Giant Papillary Conjunctivitis Research Articles

Comparison of recurrence rate of primary pterygium using conjunctival autograft with sutures versus suture-free approach.

Objective: To compare the recurrence rate of primary pterygium treated with conjunctival autograft (CAG) using sutures versus a suture-free approach. Methodology: From July 2022 to December 2022, a quasi-experimental study was carried out at the Institute of Ophthalmology, Liaquat University of Medical & Health Sciences Jamshoro. A total of 110 patients with primary pterygium underwent treatment with conjunctival autograft using sutures or a suture-less/glue-free approach, under local anaesthesia. The patients were monitored for 12 months after surgery to assess recurrence and complications, and all procedures were performed by a single surgeon. Data was collected and analyzed on SPSS version 22. Result: The study included 110 patients with pterygium, mostly males (71.81%) and from rural areas, with the nasal location being the most common. Group A had 3 recurrences at 3 and 6 months, while Group B had 4 recurrences at similar intervals. Group A had fewer complications, including graft oedema, retraction, granuloma, and giant papillary conjunctivitis, while Group B had three cases of retraction. The recurrence rate was found to be 5.08% and 7.70% with and without sutures (P value ≥ 0.53) respectively. Conclusion: The excision of primary pterygium using conjunctival autograft with sutures or suture-free/glue-free methods are safe and uncomplicated procedure that results in lower levels of induced astigmatism, improved cosmetic appearance, no tissue loss, reduced recurrence of pterygium, and decreased risk of, scleral thinning, granuloma formation. Suture-free conjunctival autograft results in less postoperative manifestation like discomfort foreign body sensation, shorter surgery time, and high levels of patient satisfaction compared to conjunctival autograft with sutures. Key words: Primary pterygium, autograft and pterygium. recurrence rate of pterygium, suture with pterygium.

496 - Conjunctivitis does not increase with longer duration of lebrikizumab exposure in patients with moderate-to-severe atopic dermatitis

Abstract IntroductionIntegrated safety data for lebrikizumab (LEB) treatment in moderate-to-severe atopic dermatitis (AD) has been previously published. Conjunctivitis and keratitis were identified as adverse events (AEs) of special interest in the AD ­program. Objectives Further characterize patient-reported conjunctivitis and keratitis AEs in LEB clinical trials for AD. Methods Data from adult and adolescent patients were analyzed in 2 groups: a) LEB 250mg every 2 weeks (LEBQ2W, N=783) vs placebo (PBO, N=404), weeks 0-16 (PC 0-16wk) from 4 clinical trials (ADvocate1, ADvocate2, ADhere, Phase 2b study); and b) patients who received at least one dose of LEB (ALL-LEB, N=1720) from 8 clinical trials (ADvocate1, ADvocate2, ADhere, ADore, ADjoin (ongoing), ARBAN, TREBLE, Phase 2b study). Conjunctivitis and keratitis refer to cluster definitions defined by MedDRA preferred terms conjunctivitis, allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis, giant papillary conjunctivitis; and keratitis, atopic keratoconjunctivitis, allergic keratitis, ulcerative keratitis, vernal keratoconjunctivitis, respectively. Exposure adjusted incidence rates (IR) are provided as per 100 patient-years. Results In PC 0-16wk, at baseline, similar proportions of LEB (21.5%) and PBO (19.3%) patients had medical history (MH) of conjunctivitis. Of ALL-LEB, 22.2% had MH of conjunctivitis; of those with conjunctivitis or keratitis AE, 40% had MH of conjunctivitis. In PC 0-16wk, conjunctivitis cluster was reported by 8.5% (IR:30.6) LEBQ2W vs 2.5% (IR:8.9) PBO; keratitis cluster was reported by 0.6% (IR:2.2) and 0.3% (IR:0.9) of patients, respectively. All conjunctivitis and keratitis events in PC 0-16wk were mild or moderate in severity; 5 events (3 conjunctivitis, 2 keratitis) led to treatment discontinuation (LEBQ2W) vs 1 conjunctivitis event (PBO). ALL-LEB treatment duration ranged from 1 dose to 100 weeks. In ALL-LEB, conjunctivitis cluster was reported by 10.6% (IR:12.2), with the majority being mild or moderate (10.3%) and 0.3% severe. Keratitis was reported by 0.5% (IR:0.6), with 1 severe event of vernal keratoconjunctivitis. Conjunctivitis and keratitis events resulted in 17 (1.0%) and 3 (0.2%) treatment discontinuations, respectively. Similar proportions of adult (11.3%; 0.6%) and adolescent (8.3%; 0.3%) patients reported conjunctivitis and keratitis events. The majority were reported within first 16 weeks of treatment. ConclusionsConjunctivitis is an AE reported by LEB-treated patients. Patients with MH of conjunctivitis may have higher risk of developing treatment-emergent conjunctivitis or keratitis. Most events were mild or moderate in severity, did not lead to treatment discontinuation, were reported within first 16 weeks of treatment, and IR did not increase with longer duration of exposure.

