Red Eye Research Articles

CHALLENGES IN MANAGEMENT OF ENDOGENOUS ENDOPHTHALMITIS IN CHILDREN: A CASE SERIES

Introduction: Endophthalmitis is one of the most feared disease in ophthalmology because it can lead to loss of vision and loss of the eyeball. Endophthalmitis from endogenous cause are very rarely found in young patients without immunocompromised condition, making it difficult to be diagnosed. The lack of established guidelines for treating endogenous endophthalmitis also presents challenges for ophthalmologist. In this case series, we present our management of two pediatric patients with different presentations of endogenous endophthalmitis. We manage to salvage both of the patient’s eye ball with two different approaches. Case Report: Our first patient was a 2-years-old boy with a chief complaint red eye since 10 days before admission. He was previously diagnosed with conjunctivitis. On admission the left eye was not very inflamed but we found hypopion and vitreous haze from ultrasound, suggestive of endophthalmitis. We gave the patient systemic antibiotics and did irrigation/aspiration of the anterior chamber. He responded well to our therapy and was discharged on tenth day of admission. 2. A 6-years-old girl with a chief complaint red painful eye since 2 days before admission. On admission, the eye was very inflamed with limited movement. The USG revealed vitreous haze suggestive of endophthalmitis. She was then given systemic and intravitreal antibiotics but showed poor response. Intravenous steroid was then given and the condition was improved. She was discharged on the fifth day. Discussion: Our two patients came with two different presentations and responds to systemic antibiotics which was considered the mainstay of treatment in endogenous endophthalmitis. The first patient responded well with systemic and intracameral antibiotics while the second patient condition was improved only after the addition of intravenous steroid. Close observation with re-examination and re-evaluation should be done repeatedly to decide which treatment option should be administered. Conclusion: Diagnosis and management of young patient with endogenous endophthalmitis is challenging. Thorough history taking, physical examination, laboratory examination, and microbiology examination should be done to make a prompt diagnosis and management.

A RARE CASE OF SUBCONJUNCTIVAL HEMORRHAGE POST COVID-19 mRNA VACCINE: A CASE REPORT

Introduction: Concurrently with the administration of COVID-19 vaccine, adverse event following immunization (AEFI) began to be reported. Some reactions involve various systems of the human body, including the ocular system. Although uncommon, subconjunctival hemorrhage also can be found, as shown in this report. Case Report: We present a case of a 68-year-old woman with subconjunctival hemorrhage a couple hours before admission. Patient also came with complaints of sudden redness and pain in left eye. Two days prior, she had her first dose of Moderna vaccine. Left eye examination revealed hemorrhage on conjunctiva with normal visual acuity. Other ocular examinations couldn’t be done due to the lack of facilities and severe pain. No other symptoms were mentioned. Patient was advised to be referred to an ophthalmologist, but she refused. After a month, the patient reportedly experienced similar complaints after receiving the second dose of Moderna vaccine. another redness and discomfort in her left eye. Her left eye was red, itched, and swollen. However, she still refused to go to an ophthalmologist. Oral analgesic, oral antihistamine, and artificial tears were given. The symptoms were completely resolved in a couple days. Conclusion: Subconjunctival hemorrhage may occur as mRNA Vaccine AEFI specifically in patients with underlying disease, however further research is needed.

CANALICULITIS CAUSED BY LACRIMAL CONCRETIONS. CASE REPORT

Canaliculitis is inflammation of lacrimal canaliculus. It is a very uncommon condition which is usually misdiagnosed and mistreated. Actinomyces israelii is the most common pathogen, which causes chronic inflammation in the upper parts of the tear drainage system. Due to long-term infectious inflammation canalicular concretions are formed, which can obstruct the lacrimal outflow system. General complaints of the patients include watering, purulent discharge, eye redness, swollen eyelid. We present 3 clinical cases of persistent canaliculitis which needed surgical treatment to rescue from the conditions leading to successful outcomes.

