Conjunctival Ulceration Research Articles

Multiple Conjunctival Ulcers in Behçet Disease.

Multiple Conjunctival Ulcers in Behçet Disease.

Anesthetic management of a child with a laryngeal mass associated with Laryngo-onycho-cutaneous syndrome

With fewer than 50 reported cases, Laryngo-onycho-cutaneous syndrome is a rare condition presenting in childhood with skin and conjunctival ulcerations and laryngeal pathology. A 4-year-old girl presented with recent onset aphonia. Airway endoscopy revealed a laryngeal mass. Tracheostomy was advised but parents denied consent. Two weeks later, she developed severe stridor warranting emergent tracheostomy. The child was diagnosed as Laryngo-onycho-cutaneous syndrome, also known as Shabbir syndrome. Subsequently, she was taken up for laser excision of the mass. Here, we describe the anesthetic management in such airway procedures. Total intravenous anesthesia and local anesthetic in the form of vocal cord spray are safe and environment-friendly alternatives to inhalational anesthesia for airway endoscopies.

First report of molecular epidemiology and phylogenetic characteristics of feline herpesvirus (FHV-1) from naturally infected cats in Kunshan, China

BackgroundFeline herpesvirus type 1 (FHV-1) is a life threatening highly contagious virus in cats and typically causes upper respiratory tract infections as well as conjunctival and corneal ulcers. Genetic variability could alter the severity of diseases and clinical signs. Despite regular vaccine practices against FHV-1 in China, new FHV-1 cases still commonly occur. The genetic and phylogenetic characteristics of FHV-1 in Kunshan city of China has not been studied yet. Therefore, this study was planned to investigate the prevalence, molecular characteristics of circulating strains, and phylogenetic analyses of FHV-1. This is the first report of molecular epidemiology and phylogenetic characteristics of FHV-1 from naturally infected cats in Kunshan, China.MethodsThe occulo-nasal swabs were collected from diseased cats showing respiratory distress, conjunctivitis, and corneal ulcers at different veterinary clinics in Kunshan from 2022 to 2023. Clinical data and general information were recorded. Swab samples were processed for preliminary detection of FHV-1. Thymidine kinase (TK), glycoprotein B (gB) and glycoprotein D (gD) genes were sequenced and analyzed to investigate genetic diversity and evolution of FHV-1.ResultsThe FHV-1 genome was detected in 43 (43/200, 21.5%) samples using RT-PCR targeting the TK gene. Statistical analysis showed a significant correlation between age, vaccination status and living environment (p < 0.05) with FHV-1 positivity, while a non-significant correlation was observed for FHV-1 positivity and sex of cats (p > 0.05). Additionally, eight FHV-1 positive cats were co-infected with feline calicivirus (8/43,18.6%). FHV-1 identified in the present study was confirmed as FHV-1 based on phylogenetic analyses. The sequence analyses revealed that 43 FHV-1 strains identified in the present study did not differ much with reference strains within China and worldwide. A nucleotide homology of 99-100% was determined among gB, TK and gD genes nucleotide sequences when compared with standard strain C-27 and vaccine strains. Amino acid analysis showed some amino acid substitutions in TK, gB and gD protein sequences. A potential N-linked glycosylation site was observed in all TK protein sequences. Phylogenetic analyses revealed minor variations and short evolutionary distance among FHV-1 strains detected in this study.ConclusionsOur findings indicate that genomes of 43 FHV-1 strains are highly homogenous and antigenically similar, and the degree of variation in major envelope proteins between strains is low. This study demonstrated some useful data about prevalence, genetic characteristics, and evolution of FHV-1 in Kunshan, which may aid in future vaccine development.