Contact lens‐related complications

The use of contact lens is very popular and its global market is growing. They have numerous applications, some well‐established and others still not consensual but which have been gaining more and more approval, namely refractive errors, dry eye management, post refractive surgery rehabilitation, persistent epithelial defects, cosmetic approaches and drug delivery systems. Unfortunately, there are some complications caused by their use, some of them sight threatening. The purpose of this presentation is to review these problems and to provide a better understanding of them.The major mechanisms implicated are numerous: trauma, decreased corneal oxygenation, reduced corneal and conjunctival lubrication, allergic and inflammatory responses and infection. However, depending on the complication we are talking about, there are other factors involved, such as contact lens‐related factors (material, design, fit and wearing schedule) and environmental factors (ocular surface condition, external environment, occupational factors, medications and compliance).The symptomatology experienced by patients ranges from hypoesthesia and mild conjunctival hyperemia to photophobia, contact lens intolerance and even decreased visual acuity.Many complications have been described. The most important (most common or most serious) are contact lens discomfort (CLD), dry eye, corneal deepithelialization (CD), sterile infiltrates (SI), corneal neovascularization (CNV), infectious keratitis (IK) and giant papillary conjunctivitis (GPC). Superior epithelial arcuate lesion, contact lens‐related peripheral ulcer, corneal distortion, hypoesthesia, ptosis, pinguecula, corneal edema, allergy aggravation, herpes reactivation and endothelial changes have also been described.CLD is an episodic or persistent adverse ocular sensation related to lens wear with a variable incidence in the literature, ranging from 23% to 94% in different series, being less common with soft lenses. Dry eye plays its role acting as a risk factor for CLD and/or as a consequence of contact lens use. CD manifests as punctate epithelial keratopathy, epithelial abrasions, foreign body tracks, corneal dellen, microcysts, vacuoles, mucin balls and dimple veiling. GPC is one of the most common adverse effects of contact lenses and the papillary reaction of the upper tarsal conjunctiva is the main feature of this entity. CNV is the formation of new vessels basically found in capillaries and venules of the pericorneal plexus, which may progress to the corneal stroma. They are much more associated with soft contact lenses, especially in extended wearers. Of note, contact lens use is one of the most common causes of CNV usually highlighted. SI are the result of an immunological reaction, often do not contain overlying epithelial defect or anterior chamber reaction and may manifest as stromal deep opacities. IK may be caused by bacteria, viruses, fungus or parasites and prompt immediate care and close revaluations to anticipate disastrous outcomes.Conservative measures play a role in almost all complications and their prevention, such as patient education, lubrication, contact lens exchange when applicable and modification of environmental factors. Addressing and learning how to prevent or quickly diagnose all these complications is crucial to prevent serious consequences.

Alergiczne zapalenie spojówek

Allergic conjunctivitis is the most common manifestation of conjunctivitis, affecting up to 40% of the population, mostly children and young adults. Among the risk factors there are air pollution, southern latitude and coexisting allergy. The disease develops when IgE-class antibodies are activated by an allergen and later Th2-dependent humoral response is activated. In seasonal and perennial allergic conjunctivitis the symptoms are limited to conjunctiva, however in vernal keratoconjunctivitis and atopic keratoconjunctivitis also the cornea can be affected. Giant papillary conjunctivitis is not an allergy but a response to irritating surface agents, most frequently a contact lens. In treatment there are three groups of medications used: antihistaminic, non-steroid anti inflammatory and steroids. Due to rise of allergic conjunctivitis, it is crucial to accurately diagnose and treat those conditions.

