Prednisolone Eye Drops Research Articles

Isolated Corneal Chemical Eye Injury Following Splash From Plantain Stem Sap: A Case Report and Review of Literature

Purpose: This article reports a case of corneal injury following a splash from the sap of plantain stem. Case Report: A 54-year-old female presented with a history of plantain stem sap splash into her right eye of 7-h duration with associated ocular pain, tearing, photophobia, and blurring of vision. On ocular examination, visual acuity was 6/18 OD; slit lamp examination revealed a well-delineated fluorescein-positive corneal epithelial defect with associated mild stromal edema. Left eye examination was essentially normal. She washed her face and eyes with water immediately after the splash and further had eye irrigation by attending ophthalmologist on presentation. The patient was immediately commenced on prednisolone, moxifloxacin, cyclopentolate, and ascorbate eye drops and tetracycline ointment. Corneal edema resolved in 4 days whereas the epithelial defect was completely healed by day 12 and visual acuity was restored to 6/6. Conclusion: Although farmers are exposed daily to various types of eye injuries from parts of plants, this report highlights corneal eye injury following plantain stem sap splash in a farmer who did not use protective eye goggles while working in the farm and how prompt institution of treatment can sight loss and loss of corneal integrity.

Effects of Anti Inflammatory Agents Following Cataract Surgery

Objectives: To assess and compare the analgesic and anti inflammatory efficacy of nepafenac and prednisolone eye drops used individually and in combination in post-operative period of cataract surgery by estimating anterior chamber cell count(ACCC) and pain in visual analogue scale(VAS). Materials and Methods: A total of 156 subjects after cataract surgery were allocated through lottery to 3 groups (n=52 each). Group A: with topical nepafenac: 1 drop thrice daily for 3 weeks, Group B with topical prednisolone: 1 drop four times daily for 3 weeks. Group C with combination of nepafenac and prednisolone as per the schedule for group A and B respectively. Drugs were continued for 22 consecutive days and there were four follow-up visits on day 4, day 8, day 15 and day 22. Anterior chamber cell count (ACCC) and pain were determined by slit lamp bio microscope and visual analogue scale respectively. Results: End results of group A for ACCC and pain were 5.41 ± 0.44 and 1.27 ± 0.41 respectively. In case of group B, ACCC and pain were 1.09 ± 0.32 and 0. Group C showed the best results where for ACCC and pain were 0.40 ± 0.22 and 0 respectively. Conclusion: Combination of Prednisolone and nepafenac eye drops was the most efficacious in reducing inflammation and pain after cataract surgery.

Topical 0.03% tacrolimus preventing rejection in high-risk corneal transplantation: a cohort study

Background/aimsThe present study aims to identify the rate of rejection and safety of 0.03% tacrolimus eye drops associated with 1% prednisolone in a topical formulation, comparing them with the use...

2247 – Manic episode in an elderly patient secondary to the application of corticosteroid eye drops: a case report

An eighty-one-year-old lady presented with mood changes within days of the commencement of prednisolone eye drops, which was prescribed following a cataract operation. She had a history of chronic schizophrenia, with one previous episode of hypomania in the early1990s. She was admitted to our institution on this occasion, with symptoms including elated mood, disinhibition, insomnia, pressured speech, flight of ideas and grandiose ideation. This was a distinctly different presentation from her previous relapses and the duration of this episode was prolonged. Her symptoms persisted despite an aggressive titration of psychotropic medications. After a review of her medication, the possible causal relationship between the prednisolone eye drops and manic episode was made. As the steroid eye drops were necessary following her eye operation, we allowed the completion of its course. Within days of its discontinuation, we saw a dramatIc improvement in her mental state and she was discharged. She currently remains in remission two months from the cessation of prednisolone. The postulation that the prednisolone eye drops triggered this manic episode can be substantiated by the clear observation that her symptoms completely resolved after the steroid course was completed. This appeared to be the one single factor which coincided with the emergence, maintenance and termination of her symptoms. Steroid-induced psychiatric symptoms are a well documented phenomenon, but are typically seen with higher doses and systemic administration of corticosteroids. This case report is of a rare presentation, and to our knowledge there are no similar cases described.

