A presentation by ophthalmologist Dr Con Petsoglou at an optometrist CPD event on Cornea, Chalazion & Cross Linking

1. Cornea, Chalazia &
Cross-Linking
DR C PETSOGLOU
Tues 21st Oct 2014 UPDATE 1

2. Cross-Linking
AIM: Prevent progressive corneal ectasia
WHO: Keratoconus, kerectasia, pellucid
marginal degeneration
WHEN: Documented change in cornea
◦ Increase in keratometry readings
◦ Change in refraction
◦ NOT in every keratoconus or newly diagnosed
patient yet!
ADVISE:
◦ Very painful for 24hrs!!!!
◦ 90% halt progression
◦ Up to 50% may show some improvement in BCVA,
Tues 21st Oct 2014 UPDATE 2

3. Tues 21st Oct 2014 UPDATE 3
Preop: UCVA 6/18 BCVA 6/9
Postop: UCVA 6/9 BCVA 6/6

4. Audit Results
Of 15 Eyes at least 6 months follow up:
◦ 3 Improved > 1D (1.6, 2.7, 3.5)
◦ 4 Improved by 1D
◦ 4 stayed the same +/- 0.5D
◦ 3 Worsened (1.5, 1.8, 3.0)
◦ 80% Improved or stable
◦ 20% Progressed
Tues 21st Oct 2014 UPDATE 4
0
10
20
30
40
50
60
AVERAGEKERATOMETRY
Audit 15 Patients
Preop Post-Op

5. Chalazia
Tues 21st Oct 2014 UPDATE 5
Meibomian gland cyst / Infected = Hordoleum
57% pts >19yo for excision have Rosacea
◦ Lempert SL Arch Ophthal 1979; 97: 1652-3
Low Serum Vitamin A in Children (China study)
◦ Chen L et al Am J Ophthal 2014; 157(5):1103-8
MANAGEMENT:
◦ Heat and Massage
◦ Oral Antibiotics if infected: Doxycycline 50mg bd or
Dicloxicillin 500mg qid
◦ Topical Antibiotic No benefit
◦ One RCT: H+M, Incision, Triamcinolone injection
◦ 3 weeks: H+M 46%, Incision 87%, Triamcinolone 84%
◦ Clinical and Experimental Ophthalmology, 2007;35(8):706- 12

6. Chalazia
Demodex brevis story
High prevalence of demodex brevis infestation in chalazia.
Liang L. et al Am J Ophthal. 157(2):342-348.e1, 2014 Feb
Skin Mite- Increasing prevalence with age
Classic teaching – NOT Pathogenic
DIAGNOSE: Eyelash epilation and view under microscope
TREATMENT:
◦ 5 drops tea tree oil shampoo in ½ cup boiled water
◦ 1:4 tea tree oil with olive oil as scrub
BUT: Some doubts still remain!
Tues 21st Oct 2014 UPDATE 6

7. Cornea
Lions NSW Eye Bank Waitlist for Corneal Transplants
Wait time <3 Months
WHY?
1. Organ Culture
2. Scheduled Surgery
3. 5 Coordinators
4. Hospice Planning
Tues 21st Oct 2014 UPDATE 7
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