Topical Antibiotic Ointment Research Articles

Hyaluronic acid-based minocycline-loaded dissolving microneedle: Innovation in local minocycline delivery for periodontitis

Periodontitis is a prevalent inflammatory disease that affects tooth-supporting tissues and is induced by complex polymicrobial dental plaques. Prior treatments, including topical antibiotic ointments, have faced difficulties in tissue permeability issues. Although dissolving microneedle (DMN) has been proposed as a painless and highly efficient transdermal drug delivery system to resolve this challenge, minocycline, widely used for the treatment of periodontitis, is light-sensitive, making it challenging to maintain its stability using conventional fabrication methods. Our hyaluronic acid-based minocycline-loaded dissolving microneedle (HAM-DMN) was designed utilizing an innovative light-blocking strategy, preserving 94.4 % of minocycline's stability, as confirmed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. HAM-DMNs demonstrated antimicrobial efficacy in in vitro zone of inhibition tests with Streptococcus mutans strains and provided enhanced local delivery of minocycline to porcine oral gingival mucosa at concentrations 6.1 times higher than those of commercial ointments. In vivo studies in periodontitis-induced rat models showed that HAM-DMNs reduced levels of junctional epithelium more effectively than control and blank DMN groups, indicating enhanced treatment efficacy. HAM-DMN is a novel local delivery system developed to overcome the limitations of systemic delivery and conventional topical treatment. We suggest that HAM-DMNs can replace injections for the treatment of intraoral mucosal and systemic diseases.

Effectiveness of additional topical antibiotics for recurrent or refractory exit-site infection: a case series

BackgroundJapanese peritoneal dialysis (PD) guidelines do not suggest applying mupirocin/gentamicin ointment to the exit sites of PD patients to prevent exit-site infection (ESI). The guidelines do not mention topical antimicrobials as a treatment for ESI.MethodsWe retrospectively investigated the additional use of topical antibiotic ointments on patients receiving oral or intravenous antibiotics for recurrent and/or refractory ESI at Aichi Medical University and Nagoya University Hospitals between 2017 and 2022.ResultsA total of 13 patients (11 men, 2 women) were included in this study. Median age was 69.0 years, median duration of PD was 26.0 months, two patients had diabetes as a complication, and ESI incidence was 2.7 episodes per patient-year. Systemic antibacterial treatment had been administered for a median of 27.0 days before application therapy. Mupirocin was used in eight cases and gentamicin in five cases, with complete resolution in all cases. No adverse effects such as skin symptoms, antibiotic resistance, or non-tuberculous mycobacterial infections were observed. Cases were divided into two groups based on the duration of topical antibiotic use: short-term group < 90 days and long-term group ≥ 90 days. All patients in both groups achieved complete resolution, with no significant differences in time to resolution, number of recurrent ESIs, or occurrence of ESIs after discontinuation of application therapy.ConclusionAdditional use of topical antibiotic for recurrent and/or refractory ESI appears safe and effective. This study suggests that future randomized controlled trials are warranted.

Topical Chinese Herbal Medicine Treatment of a Non-healing Leg Wound in a Horse: A Case Report

Wound care in horses, particularly chronic non-healing lesions, pose a major medical challenge for equine practitioners and can result in considerable financial loss as well as missed training goals for owners. The lower equine limb is particularly susceptible to damage due to the lack of protective muscling and superficial synovial and tendinous structures. This paper presents the treatment of a non-healing distal leg wound in a horse by topical application of a Chinese herbal medicine decoction using a traditional Chinese veterinary medicine (TCVM) approach. The patient had sustained damage to the palmar aspect of the flexor tendons on the left thoracic limb caused by jumping off a transport vehicle. This injury was initially treated by cleaning the area, topical erythromycin antibiotic ointment and intramuscular injection of penicillin for 3 days. Over a 2-month period the initial trauma progressed to a chronic non-healing wound. Medical management of the wound was then changed to topical application of a Chinese herbal decoction which was applied 3 times daily. Over a 29-day period, this treatment encouraged normalization of the wound healing process with epithelization, tissue remodeling and normal scar formation. The clinical results achieved in this horse suggest topical treatment with Chinese herbal medicine can decrease complications and speed the healing process of chronic wounds. The use of the topical herbal formula in this case was convenient, simple to use, and cost effective.

