Thursday, May 24, 2007


Arch Ophthalmol -- Abstract: Optimal Optical Coherence Tomography-Based Measures in the Diagnosis of Clinically Significant Macular Edema: Retinal Volume vs Foveal Thickness, May 2007, Campbell et al. 125 (5): 619:

"Optical coherence tomography–based retinal volume and central foveal thickness variables display comparable abilities to discriminate between those with and without CSME. Both measures may have clinical applications as quantitative diagnostic tests for CSME. "


Ophthalmic Plastic and Reconstructive Surgery - Abstract: Volume 23(3) May/June 2007 p 173-178 Assessing Patients With Epiphora Who Are Patent to Syringing: Clinical Predictors of Response to Dacryocystorhinostomy.

These findings show that a negative single-drop Jones I test is predictive of symptomatic improvement after dacryocystorhinostomy surgery in patients with epiphora who are clinically patent to syringing. Lacrimal syringing and the Fluorescein Dye Disappearance Test, on their own, were not predictive of surgical outcome. Jones testing was of significant value in patients, but only when the traditional single-drop test was used.

So in situations where the patient is patent to syringing, DCR may still be of value if the single drop Jones I test is negative.

Tuesday, May 22, 2007


Eye & Contact Lens: Science and Clinical Practice - Abstract: Volume 33(3) May 2007 p 144-147 Extended-Wear Silicone Hydrogel Soft Contact Lenses in the Management of Moderate to Severe Dry Eye Signs and Symptoms Secondary to Graft-Versus-Host D

Conclusions. The Focus NIGHT & DAY contact lens can improve subjective dry eye symptoms and visual acuity in patients with refractory dry eye disease secondary to GVHD.

However, objective tests such as TBUT, Schirmers, and Fluorescein staining were not mproved.


Optometry and Vision Science - Abstract: Volume 84(5) May 2007 p 429-434 The Effect of Octylglucoside and Sodium Cholate in Staphylococcus epidermidis and Pseudomonas aeruginosa Adhesion to Soft Contact Lenses.

Octylglucoside is a surfactant that inhibits pseudomonas adhesion to silicone hydrogel and conventional contact lenses. Perhaps it could be formulated as an eyedrop for extended wear users to decrease their risk of corneal ulcers.

Friday, May 11, 2007

Orbital Blow Out Fracture

27 year old uninsured man presents today after getting punched last night in his left eye. He blew his nose this morning and the lower lid immediately swelled up. Conjunctiva, cornea, anterior chamber and posterior pole examination was unremarkable. There was no diplopia on upgaze. Diagnosis?

CT of orbits and brain were ordered without contrast and follow-up with our oculoplastics scheduled. Keflex 250mg qid was given and he was instructed to not blow his nose.

Pituitary Tumor Undiagnosed

A 66 year old woman presented to an optometrist in May of 2006 with the complaint of blurred left vision. Her visual acuity was 20/30 in the right eye and 20/70 in the left. He found no pathology and recommended glasses, with only minimal improvement in visual acuity in the left eye. He explained the decreased visual acuity in the left eye as amblyopia, with no history of long-term visual acuity loss in that eye and no explanation as to why.

She was not satisfied with the answers the optometrist gave her. She saw another optometrist at Cosco who agreed with her that something wasn't right, and he referred her to a retinal specialist.

She presented to the retinal specialist on June 9th, 2006. He mentioned that she was less light sensitive in the left eye than the right and he noted very minimal optic nerve pallor in the left eye. He diagnosed possible optic neuropathy and ordered a VF 30-2, color vision, and an MRI with contrast.

The visual field confirmed a significant junctional scotoma in the left eye. The patient missed plates 10 and 13-16 on the Ishihara color vision test, and the MRI demonstrated a sellar/suprasellar mass lesion. The patient was referred to neurosurgery for urgent consulation.

The patient underwent trans-sphenoidal resection of the confirmed pituitary adenoma and a repeat visual field test in August demonstrated some improvement in the visual field but great improvement in visual acuity to 20/25.

This case is a reminder of the importance of good history, good investigation as to the cause of vision loss, and further testing and referral in the presence of unexplained vision loss.

Triamcinolone injection for SLK

Cornea - Abstract: Volume 26(4) May 2007 p 423-426 Supratarsal Triamcinolone Injection in the Treatment of Superior Limbic Keratoconjunctivitis.

Supratarsal triamcinolone injection effectively and rapidly resolved symptoms and signs associated with SLK.

Thursday, May 10, 2007

Care of Patient with Anolphthalmos

Review of Optometry
A few pearls from this article:

Note if the involved eye appears proptotic or enophthalmic with the prosthesis in place and if there is good translation of the prosthesis as the patient looks from side to side.

Excessive redness and edema may indicate inflammation.

Be aware of any foul odor emanating from the socket, as this may signify infection.

Ensure that the socket is fully closed, and that the orbital implant has not extruded through from the orbit. Any compromise of the socket provides a direct route for potential spread of infection to the orbit and, ultimately, the intracranial cavity.

Ensure that the surface of the prosthesis is smooth and not crazed or cracked, as these imperfections can harbor microbial pathogens.

corticosteroids are generally better than mast cell stabilizers for individuals with prosthesis-induced GPC.

Protective eyewear with polycarbonate lenses is vital.

AMD and Myocardial Infarction

OphthoLinx Medical News
AMD is associated with older age, female gender, being white, and having a history of myocardial infarction, hypertension, and diabetes.

Tuesday, May 01, 2007

OSN SuperSite - Proper patient selection essential while learning DSEK

OSN SuperSite - Proper patient selection essential while learning DSEK: "Descemet's stripping endothelial keratoplasty (DSEK) is indicated only for patients with endothelial failure"

This is a procedure where the endothelium is stripped, a microkeratome is used to divide a donor cornea, which is then pushed against the recipients endothelium using a bubble.


This device consists of two mirrors that work together to magnify the central field of vision while maintaining the existence of peripheral vision. Approval is being sought.