Allergic and immunopathological diseases of the ocular surface

Allergic and immunopathological diseases of the ocular surface are inflammations that can occur with mild to severe symptoms that cause visual impairment. Allergic inflammations mainly affect the conjunctiva, causing acute and/or chronic conjunctivitis. Several forms are distinguished: seasonal allergic conjunctivitis, vernal conjunctivitis, atopic keratoconjunctivitis, contact allergy, giant papillary conjunctivitis. The most common is the seasonal form, which is linked to seasons. Allergic ocular surface processes require local treatment with artificial tears, anti-allergic eye drops. If complications occur, topical corticosteroid and cyclosporin treatment may be used. Immunopathological inflammations of the ocular surface are associated with systemic diseases. Keratoconjunctivitis sicca, although occurring in the absence of systemic disease, is a common companion of Sjögren's syndrome and collagen diseases. Ocular pemphigoid belongs to the group of mucous membrane pemphigoids. After the initial conjunctivitis symptoms, subconjunctival fibrosis begins, leading to the development of sym- and ankyloblepharon. In the final stage, the ocular surface is covered by scar tissue (ocular cicatricial pemphigoid) which practically results in loss of vision. Peripheral ulcerative keratitis is usually associated with collagen vascular disease, rheumatoid arthritis. A 3-4 mm long, curved infiltration starting near the limbus becomes ulcerated and then perforates, on which the iris may prolapse. First, systemic treatment is required, which is an interdisciplinary task. Topical corticosteroid and cyclosporine eye drops may be administered. In the case of corneal perforation, amniotic membrane transplantation and/or keratoplasty may be performed. Orv Hetil. 2023; 164(43): 1686-1692.

Unilateral Eyelid Swelling Secondary to Local Palpebral Conjunctival Amyloidosis in a Young Patient

Purpose: We report a young patient with unilateral eyelid swelling secondary to local, palpebral conjunctival amyloidosis.Case summary: A 31-year-old male was referred with a 6-month history of mild, right upper eyelid swelling but without redness or tenderness. Slit-lamp examination revealed a diffuse hemorrhagic papilliform lesion on the right upper palpebral conjunctiva, this raised a suspicion of giant papillary conjunctivitis. As the lesion was unilateral, there was no history of allergic disease or contact lens use, and the lesion was refractory to topical anti-inflammatory treatment so, excisional biopsy of the right upper palpebral conjunctiva was performed. During the operation, the papilliform lesion was removed, it peeled off on the blade. After surgery, the eyelid swelling improved. Histopathological examination revealed an eosinophilic amorphous deposit consistent with amyloidosis. Further evaluation ruled out systemic amyloidosis; there were no abnormal findings. Thus, we diagnosed primary localized amyloidosis of the palpebral conjunctiva. At the 1-year follow-up, no recurrence was detected.Conclusions: Although primary localized amyloidosis of the palpebral conjunctiva is rare, this should be considered if chronic eyelid swelling accompanied by another conjunctival lesion such as giant papillary conjunctivitis is encountered.

Diagnosis and pharmacological management of allergic conjunctivitis

Background: Allergic conjunctivitis is an immune disease primarily attributed to a type 1 hypersensitivity reaction in the conjunctiva of the eye. Based on clinical findings and pathogenesis, allergic conjunctivitis is classified into the following subtypes: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis.Current Concepts: The recommended initial treatment for allergic conjunctivitis involves the use of dual-effect agents exerting both antihistamine and mast cell stabilizing effects. If symptoms persist despite the application of these agents, coexisting allergic rhinitis should be considered a possible contributing factor, as this condition can also lead to ocular symptoms. Concurrent treatment of allergic rhinitis is necessary. Although oral antihistamines effectively alleviate symptoms associated with allergic conjunctivitis, potential systemic side effects must be carefully considered, particularly in older individuals and children. Steroid eye drops should be used for limited durations to minimize side effects. Unlike seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis involve both type 1 hypersensitivity reactions and type 4 hypersensitivity mediated by T cells. In cases where dual-effect agents or steroid eye drops fail to yield improvements, topical immunosuppressants such as cyclosporine A or tacrolimus can be effective.Discussion and Conclusion: The pharmacological treatment of allergic conjunctivitis involves the initial use of dual-effect agents, with concurrent treatment of allergic rhinitis if present. Importantly, atopic and vernal keratoconjunctivitis can potentially lead to permanent vision loss, necessitating the application of steroid eye drops or immunosuppressant eye drops.