Topical antibiotics in the prevention of port-site infection after elective day care laparoscopic cholecystectomy.

Wound-related infections and complications are rare after day care laparoscopic cholecystectomy (LC). They can have a significant adverse impact on the postoperative course after an uneventful elective LC. The use of topical antibiotics over the port site may prevent such complications. This trial was conducted from January 2018 to June 2019. Two hundred and fifty patients who met the inclusion and exclusion criteria were included in the study. They were randomized into the topical antibiotic group (Group A, n = 125) and control group (Group B, n = 125). All patients underwent four-port LC. Mupirocin 2% topical antibiotic ointment was applied to all four-port sites in Group A, whereas no topical antibiotic was used in Group B. One dose of prophylactic systemic antibiotics was given to all patients in both groups. The mean age was 43.22 ± 12.7 years in Group A and 43.44 ± 12.5 years in Group B. The comorbidities and the other variables were comparable between the two groups. The port-site infection (PSI) was observed in one patient in Group A and three patients in Group B, which was statistically nonsignificant (P = 0.622). The mean time of detection of infection was 4.75 ± 1.7 days. All the infections were superficial surgical site infections. Microbiological swabs culture of the infected wounds yielded no growth of bacteria. The PSI after LC is very less. The use of topical antibiotics to prevent PSIs after LC could not be established.

Pthiriasis Palpebrarum: A Rare Case of Eyelash Infestation

We present a case of Pthiriasis palpebrarum, an eyelid infestation caused by Pthiriasis pubis. The report centers around a 38-year-old male who sought medical attention for multiple symptoms, including a sensation of lid heaviness, pain, and pruritus localized to the left eye. On slit lamp examination left eyelid and lashes were inundated with lice and nits. The patient was treated with anti-lice shampoo, anti-allergic drops, anti-allergic tablet and topical antibiotic ointment in combination with steroids. One week later, all lashes and eye brows were clean, with a few dead lice eggs; that were extracted with forceps on slit lamp. While Pthiriasis palpebrarum is acknowledged as an infrequent cause of blepharo conjunctivitis, our case underscores the potential for this condition to manifest as an isolated eyelid infestation. Importantly, the similarities it shares with lid eczema and blepharitis underscore the diagnostic challenges that may arise in clinical practice.

Multidrug-Resistant Pathogens in Burn Wound, Prevention, Diagnosis, and Therapeutic Approaches (Conventional Antimicrobials and Nanoparticles).

Multidrug-resistant pathogens are one of the common causes of death in burn patients and have a high risk of nosocomial infections, especially pneumonia, urinary tract infections, and cellulitis. The role of prolonged hospitalization and empirical antibiotics administration in developing multidrug-resistant pathogens is undeniable. In the early days of admitting burn patients, Gram-positive bacteria were the dominant isolates with a more sensitive antibiotic pattern. However, the emergence of Gram-negative bacteria that are more resistant later occurs. Trustworthy guideline administration in burn wards is one of the strategies to prevent multidrug-resistant pathogens. Also, a multidisciplinary therapeutic approach is an effective way to avoid antibiotic resistance that involves infectious disease specialists, pharmacists, and burn surgeons. However, the emerging resistance to conventional antimicrobial approaches (such as systemic antibiotic exposure, traditional wound dressing, and topical antibiotic ointments) among burn patients has challenged the treatment of multidrug-resistant infections, and using nanoparticles is a suitable alternative. In this review article, we will discuss different aspects of multidrug-resistant pathogens in burn wounds, emphasizing the full role of these pathogens in burn wounds and discussing the application of nanotechnology in dealing with them. Also, some advances in various types of nanomaterials, including metallic nanoparticles, liposomes, hydrogels, carbon quantum dots, and solid lipid nanoparticles in burn wound healing, will be explained.

ISPD Catheter-related Infection Recommendations: 2023 Update.

Peritoneal dialysis (PD) catheter-related infections are important risk factors for catheter loss and peritonitis. The 2023 updated recommendations have revised and clarified definitions and classifications of exit site infection and tunnel infection. A new target for the overall exit site infection rate should be no more than 0.40 episodes per year at risk. The recommendation about topical antibiotic cream or ointment to catheter exit site has been downgraded. New recommendations include clarified suggestion of exit site dressing cover and updated antibiotic treatment duration with emphasis on early clinical monitoring to ascertain duration of therapy. In addition to catheter removal and reinsertion, other catheter interventions including external cuff removal or shaving, and exit site relocation are suggested.