929 Case Report -Post Cataract Surgery Fungal Infection Presenting as a Mass Lesion

Abstract Purpose Fungal endophthalmitis is rare and usually causes poor outcome in untreated patients. It is important to document and be aware of uncommon presentation of fungal endophthalmitis. Case report 68-year-old male presented with complaints of redness, pain, and blurry vision in the right eye for the past 5 months. He underwent an uneventful cataract surgery in the right eye 5 months ago elsewhere and in the post operative follow-up was found to have high intraocular pressure for which he was started on antiglaucoma medications. Aqueous tap did not reveal growth of any microorganism. On examination his vision in both the eyes were 20/20. Slit lamp examination revealed congested conjunctiva, corneal superficial punctate keratitis, anterior chamber 2+ cells and 1.2mm white mass over the iris which was encroaching towards the pupillary margin. Ultrasound bio microscopy revealed 0.8mm x 1.5mm mass in the iris at 11 -12 o’clock position. Since there was a diagnostic uncertainty, excision biopsy was done which revealed fungal filaments on KOH staining. The patient was started on tablet voriconazole and advised to review in 1 month. Conclusions Due to the rare frequency, there is a lack of understanding of presentation of fungal endophthalmitis. Many cases series analysis have suggested that the late fungal endophthalmitis presents as clumpy anterior chamber or posterior chamber inflammation [1], white plaque over the lens [2], peripheral vitreous lesion or as chorioretinitis. Our case report shows a rare presentation of fungal endophthalmitis in the form of mass lesion on the iris.

When patients should seek medical care for minor ailments: Perspectives of first- and final-year pharmacy students

Background: Universities are tasked with preparing students to assist the public in managing minor ailments. This study aimed to determine when pharmacy students would refer patients to medical care as an indicator of clinical skill. Methods: First- and final-year students from four schools were surveyed to determine referral timelines for 17 scenarios. Responders also quantified symptom severity and their confidence levels. Results: Students responding to at least three cases were kept for analysis (n = 117). First-year students considered nasal congestion to be low in severity, with painful urination and rectal bleeding deemed more serious, all while considering most cases more serious than upper-year students. Student confidence was generally lower in new students. Referral times showed similar patterns between years and universities. Red eye, painful urination, diarrhoea (child), and Gastro-Oesophageal Reflux Disease (GORD) (unhealthy patient) were referred quicker than nasal allergies and cough. Referrals typically stayed within a two-week window for most situations. Conclusion: Timelines for medical care were similar between years and institutions. As expected, new students assessed cases as more serious and had less confidence than their upper-year colleagues. A concern for the institutions might be the low rate of real-world case exposure within programmes.

Epidemiology of eye-related emergencies in children under 18 years of age at a General Hospital in Spain from 2019 to 2021

PurposeTo know which ophthalmological pathologies are the most prevalent attending the emergency department. To assess what changes have occurred because of the COVID pandemic. MethodReview of emergency reports in children under 18 years of age attended in our Hospital from January 2019 to December 2021. Comparison of pre-pandemic, pandemic and “back-to-normal” data when comparing the periods 2019–2021 with each other. ResultsThere is a 57% reduction in the eye-related emergency visits in 2020. This reduction affects the three more prevalent diagnostic groups: conjunctivitis and red eye (69% fall), trauma and foreign body (45% decrease) and palpebral pathology (35% less). In 2021 there is a partial recovery in the three groups, but not reaching the 2019 data. On the other side, eye and periocular pain show an increase in consultation in both 2020 (16,7% more) and 2021 (100% increase). ConclusionThere are differences in the distribution of eye-related conditions that consulted at the Emergency Department at our hospital during years 2019–2021. This suggests a more rational use of the Health System, less banal pathology attending and an impact of mobility restrictions, handwashing and face masks wearing on ophthalmological pathology.

Adjuvant Topical Interferon Alpha 2b for the Treatment of Monkeypox Ocular Manifestations.