Treatment of hypotony maculopathy caused by traumatic cyclodialysis

A 29-year-old male experienced abrupt visual loss in the left eye following an elastic cord rebounding injury that resulted in ocular hypotony. He received topical atropine and prednisolone eye drops for more than one month without improvement. On examination, his visual acuity was 1.0 OD and counting fingers at 80 cm OS. Initial intraocular pressure (IOP) was 15 mmHg OD and 6 mmHg OS. Gonioscopic evaluation of his left eye revealed a cyclodialysis cleft positioned between 6 and 7 o'clock. A fundus photograph showed signs of hypotony maculopathy including optic disc edema, tortuous vessels, and chorioretinal folds. B-scan ultrasound displayed choroidal thickening and optical coherence tomography (OCT) demonstrated macular edema, subretinal fluid, retinal striae, and choroidal folds. Pars plana vitrectomy and sulfur hexafluoride (SF6) tamponade were performed. After gas absorption, IOP was 11 mmHg OS and remained steady during follow-up. One week after surgery, his visual acuity improved to 0.9. The present case highlights that pars plana vitrectomy with gas tamponade is worth considering for patients with cyclodialysis cleft associated with hypotony maculopathy. Early surgical intervention remains the treatment of choice when hypotony maculopathy and deteriorated vision are noted. Conservative management may be suitable in cases when visual function is not impaired.

Efficacy and tolerability of a combined gatifloxacin plus prednisolone formulation for topical prophylaxis after LASIK

Purpose:To compare the efficacy and tolerability of a fixed-dose combination of 0.3% gatifloxacin and 1% prednisolone formulation versus the same agents administered separately for prophylaxis in a laser-assisted in situ keratomileusis (LASIK) population.Methods:In a prospective, randomized, double-masked, parallel-group study, 97 patients were evaluated for signs and symptoms of ocular infection or inflammation after bilateral LASIK. Group 1 (50 patients, 100 eyes) received a combined formulation of 0.3% gatifloxacin + 1% prednisolone acetate (Zypred®) plus placebo. Group 2 (47 patients, 94 eyes) received conventional treatment with the same agents from separate vials. The cohorts were similar in age, sex, race, and refractive error. Baseline and postoperative assessments were made on surgery days −2, 1, 3, and 15 and consisted of visual acuity; intraocular pressure; severity of inflammation of eyelids, conjunctiva, and cornea; tearing; ocular discomfort (foreign-body sensation, itching, or photophobia); and ocular pain. The posterior segment was evaluated at the screening and exit visits.Results:No ocular infection or persistent inflammation was detected in either group at any time. All objective and subjective criteria of efficacy were similar regardless of treatment, with no significant differences between the groups. More patients who were dosed with the combined agent complained of mild ocular discomfort on day 3, but this difference had disappeared by day 15.Conclusion:Post-LASIK topical prophylaxis with combined gatifloxacin + prednisolone eye drops (Zypred®) was well tolerated. This formulation appears to be therapeutically equivalent to conventional dosing with gatifloxacin and prednisolone from individual bottles for topical prophylaxis after laser refractive surgery.

Bilateral Achromobacter xylosoxidans keratitis after laser in situ keratomileusis

A 31-year-old man was referred to us 2 months after bilateral laser in situ keratomileusis (LASIK). On presentation, the corrected distance visual acuity was hand motion in the right eye and 20/25 in the left eye. Slitlamp examination showed a diffuse central stromal infiltrate, flap melting, and hypopyon in the right eye and marked interface opacities with crystal-like edges in the left eye. Flap lift and irrigation were performed. Because of the progressive keratitis, penetrating keratoplasty (PKP) was done in both eyes. Achromobacter xylosoxidans was isolated from both corneal buttons, and therapy was changed to chloramphenicol prednisolone eyedrops 8 times a day and intravenous meropenem 500 mg 3 times a day according to sensitivity testing. Two months after surgery, both transplants remained clear.

A retrospective comparison of efficacy and safety of 680 consecutive lasik treatments for high myopia performed with two generations of flying-spot excimer lasers