Unilateral conjunctival concretions associated with chronic inflammation and tear instability.

Conjunctival concretions are small yellow-white subconjunctival spots that can be asymptomatic for years and are an incidental finding on routine ophthalmic examination.[1,2] The etiologies are chronic vernal conjunctivitis, severe atopic keratoconjunctivitis, and post-trachomatous changes.[1–5] The concretions are located within the conjunctival recesses layered by epithelium and are made up of cell debris and phospholipids.[3,4] Case Report A 24-year-old-female presented with chronic irritation and redness in the right eye for 1 year. Systemic evaluation was unremarkable with no immunosuppressive disorders. Her symptoms were intermittently associated with discharge. Her vision was 20/20 in both eyes. Everted upper and lower eyelids of the right eye showed multiple concretions scattered beneath the tarsal conjunctiva, more in the upper eyelid, protruding through the conjunctiva at two focal points [Fig. 1]. There was diffuse congestion in the tarsal conjunctiva with a normal lid margin appearance. The left eyelid had neither congestion nor concretions. There was no ocular surface staining with fluorescein dye, but the exposed concretions showed fluorescein uptake. Dry eye workup revealed a tear break-up time of 7.8 s with normal tear secretion in the right eye, whereas tear breakup and secretion was normal in the left eye. She gave an antecedent history of a vegetative object falling into her right eye while driving a bike. The ocular symptoms developed 1 month after that trauma. She was using topical lubricants and antibiotic ointment over the eyelid margin for the meibomitis. Because of unilateral presentation and young age, two concretions were removed on slit lamp using a sterile 26-gauge needle under topical anesthesia and sent for tissue processing.Figure 1: (a) Everted right upper eyelid of the 24-year-old female shows scattered numerous concretions in the tarsal conjunctiva, fewer in the lower eyelid (d). (b) Gomori methenamine silver stain (100×) shows presence of fungal elements within the concretions (higher magnification in inset), which are also seen on gram stain (e, 400×) as empty round and vertical spaces. (c and f) Left upper and lower eyelids show normal tarsal conjunctivaThe histopathologic examination of concretions revealed eosinophilic homogenous amorphous material containing fungal elements, which were Gomori methenamine silver stain positive [Fig. 2]. The deepest sections (till the last tissue section) also contained numerous fungal hyphae, which ruled out contamination. Due to atypical histopathologic findings of concretions, a superficial conjunctival incision biopsy containing tarsal conjunctiva, concretions, and a thin sliver of tarsus was taken at 4 mm from the upper eyelid margin. The incision biopsy showed scattered amorphous, acellular eosinophilic hyaline-like material and diffuse lymphocytic infiltration in the substantia propria. The amorphous material had a rim of conjunctival epithelium suggestive of concretions embedded within the pseudoglands of Henle. The periphery of the concretions had a slight basophilic appearance. The concretions were negative for von Kossa stain, Alcian blue, and Congo red but were red on Masson trichrome stain, suggesting cell debris and keratin to be one of the constituents. Alcian blue was focally positive in the conjunctival epithelium at the location of goblet cells. She was started on tablet fluconazole 150 mg once a week for 3 weeks along with 1% itraconazole eye ointment into the eye twice a day. Her symptoms resolved with a reduction in the conjunctival concretions’ number and conjunctival congestion.Figure 2: (a) Everted right upper eyelid with highlighted biopsied part. (b and c) Incisional biopsy from the upper tarsal conjunctiva shows diffuse subepithelial lymphocytic infiltration along with eosinophilic hyaline-like material deposits (c, at 200×). Masson trichrome (d), Congo red (e), and Alcian blue (f) were negative for amyloid and mucopolysaccharide depositsTear film instability and reduced tear production have been reported in patients with conjunctival concretions, where 51% of asymptomatic patients with conjunctival concretions have reduced tear break-up time.[3] The current case had reduced tear break-up time in the eye with concretions. An interesting finding in the current case was the presence of fungal elements, which can be explained by the possible entrapment of organic body containing fungus 1 year back. The organic material dissolved away, but the fungal elements caused persistent chronic inflammation, which resulted in the formation of concretions. This case reports the possibility of having unilateral concretions secondary to chronic inflammation with degenerative changes. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Hyderabad Eye Research Foundation, Hyderabad. Conflicts of interest There are no conflicts of interest.

