The clinical entity known as contact lens-induced acute red eye, or CLARE, is an inflammatory reaction of the cornea and conjunctiva associated with overnight contact lens wear. That’s why it’s so important to perfect your record taking. Wittig-Silva published interim results of a randomized, bilateral study in 33 eyes at 6 months, which showed an average reduction in corneal power of 0.9 diopters (D) in treated eyes and an increase of 0.6D in untreated eyes.63 To date the completed study remains unpublished. As a group, though, NSAIDs are excellent analgesics and are even more effective than intramuscular morphine for acute pain.5 The historical development of NSAIDs is closely related to the historical development of aspirin.2 In fact, topical NSAIDs are often referred to as “aspirin for the eye.” The drugs are very useful in the management of ocular pain following cataract surgery and corneal procedures. Clinically, cases of VKC are classified as either limbal, palpebral or mixed. The use of these agents shall be limited to five days, with a referral to an ophthalmologist if the pain persists. Also, it is imperative to have a good understanding of the patient’s visual goals and expectations.
Audit data was collected from 50 randomised sessions over a six-month period (March-August, 2012) and all patient information was gathered from electronic patient records (Medisoft). Corticosteroids When incorporating steroids into your treatment plan, there are three potential concerns: IOP elevation (which could lead to glaucoma), secondary infections due to the immunosuppressive nature of corticosteroids and the formation of posterior subcapsular cataracts. Blaiss is a speaker for Allergan, Bausch + Lomb and Merck; and a consultant for Allergan, Bausch + Lomb and Merck. A combination of factors—such as the lacrimal fluid flow, the blink reflex, the mucin associated apical surface of epi thelial cells and the antimicrobial proteins found in the tear film—all contribute to a rate of bacterial keratitis that is extraordinarily low when one considers the abundance of micro-organisms on the ocular surface. State-mandated local program: no. • Diana Shechtman, O.D., and Robert Wooldridge, O.D., teamed up to deliver a fast-paced, interactive presentation, “X Marks the Spot of Macular Disease and Glaucoma,” which reviewed a host of differential diagnoses for various retinal disease states and glaucomatous presentations. • Bacterial infections – Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infections.
First, the concept of frequent replacement and disposable soft lenses has greatly reduced the incidence of complications associated with lens spoilage and contamination.30,31 Second, there is a belief that effective bacterial disinfection by a given contact lens storage solution removes a significant potential ‘food’ for Acanthamoeba and, therefore, provides indirect protection.32 Third, while the contact lens case biofilm can provide Acanthamoeba with significant bacterial protection against disinfection,15 frequent replacement of the contact lens case is now more common in clinical practice and there has been the development of contact lens cases incorporating antimicrobial agents.33 Finally, it has been shown that Acanthamoeba can be removed from the surface of a contact lens by the use of a surfactant cleaner,2 with an alcohol-based cleaner being especially effective in this regard.27 This provides a strong argument against the ‘no-rub’ recommendation with most current multipurpose soft lens disinfecting solutions and may also help to explain why AK is far less common with rigid gas permeable lenses, where traditional two-step cleaning and disinfection systems are still popular. This lecture will review pediatric cases that may or may not lead to a diagnosis of amblyopia, how one should arrive at the appropriate diagnosis, and appropriate management strategies for these cases. With few case reports published, and no large scale research studies performed, this case discusses the importance of early diagnosis of herpetic ocular disease in a child. Corneal phlyctenules typically originate near the limbus but may migrate more centrally (Figure 1). When the level of suspicion is commensurate with risk factors, implementing and understanding dry eye diagnostics can point to the cause and true diagnosis. (C) Ocular inflammation, nonsurgical in cause except when comanaged with the treating physician and surgeon, limited to inflammation resulting from traumatic iritis, peripheral corneal inflammatory keratitis, episcleritis, and unilateral nonrecurrent nongranulomatous idiopathic iritis in patients over 18 years of age. (2) For purposes of this section, “treat” means the use of therapeutic pharmaceutical agents, as described in subdivision (c), and the procedures described in subdivision (e).
