Optom
Continuing on this discuss, in a previous blog I discussed the challenges I faced in managing this 3 year old boy with an Adenoviral type of Kerato-Conjunctivitis with heaps of periauricular lymph nodes superimposing the peripheral cornea of the left eye.
On the last two visits the young boy's eyes had shown a good prognosis. I am currently using a tappered dosing of the topical NSAID, an additional gutt: Ciprofloxacin i every 1hr.
Why did I not use steroids that immuno-suppresses such activitis? Why did I opt for an NSAID that would typically counteract the effect of prostalglandins on the compromised LE but wont influence immune responses? (Note the immune responses against allergens in the eyes manifests in the symptoms common with allergic conjunctivitis?). I might have been awed @ the corneal infiltrates & the exagerated dilatation of conjunctival vessels. I might have been too cautious in using a topical steroid because this hyper-active boy might be mechanically causing corneal abrassion whenever his eyes irritate him. (His parent said he does not itch his eyes, but who can tell?). I might have weighed the toxic/therapeutic consequences hence my choice of the NSAID over the corticosteroids.
I must have been too careful with the hazy cornea & the age of the boy, hence the use of Gutt: Ciprofloxacin to prophylactically check for opportunistic infection on the cornea. I did a flouresin examination of the cornea in each visit to ensure that the young boy's cornea remains intact.
It should come to our knowledge that allergic conjunctivitis of any type might not respond to a specific regimen of drug(s) but knowing its triggering factor is definately an important step in the right direction.
I have also noticed that prescribing glasses, when indicated, using cooling compresses & applying lubricants either in form of eyedrops or in form of ointments (like I used Chloramphenicol eye ointment both for its broad spectrum antibacterial property & for the viscous nature of the ointment), using antihistamines like Keturtifen Fumerates etc to reduce symptomatic itching, an immune response by the host eye to percieved allergens, have been shown to have tremendous influence in managing adenoviral Kerato-conjunctivitis...remember that type of conjunctivitis that could develop real membrane over the conjunctiva & even threatening to invade cornea itself? Recently, some researchers in clinical practice even suggested using 5% Betadine topical solution to flush off the adenoviral load on the surface of the eye! Betadine is a brand name for Povidone iodine known for its very strong antiseptic & antimicrobial charactaristics. It is often used in cataract surgery to sterilize the adnexa of the eyes in fight against opportunistic bacterias that causes Endophthalmitis.
I saw the young boy yesterday & his parents were very happy. His eyes was clearer. His vision has improved & the lustre of the eye was better. But I adviced her on keeping a close look out for any symptom on the boy's right eye & to gradually lower the dosage of all administered eyedrops... It was so good to be of help! Thanks
Dr Ezebuiroh Victor Okwudiri.
Note: This article is devoid of any financial requirements. Feel free to comment, it makes me feel better.
Our free Glaucoma screening exercise is still going on @Opposite Shell Pipeline. Happy weekend.
optometry is discussed here, eye diseases and disabilities are highlighted and management of such ocular conditions enumerated.
Saturday, 18 February 2012
Tuesday, 14 February 2012
Follicular Kerato-conjunctivitis in this boy of 3 year plus!
Optom
Happy Valentine Day folks!
Wow its just like yesterday, this time last year! What was I doing self in my last year valentine? I have forgotten... Okey I was googling, facebooking & optometry.naija was still a baby! Its really reasuring to know that somehow last year's love is still enough to go round this year...
Lets discuss a current clinical issue which I observed in managing a three year old boy whose mother brought to my clinic last week ( 7th February 2012). A boy of 3 years old presenting with a monocular redness on the L.E. the mother noticed in the child's eye the penultimate day. He had unilateral epiphora of the ipsilateral eye, mild edematous lids slightly warm & soft to feel. The was marked echymosis, perilimbal conjunctival membrane was masking early follicular infiltrations on the corneal surrounding.
There was no previous history of ill health. Child still goes to school but parents concern stems from the marked hyperemia on the left eye- it was like a pool of crimson redness!
On further observation, patient was very stubborn cos he uses his feet to kick me during diagnosis, there was no conjuntival membrane but lots of scattered papillae adorned the cul du sac like a flower wreath or just scattered. Parent said there was no associated itchiness, no discharges but strands of ropy discharge could be noticed. Cornea was slightly hazy & the follicular infiltrations on the perilimbal area, with @ least one follicular infiltration on the superior corneal area of the ipsilateral eye! These follicular infiltrations are hedge by heaps of periauricular lymph nodes that suddenly exagerated on patient's subsequent clinical appontment 3/7 days later.
The boy was very restless, not necessarily because of the eye condition. I think the boy could be hyper-active, just like many kid's of his age. The parent reports that there was no other sibling who had such similar conditions & this was patient's first eye care visit!
