infected with rZJ1-IL4. In addition, chIL4 signal was found in all tissues of rZJ1-IL4 birds at 5DPI. ConclusionsThe production of chIL4 by a recombinant NDV strain resulted in the activation of the positive feedback loop associated with IL4 production. Insertion of chIL4 into NDV may decrease necrosis to lymphoid organs while increasing the severity of lymphoid atrophy and prolonged disease. However, with a low number of birds it is difficult to determine whether these results are significant to disease outcome.

An unusual ocular presentation of histoid leprosy

Leprosy is a chronic granulomatous infection caused by mycobacterium leprae, mainly affecting the skin and peripheral nerve. Histoid type of leprosy, which is considered as an extremely rare variant of lepromatous leprosy. We report a case of a 50/year old male presented to our institute with chief complain of conjunctival swelling in both eyes, encroaching over cornea and involving limbus and sclera, associated with painless blurring of vision. An incisional biopsy of the right eye was performed under local anesthesia. Histopathology of right eye biopsy revealed spindle shaped cells having bland looking nuclei and variable amount of cytoplasm which was suggestive of histoid leprosy. A dermatology consultation was sought and patient was diagnosed to have leprosy. Consequent to which he was started on MBALD (multibacillary anti leprosy drug), and showed improvement in patient`s visual acuity as well as regression of right eye swelling and disappearance of left eye swelling.

Lack of Acute Toxicity and Mutagenicity from Recombinant Epinephelus lanceolatus Piscidin Expressed in Pichia pastoris.

The antimicrobial peptide (AMP) piscidin was identified from Epinephelus lanceolatus and demonstrated to possess antimicrobial and immune-related functions. Supplementation of feed with recombinant Epinephelus lanceolatus piscidin (rEP)-expressing yeast pellets may minimize the excessive use of antibiotics and control pathogens in aquaculture or animal husbandry. However, before implementing rEP as a supplement, it is necessary to understand whether it harbors any toxicity. Since toxicological information on the topic is scarce, the present investigation was carried out to test whether rEP exhibits allergenic and/or toxic effects. In an oral acute toxicity test (OECD 425), Sprague Dawley (SD) rats were administered rEP dissolved in reverse osmosis water, yielding an LD50 > 5000 mg/kg (no observed animal death). The compound was therefore classified as non-toxic by oral administration. In an acute respiratory toxicity test (OECD 403), heads and noses of SD rats were exposed to liquid aerosol for 4 h (the highest concentration that could be administered without causing any animal death), and a lethal concentration (LC50) > 0.88 mg/L was obtained. The mass medium aerodynamics diameter (MMAD) of rEP aerosol particles was 8.18 μm and mass medium aerodynamics diameter (GSD) was 3.04, which meant that 25.90% could enter the airway (<4 μm) of a rat, and 58.06% (<10 μm) could be inhaled by humans. An ocular irritation test (OECD 405) with rEP powder was performed on New Zealand White (NZW) rabbits. Signs of irritation included conjunctival swelling and diffuse flushing 1 h after administration. The signs were less apparent after 24 h and disappeared after 72 h. The classification assigned to the powder was mild eye irritation. Skin sensitization was performed for a local lymphoproliferative test (OECD 442B) using BALB/c mice, with the highest soluble concentration of the rEP considered to be 100% test substance; formulations were diluted to 50% and 25%, and bromodeoxyuridine (BrdU) incorporation was used to measure the degree of lymphocyte proliferation. The stimulation indexes (SIs) were 1.06 (100%), 0.44 (50%), and 0.77 (25%), all of which were less than the cutoff value for a positive sensitization result (1.6). Negative response was also seen in the bacterial reverse mutation test (OECD 471), and no chromosomal effects on Chinese hamster ovary (CHO)-K1 cells were observed (OECD 487). Based on these six toxicity tests, rEP showed neither acute toxic effects in experimental animals nor mutagenicity. Thus, rEP can be considered safe for use in subsequent research on its application as a feed additive for poultry, cattle, or aquatic animals.