To compare the visual refractive outcome and complication of laser in situ keratomileusis (LASIK) carried out with a Carl Zeiss-Meditec MEL-70 Excimer laser and a MEL-80 laser for treatment of high myopia. Journal records of 680 consecutive eyes that underwent LASIK with a Schwind Supratome microkeratome and a MEL-70 Excimer laser (Group A), or a Moria M2 microkeratome and a MEL-80 Excimer laser (Group B) were reviewed. Manifest refraction, uncorrected and best spectacle-corrected visual acuity (BSCVA), corneal topography and central corneal thickness (CCT) were recorded before and 3 months after treatment. Pre- and postoperative complications, visual and refractive outcome and frequency of retreatments were registered. Mean preoperative spherical equivalent refraction was -8.52 dioptres (-5.50- -18 dioptres), and the mean attempted laser correction was -8.02 dioptres (-5.50- -11 dioptres). Three months after LASIK, the average treatment error (difference between achieved and attempted correction) was 1.20 (SD=1.19) dioptres of under correction in Group A and 0.52 (SD=1.00) dioptres in Group B. Four eyes lost more than two lines of BSCVA (0.6%). In 110 eyes (16%), a re-LASIK procedure was performed to reduce remaining myopia after the primary procedure. Laser in situ keratomileusis treatment for high myopia can effectively reduce high degrees of myopia. Under correction was observed in both treatment groups but Group B has a slightly better predictability. Significant loss of BSCVA occurs infrequently after LASIK for even considerable grades of myopia (0.6% in each group).

Palpebral Subconjunctival Hemorrhages in Herpes Zoster Ophthalmicus

A 75-year-old previously healthy woman was referred for evaluation of pain and foreign body sensation in her left eye of 4 days' duration. Two weeks before presentation she was diagnosed with herpes zoster involving the left forehead and temple area and started on famciclovir treatment. Examination of her left cornea revealed inferior superficial punctate keratitis, but no dendrites or pseudodendrites. Upper eyelid eversion disclosed unusual raised palpebral subconjunctival hemorrhages on the left side. She was started on topical prednisolone eyedrops in the left eye, and her symptoms improved over the following week. Herpes zoster ophthalmicus can initially present in the eyelids. Careful follow-up with particular attention to the eyelids and eyelid eversion is recommended in any patient presenting with herpes zoster to detect early ocular involvement.

This issue of Acta

The cover photograph shows enhanced optical coherence tomography (OCT) and comes from the article by Soliman et al. in this issue. Costa and Arcieri review hypotony maculopathy, including the definition, mechanisms, clinical findings and treatment of this condition. The editorial discusses the physiological consequences of hypotony in light of Starling’s law. Sigurðsson et al. in Iceland show that topical application supplies steroids in significant concentration to the posterior segment of the rabbit eye and suggest that the topical route may replace intravitreal injections in steroid treatment for retinal disease. Paccola et al. in Brazil and the USA demonstrate that postoperative inflammation after vitrectomy may be controlled either by a single subtenon injection of triamcinolone or by conventional prednisolone eye drops. Khanna et al. in India describe 48 patients with histologically confirmed sarcoidosis involving the eye, more frequently as posterior than anterior uveitis. Soliman et al. in Copenhagen use enhanced OCT to describe different morphological patterns of diabetic macular oedema and suggest that these indicate the severity of the disease. The cover photo comes from this paper. Fosmark and associates in Oslo demonstrate that levels of hydroimidazolone, an advanced glycation end product, in the vitreous are associated with diabetic retinopathy level. This may relate to blood–retinal barrier breakdown. Joussen et al. in Germany describe the design of a multicentre study to investigate the role of heavy silicone oils in proliferative vitreoretinopathy. The results of the clinical trial will be forthcoming in Acta in years to come. You and associates in China and Germany report from the Beijing Eye Study, where 0.7% of individuals have myelinated retinal nerve fibres and this has no clinical consequence. Minami et al. in Osaka study the effect of intraocular infusion pressure in vitreous surgery in rabbits. They suggest that ganglion cells may suffer from high intraocular pressure in this situation. Kjeka and associates in Bergen find photoptic ERG useful to predict neovascularization in patients with central retinal vein occlusion. Kirwan et al. in Dublin suggest that morphine analgesia may replace general anaesthesia in children who need laser treatment for retinopathy of prematurity. Vouri and Mäntyjärvi in Turku report for the first time that colour vision may be impaired in eyes with tilted optic discs. Delyfer et al. from Bordeaux contribute case reports on cytomegalovirus retinitis following intravitreal triamcinolone injections. Georgeopoulos et al. in Athens find capsular tension rings to be useful in eyes with traumatic zonular dialysis, which need cataract surgery. Wong et al. in Hong Kong find nylon and polyglactin sutures to be satisfactory in pterygium surgery. Caines and associates in Uppsala find that children with spina bifida have a high risk of stabismus, refractive error and subnormal vision. Muen et al. in Liverpool find periventricular leukomalacia in children who present with strabismus. Yazici and Akova from Turkey suggest that dacryocystorhinostomy may be performed bilaterally at the same time. In the Perspectives in Ophthalmlogy section, Sundling and associates in Norway survey Norwegian optometrists and report on their practice patterns, referrals and the disease prevalence of their patients. Kawana et al. in Japan use OCT to evaluate anterior chamber angle recession. Margolis et al. in Cleveland show a case with macular involvement resulting from breast cancer. I hope that each reader of Acta finds something of interest in this issue. You are invited to contribute letters to the editor regarding the subjects discussed in these articles.

