Abstract: CASE REPORT: A 37-year-old psychotic patient inflicted injuries to his skin and eyes in the context of an interpretational delirium with aesthetic content. He used magnifying glasses to concentrate sunlight and suffered burns to his arms and face. In the eyes, these resulted in massive iridial atrophy with loss of the sphincteric function, photic maculopathy and peripheral retinal coagulation. The macular lesion resolved spontaneously although he did not recover visual acuity. DISCUSSION: This is the first reported case of ocular self-injury secondary to sunlight. It is also the first case reporting retinal photo-coagulative lesions secondary to sunlight.
Abstract: PURPOSE: Optic nerve drusen needs to be included in the differential diagnosis of pseudopapilledema. As the identification of this entity by funduscopy may be difficult, ultrasonography has thus become the gold standard for its diagnosis. Severe optic nerve drusen has been correlated with a reduction of the nerve fiber layer measured by optic coherence tomography and with the presence of serious visual field defects. To demonstrate the relationship between extensive optic nerve drusen and visual field defects. METHOD: A prospective observational study of the visual fields of a series of 5 patients with severe optic nerve drusen diagnosed by ultrasonography. RESULTS: Visual field defects of widely differing severity, from inferior nasal quadrant to severe hemivisual field defects, were described in each patient studied. CONCLUSIONS: Visual field defects of diverse severity are common in patients with deep optic nerve drusen. For that reason ultrasonography and/or optical coherence tomography is highly recommended where such visual field defects exist.
Abstract: PURPOSE: To report an unusual bilateral ulcerative lid involvement as the presenting manifestation of a severe Crohn disease. DESIGN: Observational case report. METHOD: Description of an otherwise healthy woman who initially presented with bilateral ulcerative lid involvement before the discovery of an extensive ulcerative intestinal inflammatory disease. RESULTS: A 32-year-old woman presented with bilateral ulcerative blepharitis. She also complained of aphthous oral lesions and diarrheic episodes for the previous 3 days. Impression cytology of the lid ulcers showed conjunctival cells, together with the presence of lymphocytes and macrophages. Colonoscopy and colonic biopsy were characteristic of Crohn disease. The treatment with systemic corticosteroids healed bowel, oral, and lid margin ulcerative lesions. CONCLUSION: The simultaneous appearance of ulcerative lesions in the intestinal mucosa and in the mucocutaneous lid margin and the comparable features encountered in the cytologic studies indicate that ulcerative lid margin disease could be an ocular manifestations of Crohn disease.
Abstract: CASE REPORT: A 55 year-old Spanish woman with a personal history of lepromatous leprosy treated for 10 years with anti-lepromatous triple therapy was referred to us presenting nodular scleritis in her left eye with no other clinical manifestations. Ophthalmological evaluation disclosed several inflammatory features in both eyes. Complementary tests performed were negative and the clinical picture was diagnosed as an immuno-mediated manifestation of leprosy. A favorable outcome was achieved with steroidal treatment. DISCUSSION: Scleritis and some immunomediated conditions may appear during the evolution of lepromatous patients whose disease may have been declared clinically cured.
Abstract: OBJECTIVE: To evaluate the efficacy of the topical use of periocular and conjunctival povidone-iodine solution applied the day before cataract surgery to reduce conjunctival flora. PATIENTS AND METHODS: Randomized and prospective clinical trial with 82 patients. The treatment group (41 patients) received an application of topical 10% povidone-iodine solution on the periocular skin and instillation of topical 5% povidone-iodine solution on the forniceal conjunctiva the day before and one hour before surgery. The control group (41 patients) only received the usual perioperative disinfectant. Conjunctival smears were obtained from in all patients at the end of the surgery and these were sent to the Microbiology Laboratory for culture. RESULTS: In the treatment group 1 positive culture was found in the 41 eyes (2.4%). In the control group, there were positive cultures in 6 out of 41 eyes (14.6%). The difference is statistically significant (p<0.05). CONCLUSIONS: The disinfecting of the periocular skin with 10% povidone-iodine solution and of the conjunctiva with 5% povidone-iodine solution the day before and one hour before cataract surgery is effective in reducing conjunctival bacterial colonization compared with perioperative disinfection alone.
Abstract: Nine hydrocephalic shunted children with infected cerebrospinal fluid (CSF) were treated. Ages ranged from 0 to 10 years. Diagnosis was made through clinical symptoms, CSF examination, echographic and computed tomography (CT). The microorganism which was seen more frequently, was S. epidermidis. This germ was more often found in young children. Treatment of these patients consisted of a systematic change of the shunt which was externally diverted, implantation of a CSF Ommaya reservoir in the lateral ventricle, and intraventricular and systemic administration of antibiotic, were made. Using this protocol CSF sterilization was obtained in all cases, after 5 to 12 days of treatment. CSF shunt infected with S. epidermidis can be effectively cleaned with daily intra-shunt vancomycin, and shunt infected with gram-negative are also cleaned with daily intra-shunt gentamycin.