Infiltrating ocular dermolipoma leading to diplopia

We report the observation of a 12-year-old child, who had left lower temporal swelling, gradually increasing in volume, evolving over several years, causing discomfort to ocular motility with binocular diplopia in the abduction look. The visual acuity was at 60/60 in both eyes, the anterior and posterior segment were without particularities. The examination found a voluminous « yellow» conjunctival swelling in inferior-temporal of left eye, not reaching the limb and whose size is unmodifiable. The eye motility examination found a limitation of abduction of the left eye, confirmed by a Lancaster test. An orbito-cerebral MRI was performed, revealing an orbital tumor of «greasy» density, with a suspicion of muscle infiltration, strongly suggestive of a dermolipoma. The patient had a surgical resection of the tumor, with a good post-operative evolution. The conjunctival dermolipoma is a benign congenital tumor, usually located at the temporal region of the bulbous conjunctiva, near the lateral canthus, its represent 5% of all orbital lesions in children. Dermolipoma are most often asymptomatic, or may progress during the first or second decade of life, and become visible in the primary eye or in adduction, requiring surgery for cosmetic purposes. However, many precautions must be taken, as cases of diplopia, strabismus, blepharoptosis and dry keratocontivitis, were reported after surgery, following aggressive resection; by damaging the right muscles, the upper eyelid lifter and the tear gland. Therefore, resection of the dermolipoma should be treated more conservatively,to avoid this complications..

Ocular juvenile xanthogranuloma

We present a case of a 3-year-old male child with a history of swelling in the left eye of 1-month duration who was seen elsewhere for this complaint and was started on topical steroids. Slit-lamp examination revealed a conjunctival swelling of size 2 mm × 2 mm, well-defined margins, slightly raised from the surface, had a pink hue without any surrounding conjunctival congestion. A clinical diagnosis of foreign body granuloma was made, and the child underwent excision biopsy. Histopathological examination revealed Juvenile Xanthogranuloma (JXG). JXG was first described by Adamson in 1905 in a child who had multiple skin nodules. He defined those lesions by the name congenital xanthoma multiplex. A case of JXG with iris involvement was presented for the first time in 1948 at the Ophthalmic Pathology Club gathering in Washington DC, and it was published 1 year later by Blank et al.

Allergic contact dermatitis of both eyes caused by alcaftadine 0.25%: a case report

BackgroundTo report the first case of allergic contact dermatitis (ACD) associated with alcaftadine 0.25% ophthalmic solution.Case presentationThe patient was a 51-year-old woman with no previous history of side effects to ophthalmic antihistamine agents. She had been prescribed alcaftadine 0.25% for allergic conjunctivitis. On first application of the medication, she did not experience any cutaneous reaction. One day later, after the second alcaftadine 0.25% application, both eyelids became swollen, and erythematous changes were evident. On slit-lamp examination, conjunctival injection was noted in the absence of conjunctival swelling or any other findings. Fundus examination was unremarkable. To evaluate the cause of ACD, a patch test was performed and 48 h later was noted to be positive for alcaftadine 0.25%. Based on the positive patch test, the patient was diagnosed with ACD caused by alcaftadine 0.25%. After 9 days of treatment, the swelling and erythema completely resolved.ConclusionsAlthough there have been no previous reports of alcaftadine 0.25%-associated ACD, it should be suspected in patients with swelling and erythematous change of both eyes after using alcaftadine 0.25%.

