A Chilling Presentation

A Chilling Presentation

Corneal research presented at ARVO has always been a fruitful area of innovation, and this year was no exception––with numerous studies aimed to improve our understanding of graft surgery outcomes, dry eye management and successful lens wear strategies. Other states have all followed suit, but with these privileges often come challenges. The most commonly prescribed ketone-based steroids are prednisolone and dexamethasone. Because the double vision was only intermittent, the patient wasn’t overly concerned––he simply wanted to express the complaint. Please check your state licensing board to see if this approval counts toward your CE requirement for relicensure. Its effectiveness is seriously compromised if you have to wait days to do that. The neurologist also ordered magnetic resonance imaging (MRI), which revealed an old lacunar infarct in the right corona radiata, but the etiology of the neurological deficits was not apparent.

Talk to the Pharmacist There is no better way to become better informed about prescription drugs and their price points than talking to the experts themselves, the pharmacists. Slit-lamp exam showed bilateral sectoral nodular scleritis. Often, these patients can barely open the afflicted eye during an examination. Discussion Based on the clinical findings, we suspected that our patient had acute retinal necrosis (ARN). The iris and lens were unremarkable. There were 2+ cells in the vitreous. The anterior segment of the left eye was completely unremarkable.

Intraocular pressure measured 11mm Hg OU. Most eye care experts recommend that you have a comprehensive eye exam every one to two years, depending on your age, risk factors and whether you currently wear corrective lenses. We also obtained a spectral-domain optical coherence tomography (SD-OCT) scan of the patient’s right eye (figure 2). At the subsequent review IOP was RE 9 and LE 22mmHg and the anti-inflammatory drops were tapered over the next few weeks. Additionally, there was a full-thickness retinitis located adjacent to the optic nerve, which extended nasally along the superior and inferior arcades. Under normal conditions, it is clear, structurally stable, resilient and resistant of infection and penetration. Slit lamp examination at this visit revealed a 4mm x 1.5mm central epithelial defect just below the visual axis.
A Chilling Presentation

Known for its “cutting edge” posture in the contact lens field, L.A. The CMV retinitis was responsible for the vitreous cells and the spillover into the anterior chamber, which gave us the somewhat hazy view into the retina. In the literature, most cases of FBA have presented bilaterally and were more common in females.1,2 Although our patient is female, the condition presented unilaterally. This is not much of a surprise, however, considering that the CMV was present only in that eye. For each eye, the tear meniscus height, area and length of anterior excursion at the center of the lower eyelid were measured using spectral-domain OCT. If a patient has a very aggressive uveitis, for instance, he prescribes a brand-name steroid and not a generic. Certainly the patient was considerably inconvenienced, but ultimately, no enduring harm was done.

Further, if the patient is elderly and has a fourth nerve palsy of truly recent origin, an ischemic vascular evaluation should be undertaken to search for diabetes and hypertension. Treating the pregnant patient always requires an increased level of caution. and would the results stand up to our quality-standards in article space? There was significant improvement of facial paresis on the right side with better lid position and lid closure on blinking. I pulled out my iPhone, opened the GoodRx app, typed in Valtrex and our zip code. Left anterior segment showed moderate conjunctival/scleral erythema, a 2+ anterior chamber cell and a very shallow anterior chamber with a patent peripheral iridotomy. Eye (Lond).

2004 May;18(5):527-33. 2. Silva RA, Albini TA, Flynn HW. Retinal Physician. It still happens today: bilateral frosted branch angiitis in cytomegalovirus retinitis. Finally, prepare and bring a list of questions or concerns that you would like to discuss with the doctor. Accessed August 15, 2013.

Nagaraki S, Mishima, S. Jabs DA, Van Natta ML, Kempen JH, et al. Contact lens-related CLSD is a serious and potentially sight threatening condition. He continues to use the lens daily, removing the lens at bedtime and inserting the lens upon waking. 2002 Jan;133(1):48-61.

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