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If, after this two-step therapeutic intervention, the patient is still not below symptomatic threshold, a consult with a cornea and external disease surgical subspecialist for a conjunctival resection of these afflicted tissues is in order. Superior limbic keratoconjunctivitis is a commonly missed and/or misdiagnosed condition. Being thorough in your diagnostic pursuit will easily reveal the cause for the patient’s visit. While rare, SLK is yet another opportunity to care for our patients. • Baby shampoo for treatment of blepharitis has gone the way of the horse and buggy. There are numerous commercially prepared “eyelid cleansers” readily available over-the-counter, and we exclusively recommend these when eyelid scrubs are indicated in the care of patients with symptomatic blepharitis. • Monocular “diplopia” can result from a couple of subtle corneal conditions: unilateral Thygeson’s SPK and epithelial basement membrane dystrophy. Instillation of fluorescein dye can help uncover these two subtle presentations. There is always an explanation for monocular diplopia; our duty is to find the correct cause and treat it appropriately. • Ethambutol is commonly used to treat tuberculosis, but it can lead to toxic optic neuropathy. Color vision is commonly compromised in this situation, so, if possible, be sure to perform a color vision test to establish a baseline prior to starting therapy for tuberculosis. The general toxic threshold is 30mg/kg per day, so the greater the dose, the higher the risk of neuronal toxicity. Beyond color vision testing, certainly establish best visual acuity and baseline 10-2, as well. Depending upon dosage, follow these patients quarterly and repeat testing as deemed necessary.1 • A recent review in a cardiology journal notes that diagnoses of COPD were incorrect in about 62% of cases. The authors caution, “Physicians need to do a better job of identifying patients with COPD and not overdiagnosing it. Performing spirometry before and after administration of a bronchodilator is essential before making a diagnosis.”2 Our take: This seems to be somewhat parallel to the challenges that eye doctors face with regard to glaucoma. Obviously, it is essential to MIND YOUR MEDICINES An OD recently encountered a woman in her late 20s whose chief complaint was near blur. She did not have hyperopia nor did she have latent hyperopia on cycloplegic refraction. Her exam was normal except for “presbyopia.” With a +2.50, she saw a crisp 20/20. Reviewing her medical record, it was seen that she was taking Qbrexa for her axillary sweating which has a significant anticholinergic effect, thus causing her symptom.
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