The aim of this study was to report a case of ocular Mpox that responded favorably to treatment with topical interferon and oral doxycycline. This is a case report of a previously healthy 24-year-old woman who developed a pustular rash, headache, fever, arthralgia, sore throat, and asthenia 3 weeks before attending to our clinic. Her main complaint at the moment of the visit was pain, photophobia, foreign body sensation, blurred vision, red eye, and discharge on the left eye. The slit-lamp examination of the left eye showed severe conjunctival hyperemia associated with tarsal follicles, 360 degrees ciliary injection, diffuse corneal epithelial edema with white linear epithelial infiltrates, pigmented and nonpigmented keratic precipitates, and two 1-mm peripheral corneal ulcers with white infiltrates, associated with positive fluorescein staining. Anterior chamber cellularity and flare were mildly present. Mpox with ocular manifestations diagnosis was confirmed by real-time quantitative reverse transcription polymerase chain reaction assay (qRT-PCR) testing; samples were taken from corneal, conjunctival, and nasopharynx swab as well as a skin scab. Topical interferon alpha 2b 1 MIU/mL every 6 hours for 1 month and oral doxycycline 100 mg BID were administered along with other medications with consequent decrease of inflammation and malaise symptoms 1 week later, associated with uncorrected visual acuity improvement. Alternative and efficacious treatment options for Mpox ocular manifestations are needed to prevent further disease progression and sequelae in countries with no access to the gold-standard therapy. Topical interferon alpha 2b and oral doxycycline have shown adequate response as shown with this patient.

Young woman with red eyes and shock

Young woman with red eyes and shock

Evaluation of the Clinical Course of Endogenous Endophthalmitis.

Purpose: To evaluate the presentations, clinical course, treatments, and outcomes of endogenous endophthalmitis cases. Methods: Consecutive medical records from 2016 to 2021 of a county hospital and an academic, private hospital in Dallas, Texas were retrospectively reviewed. This study comprised 37 eyes of 31 patients with endogenous endophthalmitis. Collected data included demographic factors, identifiable risk factors, medical history, presenting symptoms, infectious data, complications, and best-corrected visual acuity (VA) throughout the clinical course. Results: Twenty-two eyes had bacterial endophthalmitis, 7 had fungal endophthalmitis, and 8 had infections that could not be classified. Of the bacterial cases, 5 eyes had panophthalmitis with associated cellulitis. The most common organisms were Staphylococcus aureus, Candida albicans, and Pseudomonas aeruginosa. The most common presenting symptoms were decreased vision (70%), eye redness (41%), and eye pain (38%). Among all cases, there was no significant difference in the presenting logMAR VA (1.86) before treatment and the most recent logMAR VA (1.75; P = .70) after treatment. However, fungal infections demonstrated better logMAR VA than bacterial infections 6 months after diagnosis (mean logMAR VA, 0.93 vs 2.54, respectively; P = .016) and at most recent follow-up (mean logMAR VA, 0.76 vs 2.3, respectively; P = .004). There was also a strong correlation between presenting VA and most recent VA (r2 = 0.81; P < .01). Conclusions: Visual outcomes of endogenous endophthalmitis cases were poor. Our study found 2 components to be predictive of final VA: (1) whether the infecting organism was bacterial or fungal and (2) a patient's presenting VA.

Efficacy of Homoeopathy in Managing Conjunctivitis/Pink Eye: Review Article

The inflammation or infection of the conjunctiva is referred to as conjunctivitis. It is the most prevalent cause of eye redness in both general and emergency care. Conjunctivitis is the most common cause of eye redness and discharge. Every day, many cases of conjunctivitis are reported in the national capital region. "Every day, we get at least 100 cases of conjunctivitis." Conjunctivitis cases typically increase seasonally, coinciding with flu season. Homeopathic medications for conjunctivitis are extremely effective natural treatments. They can effectively treat ocular discharges, edema, redness, and a gritty sensation in the eyes. Conjunctivitis can be treated quickly with homeopathic remedies. They shorten the disease's course if taken on time. They are completely safe to use and have no negative side effects. Keywords: Conjunctivitis, Pink Eyes, Infection, Homoeopathy, Discharge.

Epidemiología de las urgencias oftalmológicas en menores de 18 años en un hospital comarcal de 2019 a 2021

ObjectiveTo know which ophthalmological pathologies are the most prevalent attending the emergency department. To assess what changes have occurred because of the COVID pandemic. MethodReview of emergency reports in children under 18 years of age attended in our Hospital from January 2019 to December 2021. Comparison of pre-pandemic, pandemic and «back-to-normal» data when comparing the periods 2019–2021 with each other. ResultsThere is a 57% reduction in the eye-related emergency visits in 2020. This reduction affects the three more prevalent diagnostic groups: conjunctivitis and red eye (69% fall), trauma and foreign body (45% decrease) and palpebral pathology (35% less). In 2021 there is a partial recovery in the three groups, but not reaching the 2019 data. On the other side, eye and periocular pain show an increase in consultation in both 2020 (16.7% more) and 2021 (100% increase). ConclusionThere are differences in the distribution of eye-related conditions that consulted at the Emergency Department at our hospital during years 2019–2021. This suggests a more rational use of the Health System, less banal pathology attending and an impact of mobility restrictions, handwashing and face masks wearing on ophthalmological pathology.