Multiple and Recurrent Ocular Manifestations in a Patient of Vogt-Koyanagi-Harada Syndrome

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) syndrome with multiple ocular manifestations and recurrences. Methods: Case report. Case Report: A 17-year-old female patient presented with bilateral blurred vision for one week. Fundus examinations showed bilateral macular serous detachment, and fluorescein angiography revealed multiple pinpoint leakages, compatible with VKH syndrome. Subsequently, the patient developed a total of 5 consecutive episodes of anterior uveitis, occurring mostly after steroid tapering or a URI episode. Each attack responded well to oral prednisolone, prednisolone eye drops and sub-Tenon's triamcinolone injection, with a good recovery of visual acuity to 20/20 bilaterally. The oculocutaneous sequelae were a sunset-glow fundus with residual disc edema and depigmented regressed Dalen-Fuchs' nodules and cutaneous changes of hair loss and whitish hair. Because of later development of atrophic scars at the fovea, the final visual acuity deteriorated to 20/600 in the right eye and 20/50 in the left eye. Conclusions: This patient developed multiple ocular and cutaneous manifestations of VKH syndrome with frequent recurrences. Steroid treatments can yield good results but must but be tapered gradually, and sub-Tenon's injection of triamcinolone cam be ised om severe pr omtractable cases. Particular precaution should be taken for young patients for their recurrences and poor visual outcome.

Topical 0.1% Prednisolone Lowers Nerve Growth Factor Expression in Keratoconjunctivitis Sicca Patients

To compare nerve growth factor (NGF) levels in tears and on the ocular surfaces of normal control and non-Sjögren's type keratoconjunctivitis sicca subjects, and to investigate the effect of 0.1% prednisolone eyedrops on NGF levels in keratoconjunctivitis sicca patients. Prospective, double-masked, randomized, comparative clinical trial. Forty-one keratoconjunctivitis sicca patients and 23 age- and gender-matched healthy subjects. Baseline tear NGF levels were measured in keratoconjunctivitis sicca patients and healthy control subjects using enzyme-linked immunosorbent assays. Keratoconjunctivitis sicca patients received 0.1% prednisolone drops in one eye and 0.1% hyaluronic acid drops in the other, 3 times a day for 28 days. Also, impression cytology (IC) and immunostaining for NGF on conjunctival epithelium were performed on both groups. Tear NGF/total tear protein (TP) concentration ratio, IC and NGF immunocytologic staining, subjective symptom scale, tear breakup time, and Schirmer values. Keratoconjunctivitis sicca patients were found to have baseline tear NGF concentrations higher than those of age- and gender-matched healthy control subjects (65.9+/-14.5 vs. 122.1+/-45.3 pg/mug, P<0.0001). In keratoconjunctivitis sicca patients, prednisolone treatment for 28 days resulted in a decrease in tear NGF levels, symptom scores, and IC scores, whereas hyaluronic acid treatment had no such effect (68.2+/-25.0 pg/mug vs. 108.0+/-43.4 pg/mug, P<0.0001 for tear NGF/TP ratio; 2.16+/-1.01 vs. 3.39+/-1.50, P = 0.0014 for symptom scale; 1.05+/-0.67 vs. 1.61+/-0.86, P = 0.0317 for IC). Measurements taken at both 14 and 28 days indicated that neither prednisolone nor hyaluronic acid treatment affected breakup time or Schirmer values. Keratoconjunctivitis sicca patients showed elevated levels of tear NGF, which were decreased by treatment with 0.1% prednisolone. These data suggest that ocular surface NGF may play an important role in ocular surface inflammation processes associated with dry eyes.

