Case presentation - Corneal ulcers and dystrophies
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This document presents two clinical case analyses: Case 1 involves a 66-year-old female diagnosed with Stage 1 Fuchs Endothelial Dystrophy in her left eye. She has a history of cataract surgery and is experiencing decreased vision. Her examination shows guttata lesions and corneal edema. She is being managed medically with dehydrating eye drops. Case 2 involves a 19-year-old male with a red, irritated right eye for two days. He wears monthly contact lenses and felt dryness previously. Examination reveals a paracentral corneal ulcer that is being treated with antibiotics and NSAIDs. Follow up shows the ulcer remains the same size but discomfort decreased.
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Case presentation - Corneal ulcers and dystrophies
- 1. CLINICAL CASE ANALYSIS CASE PRESENTATION BOV 425 FACILITATOR : DR. SHEILAH NANGENA
- 2. GROUP 4 JOHN OPONDO – HOV/B/01-02916/2016 FAITH KIRAARA – HOV/B/01-03352/2017 BRIAN ODHIAMBO - HOV/B/01-03381/2017 CELIA OKELLO - HOV/B/01-03361/2017 MARION KEMBOI - HOV/B/01-03371/201
- 3. CASE 1
- 4. PATIENT INFORMATION • NAME : JANE DOE • AGE: 66 • GENDER: FEMALE • RACE:WHITE • ADDRESS: NY • OCCUPATION: RETIREDTEACHER
- 5. CHIEF COMPLAIN • Decreased vision in the right eye for the past 6 months • Overall blurry vision worse upon waking up • Difficulty seeing in low light
- 6. HISTORY • Diagnosed with right eye pseudo phakic bullous keratopathy due to microcystic epithelial edema • Positive history of cataract in both eyes • She underwent IOL implantation in both eyes • No relevant family history • No known allergy
- 7. VISUAL ACUITY & REFRACTION • VISUALACUITY DISTANCE UNAIDED ACUITY PINHOLE OD 6/60 6/60 OS 6/12 6/12
- 8. OCULAR EXAMINATION • Slit lamp examination of the left eye ,revealed presence of cornea guttata • There was also beaten metal appearance on the cornea • Corneal stroma had normal transparency • Lids, adnexa and conjunctiva were normal • AC normal in depth
- 9. DIAGNOSIS • Stage 1 Fuchs Endothelial Dystrophy
- 10. DIFFERENTIAL DIAGNOSIS • Aphakic bullous keratopathy • Interstitial keratitis • Pseudo phakic bullous keratopathy • Posterior polymorphous dystrophy • Congenital hereditary endothelial dystrophy • Postoperative corneal edema • Recurrent corneal erosion • Traumatic corneal decompensation
- 11. INVESTIGATIONS • Specular endothelial microscopy
- 12. MANAGEMENT & FOLLOW-UP Medical management • Dehydrating drops : NaCl / hypertonic saline • Warm air evaporation • Lowering IOP
- 13. • FED is a bilateral, slowly progressive degeneration of the cornea • Women > Men • Formation of guttate lesions between endothelium and Descemet membrane • Guttata- dew drop/ small excrescences noted in the Descemet’s Membrane • As the lesions enlarge , they covering endothelial cells stretch and eventually fall off • Cornea begins to swell causing glare, halo and reduced visual acuity DISCUSSION
- 15. CASE 2
- 16. PATIENT INFORMATION • NAME : JOHN DOE • AGE: 19 • GENDER: MALE • RACE:WHITE • ADDRESS:VANCOUVER • OCCUPATION: STUDENT
- 17. CHIEF COMPLAIN • Red ,irritated right eye for the past two days
- 18. HISTORY • Wears soft contact lenses on a monthly basis • Felt some dryness in the past week and kept removing the lenses • No history of trauma • No known allergies • Hobbies include reading
- 19. VISUAL ACUITY & REFRACTION VISUALACUITY FINAL SUBJECTIVE PRESCRIPTION DISTANCE UNAIDED ACUITY PINHOLE OD 6/36 6/36 OS 6/60 6/60 FINAL RX SPHERE CYLINDER AXIS OD +1.25 +1.00 180 OS +1.00 +1.00 180
- 20. OCULAR EXAMINATION • SL examination revealed a paracentral raised ulcer on the cornea • Approx. 0.8mm in size and surrounding ring of sub epithelial infiltrates • Ulcer was considered elevated • There was 1n to 2+ injection OD
- 21. DIAGNOSIS • Infectious corneal ulcer
- 22. DIFFERENTIAL DIAGNOSIS • Bacterial keratitis • Episcleritis • Fungal keratitis • Herpes SimplexVirus Keratitis • Corneal graft rejection
- 23. INVESTIGATIONS Diagnostic testing • Corneal scraping to obtain fungal culture • Used to rule out possibility of a fungal ulcer
- 24. MANAGEMENT & FOLLOW-UP • DiscontinueCL use • Antibiotics ( Zymar ophthalmic solution) : initial dose instilled every 15 min for the first hour and q2h thereafter • NSAID ( NSAIDAcular LS) q.i.d to ease the discomfort • Patient instructed to return the next day Follow –up • Ulcer remained approx. the same size • Patient reported less discomfort • Continue therapy and instructed to call clinic if discomfort increases
- 25. REFERENCES • SHERERJW.TRAUMATIC CORNEALULCER; REPORTOF A CASE.JAMA. 1898;XXX(21):1215–1216. doi:10.1001/jama.1898.72440730021002d • Nicula,C., & Szabo, I. (2016). Complicated corneal ulcer. Case report. Romanian journal of ophthalmology, 60 4, 260-263 . • Fuchs E. Dystrophia epithelialis corneae. Grafes Arch Clin Exp Ophthalmol. 1910; 76: 478–508. • Elhalis H, Azizi B,Jurkunas UV. Fuchs endothelial corneal dystrophy. Ocular Surf. 2010;8: 173–184.