‘BARCELONA CP’ A case of chronic cyanoacrylate glue

Purpose To report a case of idiopathic corneal perforation with chronic inflammation in the setting of a persistent cyanoacrylate corneal glue patch lasting 420 days. Observations Cyanoacrylate glue is a fast-acting and effective adhesive which has been utilised in the repair of corneal perforations. Their strength, quick drying, non-biodegradable and anti-microbial properties make them a valuable tool in closing small corneal wounds, often as a temporising measure before definitive management is performed. Complications associated with cyanoacrylate patch include glue toxicity, inflammation, corneal neovascularisation and giant papillary conjunctivitis. Conclusions Cyanoacrylate glue should be considered a transitory measure. It is preferable to remove cyanoacrylate at the end of the treatment unless the glue has self-dislodge. Controversies surround the issue of selecting proper timing for removal of cyanoacrylate glue with no clear consensus.

373 Safety of lebrikizumab in adults and adolescents with moderate-to-severe atopic dermatitis: data from eight trials

Abstract Lebrikizumab (LEB) is a monoclonal antibody that binds with high affinity to interleukin (IL)-13, thereby blocking the downstream effects of IL-13 with high potency. To report integrated safety information in adult and adolescent patients with moderate-to-severe atopic dermatitis treated with LEB, from an integrated safety analysis of eight clinical Phase 2 and 3 trials. These data include adult and adolescent patients who received at least one dose of study drug from a total of eight atopic dermatitis clinical trials: ADvocate1, ADvocate2, ADhere, ADore, ADjoin (ongoing), ARBAN, TREBLE and a Phase 2b study. Treatment duration ranged from a single dose to 100 weeks. This analysis includes all placebo-controlled Week 0- to 16-safety data in patients treated with LEB 250 mg every 2 weeks (LEBQ2W, n = 783) compared with placebo (n = 404) known as ALL PC Weeks 0–16, and all patients who received at least one dose of LEB (n = 1720) known as ALL LEB. Conjunctivitis cluster is defined by MedDRA-preferred terms of conjunctivitis, allergic conjunctivitis, bacterial conjunctivitis, viral conjunctivitis and giant papillary conjunctivitis. Exposure adjusted incidence rates (IR) are provided as per 100 patient-years. In ALL PC Weeks 0–16 analysis, the frequency of treatment-emergent adverse events (TEAE) was 49.2% in LEBQ2W (n = 384) compared with 53.1% in placebo (n = 215). The majority of TEAEs reported were mild or moderate in severity with 2.3% (n = 18) reported as severe in LEBQ2W and 4.4% (n = 18) in placebo. Serious adverse events (SAEs) were reported by 1.3% (n = 10) in LEBQ2W and 1.9% (n = 8) in placebo. No deaths reported in LEBQ2W and one death in placebo. The most frequently reported TEAE in LEBQ2W was conjunctivitis and in placebo was atopic dermatitis. Conjunctivitis cluster was reported by 8.5% (n = 67) in LEBQ2W and 2.5% (n = 10) in placebo. All conjunctivitis cluster events were mild or moderate. Injection site reactions (ISRs) were reported by 2.6% (n = 20) in LEBQ2W and 1.5% (n = 6) in placebo. Adverse events leading to discontinuation were reported by 2.3% (n = 18) in LEBQ2W and 1.4% (n = 6) in placebo. In ALL LEB, the frequency of TEAEs was 64.3% (n = 1106, IR: 137.9), with the majority being mild or moderate in severity. Severe TEAEs were reported by 5.3% (n = 91). The incidence rates of TEAE did not increase with duration of treatment exposure. The SAEs were reported by 3.3% (n = 56, IR: 3.5). Three (0.2%) deaths occurred in ALL LEB. Conjunctivitis cluster was reported by 10.6% (n = 183, IR:12.2) with the majority being mild or moderate in severity and 0.3% (n = 6) being reported as severe. The ISRs were reported by 3.1% (n = 53, IR: 3.3). Adverse events leading to discontinuation were reported by 4.2% (n = 73, IR: 4.5). The overall safety profile for lebrikizumab consisted of AEs that were mostly nonserious, mild or moderate in severity, and did not lead to treatment discontinuation. Safety profile was similar in both adults and adolescents.