An unusual case of bilateral conjunctival ulcer post dengue fever: A case report

A 25-year-old male patient presented with redness and pain in both eyes since 2 days with history of fever in the past 1 week and tested positive for dengue. On examination, the patient had bilateral nasal congestion and a whitish-yellow lesion in the right eye canthal region measuring 4 mm × 4 mm and 2 mm × 1 mm in the left eye; the lesion was fluorescein stain-positive. A provisional diagnosis of bilateral conjunctival ulcer was made and sent for culture and sensitivity. Culture revealed mixed bacterial and fungal growth of Pseudomonas aeruginosa and Aspergillus niger. The patient was started on fortified vancomycin 50 mg/mL (5%) and ceftazidime 50 mg/dL (5%) along with natamycin 5% eyedrops and oral ketoconazole 200 mg. The patient reviewed after 5 days showed fluorescein stain-negativity in both eyes and was completely asymptomatic on further follow-up. Opportunistic infections are common in dengue fever and should be treated aggressively to prevent further ocular complications.

Large Conjunctival Ulceration from Ocular Monkeypox

Figure Description: A 34-year-old transgender female with history of human immunodeficiency virus (HIV) presented to the emergency department with complaint of a painful rash. Vesiculopapular lesions were present on the hands, face, and genitals raising clinical suspicion for monkeypox. The lesions were positive for monkeypox (orthopoxvirus) by polymerase chain reaction (PCR) and the patient's absolute CD4 count was 19 cells/uL. Tecovirimat was initiated for treatment of monkeypox as well as bictegravir-emtricitabine-tenofovir for newly diagnosed acquired immunodeficiency syndrome (AIDS). Two weeks later, the patient developed left eye pain. External examination findings (Figure 1) revealed a healing pox lesion present on the glabella (panel A), the left eye had temporal conjunctival injection, engorgement of the episcleral vessels, and a raised papule (panel B) that was PCR-positive for monkeypox. Higher magnification revealed conjunctival ulceration (panel C) with an epithelial defect demonstrated by green fluorescein staining under a cobalt blue light (panel D). The patient was started on erythromycin ointment and the lesion subsequently healed over the course of three weeks. As our understanding of ocular monkeypox evolves, it is apparent that the manifestations can be quite variable, ranging from classic papulovesicular eyelid lesions, conjunctivitis, keratitis, and subconjunctival nodules which can ulcerate as observed in this patient. Acknowledgement This study was supported by NIH/NEI grants EY029395 and EY034114 awarded to Dr. Edgar M. Espana.

Conjunctival necrosis due to periocular clear steroid injection mimicking scleral nodule

Abstract Conjunctival necrosis with or without scleritis is a rare complication following periocular administration of corticosteroids. A 60-year-old lady presented with a diffuse scleral nodule with an overlying sinus in her left eye following cataract surgery. Tests for immune and infective etiology were negative. Due to its recalcitrant nature despite scraping, antibiotic, and steroid treatment, she underwent a scleral biopsy of the affected area, which was negative for organisms. However, high-pressure liquid chromatography with photodiode array detector revealed a significant presence of dexamethasone in the biopsy samples, which was the possible cause of conjunctival necrosis and ulceration mimicking scleritis.

Nocardia infection following ocular surface surgery

ObjectiveTo investigate the clinical characteristics and treatment outcomes of Nocardia infection after ocular surface surgery.MethodsThis is a retrospective study. Eight cases of culture-proven Nocardia infection, which developed within 1 month after ocular surface surgery were included. Demographics and clinical history of patients were investigated.ResultsThere were 8 eyes (2 left and 6 right) of 8 patients (5 males and 3 females), aged 27–65, with a median age of 52.9 years. Three cases underwent pterygium excision, three were subjected to conjunctival flap covering, and two were treated with lamellar corneal transplantation. The time interval between previous surgery and the onset of symptoms varied from 7 to 28 days (mean = 20.5 ± 7.13 days). All the cases presented grey-white infiltrates at the surgical incision site while appearing with six corneal ulcers and two conjunctival ulcers. Filaments of Nocardia were founded by confocal microscopy in two of the five cases. All responded poorly to medical therapy. Seven of the eight cases were treated with reoperation. Nocardia infection recurred in three cases after reoperation, and one was eviscerated.ConclusionsSurgical trauma is a risk factor for ocular Nocardia infection. Nocardia infection should be suspected when secondary infection occurs in a surgical incision with an atypical clinical presentation. The use of corticosteroids may influence the efficacy of drugs. Complete removal of lesions may lower the recurrence of Nocardia infection with poor drug treatment effects.

