founder of McDonald s Restaurants

Transcription

1 Press On Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education alone will not; the world is full of educated derelicts. Persistence & determination alone are omnipotent. By Ray A Krog--- founder of McDonald s Restaurants 1

2 Thygeson Keratitis (superficial punctate keratitis- SPK) Uncommon, noncontagious,, recurrent condition of unknown etiology Symptoms: Mild to moderate foreign body sensation, tearing, white & quiet eye, and photophobia; exacerbations & remissions common- attacks lasting 1-2 months, most common in 2 nd to 3 rd decades, may last years Signs: Bilateral, symmetrical, randomly distributed, discrete, elevated, coarse punctate epithelial keratitis of central cornea- fine or coarse keratitis, VA mildly effected; discrete, gray-white dots; snowflake-like infiltrates develop under keratitis; varying in number from 1 opacity to 50 at any given time. Classic appearance of coarse, oval shaped slightly raised white grey dots that stain during active stage. Absence of conjunctival injection, edema, no corneal neovascularization,, A- C reaction or eyelid reaction Etiology: Unknown- possibly due to chronic sub-clinical viral infection: has not been proven Immunological basis- rapid response to steroids Course: Remission and relapses for as many as 3 to 4 years or longer, leaving behind no serious sequelae,, no scars 2

3 Diferrential Diagnosis Viral, toxic, bacterial, chlamydial, exposure & dry eye Treatment: Artificial tears 4 to 8 times daily (Refresh plus) in mild cases plus ointment/gel at night: Topical corticosteroids (0.12% to 1% prednisolone acetate) q2-4h for days; newer topical steroids-flarex Flarex, Efolon, Vexol, Alrex and Lotemax), seek the lowest steroid dose, bandage lenses, goal of treatment is comfort Questionable use of topical antivirals Cyclosprine 0.05% Restasis qid? 3

4 Superior Limbic Keratoconjunctivitis (SLK of Theodore) Uncommon, chronic inflammatory condition which affects typically middle aged women Symptoms: Severe foreign body, pain, burning, tearing, photophobia, mucous discharge; symptoms are more severe than clinical findings would suggest; patients generally do not report a red eye. Signs: Unilateral or bilateral superior bulbar conjunctiva injection and chemosis; ; a fleshy, gray thickening of epithelium at superior limbus; ; papillary reaction of tarsus, fine superior punctate epithelial keratitis, micropannus and filamentary keratitis (50%), rose bengal or lissamine green staining of cornea and conjunctiva; dry eyes, decrease corneal sensation Red eye missed unless upper eyelid lifted and patient looks down Etiology: Unknown, female > male, possibly an association to abnormal thyroid function in 50% of reported cases (T3, T4 & TSH)- defective blinking due to lid retraction; Mechanical- A friction between superior bulbar conjunctiva and tarsal conjunctiva leading to surface cell damage of conjunctiva & upper cornea CL-related SLK Course: Heals without scarring, chronic (1 to 10 years) course with exacerbations and remissions Treatment: Control of thyroid state; Artificial tears, punctal occlusion?, bandage soft lenses, and possibly silver nitrate application with cue tip (0.5% to 1%), questionable use of topical steroids; surgical intervention- conjunctival resection or transconjunctival cautery of effected upper bulbar conjunctiva; reports of cromolyn or lodoxamide sol. helpful: if significant mucus or filaments, try Acetylcysteine 10% drops (Mucomyst( Mucomyst) Consider treatment with Restasis bid 4

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