Prevalence of Demodex spp. in patients with chronic blepharitis

Blepharitis is a very common disease in ophthalmology, dermatology and allergy practice. It generally follows a chronic course and is frequently associated with objective and/or subjective symptoms such as epiphora, red eye, dandruff, gritty sensation, itching, burning, photophobia, and blurred vision. The purpose of this study is to analyze the prevalence of Demodex spp. in patients with symptoms of chronic blepharitis. An analytical cross-sectional study was conducted in the period between 2016 and 2020. All patients with symptoms of chronic blepharitis who underwent a parasitological test of eyelashes (Rapitest) in the Dermatology Department of the Hospital Italiano de Buenos Aires were included. Those with previously established blepharitis due to another infectious cause were excluded. We analyzed 972 patients. Sixty percent (n=585) underwent a positive Rapitest for the presence of Demodex spp. Seventy five percent (n=728) were women. There were no significant differences in the prevalence associated with sex (p=0.38). Among the patients positive for Demodex spp., 65% (n=628) were older than 60 years old. The most frequently associated symptom was itching, present in 35% (n=342). A statistically significant decrease in the number of consultations was observed during the cold months of the year (May–June–July–August). Our results show a high prevalence of Demodex spp. in patients with chronic blepharitis. As its presence reveals a direct association with age, we recommend looking for this parasite in this age group.

Retained Intraocular Iron Foreign Body Leading to Late-Onset Siderotic Glaucoma: A Challenging Case Report.

BACKGROUND A retained ferrous intraocular foreign body (IOFB), introduced via penetrating ocular trauma, may result in ocular siderosis and visual loss that may occur after days or years. If diagnosis is delayed, therapy may also be delayed, resulting in a poor outcome. The present report presents the case of a 58-year-old man with a retained iron IOFB and late-onset siderotic glaucoma 1 month after the initial trauma. CASE REPORT A 58-year-old man presented with redness and eye pain in the right eye for 1 month after ocular trauma. His visual acuity was very good, with no sign of eye strain. High intraocular pressure had been detected for several weeks, but the B-scan ultrasound and fundus examination were normal and the reason for the high intraocular pressure was unknown. He was later transferred to our senior hospital. The diagnosis of IOFB was confirmed by computed tomography (CT) scan and ultrasound biomicroscopy (UBM). The patient was successfully managed by vitrectomy. CONCLUSIONS This report highlights that a retained IOFB can be challenging to diagnose and that cases associated with siderotic glaucoma require multiple investigations. Early detection of the IOFB using the right tools is vital to reduce the risk of siderotic glaucoma. Although the fundus examination was normal after ocular trauma, the use of CT scan and UBM assisted in finding the IFOB and the patient was successfully treated by vitrectomy.

ANALISIS FAKTOR YANG MEMPENGARUHI PRODUKSI DAN EFISIENSI ALOKATIF CABAI RAWIT MERAH DI KECAMATAN BANYUPUTIH KABUPATEN SITUBONDO

The aims of this study were (1) to analyze the factors that influence cayenne pepper production and (2) allocative efficiency of cayenne pepper production in Banyuputih District, Situbondo Regency. The research was conducted on farmers who are members of the prima donna farmer group with a population of 88 farmers. The sample used was 44 respondents who were determined by the Stratified Random Sampling technique with the area of land used by farmers. Data collected through observation, interviews and questionnaires were analyzed using the coob douglas production function and allocative efficiency analysis. Factors that influence the production of red bird's eye chilies are partially influenced by variables of land area, urea fertilizer, Phonska fertilizer, Za fertilizer and labor. While simultaneously all variables have a significant effect on the production of red bird's eye chilies. The use of production factors for seeds, phonska fertilizer, pesticides and labor is not efficient, while for land area, urea and Za fertilizers are not efficient

Pressure-Lowering Effect of Interventional Fistula Occlusion in Secondary Glaucoma due to Orbital Draining Intracerebral Fistulae.