Role of topical antibiotic ointment in the lateral graft following underlay myringoplasty: a prospective randomised study

ObjectiveThe objective of this study was to compare the graft outcome and postoperative infection of with and without the use of antibiotic ointment following myringoplasty for the treatment of chronic perforations.Study DesignRandomized controlled trial.Material and Methods135 chronic perforations were prospectively randomized to use of antibiotic ointment group (UAO, n = 68) or no use of antibiotic ointment group (NAO, n = 67) following myringoplasty. The graft outcomes and postoperative infection were compared among two groups at 6 months.ResultsAt postoperative 6 months, the graft infection rate was 4.4% in the UAO group and 10.4% in the NAO group, the difference was not significant (P = 0.312).The graft success rates were 92.6% in the UAO group and 91.0% in the NAO group, the difference was not significant (P = 0.979). In the UAO group, 3 patients with purulence ear discharge resulted in a residual perforation although they received ofloxacin ear drops and intravenous antibiotic therapy treatment. In the NAO group, 6 patients with purulence ear discharge resulted in a residual perforation, only one, with mild purulence discharge was successfully treated and closed. In addition, no significant between-group differences were observed pre- (P = 0.746) or post- (P = 0.521) operative air bone gap (ABG) values or mean ABG gain (P = 0.745). However, granular myringitis with minimal moistness but without infection has been noted in 3 (4.4%) patients in the UAO group and in 5 (7.5%) in the NAO group, the difference was not significant (P = 0.699).ConclusionsUse and non-use of antibiotic ointments for lateral packing of graft are both comparable methods following myringoplasty for postoperative infection and graft outcomes.

Evaluation of topical oclacitinib and nail trimming as a treatment for murine ulcerative dermatitis in laboratory mice.

Murine ulcerative dermatitis (UD) is a common, multifactorial skin disease of C57BL/6 and C57BL/6-background strains of mice. Many treatment options have been previously reported but have been variably successful and may interfere with specific research studies. Janus kinase (JAK) inhibitors, such as oclacitinib, have been used to treat allergic dermatitis in humans, dogs, and other species. Additionally, topical oclacitinib was shown to improve an induced model of dermatitis in mice. We hypothesized that topical application of oclacitinib in conjunction with hind limb nail trimming would improve UD lesion scores more than our institutional standard treatment regime using meloxicam, topical antibiotic ointment, and nail trimming or nail trimming alone. To test this, mice with naturally occurring UD were recruited to the study and assigned to one of three treatment groups (n = 14/group): nail trim only; nail trim plus meloxicam and topical triple antibiotic ointment; or nail trim plus topical oclacitinib. UD was assessed on days 1, 7, and 14 for all treatment groups, and scored based on a previously published scoring system that quantitatively scored UD lesions based on pruritus, character of the lesion, size of lesion, and location of lesion. Here we found that mean UD scores decreased from day 1 to day 7 and from day 1 to day 14 for all treatment groups. However, there was no significant difference in mean UD score between the treatment groups at any timepoint. These data show that topical oclacitinib and nail trimming together improved UD lesion scores comparably to our institutional standard treatment and nail trimming alone. However, further studies may be warranted to investigate other potential applications of oclacitinib to treat UD.

Short-Term Topical Antibiotic Treatment in Nasal Cavity Actinomycosis: Case Report and Literature Review

Actinomycosis is a rare acute-to-chronic bacterial infection caused by Actinomyces. A 7-year-old healthy girl presented with left-sided nasal obstruction and purulent discharge. She had no special medical or trauma history, and the symptoms developed gradually after severe vomiting one month prior to the visit. Nasal endoscopy revealed white-black-colored cheesy material that appeared as a foreign body or fungal material in the left nasal cavity. The lesion was completely removed endoscopically under local anesthesia. The patient was prescribed only a topical antibiotic ointment without any additional systemic antibiotics. She was diagnosed with actinomycosis based on histopathological examination after a few days. There was no recurrence at six months post-procedure. The common treatment for actinomycosis is surgical removal and a systemic antibiotic therapy. However, this case was successful with complete surgical removal and only a short-term topical antibiotic ointment therapy. Therefore, the treatment for actinomycosis should differ based on clinical characteristics and the patient’s condition.