Giant Papillary Conjunctivitis Caused by a Fibroepithelial Polyp of the Lower Eyelid.

Giant Papillary Conjunctivitis Caused by a Fibroepithelial Polyp of the Lower Eyelid.

Development in therapeutic strategies for allergic conjunctivitis

Conjunctivitis, also known as pink eye, is a conjunctival inflammation. It is brought on by bacteria, viruses, toxins, and allergies, including coronaviruses, the most frequent reason being allergic conjunctivitis (AC), which is brought on by exposure to pollutants like pollen, animal hair, or mold. The primary contributor to it is the linkage of immunoglobulin E caused by allergens and receptors on stimulated conjunctival mast cells. As a consequence, mast cells are degranulated, along with the release of histamine, cytokines, chemokines, and lipid mediators. The particular eye tissues impacted and the immune mechanism(s) (both local and systemic) that are involved all play a role in the clinical course, length, intensity, and co-morbidities. It frequently occurs in conjunction with allergic rhinitis, also known as allergic rhino-conjunctivitis and other allergy conditions. Atopic keratoconjunctivitis, giant papillary conjunctivitis, seasonal and perennial conjunctivitis, and vernal keratoconjunctivitis are the different types of allergic conjunctivitis. Ocular allergies are frequently misdiagnosed and undertreated, despite the emergence of innovative therapeutic strategies. This review focuses on several previously published studies to discuss the available therapeutic options for treating allergic conjunctivitis as well as the potential targets for the therapies. The association of conjunctivitis with COVID-19, along with recent patents and research, has also been explored.

The Outcome of Surgical Treatment of Giant Papillary Conjunctivitis by Simple Excision Only, Excision with Conjunctival Autograft or Amniotic Membrane Transplantation

The Outcome of Surgical Treatment of Giant Papillary Conjunctivitis by Simple Excision Only, Excision with Conjunctival Autograft or Amniotic Membrane Transplantation

Major considerations and clinical findings on the allergic conjunctivitis: a narrative and systematic review

Introduction: Allergic conjunctivitis (AC) is a disease of increasing prevalence, affecting children and adults, with progressive loss of quality of life. It has been reported that about 20 % of the entire human population undergoes a form of allergy. The prevalence of allergic conjunctivitis (AC) varies around the world, usually ranging from 15 to 40 %. In Japan, the prevalence of allergic diseases is the conjunctiva is estimated to be as high as 15% -20% of the population is on the rise. Objective: the present objective was to carry out a narrative and systematic review of the major clinical considerations of allergic conjunctivitis, as well as the main treatments, immunological aspects, and allergic conjunctivitis classification. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to June 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Scientific articles from the last 20 years were selected. The quality of the studies was based on the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results: A total of 512 articles were found, and 35 articles were included in the systematic review. Allergic conjunctivitis (AC) is an inflammation of the conjunctiva secondary to an immune response to foreign antigens, usually called allergens. This inflammation can be mediated or non-IgE and atopy could play a significant role in the outcome. These forms include seasonal and perennial allergic conjunctivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis. Giant papillary conjunctivitis and contact or induced by dermatoconjunctivitis drugs are considered to be allergic conjunctivitis subtypes. Conclusion: It was concluded that allergic conjunctivitis is a frequent comorbid with many undiagnosed patients. Then, an additional specific questioning and a therapeutic challenge in suspected patients may help identify patients who may benefit from treatment of Allergic conjunctivitis.

Role of Vitamin D & Immunoglobulins E in patients of Seasonal Allergic Conjunctivitis