Acute corneal injury in rabbits following nitrogen mustard ocular exposure

Sulfur mustard (SM), a potent vesicating chemical warfare agent, and its analog nitrogen mustard (NM), are both strong bi-functional alkylating agents. Eyes, skin, and the respiratory system are the main targets of SM and NM exposure; however, ocular tissue is most sensitive, resulting in severe ocular injury. The mechanism of ocular injury from vesicating agents' exposure is not completely understood. To understand the injury mechanism from exposure to vesicating agents, NM has been previously employed in our toxicity studies on primary human corneal epithelial cells and ex vivo rabbit cornea organ culture model. In the current study, corneal toxicity from NM ocular exposure (1%) was analyzed for up to 28 days post-exposure in New Zealand White male rabbits to develop an acute corneal injury model. NM exposure led to conjunctival and eyelid swelling within a few hours after exposure, in addition to significant corneal opacity and ulceration. An increase in total corneal thickness and epithelial degradation was observed starting at day 3 post-NM exposure, which was maximal at day 14 post-exposure and did not resolve until 28 days post-exposure. There was an NM-induced increase in the number of blood vessels and inflammatory cells, and a decrease in keratocytes in the corneal stroma. NM exposure resulted in increased expression levels of cyclooxygenase-2, Interleukin-8, vascular endothelial growth factor and Matrix Metalloproteinase 9 indicating their involvement in NM-induced corneal injury. These clinical, biological, and molecular markers could be useful for the evaluation of acute corneal injury and to screen for therapies against NM- and SM-induced ocular injury.

Comparison of bilateral medial rectus plication and resection for the treatment of convergence insufficiency-type intermittent exotropia.

To compare the clinical outcomes of bilateral medial rectus plication and resection for the treatment of convergence insufficiency (CI)-type intermittent exotropia (IXT). Fifty-five patients with CI-type IXT were included in this prospective study and were followed for 6months. The patients were randomized into two groups: the bilateral medial rectus plication (BMRP) group (n=27) and the bilateral medial rectus resection (BMRR) group (n=28). The eye examinations of each patient were carried out before the surgery and at 1day and 1, 3 and 6months postoperatively. The success rate, angle of deviation, stereoacuity, operative time and postoperative conjunctival swelling and redness score were analysed. The mean deviation at distance at 1day postoperatively was +6.6±5.6prism dioptres (PD) in the BMRP group, which was lower than the value of +10.8±9.3PD observed in the BMRR group (p=0.046). There was more overcorrection in the BMRR group at first day after surgery. However, there were no significant differences in deviations or success rates were observed between the two groups at 1, 3 and 6months after surgery (p>0.05). The operative time in the BMRP (12.9±1.4min) group was shorter than that in the BMRR (14.7±1.4min) group (p<0.001). Postoperative conjunctival swelling and redness were milder in the BMRP group than in the BMRR group (p<0.001). The BMRP surgery could be an alternative procedure to BMRR for the treatment of CI-type IXT with less immediate postoperative overcorrection and simpler, safer, less traumatic characteristics.