A single intraoperative sub–Tenon's capsule triamcinolone acetonide injection for the treatment of post–cataract surgery inflammation

Purpose To compare a single intraoperative sub–Tenon's capsule triamcinolone acetonide injection with steroid drops in the treatment of ocular inflammation after cataract surgery. Design Randomized, double-masked controlled trial. Participants A total of 100 patients were randomized prospectively into 2 groups: 50 patients treated with 1% prednisolone eyedrops (control group A) and 50 patients treated with sub–Tenon's capsule triamcinolone (treatment group B). Methods All patients underwent phacoemulsification and intraocular posterior lens implantation. After surgery, patients were randomized to receive either (group B) an intraoperative 40 mg triamcinolone acetonide sub–Tenon's capsule injection or (group A) 1% prednisolone acetate eyedrops, according to the following schedule: 1 drop 4 times daily (week 1), 3 times daily (week 2), 2 times daily (week 3), once daily (week 4). To mask the study, group B received vehicle drops administered on a similar schedule, and group A received an intraoperative sub–Tenon's capsule injection of a 1 ml balanced salt solution. Main outcome measures The main outcome measures included inflammation (cell, flare, ciliary flush), intraocular pressure, and lack of response. Results Triamcinolone was shown to have anti-inflammatory efficacy clinically equivalent to conventional 1% prednisolone eyedrops in reducing intraocular inflammation, as measured by clinical methods. Triamcinolone was found to be as safe as the prednisolone in terms of adverse effects, changes in visual acuity, intraocular pressure, and biomicroscopic and ophthalmoscopic variables. On the third, seventh, fourteenth, and twenty-eighth postoperative days, a significantly lower intraocular pressure ( P<0.01) was noted in the triamcinolone group than in the prednisolone group. Conclusions A single intraoperative 40-mg triamcinolone acetonide sub–Tenon's capsule injection demonstrated a clinically equivalent therapeutic response and ocular tolerance compared with 1% prednisolone drops in controlling postoperative inflammation after uncomplicated cataract surgery and merits further investigation.

Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection: 5-year experience.

To report the mid-term results of a treatment strategy using topical steroids, intravenous pulse methyl prednisolone and oral cyclosporine A (CSA) for the treatment of acute corneal graft rejection. Noncomparative, interventional case series. Treatment of corneal graft rejection included 1% prednisolone eye drops, intravenous infusion of 500 mg methyl prednisolone, and oral CSA in two regimens--standard dose was 15 mg/kg/day for 2 days, 7.5 mg/kg/day for 2 days, then adjusted to maintain trough blood levels of 100-200 microg/l; low dose was 2 mg/kg/day with no loading dose. Outcome in 34 eyes of 34 patients (21 M;13 F) aged 60 +/- 17.7 years (range 9-83 years), who presented after an average duration of 6.6 +/- 6.3 days (range 0-30 days) following acute corneal graft rejection, are reported. Twenty-five patients received standard dose CSA while nine patients received the low dose regimen. Mean duration of treatment before reversal of graft rejection was 13.6 +/- 12.1 days (range 3-54 days). Treatment was successful in reversing the graft rejection in 32/34 (94%) eyes. Irreversible graft failure occurred in one eye in each group. During a mean follow-up period of 19.2 +/- 16.7 months (range 1-55 months), further episodes of graft rejection were seen in 1/32 (3%) eyes. Complications due to treatment included: duodenal ulcer in one patient that responded to medical treatment, and transient elevation in serum creatinine levels in three patients, which returned to normal after decrease in dosage or cessation of oral CSA. Our 5-year experience with the use of oral CSA in the treatment of acute corneal graft rejection has shown this treatment approach to be safe and effective in reversing the rejection process. This approach may also protect the graft from subsequent episodes of allograft rejection. A randomised controlled trial to further delineate the role of CSA in reversing acute graft rejection seems warranted.