Introduction: Allergic conjunctivitis is in fact a bunch of diseases affecting the visual surface and is usually related with type1 hypersensitivity reactions. Two acute disorders, seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do 3 chronic illnesses, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis. Seasonal allergic conjunctivitis is related with seasonal hypersensitivities that ordinarily happen amid the spring and summer months, and in some cases amid the fall. Exposure to dust, grass and other airborne allergens causes seasonal allergic conjunctivitis. Low levels of vitamin D somewhat related to allergic disorders. This study show a relationship between Serum vitamin D and Immunoglobulin’s E in patients of seasonal allergic conjunctivitis Objective: To evaluate serum vitamin D and serum total immunoglobulin E levels in patients with seasonal allergic conjunctivitis (SAC). Material and Methods Study design: quantitative cross sectional Duration: Six months i.e. 1st September 2021 to 28th February 2022 Data Collection procedure: A cross sectional study was conducted on 100 patients. The study was conducted in Holy Family Hospital Rawalpindi. Ethical approval was taken from ethical committee. An educated consent was taken from the participants. 60 patients in this study presented with seasonal allergic conjunctivitis and 40 healthy normal persons were included. Serum vitamin D and serum total IgE levels were calculated. Results: The average age of the participant in this study was in between 30-50 years of age. In SAC group 40 were males and 20 females. Group two healthy normal consist of 25 males and 15 females. There is a significant decrease of vitamin D level in patients who were diagnosed seasonal allergic conjunctivitis and IgE levels were high when compared to normal healthy group Conclusion: In conclusion, we demonstrated lower plasma vitamin D levels in patients with SAC compared with the control bunch. To conclude a certain association between vitamin D status and allergic conjunctivitis, both multicenter larger case arrangement and further studies examining the impacts of vitamin D supplementation ought to be performed in the long run. Keywords: Vitamin D, seasonal allergic conjunctivitis, IgE, Allergy

Thelaziasis as an uncommon cause of giant papillary conjunctivitis

We report a local human case of Thelazia callipaeda eye infection in a 49-year-old lady who presented with right eye foreign body sensation for 1 month. She recalled a fly being stuck onto her right upper eyelashes with mascara when she went hiking in a forest trail in Hong Kong. On assessment there were a lot of giant papillae on palpebral conjunctiva. Three living worms crawling on the surface of conjunctiva were removed by the ophthalmologist. The worm was identified as female Thelazia callipaeda based on the anterior location of vaginal opening relative to the oesophago-intestinal junction and the wide cup-like buccal capsule.

Combinatorial therapy with immunosuppressive, immunomodulatory and tear substitute eyedrops (“Triple Play”) in Recalcitrant Immunological Ocular Surface Diseases

PurposeThe current paradigm for therapy of recalcitrant ocular surface diseases (OSD) consists of a sequential, step-up treatment approach. A combinatorial topical therapy (anti-inflammatory/immunosuppressive [steroid] with immunomodulatory [pooled human immune globulin] and tear substitute [serum]) that simultaneously targets several immunological pathways may be more efficacious. This report evaluates if the combinatorial therapy resulted in clinical benefit in patients with recalcitrant OSD. MethodsWe performed a retrospective case study of patients receiving topical, preservative-free, compounded formulations of steroids, pooled human immune globulin, and serum tears. Outcome measures included visual acuity, ocular surface disease index (OSDI), ocular discomfort score, subjective global assessment (SGA), corneal staining, conjunctival redness, and slit lamp photographs. ResultsPatients consisted of one male and 11 females ranging in age from 27 to 87 years old. Pathologies included ocular graft-versus-host disease (n = 4), Sjögren's syndrome (n = 3), ocular cicatricial pemphigoid (n = 1), pemphigus vulgaris (n = 1), peripheral ulcerative keratitis (n = 1), Stevens-Johnson syndrome (n = 1), and giant papillary conjunctivitis (n = 1). All patients were “improved” or “much improved” on SGA after combinatorial therapy. There was a clinically meaningful reduction in OSDI, ocular discomfort, corneal staining, and conjunctival injection. Additionally, three patients had improvement in their visual acuity (one from 20/400 to 20/20). Adverse effects included increased intraocular pressure in two patients, presumably due to topical steroid use. ConclusionsCombinatorial therapy provides clinical benefit by reducing the symptoms and signs in recalcitrant OSD. Our study provides the rationale for performing prospective clinical trials to evaluate the efficacy of combinatorial therapy for treating recalcitrant OSD.

Subconjunctival Silicone Oil Causing Giant Papillary Conjunctivitis

A 43-year-old man presented with giant papillary conjunctivitis of the left eye 5 months after retinal detachment repair with silicone oil that was complicated by massive postoperative subconjunctival oil leak. Examination demonstrated clear mobile cysts in Tenon’s capsule for 360 degrees (Fig A), punctate keratopathy, and a giant papillary reaction on the superior tarsal conjunctiva (Fig B). Surgical excision of the cystic lesions was performed. Histopathology demonstrated encysted lipid vacuoles throughout the subconjunctival space with a foreign body reaction (Fig C), consistent with giant papillary conjunctivitis secondary to subconjunctival silicone oil.