Combination of available topical beta-blockers and antibiotic ointment for epidermal growth factor receptor tyrosine kinase inhibitor-induced paronychia and pseudopyogenic granulomas in Taiwan.

Painful paronychia and pseudopyogenic granuloma (PG) are common adverse drug reactions (ADRs) associated with the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) to treat non-small cell lung cancer (NSCLC). Multiple local management approaches have been tested with unsatisfactory results. We have introduced an occlusion therapy technique through which available topical drugs for longer than 2 years. Based on the cancer registry and case management system of our hospital, from July 2019 to July 2020, we retrospectively enrolled patients with NSCLC who were treated with EGFR-TKIs and received applications of 0.5% timolol ophthalmic solution (TIMOPTOL XE 0.5%®) combined with a neomycin/tyrothricin ointment (Biomycin®) using the occlusion method to treat paronychia or PG. A total of 22 patients were enrolled, with a mean age of 66.5 years, most of whom were women (72.7%). Periungual lesion-related pain was reported by all patients, and periungual bleeding and PG were reported in 14% (3/22) and 64% (14/22) of patients, respectively. After the occlusion therapy application of timolol ophthalmic solution combined with neomycin/tyrothricin ointment twice daily, the overall response rate was 83.3%, including complete response in 18% (4/22) of cases and partial response in 68% (15/22) of cases. We presented an occlusion method using available topical beta-blockers and antibiotic ointment for EGFR-TKI-induced paronychia and PG in Taiwan. The result is favorable. Further randomized control trial is urgent to validate our findings.

Clinical Challenge in Urology: A Nonhealing Wound on the Glans Penis

A 63-year-old male presented to his surgeon 6 months following circumcision for phimosis with complaints of a nonhealing wound on the glans penis. He reported persistent bleeding, pain, and progressive difficulty urinating in the months following the procedure. He was noted to have a grossly dehisced circumcision, with erythematous, beefy granulation tissue involving the entire glans (Fig. 1). Biopsy taken from the glans demonstrated pseudoepitheliomatous hyperplasia, intraepidermal microabscess formation, and focal subepidermal vesiculation overlying brisk inflammation including neutrophils, plasma cells, eosinophils, and lymphocytes (Fig. 2). Infectious workup revealed MRSA on tissue culture (treated without clinical improvement), negative HSV PCR, and negative special stains and tissue cultures for mycobacterial and fungal species. Further laboratory evaluation included rapid plasma reagin (RPR), antineutrophilic cytoplasmic autoantibody (ANCA), Hepatitis A/B/C, HIV, Lyme, antineutrophilic antibody (ANA), and tuberculosis interferon-γ release assay (IGRA)—all were unremarkable/negative. There was no clinical improvement with topical lidocaine, antibiotic ointment, testosterone, halobetasol cream, and courses of oral antibiotics and fluconazole.

Skin and Soft Tissue Infection Treatment and Prevention Practices by Pediatric Emergency Medicine Providers.

The aim of the study was to evaluate skin and soft tissue infection (SSTI) treatment and prevention practices among pediatric emergency medicine (PEM) clinicians in the context of current clinical practice guidelines and contemporary evidence. This was a cross-sectional survey of PEM clinicians belonging to the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. Four varying hypothetical clinical scenarios of children with SSTI were posed to respondents; subsequent items assessed SSTI treatment and prevention practices. Provider demographics were collected. Of 160 survey respondents, more than half stated that they would prescribe oral antibiotics for each clinical scenario, particularly for more complex presentations (small uncomplicated abscess, 51.8%; large uncomplicated abscess, 71.5%; recurrent abscess, 83.5%; febrile abscess, 90.3%; P < 0.001). Most commonly selected antibiotics were clindamycin and trimethoprim-sulfamethoxazole. Across scenarios, more than 80% selected a duration of treatment 7 days or more. Of the 121 respondents who prescribe preventive measures, 85.1% recommend hygiene measures; 52.5% would prescribe decolonization with topical antibiotic ointment and 77.5% would recommend antiseptic body washes. Half of the respondents reported that their institution has standard guidance for SSTI management. Although current evidence supports adjuvant antibiotics for all drained SSTI and decolonization for the index patient and household contacts, PEM clinicians do not consistently adhere to these recommendations. In light of these findings, development and implementation of institutional guidelines are necessary to aid PEM clinicians' point-of-care decision making and improving evidence-based practice.

