- Email: [email protected]
Poster 45
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Optometry, Vol 78, No 6, June 2007
begin amblyopia treatment. Sunglasses were also recommended for the photophobia caused by the coloboma. Conclusions: Due to the enormous phenotypic variability of CES, it is important for optometrists to inquire about other systemic symptoms. This is especially true as most cases do not include an iris coloboma, but may include such findings as retinal coloboma, epicanthal folds, strabismus, microphthalmia, Duane’s, corneal clouding, and cataract. Bilateral iris colobomas are more common than unilateral as seen in this case. Refractive amblyopia is rarely mentioned in literature but can be linked to retinal and uveal colobomas. It seems plausible that the structural changes could induce significant hyperopia and that this should be addressed.
optic neuropathy as in this case report. Because the eye doctor is often the first to detect this life-threatening condition, it is important to recognize the signs and refer promptly.
Poster 44
Background: Punctal plugs play an important role in the treatment and management of dry eyes. Pyogenic granuloma is a rare complication of punctal plugs but will likely present more frequently as punctual plug therapy becomes more prevalent. Recent studies have shown that pyogenic granulomas present in 4.2% of patients approximately 3 months after punctual plug insertion. Pyogenic granuloma needs to be differentiated from other conditions including squamous cell carcinoma. Case Summary: A 64-year-old male presented with a long history of dry eye symptoms OU. The patient reported using various ocular surface lubricants with minimal temporary relief of symptoms. His medical history was positive for hypertension and hyperlipidemia. Examination revealed BCVA 20/20 OU and normal posterior segment findings. Slit lamp examination revealed superficial punctate keratopathy, and diagnostic testing confirmed aqueous-deficient dry eyes OU. Punctal occlusion of the lower right and lower left punctal was performed using the Sharpoint UltraPlug. Three months after plug insertion, the patient presented with mild discharge and foreign body sensation upon blink O.S. Examination revealed a pedunculated, fleshy, vascularized mass protruding from the nasal punctum, which was more evident after the plug was removed. The patient was conservatively treated with topical therapy and subsequently showed clinical improvement and resolution of the lesion. Since the lesion resolved with topical therapy, a biopsy was not required. Conclusion: Although pyogenic granuloma is a rare complication of punctual plugs, it is necessary to inform patients of all possible complications. It is also important to schedule regular follow-up visits due to the long delay between insertion of the plug and granuloma development. This report discusses the different factors related to pyogenic granuloma formation and the histopathology that confirms the diagnosis of pyogenic granuloma. A discussion of different treatment options and prognosis will also be included.
Ocular Emergency Results in Optic Neuropathy Thao M. Vu, O.D., and Anney B. Kunthara, O.D., Lake City VA, 619 South Marion Avenue, Lake City, Florida 32025 Background: Malignant hypertension, occurring in less than 1% of patients with hypertension, is a potential blinding and life-threatening condition. Classic ocular manifestions include optic disc edema, exudates, hemorrhages, and cotton wool spots. Permanent visual loss is seen in severe cases from optic neuropathy. This case report discusses the diagnosis, management, and treatment of bilateral disc edema with optic neuropathy secondary to malignant hypertension. Case Report: A 51-year-old white male reported to the eye clinic with complaints of foggy vision in the lower left field for 2 to 3 weeks. Past medical history included a cerebrovascular accident and systemic hypertension. He stopped taking anti-hypertensive medication 1 year prior. Entering uncorrected visual acuities were 20/40 O.D. and 20/50 O.S., pinholed to 20/25 O.D. and O.S. Confrontation fields were restricted in all gazes; red-cap revealed equal desaturation in both eyes, and color vision was reduced in both eyes. A positive afferent pupillary defect was noted in the left eye. Fundus examination revealed bilateral disc edema, cottonwool spots, exudates, and hemorrhages surrounding the optic nerve head in the left eye (greater than the right eye). His blood pressure was measured at 204/122 mmHg. The patient was diagnosed with malignant hypertension and immediately referred to the emergency room. He was treated and discharged with anti-hypertensive medications. At the 4-week follow-up examination, the disc edema was dramatically reduced with resolution of sequelae in both eyes. Optic nerve pallor was also noted in the left eye. His HVF showed a dense inferior altitudinal defect in the left eye. Lab results indicated elevated creatinine levels, and his CT scan was normal. The patient was diagnosed with optic neuropathy and is currently under the care of eye and primary care physicians. Conclusion: Malignant hypertension can cause serious irreversible damage to multiple organs, including the eyes. In rare instances, it can lead to permanent vision loss from
Poster 45 Pyogenic Granuloma: A Rare Complication of Silicone Punctal Plugs Stacey Tawnie Gin, O.D., Connie C. Liu, O.D., Dawn Pewitt, O.D., James K. Yi, O.D., and Benjamin Gilsdorf, O.D., VA San Diego Healthcare System, Southern California College of Optometry, 3550 La Jolla Village Drive, San Diego, California 92161
Optometry, Vol 78, No 6, June 2007
begin amblyopia treatment. Sunglasses were also recommended for the photophobia caused by the coloboma. Conclusions: Due to the enormous phenotypic variability of CES, it is important for optometrists to inquire about other systemic symptoms. This is especially true as most cases do not include an iris coloboma, but may include such findings as retinal coloboma, epicanthal folds, strabismus, microphthalmia, Duane’s, corneal clouding, and cataract. Bilateral iris colobomas are more common than unilateral as seen in this case. Refractive amblyopia is rarely mentioned in literature but can be linked to retinal and uveal colobomas. It seems plausible that the structural changes could induce significant hyperopia and that this should be addressed.