Herpes simplex virus conjunctival dendritic ulcer as a primary infection in an immunocompetent patient

AbstractPurposeTo describe an atypical case of conjunctival herpetic dendritic ulceration in an immunocompetent patient with no history of herpetic primary infection.MethodsThis is a single observational case report and a review of the literature. The patient was followed in successive appointments.ResultsOcular involvement by the herpes simplex virus (HSV) in its recurrent form is characteristic for dendritic ulcers in the corneal epithelium, which are postulated to obtain this form due to the corneal nerve plexus. We describe the first case to date of an immunocompetent patient, age &gt; 70 years and without prior immunosuppressive treatment, with a primary herpetic infection clinically diagnosed by presenting a dendritic ulcer in the bulbar conjunctiva. The patient had nonspecific corneal involvement, and the case was subsequently confirmed with polymerase chain reaction for HSV‐1.ConclusionsThe presentation of a dendritic ulcer in the bulbar conjunctiva in a case of ocular herpes infection is a rare finding, and the physiopathology is unknown. It casts doubt on the theory that corneal dendritic ulcer morphology is only formed because of the corneal sub‐basal nerve plexus involvement. This suggests that conjunctiva examination is of vital importance in herpetic ocular infection, and that it can used a diagnostic methodology if no other eye conditions are found.

Conjunctival herpetic ulcer in an immunosuppressed patient with birdshot chorioretinopathy

Introduction: Herpes Simplex Virus (HSV) is a human herpesvirus responsible for systemic infections. Ocular involvement spans all ocular tissues. Corneal lesions, such as dendritic or geographic ulcers, are frequently found in HSV keratitis while conjunctival lesions have been described as infrequent.&#x0D; Clinical case: A 62-year-old man diagnosed with Birdshot chorioretinopathy presented a stye in his eyelid that was treated with oxytetracycline-hydrocortisone ointment. One week later he returned presenting several small dendritic corneal ulcers in both eyes and a conjunctival ulcer in one of them. All lesions healed completely after treatment with topical acyclovir ophthalmic ointment at 3%.&#x0D; Conclusions: We should pay attention to the conjunctiva and not merely focus on the cornea when examining patients with herpetic eye disease, especially if being treated with inmunosupressors.

An Unusual Case of Surma (Eye Cosmetic) Induced Conjunctival and Scleral Ulceration

An Unusual Case of Surma (Eye Cosmetic) Induced Conjunctival and Scleral Ulceration

Conjunctival Ulcers in Behcet's Disease and Response to Colchicine.

Conjunctival Ulcers in Behcet's Disease and Response to Colchicine.

Sterile Conjunctival Ulcer Secondary to Punctal-Entrapped Eyelash

Sterile Conjunctival Ulcer Secondary to Punctal-Entrapped Eyelash

Persistant red eye? Look out for conjunctival ulcers; eye opener for systemic differential diagnosis

Persistant red eye? Look out for conjunctival ulcers; eye opener for systemic differential diagnosis - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/2395-1451.2019.0033, Indian Journal of Clinical and Experimental Ophthalmology-Indian J Clin Exp Ophthalmol

