Vision Science and Eye Health Journal

The Challenge in Diagnosis and Management of Secondary Conjunctival Cysts

2024-04-23T17:29:21+07:00

Introduction: Conjunctival cysts can be categorized as primary or secondary. This report emphasizes difficulties in diagnosing secondary conjunctival cysts and distinguishing them from other conjunctival lesions like conjunctival benign reactive lymphoid hyperplasia (BRLH). Case Presentation: A 43-year-old male had a painless progressive conjunctival mass for four months. He took anti-aging and muscle-enhancing injections for a year and changed the product brand four months ago. Our examination revealed a conjunctival translucent mass with distinct margins and surface-feeding vessels without visual disturbance. We provisionally diagnosed it as a conjunctival cyst with a differential diagnosis of BRLH. We treated the patient with oral methylprednisolone and dexamethasone eye drops and discontinuation of anti-aging injections. The mass completely disappeared after one month of treatment. Conclusions: This case presented a diagnostic challenge due to the presence of a feeding vessel, which indicated inflammation. This made differentiating from inflamed conjunctival masses, such as BRLH, difficult. The patient had a history of suspected inflammation from changing the brand of injectable drug. Initially, we used steroids to reduce inflammation and prevent mass growth, but surprisingly, the lesion completely disappeared. If it recurs, a biopsy may be needed to identify the exact cause, as we have not ruled out BRLH. Secondary conjunctival cysts can result from toxins, trauma, or allergies. A thorough history taking, eye examination, and biopsy may be necessary to rule out other causes of inflamed conjunctival masses.

Bandage Contact Lens Associated Infection after Amnion Membrane Transplantation in Peripheral Ulcerative Keratitis Case with Spondyloarthritis

2024-06-25T20:32:49+07:00

Introduction: Bacterial keratitis causes around 90% of all cases of microbial keratitis. The global rise in contact lens usage has contributed to an increased risk of microbial keratitis. Peripheral ulcerative keratitis (PUK) is essential to diagnose as it can be the first presenting feature of a sight-threatening and associated with rheumatic autoimmune disease. Case Presentation: The case presents a 35-year-old woman with redness, discharge, and tenderness in her right eye (RE) since the day before, along with light sensitivity and tearing. Three months prior, she underwent multilayer amniotic membrane transplantation (AMT) surgery for corneal thinning due to peripheral ulcerative keratitis (PUK) and wore a contact lens postoperatively as a bandage. She had a history of conjunctival resection related to the PUK a year ago. She received oral cyclosporin and methylprednisolone for spondyloarthritis. Initially, her visual acuity of the RE was limited to hand movement. Diagnosis included RE keratoconjunctivitis related to contact lens and PUK post-AMT surgery; treatment comprised intravenous and topical antibiotics, artificial tears, cycloplegics, analgesics, and oral ascorbic acid. After four days of treatment, clinical signs were improved, with visual acuity progressing from hand movement to counting fingers at one meter. Conclusions: Careful management is essential for PUK patients after AMT surgery, especially those using contact lenses as bandages due to the potential risk of infection. Early PUK identification is crucial, as it may indicate sight-threatening issues and underlying systemic diseases. Meticulous examination and multidisciplinary management are required to ensure patient safety.

Management Reconstruction of Eyelid Kissing Nevus

2024-05-23T13:33:51+07:00

Introduction: An unusual type of congenital nevus known as "kissing nevus" develops on one eye's upper and lower lid and becomes enormous while the eyelids are closed. Reconstruction is complex since it creates both aesthetic and functional issues. Case Presentation: A 23-year-old female patient attended our ophthalmology outpatient clinic stating that she had a painless, non-progressing black nevus covering her left upper and lower eyelid since birth. The dark brown-black, 55 mm in size, with hypertrichosis that extended to the cheek and covered about two-thirds of the left upper and lower eyelid edges. A free supraclavicular skin transplant restored the complete nevus shortly after removal. We performed canthoplasty, lateral canthopexy, and full-thickness graft procedures. Three weeks following the procedures, the result was satisfactorily proved. Through histopathological examination, intradermal nevus pigmentosus was identified. Conclusions: A secure, trustworthy, and aesthetically pleasing option for head and neck deformities reconstruction involves a free supraclavicular graft.

Various Corneal Foreign Body Materials

2024-06-18T23:38:47+07:00

Introduction: Cornea is an important refractive part of the eye. The corneal foreign body can disturb corneal function, depending on its material. Any materials are inert and can be retained with serial observation, while others can cause an inflammatory reaction. Purpose: To determine the effects of various foreign body materials on the cornea. Review: Corneal foreign body materials are divided into non-organic and organic materials. Organic foreign bodies (plant and insect parts) often cause severe inflammation; meanwhile, the effects of non-organic foreign bodies (metal, glass, graphite) depend on their materials. Some metals, such as iron and copper, can develop a stained deposition, disturb corneal clarity, and lead to inflammation. Other metals such as gold, silver, and platinum are almost inert and cause little or no reaction. Glass, sand, or stone is relatively inert if it is sterile. Intrastromal graphite is also inert, however, organic materials are associated with infection. Wood can lead to bacterial or fungal infection. Insect parts such as caterpillar hair can cause ophthalmia nodosa, and insect stings elicit an inflammatory response. Conclusions: Any non-organic corneal foreign bodies (gold, silver, platinum, glass, sand, stone, and graphite) may be retained safely if the removal of the foreign body results in significant scarring, which can distort the topography of the cornea. Iron, copper, and organic materials (wood and insect parts) must be removed due to their toxicity or risk of infection.