Bug alert! A case report and review of literature on bilateral phthiriasis palpebrarum

We report a case of phthiriasis palpebrarum in an immunocompetent individual along with the review of the literature. A 61-year-old woman presented with a 2-month history of itching and burning sensation in both eyes. Examination revealed lice and nits anchored to the eyelashes with a mild follicular conjunctival reaction and no evidence of discharge. The patient recovered fully within 2 weeks after manual removal of the lice and crusts along with topical antibiotic ointment and oral ivermectin, with no evidence of lice or nits on follow-up. This study suggests that patients presenting with itching of the eyelids and other asthenopic symptoms should be carefully examined by slit-lamp examination, to not miss out on unusual diagnoses such as found in this case.

A CASE REPORT OF APLASIA CUTIS CONGENITA TYPE VI: BART'S SYNDROME

Aplasia cutis congenita type VI (Barts syndrome), is a rare genetic disorder characterized by congenital localized absence of skin, formation of blisters (epidermolysisbullosa), and nail abnormalities. In this report, we present a rare case of aplasia cutis congenita type VI (Barts syndrome) in a newborn malebaby with the absence of a skin layer over the anterior right leg, slightly below the patella (kneecap) and around the ankle joint.On the second day, the affected areas developed blisters characterizing epidermolysisbullosa.Laboratory investigationswere all normal. The patients wound was managed conservatively with dressing and topical antibiotic ointments.

A SINGLE CASE STUDY TO EVALUATE THE EFFECTIVENESS OF AYURVEDA TREATMENT PROTOCOL USING EUPHORBIA LATEX IN UTSANGINI W.S.R TO CHALAZION

Introduction: - Chalazion is also known as a tarsal ‘cyst’ or meibomian ‘cyst’. This is not a cyst but a chronic inflammatory granuloma of a meibomian gland. Chalazia are often multiple, occurring in crops. The contem- porary treatment modalities include eyelid hygiene with hot compresses, topical antibiotic ointment and also steroid injections. Most lesions usually necessitate more invasive procedures. If the chalazion does not resolve, it should be incised and curetted. its management is difficult, due to its high recurrence rate and chronicity. It is correlated to Utsangini in Ayurveda. Ayurveda can provide safe and cost-effective results in Utsangini with both Shodhana and Shamana Chikitsa. Materials and Methods: -A case of Chalazion successfully treated with local application of dugdhika ksheera and bidalaka with mukkadi churna along with a few internal medicines is recorded here. Result: The subject had shown good improvement Conclusion: Latex of euphorbia latex has a good effect on the management of Utsangini. Keywords: Chalazion, Utsangini Bidalaka, Dugdhika Ksheera, Mukkadi Churna.

Lipoma Removal Surgery in White-Rumped Shama (Kittacincla malabarica macraoura)

Lipoma in birds is a benign tumor of adipose cells that often occurs in the subcutaneous area. White-rumped shama, more than three years old, was rushed to the puskesmas with symptoms of decreased activity and singing ability. The results of the examination were two round, multi-focal masses, firmly demarcated, yellowish in color with a soft, chewy consistency measuring ± 4 x 2 x 1 cm on the chest and ± 1 x 1 x 1 cm. in the abdominal area, firmly attached to the subcutaneous layer since six months ago, and getting bigger. The feathers around the mass are shed and vascularized on the surface of the mass. Surgery was performed because the mass suspected of being a tumor growing rapidly and causing pain. It was fasted two hours before surgery and the anesthetic used was a combination of ketamine HCl and xylazine. Postoperative therapy using the antibiotic enrofloxacin, ketoprofen analgesics, 0.9% NaCl fluid therapy and topical antibiotic gentamicin ointment. The tumor that has been successfully removed is yellowish in color with several areas of hyperemia and an oily surface. The results of histopathological examination characterized by the presence of adipose cells that appeared to proliferate well confirmed that the tumor was a lipoma.

