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The ease of operation and precise results were a blessing to the team and to those who were served. We highly recommend this technology, not only for mission service, but also in optometric practices. 1 2 5 6 3 4 STRATEGIES FOR SUCCESS This perilous emergency ultimately had a positive outcome thanks Acute White Lesions in the Peripheral Cornea: Infectious or Inflammatory? Don’t let unfounded fears about steroids make it harder than it should be. REVIEW OF OPTOMETRY JUNE 15, 2020 19 Below are three more cases where patients were seen by other eye doctors and placed on antibiotics, were not improving, and presented to us for a second opinion. In all cases we prescribed a topical steroid, and here you can see the dramatic improvement in just two or three days. ANTERIOR SEGMENT CARE CASE 1 CASE 2 CASE 3 Note this white band of leukocytic (sterile) infiltrates. The overlying zone of secondary epithelial breakdown can be seen with the cobalt blue filter. MANAGING MICROCYSTIC CORNEAL EDEMA This condition is generally seen in two circumstances: with acute intraocular pressure rises, usually above 50mm Hg, and as a response to marked corneal inflammation such as with herpes zoster ophthalmicus. The former is treated with IOPlowering medicines of timolol and/or brimonidine (or in the combination Combigan). Note that prostaglandins are not nearly as fast-acting as are timolol and brimonidine. The latter condition is treated with a topical corticosteroid to suppress the epithelial tissue inflammation. This patient developed PosnerSchlossman syndrome, also known as glaucomatocyclitic crisis, and presented acutely with an IOP of 56mm Hg. This patient developed herpes zoster ophthalmicus, and delayed in seeking care. He manifested considerable corneal edema as a result of untreated corneal inflammation. These corneal microcysts negatively stain with fluorescein dye, just like pseudodendrites (which are more of a pronounced expression of epithelial toxicity). 20 REVIEW OF OPTOMETRY JUNE 15, 2020 Dry eye has got to be the most common condition we encounter in practice. Because there are so many patients, some clinicians overthink their approach. Here are some of our best tips, suitable for most patients. • Diagnosis is heavily symptomguided. • Only history, a slit lamp examination of the ocular surface with a vital dye, assessing the tear meniscus height and the tear film breakup time are needed for diagnosis. All other assessments are superfluous. Keep it simple—it is! • Since the vast majority of dry eye disease results from lipid deficiency, always try a standard bottle of a lipid-based artificial tear first. If there is a clinically significant amount of punctate epithelial erosions, then perhaps a preservativefree formulation could be used initially along with something like GenTeal Gel (Alcon) lubricant at bedtime.
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