THE SUPERINFECTION THAT’S A REAL HEADACHE

SESSION TITLE: Critical Care 1 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Legionnaires’ disease serves as one of the most ubiquitous causes of community-acquired pneumonia. We are reporting a rare case of influenza with a superinfection of Legionnaires disease presenting with altered mental status due to severe hyponatremia. CASE PRESENTATION: A 60-year-old woman with no significant medical history was brought to the ER by her sister after she was found on the ground. According to her sister, the patient had a right facial droop with dried blood in her nares and sub-conjunctival hemorrhage as well as an “unusual posturing” of her hands and feet. Prior to the event, she had been complaining of nausea and vomiting for the past two days for which she had been taking Alka-Seltzer and herbal teas. On physical examination, she remained unconscious with bilateral conjunctival swelling and injection but no nuchal rigidity or apparent head injury. Temperature was 99.7 F with heart rate of 70 bpm, blood pressure was elevated to 221/105 mmHg. She was intubated with subsequent improvement in BP. The initial laboratory results revealed hyponatremia with sodium of 109 mEq/L and elevated creatinine kinase level of 11108. Urine toxicology report was negative. CT imaging of head demonstrated cerebral edema with loss of the gray and white matter significant for global ischemia. After admission to the ICU for management of hyponatremia and cerebral edema, she was found to be influenza and legionella positive. She completed a course of Tamiflu and Levaquin and sodium was slowly corrected to 134mEq/L. She was extubated on hospital day 3, by day 6 she had complete restoration of mental status and strength and was discharged home. DISCUSSION: While the most common superinfections with influenza are S. pneumoniae, H. influenzae, and S. aureus, Legionella has been associated with influenza virus (1). There exists no particular set of clinical features that should raise suspicion for the disease as the presentations may differ. Legionella etiology of community acquired pneumonia serves as a strong predictor for low sodium level, independent of disease severity (2). Although previous studies suggested antidiuretic hormone-independent mechanisms such as direct renal effects of cytokines and toxins as the culprit, the mechanism still remains unknown. (3). However, since hyponatremia can cause a number of serious complications, such as coma and death, there still needs to be a careful management of those patients presenting as symptomatic hyponatremia. When dealt with the right management with correction of sodium level and appropriate antibiotics in a timely manner, one may expect a dramatic improvement in patients’ physical and mental status. CONCLUSIONS: Even though the extent of hyponatremia in patients with Legionella pneumonia may not correlate with the severity of the disease, hyponatremia in itself can lead to dangerous outcomes and suspicion for legionella infection should be high. Reference #1: Morris DE, Cleary DW, Clarke SC. Secondary Bacterial Infections Associated with Influenza Pandemics. Frontiers in Microbiology. 2017;8:1041. https://doi.org/10.3389/fmicb.2017.01041. Reference #2: Yu, Victor L. Legionnaires' Disease: Importance of High Index of Suspicion in Patients in the ICU with Community-Acquired Pneumonia. CHEST. 2014;145:2. DOI: https://doi.org/10.1378/chest.13-2170 Reference #3: Schuetz P, Haubitz S, Christ-Crain M, Albrich WC, Zimmerli W, Mueller B. Hyponatremia and anti-diuretic hormone in Legionnaires’ disease. BMC Infectious Diseases. 2013;13:585. https://doi.org/10.1186/1471-2334-13-585. DISCLOSURES: No relevant relationships by Erica Altschul, source=Web Response No relevant relationships by Cyra-Yoonsun Kang, source=Web Response

Clinical Efficacy of Platelet-Rich Plasma in the Treatment of Neurotrophic Corneal Ulcer

Purpose Platelet-rich plasma (PRP) is an autologous blood product without preservatives and rich in proteins and growth factors which make it possible for cells to differentiate, proliferate, and migrate, thus stimulating healing and regeneration of tissues. The aim of this study was to evaluate the efficiency of autologous platelet-rich plasma in the treatment of neurotrophic keratopathy. Methods The study group consists of 25 patients with nonhealing corneal ulcers due to herpes simplex or herpes zoster infection and facial nerve or trigeminal nerve paralysis as a result of a neurosurgical operation caused by a tumour or stroke. The patients were given autologous platelet-rich plasma drops five times a day and additionally preservative-free artificial tears and a vitamin A ointment at night for maximum 3 months. The following were evaluated: best corrected visual acuity (BCVA), healing of corneal surface, subjective symptoms, and changes in corneal thickness with the use of anterior segment optical coherent tomography (AS-OCT). Results BCVA before the treatment was 0.10 ± 0.14, and after the treatment it was –0.3 ± 0.27 (p=0.001). Improved visual acuity and less subjective symptoms were observed in all patients. Complete healing of the ulceration was observed in 20 patients (80%). Four patients (16%) experienced considerable improvement of their clinical condition (reduced size and depth of the ulceration and inflammatory state: smaller conjunctival injection and swelling, improved visual acuity, and less subjective symptoms). In one of the patients, an amniotic membrane was transplanted due to the lack of improvement of his local condition. In all patients, the progression of corneal thinning was stopped. An average corneal thickness in its thinnest point was 322.3 ± 125.8 µm before the treatment, and 404.5 ± 118.7 µm (p < 0.05) after the treatment. None of the patients reported general or local side effects of the treatment. Conclusions Autologous platelet-rich plasma is a blood-based product which seems efficient in the treatment of neurotrophic keratopathy.