- Contact lens wearer
- Symptoms are usually unilateral ocular pain out of proportion to exam, redness, decreased visual acuity, foreign body sensation, photophobia , and protracted progressive course with no therapeutic response to topical antimicrobial agents.
- Corneal manifestations
o elevated epithelial lines that may form dendritic lesions,
o epithelial erosions,
o decreased corneal sensation,
o a gray-white ring infiltrate,
o nummular infiltrates,
o radial keratoneuritis,
o satellite lesions,
o disciform edema,
o thinning,
o Other signs may include follicular conjunctivitis, tender preauricular node, iritis, and lid abnormalities (edema, pseudoptosis).
- Diagnostic modalities include culture, Giemsa Stain, corneal biopsy stained with Calcofluor White, confocal microscopy to detect organisms in vivo, and PCR (which is more sensitive than culture).
- Early initiation of treatment is most effective and typically requires long-term therapy. Reported treatment modalities include epithelial debridement, diamidine derivatives (brolene, pentamidine), imidazole derivatives (miconazole, clotrimazole, ketoconazole), aminoglycosides (neosporin, paromycin) and cationic antiseptics (PHMB, chlorhexidine diacetate).
- Controversial therapies include penetrating keratoplasty, steroids, and cryotherapy.
Unless there is a real need for steroid treatment, I'd advise people to avoid it. The side-effects can be worse than the problem for which the steroid is prescribed.
ReplyDelete