The boy could not identify any visual acuity chart neither was he paynig any attention to other cues. I went straight to applying Gutt: Procaine ii in 5 minutes interval for 15 minutes. This was to numb his over-sensitive L.E. cornea to give patient some soothing relief & prepare patient for the application of flouresin sodium strip on the affected eye for another 1 minute. I had to ensure that the infiltration had not invaded the epithelium of the cornea. The young boy barely allowed my torchlight close to him, hence I could check for the presence of keratic precipitate. The picture depicted a unique likelihood of Epidemic Keratoconjunctivitis.
Adenoviral infection in the eye is the cause of Epidemic Keratoconjunctivits. Treatment of this condition with steroids, topical NSAID, eye lubricant, cyclosporine, cold compress etc is tailored to the symptoms associated with the conjunctivitis. It is usually self-limiting but could cause consequenses!
I followed the typical treatment pattern but only that I replaced steroid with a combination of NSAID & gentamicin (Gutt: Diclogenta i every hour for 3 days & tapered to, Gutt: Diclogenta i qds 1/52). I applied gutt: Mydracyl 1% ii on the Right Eye . I prescribed oint: Chloramphenicol i noct, to soothe the eye & provide a lubricating cover. I added Tab:Vit C ii tds 1/52, Tab: Yeast ii tds 2/52.
In their return visit, I observed a marked improvement in child's vision. I have currently placed her on Gutt: Ciprofloxacin i every 1 hour. Their second visit was better, patient's eye has stopped tearing & the lid edema has gone down & the redness is reducing!
Thanks,
Dr Ezebuiroh Victor.
Note: 1) There is no financial attachment to this article!
2) Pan-Oj clinic & Diagnostic service limited opposite Shell pipeline is organizing a FREE GLAUCOMA screening from 14th february to 18ths february.
Thanks.
Happy Valentine Day folks!
Wow its just like yesterday, this time last year! What was I doing self in my last year valentine? I have forgotten... Okey I was googling, facebooking & optometry.naija was still a baby! Its really reasuring to know that somehow last year's love is still enough to go round this year...
Lets discuss a current clinical issue which I observed in managing a three year old boy whose mother brought to my clinic last week ( 7th February 2012). A boy of 3 years old presenting with a monocular redness on the L.E. the mother noticed in the child's eye the penultimate day. He had unilateral epiphora of the ipsilateral eye, mild edematous lids slightly warm & soft to feel. The was marked echymosis, perilimbal conjunctival membrane was masking early follicular infiltrations on the corneal surrounding.
There was no previous history of ill health. Child still goes to school but parents concern stems from the marked hyperemia on the left eye- it was like a pool of crimson redness!
On further observation, patient was very stubborn cos he uses his feet to kick me during diagnosis, there was no conjuntival membrane but lots of scattered papillae adorned the cul du sac like a flower wreath or just scattered. Parent said there was no associated itchiness, no discharges but strands of ropy discharge could be noticed. Cornea was slightly hazy & the follicular infiltrations on the perilimbal area, with @ least one follicular infiltration on the superior corneal area of the ipsilateral eye! These follicular infiltrations are hedge by heaps of periauricular lymph nodes that suddenly exagerated on patient's subsequent clinical appontment 3/7 days later.
The boy was very restless, not necessarily because of the eye condition. I think the boy could be hyper-active, just like many kid's of his age. The parent reports that there was no other sibling who had such similar conditions & this was patient's first eye care visit!
The boy could not identify any visual acuity chart neither was he paynig any attention to other cues. I went straight to applying Gutt: Procaine ii in 5 minutes interval for 15 minutes. This was to numb his over-sensitive L.E. cornea to give patient some soothing relief & prepare patient for the application of flouresin sodium strip on the affected eye for another 1 minute. I had to ensure that the infiltration had not invaded the epithelium of the cornea. The young boy barely allowed my torchlight close to him, hence I could check for the presence of keratic precipitate. The picture depicted a unique likelihood of Epidemic Keratoconjunctivitis.
Adenoviral infection in the eye is the cause of Epidemic Keratoconjunctivits. Treatment of this condition with steroids, topical NSAID, eye lubricant, cyclosporine, cold compress etc is tailored to the symptoms associated with the conjunctivitis. It is usually self-limiting but could cause consequenses!
I followed the typical treatment pattern but only that I replaced steroid with a combination of NSAID & gentamicin (Gutt: Diclogenta i every hour for 3 days & tapered to, Gutt: Diclogenta i qds 1/52). I applied gutt: Mydracyl 1% ii on the Right Eye . I prescribed oint: Chloramphenicol i noct, to soothe the eye & provide a lubricating cover. I added Tab:Vit C ii tds 1/52, Tab: Yeast ii tds 2/52.
In their return visit, I observed a marked improvement in child's vision. I have currently placed her on Gutt: Ciprofloxacin i every 1 hour. Their second visit was better, patient's eye has stopped tearing & the lid edema has gone down & the redness is reducing!
Thanks,
Dr Ezebuiroh Victor.
Note: 1) There is no financial attachment to this article!
2) Pan-Oj clinic & Diagnostic service limited opposite Shell pipeline is organizing a FREE GLAUCOMA screening from 14th february to 18ths february.
Thanks.
Subscribe to:
Posts (Atom)