Evisceration with acrylic spherical implant: An evaluation

Purpose: The purpose of this study is to assess the acceptance, of non-integrated acrylic implant in terms of cosmesis, patient comfort, socket component as well as the comparison of these parameter between eyes with and without implant. Materials and Methods: A total of 25 eyes with specific indications for sacrificing the eye were randomly divided with 2 groups of with and without implant. Ocular parameters were taken before and after surgery. Results: Follow up assessment was done post operatively, at 2nd week, 4th week and 6 months after surgery. In the immediate post operative period, the symptoms of pain, discharge and discomfort were present in all patient belonging to either group. However, on future follow up of 1st week these complaints were significantly less in the group without implant. At 6 months serous, non infectious discharge was present in 20% of the study population of both the groups. Evaluation of the post operative socket in terms of infection, superior sulcus deformity revealed comparable (with implant 13.3% and without implant 20%) data in terms of post operative infection, all of which were well controlled after administering appropriate antibiotics whereas, superior sulcus deformity was present in 100 ?ses without implant compare to only 13% at 6 months follow up. Assessment of the complications associated with lid showed that in the group without implants ptosis was present in all cases compared to only 13% (2 cases) in the group with implant. At 6 months, lid complications in the group without implants comprised of 2 cases of entropion and 4 cases of ectropion compared to only one case of ectropion in those with implants. The results in both the group were comparable in terms of occurrence of conjunctival dehiscence and giant papillary conjunctivitis. Conclusion: The placement of an acrylic spherical implant was associated with cosmesis with a much better amplitude of movements at the cost of a relatively more prolonge

Current Knowledge in Allergic Conjunctivitis.

Allergic conjunctivitis is a disease of increasing prevalence that affects both children and adults and causes significant deterioration of their quality of life and sometimes irreversible visual damage. There are various forms of the disease, some are allergen-induced such as seasonal and perennial allergic conjunctivitis, giant papillary conjunctivitis, and contact allergic blepharoconjunctivitis, whereas others are not always explained by allergen exposure, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis. We review their clinical course, characteristics, and differential diagnosis, and highlight recent advances in their pathophysiology and treatment.

The structure of soft contact lens users and the incidence of papillary conjunctivitis in the analyzed groups according to the data of “Krugozor” ophthalmology clinic

Introduction. Vision correction by contact lenses is one of the most common and effective methods for correcting refractive errors in children and adults. Compliance with rules of soft contact lenses (SCLs) wearing is one of the most important conditions for a safe use, while violation of compliance is usually the main cause of complications.Purpose. To study the structure of contact lens wearers by ametropia and lens wearing time as well as to determine the relationship between the incidence of giant papillary conjunctivitis (GPC) with lens wear time and overwear time.Material and methods. A retrospective analysis of 1 000 records (1 000 patients) of patients who underwent vision correction by SCLs in “Krugozor” ophthalmology clinic in the year 2019 was carried out. Mean age of patients was 24.95 ± 8.62 years. Age, type and degree of ametropia, material (hydrogel, silicone hydrogel or biocompatible hydrogel), lens replacement schedule, presence of complications, lens overwear time and daily wear time were taken into account.Results. Most SCLs users are patients between 21 and 30 years old (47%) who have a moderate degree of ametropia (52%). Most of them (46%) preferred monthly replacement SCLs, 29% – bi-weekly replacement SCLs, 9% preferred daily replacement lenses, while quarterly replacement lenses were used by 16%. Only 26.9% of SCL users complied with the instructions for lens wear, while for 29.4% of them lens overwear time amounted to up to 14 days, for 34.1% – up to 28 days, and for 9.6% – more than 1 month. More than half (56%) of patients mainly wore SCLs during 16 hours a day, one in five (22.7%) used SCLs during 12 hours a day, and 12.6% – up to 20 hours a day. 8.7% wore lenses during up to 7 days. The incidence of GPC in patients who did not comply with replacement schedule and were overwearing lenses was significantly higher (38.71%) than in patients who followed the replacement schedule (3.21%).Conclusion. More than half of the users comprised young people with a moderate degree of myopia. The most commonly used SCLs were monthly replacement. It was discovered that only one in four wearers followed recommendations of manufacturers and replaced lenses on time. Lens overwear may lead to a development of a giant papillary conjunctivitis (GPC).