An optometrist shall consult with an ophthalmologist or appropriate physician and surgeon if a patient has a recurrent case of episcleritis within one year of the initial occurrence. Typically, there is minimal to no epithelial disruption with CLARE; however, if there is corneal staining present in association with an infiltrate, the diagnosis no longer clear-cut and the lesion becomes suspicious for MK. What if the pink eye isn’t the result of the common bacteria or virus? Current treatment protocols utilize UVA energies of 3mW/cm2 and require 30min of UVA exposure to achieve the desired clinical effect.25,43–64 It has been theorized that by increasing the UVA fluence while simultaneously reducing the exposure time (the Bunsen–Roscoe law of reciprocity), the same sub-threshold cytotoxic corneal endothelial UVA dosage can be administered, thereby maintaining efficacy and safety, but with a reduced treatment time. Bowling is center director at Vision America, a surgical comanagement center in Gadsden, Ala. Also known as contact lens-induced papillary conjunctivitis (CLPC), this condition results from an immunological response in combination with mechanical trauma. (7) Any optometrist who graduated from an accredited school of optometry on or after January 1, 1992, and before January 1, 1996, shall not be required to fulfill the requirements contained in paragraphs (1), (4), and (5).
In conjunction with these surgical advances, we now have enhanced corneal tomography devices that enable us to more accurately predict postoperative outcomes in patients who are good candidates. Adhering to the PEARS guidelines would enable 72% of all new patients to have their first appointment with the community optometrist on a minor eye conditions pathway. • Don’t mix steroids and contact lenses. Not only do they have obvious symptoms such as trouble sleeping or breathing, and the obvious implications of contact lens wear, but there’s also a huge issue of red eyes and how that impacts their lives. Sterile hypopyon often accompanies the keratitis. In using steroid medication for: (A) Unilateral nonrecurrent nongranulomatous idiopathic iritis or episcleritis, an optometrist shall consult with an ophthalmologist or appropriate physician and surgeon if the patient’s condition worsens 72 hours after the diagnosis, or if the patient’s condition has not resolved three weeks after diagnosis. If the patient is still receiving medication for these conditions six weeks after diagnosis, the optometrist shall refer the patient to an ophthalmologist or appropriate physician and surgeon.
(B) Peripheral corneal inflammatory keratitis, excluding Moorens and Terriens diseases, an optometrist shall consult with an ophthalmologist or appropriate physician and surgeon if the patient’s condition worsens 72 hours after diagnosis. (C) Traumatic iritis, an optometrist shall consult with an ophthalmologist or appropriate physician and surgeon if the patient’s condition worsens 72 hours after diagnosis and shall refer the patient to an ophthalmologist or appropriate physician and surgeon if the patient’s condition has not resolved one week after diagnosis. (5) Topical antibiotic agents. (6) Topical hyperosmotics. Differential Diagnoses Phylectenules resulting from staphylococcal infections are due to a hypersensitivity response. Computer vision syndrome: A review. (B) If the glaucoma patient also has diabetes, the optometrist shall consult with the physician treating the patient’s diabetes in developing the glaucoma treatment plan and shall inform the physician in writing of any changes in the patient’s glaucoma medication.
(A) If the patient has been diagnosed with herpes simplex keratitis or varicella zoster viral keratitis and the patient’s condition has not improved seven days after diagnosis, the optometrist shall refer the patient to an ophthalmologist. (9) Oral antihistamines. Dumbleton K, Jones L. The formal terminology for this is the HPI. These cases have been typically associated with a possible with atopic eye disease.126 A single case of corneal melting associated with activation of herpes simplex keratitis has also been reported.127 It is prudent therefore to fully control atopic eye disease prior to cross-linking and to give prophylactic systemic Acyclovir in patients with previous Herpetic Eye disease. Effect of indomethacin in preventing surgically induced miosis. However, long-term use of topical steroids can have potential side effects such as elevated intraocular pressure, glaucoma and cataracts.