LIGNEOUS CONJUNCTIVITIS IN A HORSE: A CASE OF ELEVEN MONTHS DURATION

A six months old throughbred female race horse was received presenting events of mucous purulent discharge from the right eye for two days. Close examination of both eyes revealed bilateral mucous purulent conjunctivitis, more severe on the left eye where discharge was more profuse, with tarsal and bulbar chemosis and blepharospasm. This animal also had a fluoresceine fixing superficial linear ulcer on the left eye. It was performed culture of material from the botton of conjunctive sack, which revealed an infection by Pseudomonas spp, sensitive to tobramycine. Based upon microbiological tests, tobramycine eye drops (15 mg/ml) and ophtalmic ointment (15 mg/g) was given for three weeks, and a two percent atropine and one percent dichorphenac eye drops were given for five days. At the end of the treatment, the right eye was calm and without alterations while the left eye displayed a tarsal membranous conjunctivitis with minimal serous ocular discharge. The presence of an allergic conjunctivitis was suspected and four percent dissodium chromoglicate eye drops were given. In spite of the decrease of inflamation observed, the conjunctive membranes remained. Surgical debridement of the membranes was performed and representative material was collected and sent for histological examination. Based upon human and canine reports and histological findings, the most probable diagnosis was ligneous conjunctivitis. After biopsy, the drug chromoglicate was replaced by one percent prednisolone eye drops for three weeks. After this, the eye showed a discreet dorsal tarsal chemosis and hyperemia but no membranous conjunctivitis. As supporting therapy a daily morning instillation of corticoid for 30 days was ordered. Five months later, a recurrence of the membranous conjunctivitis was verified and these membranes invaded the cornea, causing temporal pigmentary keratitis. A two percent cyclosporine ointment was then given and a new biopsy asked. The diagnosis of recurrent severe ligneous conjunctivitis was evident, and a wide surgical resection of the membranes and vascular cauterization was decided. Postoperative treatment was composed by one percent prednisolone, one and a half percent tobramicine eye drops together with 5,000 IU /ml heparin. Treatment proceeded for 30 days when the antibiotic was taken off, corticoid frequency was reduced and topic heparin kept. Ligneous conjunctivitis is a chronic membranous conjunctivitis with presence of membranes mainly in the tarsal superior conjunctives, of ignored etiology. Up to the present, two months after the surgical resection of the membranes, the topical use of corticoid and heparin satisfactorily controls the case, now eleven months old.

Design and organization of the herpetic eye disease study (HEDS)

The Herpetic Eye Disease Study (HEDS) includes three double-masked, placebo-controlled clinical trials for potentially blinding herpes simplex virus (HSV) eye infections. One study compares a tapering dosage of topical prednisolone or placebo eye drops for HSV stromal keratitis (HEDS-SKN). Two other trials compare oral acyclovir to placebo capsules for HSV stromal keratitis (HEDS-SKS) or iridocyclitis (HEDS-IRT) in patients on a tapering dosage of topical prednisolone drops. All medications are administered for 10 weeks. Outcome is judged by time to recurrent disease or treatment failure. This paper presents the design, estimated sample size and recruitment as of July 25, 1990.

A comparison of local and systemic acyclovir in the management of herpetic disciform keratitis.

Forty-three patients with active herpetic disciform keratitis were entered into an open study to compare the efficacy of oral acyclovir (400 mg) with acyclovir ophthalmic ointment (3%) to inhibit viral replication during treatment with 0.05% prednisolone eye drops. All patients, regardless of the mode of therapy, were treated five times a day until they were healed. The mean time to heal in the oral group was 25.9 days and in the topical group was 25.3 days. Resolution of lacrimation was significantly faster in the oral group (12.1 days versus 27.6 days). The patients on tablets also showed a greater improvement in visual acuity. No statistically significant differences were found between the two groups in the incidence of recurrences over a three-year post-treatment period. It is concluded that oral acyclovir treatment is an effective alternative to ophthalmic ointment in the management of herpetic disciform keratitis.

Erythema Multiforme After Use of Topical Sulfacetamide

An 8-year-old boy developed erythema multiforme major after topical administration of sodium sulfacetamide for conjunctivitis. He had received systemic treatment with trimethoprim-sulfamethoxazole four months previously without evidence of drug allergy. There was no history of recent exposure to other drugs or evidence of herpes simplex or Mycoplasma infection. After 12 days of treatment with erythromycin ointment, 1% prednisolone eyedrops, systemic prednisone, and intravenous nafcillin, the patient's condition improved dramatically. A slit-lamp examination showed only superficial punctate keratitis. Two months later his visual acuity had improved from 20/200 bilaterally to R.E.: 20/40 and L.E.: 20/30.

Comparative drug treatment of endocrine exophthalmos

The degree of exophthalmos and the width of the palpebral fissure were studied serially in 58 previously thyrotoxic patients, who were divided into 6 treatment groups: 1. guanethidine eye drops; 2. oral thyroxine; 3. guanethidine eye drops and oral thyroxine; 4. guanethidine and prednisolone eye drops; 5. napththazoline nitrate 0.1% and zine sulfate 0.5% eye drops; and 6. metronidazole orally. Exophthalmos increased significantly in the first and third group, and the palpebral fissure decreased in the first group. It was concluded that guanethidine eye drops should be given when there is marked lid retraction with minimal exophtalmos; that prednisolone eye drops are not indicated in endocrine exophthalmos; and that the combination of guanethidine eye drops with oral thyroxine in different dosages is worth further study.