Stevens Johnson syndrome during postoperative period. A case report

Introduction The Stevens Johnson syndrome is a rare and potentially fatal cutaneous reaction to medicaments or infections. The most common drugs linked to this syndrome are antibiotics (such as sulfonamides, cephalosporines and quinolones), anticonvulsivant drugs (carbamazepine, phenytoin) and nonsteroidal anti-inflammatory drugs (NSAIDs). It is characterized by extensive necrosis with detachment of the epidermis, and the mortality rate rises up to 30%. We present a case of Stevens Johnson syndrome associated with drugs administration during postoperative period. Case description A 73-year-old female reported to Department of Hepatic Surgery for a hepatectomy due to colorectal liver metastases. Her oncological history initiated 5 months ago with a colorectal obstructive tumor and liver metastases in both lobes. An emergency Hartmann procedure was performed following adjuvant chemotherapy, with good response. The surgical team decided to perform a two stage hepatectomy. The postoperative period was torpid and a reintervention for bowel obstruction was required, as well as two long stays in the Intensive Care Unit. A month after the first surgery, the patient presented with a reddish maculopapular lesion on the neck that rapidly extended to the back and forearms. An intra-oral erythema and conjunctival ulcerations were also noted. The diagnosis of syndrome was confirmed by the Department of Dermatology with a skin biopsy. Pharmacology and Allergy Departments completed the study and proposed that the syndrome was possibly due to peniciline and NSAIDs. Despite the efforts of the multidisciplinary team, the supportive care, and the early retreat of the possible causing drugs and ciclosporine plus corticosteroids treatment, the patient presented with severe liver failure and finally died after 2 months of hospitalization. Conclusions Cutaneous reactions are a very common condition during the postoperative period, most of them are related to habitual drugs regimens. Considering this, it is of paramount importance to keep in mind that the Stevens Johnson syndrome is a rare but severe dermatological pathology in which early diagnosis and treatment is vital.

Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children

To describe the acute and chronic ocular manifestations of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN Overlap syndrome (Overlap syndrome) in children. Retrospective case series. Medical records of children admitted to the Hospital for Sick Children between 2001 and 2011 with SJS, TEN, and Overlap syndrome were reviewed. Demographic information, all abnormal ophthalmic findings (and median time to first diagnosis), visual acuities, and ophthalmic treatments prescribed were collected for each eye for every patient. Thirty-six children were identified for inclusion in the study. Twenty-nine (81%) had acute ocular involvement, including all patients with TEN (n= 7). Conjunctivitis was the most common (78%) clinical sign. This, together with conjunctival membranes and subconjunctival hemorrhage, were the earliest signs, presenting by a median of 1day. The percentage of patients and median time to occurrence of complications were as follows: for lid margin ulceration and corneal epithelial defects, 25%, 3days; conjunctival ulceration, 39%, 3.5days; symblepharon, 28%, 4weeks; corneal opacification, 11%, 4months; limbal stem cell failure, 8%, 7months; and corneal vascularisation, 8%, 10months after admission. Over 90% of children maintain a visual acuity of 20/40 or better in each eye at a mean follow-up of 1.4 years. Ocular involvement in SJS, TEN, and Overlap syndrome is common and the ocular manifestations may develop many months after the initial presentation, mandating the need for long-term follow-up of these children. Despite the high frequency of sight-threatening disease, most children maintain good vision in the long term.

Prévalence des ruptures de la capsule dorsale du poignet chez 100 patients ayant une arthroscopie pour douleur de poignet

Button batteries can cause local tissue necrosis within 2 h of exposure due to hydrolysis of tissue fluid and generation of hydroxide ions. Tissue damage resulting from battery exposure has been associated with acute and chronic complications via several routes, however, previous experience with ocular battery exposures is predominantly limited to batteries that have exploded or penetrated the eye.A case is presented of an intact battery causing significant damage after ocular exposure without penetrating the eye.An 18-year-old woman presented to the Emergency Department after a toy balloon propelled a button battery into the patient's eye. The battery did not penetrate the orbit and was intact upon removal from the inferior fornix in the operating room 4 h later. The patient had severe conjunctival ulceration, subconjunctival hemorrhage, vitreous opacification, and a partially dilated pupil, with the greatest area of injury adjacent to the negative pole of the battery. The eye was extensively irrigated and the patient was treated with topical antibiotics, steroids, and a daily rodding procedure to prevent conjunctival adhesions. The eye ultimately healed over the subsequent 6 months, with normal visual acuity on follow-up.Prolonged ocular exposure to an intact battery can cause significant tissue necrosis, which may threaten sight. Early removal is critical to prevent significant ocular damage and visual compromise.