(A) If the patient has been diagnosed with herpes simplex keratitis or varicella zoster viral keratitis and the patient’s condition has not improved seven days after diagnosis, the optometrist shall refer the patient to an ophthalmologist. However, several technological advances have helped make refractive surgery possible for affected individuals. (B) If the patient has been diagnosed with herpes simplex viral conjunctivitis, herpes simplex viral dermatitis, varicella zoster viral conjunctivitis, or varicella zoster viral dermatitis, and if the patient’s condition worsens seven days after diagnosis, the optometrist shall consult with an ophthalmologist. 1. And a lot of times, it is not recognized unless I ask specific questions (e.g., “are your eyes itchy or watery?”). Once in the cornea, keratocytes seem to be the organism’s primary target.27 Again, as with bacterial keratitis, an intact epithelium presents a barrier to infection that may be overcome via microtrauma associated with contact lenses. Sec.
801 et seq.). The use of these agents shall be limited to three days, with a referral to an ophthalmologist if the pain persists. (d) In any case where this chapter requires that an optometrist consult with an ophthalmologist, the optometrist shall maintain a written record in the patient’s file of the information provided to the ophthalmologist, the ophthalmologist’s response, and any other relevant information. Upon the consulting ophthalmologist’s request and with the patient’s consent, the optometrist shall furnish a copy of the record to the ophthalmologist. (e) An optometrist who is certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may also perform all of the following: (1) Corneal scraping with cultures. As this condition isn’t inflammatory, steroids are of little therapeutic benefit. Balci O.
(4) Venipuncture for testing patients suspected of having diabetes. (11) Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter. (6) Treatment or removal of sebaceous cysts by expression. Sweeney D, Silicone Hydrogels: Continuous Wear Contact Lenses (pp. Regardless, it would be inappropriate to treat this patient with only topical agents and without further evaluation. (9) Ordering of smears, cultures, sensitivities, complete blood count, mycobacterial culture, acid fast stain, urinalysis, and X-rays necessary for the diagnosis of conditions or diseases of the eye or adnexa. 1992 Nov-Dec;8(6):466-74.
Vernal keratoconjunctivitis. (11) Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter. Thus, laser-assisted keratoplasty patients typically experience rapid healing, as well as visual recovery within six weeks of surgery.6 Additionally, patients usually develop very low levels of postoperative regular astigmatism. (13) Removal of foreign bodies from the cornea, eyelid, and conjunctiva with any appropriate instrument other than a scalpel or needle. Srinivasan M, Mascarenhas J, Rajaraman R et al. Mah: We do refractive surgery in my office, so for me, the bulk of the patients whom I identify are either known allergic conjunctivitis sufferers or those who are unknown and are refractive surgery-seeking patients. Regardless, viral infections are significant causes of vision loss, with herpes simplex infection (and its sequelae) constituting the numberone source of infectious vision loss in the United States.
Any optometrist who graduated from an accredited school of optometry on or after May 1, 2000, shall be exempt from the certification requirement contained in this paragraph. (f) The board shall grant a certificate to an optometrist certified pursuant to Section 3041.3 for the treatment of glaucoma, as described in subdivision (j), in patients over 18 years of age after the optometrist meets the following applicable requirements: (1) For licensees who graduated from an accredited school of optometry on or after May 1, 2008, submission of proof of graduation from that institution. (2) For licensees who were certified to treat glaucoma under this section prior to January 1, 2009, submission of proof of completion of that certification program. (3) For licensees who have substantially completed the certification requirements pursuant to this section in effect between January 1, 2001, and December 31, 2008, submission of proof of completion of those requirements on or before December 31, 2009. “Substantially completed” means both of the following: (A) Satisfactory completion of a didactic course of not less than 24 hours in the diagnosis, pharmacological, and other treatment and management of glaucoma. (B) Treatment of 50 glaucoma patients with a collaborating ophthalmologist for a period of two years for each patient that will conclude on or before December 31, 2009. Although these studies did not evaluate the commercially available cyclosporine 0.05% (Restasis, Allergan), you may consider it in recalcitrant cases or where topical steroids are contraindicated.
2014 May-Jun;59(3):263-85. (g) Other than for prescription ophthalmic devices described in subdivision (b) of Section 2541, any dispensing of a therapeutic pharmaceutical agent by an optometrist shall be without charge. (k) For purposes of this chapter, “adnexa” means ocular adnexa. “Surgery” means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or laser means. 9. Nothing in this section shall limit an optometrist’s authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice. (i) An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telemedicine.
Price MO, Price FW. 7. (k) For purposes of this chapter, “adnexa” means ocular adnexa.