Carotid cavernous sinus fistulas (CSCF) are pathological connections of the internal and/or external carotid artery (and/or its branches) to the cavernous sinus. Ophthalmological symptoms and problems occur particularly when drainage is via the superior ophthalmic vein. Seven eyes of six patients with a high-grade suspicion of CSCF were included in this retrospective monocentric study. Digital subtraction angiography (DSA) was performed in the included patients, where an interventional fistula closure was performed in the case of CSCF. Four of the six patients received a pre- and post-interventional day-night intraocular pressure profile. Furthermore, medical history, symptoms, visual acuity, slit lamp microscopic findings, and DSA findings were evaluated. The most common symptoms reported by patients were red eyes, diplopia, and exophthalmos. When the intraocular pressure (IOP) was measured, 83.33% of the patients showed increased values. The mean IOP in the day-night intraocular pressure profile in the affected eye before intervention was 23.5 (± 2.7) mmHg compared to 14.1 (± 2.3) mmHg in the healthy eye. A significant difference could thus be demonstrated in side comparison (p = 0.0047). The post-interventional measurement showed a mean IOP of 15.3 (± 1.0) mmHg in the affected eye and thus a significant difference to the pre-interventional measurement in the affected eye (p = 0.0018). Four of the six patients with CSCF were taking antiglaucomatous eye drops before the intervention, and two patients after the intervention. The number of antiglaucoma drugs used could also be reduced. Interventional fistula closure is an effective method for treating the secondary increase of IOP in CSCF. Successful closure of the fistula showed a significant reduction in IOP, which was not possible with the sole administration of antiglaucoma drugs. Radius-Maumenee syndrome should be considered as a differential diagnosis.

Protective properties of AgNPs green-synthesized by Camellia sinensis on ovalbumin-induced allergic conjunctivitis

Allergic conjunctivitis is the main usual red eye cause influencing many people. Allergic conjunctivitis is like an umbrella that includes different types of clinical manifestations, from a mild but annoying form of IgE-dependent allergy to inhaled allergens to very severe forms such as keratoconjunctivitis. Cornea involvement in allergic conjunctivitis needs the steroids use, which can cause severe eye complications. Research on allergic conjunctivitis should focus more on more severe forms of eye allergies to gain a better the pathophysiology understanding of the disease, diagnosis methods should be standardized and new treatment methods should be suggested. In the recent study, due to high therapeutic effects of Camellia sinensis, we used its aqueous extract for green-synthesizing of the silver nanoparticles and allergic conjunctivitis treatment in the in vivo condition. UV–Vis spectroscopy, FE-SEM and TEM were used for characterization of nanoparticles. This research therefore evaluated the AgNPs@Camellia sinensis antiallergic potential in ovalbumin-induced allergic conjunctivitis and attempted to predict its mode of action. ELISA determined serum ovalbumin-specific total IgE, IgE and IgG. Clinical scores for allergic conjunctivitis induced by intraperitoneal ovalbumin sensitization and topical conjunctival challenge in Dunkin-Hartley guinea pigs were estimated after treatment with 10, 20, 40 and 80 µg kg−1 AgNPs@Camellia sinensis, 10 mg kg−1 chlorpheniramine, 30 mg kg−1 prednisolone, or 10 mL kg−1 PBS. Serum ovalbumin-specific total IgE, IgE and IgG decreased significantly (p < 0.01). The conjunctival tissue in AgNPs@Camellia sinensis treated guinea pigs had mild mononuclear infiltration compared to the PBS-treated ones, which had intense conjunctival tissue inflammatory infiltration. The 40 and 80 mg kg−1 AgNPs@Camellia sinensis treatment resulted in allergic conjunctivitis low clinical score.

Autoimmune Inflammatory Eye Disease: Demystifying Clinical Presentations for the Internist.

Provide a framework for recognizing key symptoms and clinical findings in patients with autoimmune inflammatory eye disease. The most common manifestations of autoimmune inflammatory eye disease are episcleritis, scleritis, uveitis (anterior, intermediate, posterior, and panuveitis), and keratoconjunctivitis sicca. Etiologies can be idiopathic or in association with a systemic autoimmune condition. Referral of patients who may have scleritis is critical for patients presenting with red eyes. Referral of patients who may have uveitis is critical for patients presenting often with floaters and vision complaints. Attention should also be directed to aspects of the history that might suggest a diagnosis of a systemic autoimmune condition, immunosuppression, drug-induced uveitis, or the possibility of a masquerade condition. Infectious etiologies should be ruled out in all cases. Patients with autoimmune inflammatory eye disease may present with ocular or systemic symptoms alone, or in combination. Collaboration with ophthalmologists and other relevant specialists is vital to optimal long-term medical care.