Conjunctival and corneal ulceration associated with nicorandil

Context/Objective: To report an association between conjunctival and corneal ulceration and nicorandil therapy for angina.Methods: Review of the literature and spontaneous reports collected at the National Registry of Drug-Induced Ocular Side Effects (Portland, Oregon), the FDA Spontaneous Reporting System (Bethesda, Maryland) and the World Health Organization’s Uppsala Monitoring Center (Uppsala, Sweden).Results: Thirteen case reports of adverse ocular reactions were collected. Abnormal vision (5 reports), corneal ulcer (4 reports) and conjunctival ulcer (4 reports) were associated with nicorandil. Eight subjects were male and 5 female with an average age of 75.4 ± 8.3 years. The average duration of therapy to development of the ADR was 30.4 days ±3 days. Eleven case reports had positive dechallenge and the patients fully recovered. The average dose was 21.6 mg daily.Conclusion: Using WHO classification for adverse drug reactions, the association between nicorandil and conjunctival and corneal ulceration is “possible”. The case reports indicate that, if recognized, withdrawing nicorandil will lead to resolution of the conjunctival or corneal ulceration. Advanced age and accumulation of nicotinic acid in tissues may be contributory to the risk of developing ocular ulcerations from nicorandil.

THU0206 Population-based epidemiology and description of behcet’s disease in the african descent population of martinique, french west indies

BackgroundNo study describes the frequency of Behcet’s disease (BD) in the populations of African origin and its characteristics.ObjectivesTo retrospectively assess by retrieval of multiple sources, the epidemiology and characteristics of...

Epidemiology of Behçet Disease

Behçet disease (BD) is a multisystem inflammatory disorder that is an important cause of morbidity worldwide. BD is most common along the ancient “Silk Road” route in the Far East and Mediterranean basin. The eye is the most commonly involved organ in BD patients.The prototypical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Less commonly, BD may present in the form of conjunctivitis, conjunctival ulcers, keratitis, episcleritis, scleritis, and extraocular muscle paralysis. Uveitis in BD carries significant implications for the patient, because it is a chronic recurrent disease characterized by explosive attacks of severe inflammation that may cause significant, cumulative damage to the intraocular structures. This review summarizes the epidemiology of systemic and ocular clinical features of BD with particular focus on risk factors, clinical characteristics, complications, and prognosis of BD-associated uveitis.

Severe Ocular Injury after Button Battery Exposure

BackgroundButton batteries can cause local tissue necrosis within 2h of exposure due to hydrolysis of tissue fluid and generation of hydroxide ions. Tissue damage resulting from battery exposure has been associated with acute and chronic complications via several routes, however, previous experience with ocular battery exposures is predominantly limited to batteries that have exploded or penetrated the eye. ObjectivesA case is presented of an intact battery causing significant damage after ocular exposure without penetrating the eye. Case ReportAn 18-year-old woman presented to the Emergency Department after a toy balloon propelled a button battery into the patient's eye. The battery did not penetrate the orbit and was intact upon removal from the inferior fornix in the operating room 4h later. The patient had severe conjunctival ulceration, subconjunctival hemorrhage, vitreous opacification, and a partially dilated pupil, with the greatest area of injury adjacent to the negative pole of the battery. The eye was extensively irrigated and the patient was treated with topical antibiotics, steroids, and a daily rodding procedure to prevent conjunctival adhesions. The eye ultimately healed over the subsequent 6 months, with normal visual acuity on follow-up. ConclusionProlonged ocular exposure to an intact battery can cause significant tissue necrosis, which may threaten sight. Early removal is critical to prevent significant ocular damage and visual compromise.