In Vivo confocal microscopy findings after COVID-19 infection

ABSTRACT Purpose: To evaluate clinical and in vivo confocal microscopy (IVCM) findings of a patient who developed multiple unilateral subepithelial stromal opacities following conjunctivitis that developed during a COVID-19 infection. Methods: A 22-year-old female presented to our clinic with blurred right vision. The history revealed that she had experienced a COVID-19 infection one month ago. Redness and stinging of the right eye had started at the same time and she had been prescribed topical antibiotic drops and ointments. The redness in the right eye had decreased but blurred vision had then developed. Results: Slit lamp examination revealed a normal left eye. Several tiny subepithelial infiltrates without fluorescein staining of the cornea were present in the right eye. The anterior chamber, lens and fundus were bilaterally normal. IVCM revealed irregular corneal epithelial cells with bright borders in addition to scattered inflammatory cells and cell debris in the right eye. There were activated dendritic cells in the subbasal epithelial area with a significant decrease in the subbasal corneal nerve plexus. Clusters of highly reflective cells with an irregular shape were seen in the anterior corneal stroma together with foci of activated keratocytes. The corneal endothelial cell layer was normal. The left eye IVCM findings were all within normal limits. The right eye also showed decreased corneal sensitivity compared to the left. Conclusions: The possible role of corneal infiltrates as a trigger for COVID-19 could be explained with an immune-mediated mechanism. SARS-CoV-2 can result in decreased corneal sensitivity through corneal nerve involvement. The clinical results of this effect need to be evaluated in larger series.

Patient Satisfaction and Management of Postoperative Complications Following Ablative Carbon Dioxide Laser Resurfacing of the Lower Eyelids.

To describe postoperative management following ablative carbon dioxide laser resurfacing of the lower eyelids. A retrospective review of patients who consecutively underwent bilateral lower eyelid ablative carbon dioxide laser resurfacing by a single experienced oculoplastic surgeon over a 6-year period was conducted. Patient satisfaction, aesthetic outcomes, and postoperative complications were evaluated as adjunctive or monotherapy. Among 424 patients included in the study, most were female (n = 356, 84.0%) and Caucasian (n = 404, 95.3%), with Fitzpatrick skin types II-III (n = 381, 89.9%). Mean age was 62.8 years (standard deviation: 9.7 years). Most (n = 324, 76.4%) underwent fractional ablative carbon dioxide laser resurfacing of the lower eyelids, whereas 91 (21.5%) received traditional laser resurfacing and 9 (2.1%) had both fractional and traditional laser resurfacing during the same session. At the time of lower eyelid laser resurfacing, most patients also underwent concurrent procedures, including upper (n = 321, 75.7%) and lower blepharoplasty (n = 348, 82.1%); a small proportion of patients (n = 39, 9.2%) did not undergo any concurrent surgical procedure. In addition to ablative laser resurfacing of the lower eyelids, 25 (5.9%) had upper eyelid laser resurfacing, 60 (14.2%) had full-face laser resurfacing, 55 (13.0%) had neck laser resurfacing, and 42 (9.9%) had additional treatment of solar lentigines or dyschromias on the face. Median follow-up duration was 3.9 months (interquartile range: 2.0-11.0 months). In the immediate postoperative period, 22 patients (5.2%) developed contact dermatitis from topical antibiotic eye drops and/or ointment prescribed postblepharoplasty. Postinflammatory hyperpigmentation was observed in 40 patients (9.4%) despite topical prophylaxis; all were eventually successfully treated with a combination of topical nonprescription and prescription creams and/or oral tranexamic acid. A localized herpetic outbreak occurred in 3 (0.7%) who underwent full-face laser resurfacing and 1 (0.2%) who underwent periocular laser resurfacing only; all were successfully treated with oral antiviral therapy. Two (0.5%) developed culture-proven atypical mycobacterial infection of the resurfaced lower eyelid skin and were treated with combination antibiotic therapy for several months until resolution. A small scar was noted in 4 patients (0.9%), which resolved after local corticosteroid injections. No patient developed persistent scarring or ectropion. Patient satisfaction was overall high, with 363 (85.6%) very satisfied and 48 (11.3%) satisfied with the aesthetic outcome of lower eyelid laser resurfacing. Ablative carbon dioxide laser resurfacing of the lower eyelids can be a useful tool in the armamentarium of the experienced oculoplastic surgeon, with excellent aesthetic results, high patient satisfaction, and low complication rates as adjunctive or monotherapy. Proper and timely management of postoperative complications is essential to maximizing successful cosmetic outcomes.