A Dusty Road for Astronauts.

The lunar dust problem was first formulated in 1969 with NASA's first successful mission to land a human being on the surface of the Moon. Subsequent Apollo missions failed to keep the dust at bay, so exposure to the dust was unavoidable. In 1972, Harrison Schmitt suffered a brief sneezing attack, red eyes, an itchy throat, and congested sinuses in response to lunar dust. Some additional Apollo astronauts also reported allergy-like symptoms after tracking dust into the lunar module. Immediately following the Apollo missions, research into the toxic effects of lunar dust on the respiratory system gained a lot of interest. Moreover, researchers believed other organ systems might be at risk, including the skin and cornea. Secondary effects could translocate to the cardiovascular system, the immune system, and the brain. With current intentions to return humans to the moon and establish a semi-permanent presence on or near the moon's surface, integrated, end-to-end dust mitigation strategies are needed to enable sustainable lunar presence and architecture. The characteristics and formation of Martian dust are different from lunar dust, but advances in the research of lunar dust toxicity, mitigation, and protection strategies can prove strategic for future operations on Mars.

Differential Diagnostic Indicators for the Appointment of Non-Steroidal Anti-Inflammatory Therapy in the Treatment of Red Eye Syndrome at the Stage of Primary Outpatient Admission. Part 1

Every practicing ophthalmologist, regardless of the scope of their clinical and scientific interests, is faced with a dilemma — what treatment to prescribe to a patient who applied for a primary outpatient appointment with signs of red eye syndrome? Prescribing an adequate amount of pathogenetically substantiated therapy will reduce the potential risk of developing complications associated with drug therapy.Purpose: to study the effectiveness of the treatment the blepharoconjunctivitis, episcleritis and keratitis, the regimen of which included the non-steroidal anti-inflammatory drug Okofenac 0.09 % (Otisipharm, Russia), the main active component of which is bromfenac, showed that the average term for stopping the inflammatory process in in all groups of patients included in the study, was 7–14 days, which indicates a high level of effectiveness of the treatment. At the same time, the maximum amount of drug therapy — more than two groups of drugs was prescribed to patients with keratitis. The quality of life according to the SPEED questionnaire, which reflects the symptoms characteristic of dry eye syndrome, was significantly lower in patients in the keratitis group, which suggested a relationship between the amount of drug therapy and the onset of dry eye syndrome in the long-term period — 1 month. This assumption was confirmed by a correlation analysis, which revealed a direct correlation between the number of prescribed drugs at the beginning of treatment and the quality of life according to the SPEED questionnaire after 1 month in all three groups of patients included in the study. Since this study was aimed at studying the effectiveness of anti-inflammatory therapy in the treatment of different, not only in terms of pathogenesis, but also the localization of the process, it only revealed certain trends in the relationship between the number of prescribed drugs at the beginning of treatment and the development of dry eye signs in the long-term period. Therefore, further research is needed to study the above trend in detail.In addition, as the analysis of literature data has shown, there are currently no indications for prescribing one or another type of drug therapy in the complex treatment of inflammatory diseases related to the “red eye syndrome”. In order to form criteria that take into account the history data — somatic status, duration of the inflammatory process, complaints of patients characterizing the inflammatory process, as well as biomicroscopic signs of inflammation, to select one or another pharmaceutical group of drugs, a survey of expert ophthalmologists was conducted. Based on the data of the survey, an algorithm for rational therapy of one of the most common pathologies included in the group of diseases red eye syndrome — conjunctivitis was formed. The above algorithm will be presented in the second part of this article.

Rare cause of red eyes: Cogan’s syndrome

ABSTRACT A 74-year-old hypertensive male presented with redness of both the eyes, bilateral hearing loss and on and off fever since 1 month. A diagnosis of Cogan’s syndrome was made, and treatment with systemic steroids and immune-suppression led to complete reversion of his symptoms, red eyes and hearing loss.