optic neuropathy as in this case report. Because the eye doctor is often the first to detect this life-threatening condition, it is important to recognize the signs and refer promptly.
Poster 44
Background: Punctal plugs play an important role in the treatment and management of dry eyes. Pyogenic granuloma is a rare complication of punctal plugs but will likely present more frequently as punctual plug therapy becomes more prevalent. Recent studies have shown that pyogenic granulomas present in 4.2% of patients approximately 3 months after punctual plug insertion. Pyogenic granuloma needs to be differentiated from other conditions including squamous cell carcinoma. Case Summary: A 64-year-old male presented with a long history of dry eye symptoms OU. The patient reported using various ocular surface lubricants with minimal temporary relief of symptoms. His medical history was positive for hypertension and hyperlipidemia. Examination revealed BCVA 20/20 OU and normal posterior segment findings. Slit lamp examination revealed superficial punctate keratopathy, and diagnostic testing confirmed aqueous-deficient dry eyes OU. Punctal occlusion of the lower right and lower left punctal was performed using the Sharpoint UltraPlug. Three months after plug insertion, the patient presented with mild discharge and foreign body sensation upon blink O.S. Examination revealed a pedunculated, fleshy, vascularized mass protruding from the nasal punctum, which was more evident after the plug was removed. The patient was conservatively treated with topical therapy and subsequently showed clinical improvement and resolution of the lesion. Since the lesion resolved with topical therapy, a biopsy was not required. Conclusion: Although pyogenic granuloma is a rare complication of punctual plugs, it is necessary to inform patients of all possible complications. It is also important to schedule regular follow-up visits due to the long delay between insertion of the plug and granuloma development. This report discusses the different factors related to pyogenic granuloma formation and the histopathology that confirms the diagnosis of pyogenic granuloma. A discussion of different treatment options and prognosis will also be included.
Ocular Emergency Results in Optic Neuropathy Thao M. Vu, O.D., and Anney B. Kunthara, O.D., Lake City VA, 619 South Marion Avenue, Lake City, Florida 32025 Background: Malignant hypertension, occurring in less than 1% of patients with hypertension, is a potential blinding and life-threatening condition. Classic ocular manifestions include optic disc edema, exudates, hemorrhages, and cotton wool spots. Permanent visual loss is seen in severe cases from optic neuropathy. This case report discusses the diagnosis, management, and treatment of bilateral disc edema with optic neuropathy secondary to malignant hypertension. Case Report: A 51-year-old white male reported to the eye clinic with complaints of foggy vision in the lower left field for 2 to 3 weeks. Past medical history included a cerebrovascular accident and systemic hypertension. He stopped taking anti-hypertensive medication 1 year prior. Entering uncorrected visual acuities were 20/40 O.D. and 20/50 O.S., pinholed to 20/25 O.D. and O.S. Confrontation fields were restricted in all gazes; red-cap revealed equal desaturation in both eyes, and color vision was reduced in both eyes. A positive afferent pupillary defect was noted in the left eye. Fundus examination revealed bilateral disc edema, cottonwool spots, exudates, and hemorrhages surrounding the optic nerve head in the left eye (greater than the right eye). His blood pressure was measured at 204/122 mmHg. The patient was diagnosed with malignant hypertension and immediately referred to the emergency room. He was treated and discharged with anti-hypertensive medications. At the 4-week follow-up examination, the disc edema was dramatically reduced with resolution of sequelae in both eyes. Optic nerve pallor was also noted in the left eye. His HVF showed a dense inferior altitudinal defect in the left eye. Lab results indicated elevated creatinine levels, and his CT scan was normal. The patient was diagnosed with optic neuropathy and is currently under the care of eye and primary care physicians. Conclusion: Malignant hypertension can cause serious irreversible damage to multiple organs, including the eyes. In rare instances, it can lead to permanent vision loss from
Poster 45 Pyogenic Granuloma: A Rare Complication of Silicone Punctal Plugs Stacey Tawnie Gin, O.D., Connie C. Liu, O.D., Dawn Pewitt, O.D., James K. Yi, O.D., and Benjamin Gilsdorf, O.D., VA San Diego Healthcare System, Southern California College of Optometry, 3550 La Jolla Village Drive, San Diego, California 92161