Atypical Christmas Eye Disease: A Case Report and Literature Review

Background: Christmas Eye Disease (CED), also known as the “Albury-Wodonga syndrome” or “Harvester's Keratitis”, is a seasonal acute corneal ulceration syndrome, which is geographically limited to Australia, specifically in the south-west region of New South Wales (NSW) and north-east region of Victoria. The mechanism of injury is unknown, but the secretions from native beetles of the genus Orthoperus have been implicated. There remains a dearth of literature on CED, particularly with atypical disease presentations. We present the first reported case of CED in the upper Blue Mountains Region, presenting atypically with mild pain and foreign body sensation. We also aim to explore the possible entomological precipitants of the disease. Case Presentation: A 77-year-old man with a 1-day history of a mildly painful red eye was found to have acute corneal ulceration. He experienced mild discomfort in his right eye while asleep and woke the following morning with persistent blur, foreign body sensation, and photophobia. He had no history of ocular trauma or chemical exposure. He reported going for daily bushwalks in the upper Blue Mountains region but did not recall any exposure to environmental or entomological precipitants. Clinical Findings and Outcomes: Slit-lamp examination revealed a substantial corneal epithelial loss in the right eye with fluorescein staining, revealing a characteristic ‘green splash’ over 90% of the cornea. Other clinical findings included marked corneal edema, moderate conjunctival injection, mild palpebral swelling, and mild papillae. No anterior uveitis was observed, and the posterior segment examination was normal. There was a considerable reduction in his right visual acuity from baseline. He was empirically treated with 1% tropicamide ocular drops, 1% chloramphenicol ointment, and lubricant ocular drops. The bacterial and viral conjunctival swabs were unremarkable. Clinical progression was self-limiting, and complete resolution of the ulcer was achieved after one month. Conclusion: CED is a clinical diagnosis, and medical practitioners should be aware of atypical features, such as the absence of debilitating pain. Additionally, our case demonstrates that the geographic distribution of CED appears to be far more extensive than previously thought, thereby raising the possibility of disease manifestation in regions not commonly associated with it. Entomological precipitants of this condition remain circumstantial and warrant further validation.

Complicated corneal ulceration in cats: diagnosis and treatment outcomes of 80 cases (2014-2018)

The study describes the most common clinical and endoscopic findings associated with complicated corneal ulcers in cats and evaluates the short-term outcomes after surgical interventions. Eighty client-owned cats of different breeds with corneal ulcers were included. Cats were clinically evaluated to initially determine corneal abnormalities. Endoscopic examination of the corneas was performed to determine anterior and posterior segments’ abnormalities. Non-healing superficial ulcer was treated by superficial keratectomy and deep stromal ulcers were treated using conjunctival flaps. Corneal sequestrum were treated by partial keratectomies and conjunctival flaps. Anterior synechiae were treated via peripheral iridectomy and separation of the adhesion between the iris and the inner cornea. Symblepharon were treated by removal of the adhered conjunctival membrane from the cornea. Unresponsive endophthalmitis was treated surgically by exenteration. Outcomes after surgical managements of selected corneal abnormalities were assessed clinically and endoscopically. Non-healing superficial ulcer, deep stromal ulcer with descemetocele, endophthalmitis, symblepharon, corneal sequestration and anterior synechiae with secondary glaucoma and corneal scarring were the recorded complications of corneal ulcer. FHV-1 was a common etiologic factor of corneal ulceration. Persistent corneal scars of varying shape and size developed in cats with deep stromal ulcer, anterior synechiae, and corneal sequestration. Domestic shorthaired and Persian cats were the most predisposed breeds to FHV-1 infection and subsequent corneal ulceration. Management of patients with corneal ulcer would prevent serious complications. No age or sex predisposition to complicated corneal ulceration in cats was noticed.

Feline Eosinophilic Keratitis—A Review

Eosinophilic keratitis is a disease occurring in cats, horses and rabbits. Its clinical signs include blepharo-spasm, discharge, chemosis, conjunctival hyperaemia and the presence of corneal ulceration. The typical signs of the disease are white to pink plaques on the cornea accompanied with keratitis. The diagnosis of the disease has to be confirmed with cytology examination and the presence of eosinophils and mast cells in the specimen. Local application of corticosteroids and cyclosporine has good therapeutic effect and has been recommended in all affected species. In samples collected from cats, the presence of feline herpes virus DNA has been reported. Eosinophilic keratitis might be caused by an aberrant immune response or reaction to unknown allergic stimuli. The primary cause of the disease is currently unknown.

A Study on Microbial Profile of Corneal Ulcer Cases in a Tertiary Health Care Centre of Southern Assam

Background-Visual impairment due to corneal ulceration has for long been acknowledged as leading cause of blindness both worldwide and in India only next to Cataract. The aetiology for infective corneal ulcer varies considerably with occupation of patients in different regions of India. Thus, continuing with empirical management without lab diagnosis leads to protracted clinical course. So, understanding the microbial profile of corneal ulcers in agriculture dependent population of Southern Assam helps in improved management of this morbidity. Aims- To 1) Find the prevalence of infected corneal ulcers in untreated patients attending Ophthalmology department of a tertiary care hospital of Southern Assam. 2) Study the pattern of microbial aetiology in the infected corneal ulcer cases. 3) Find the association of infected corneal ulcers with various attributing factors. Method-Corneal scrapings from 86 routine untreated cases of corneal ulceration from Ophthalmology Department were studied prospectively from Dec2017 to Jan2019 and subjected to Gram staining and direct examination with 10%KOH. Culture on SDA and Blood Agar were incubated at 25°C and 37°C respectively and followed up for 3 weeks before declaring sterile. Antimicrobial sensitivity was performed for bacterial isolate and yeast-like species. Slide culture and LPCB tease mount were done for identification of moulds. Result- Out of the 86 cases, 58 were positive in direct microscopy, of which 44 were culture positive. Of the 28 samples negative in direct microscopy, 2 were positive by Culture. Bacterial isolates were found in 5 cases and fungal aetiology in 41 cases. Conclusion- The prevalence of infected corneal ulcer as per standard of Culture positivity is 53.5% (46/86). Mycotic involvement was found in 90% cases. Important fungal isolates identified were Aspergillus species, Penicillium species, Curvularia species, Fusarium species, Sarocladium species. Higher prevalence was significantly associated with harvesting season, agricultural practice and history of trauma while diabetes and steroid intake were not significantly associated with mycotic ulcers. Keywords: Corneal ulcer, Assam, Fungal, Fusarium, Sarocladium, Pseudomonas.

Corneal ulcers part 2: aetiology and management of deep corneal ulcers

Corneal ulceration is one of the most common ocular problems presented in first opinion practice. Ocular diseases in dogs can be distressing for both the patient and owner, registered veterinary nurses can provide advice to distressed owners and ensure that patients are provided with evidence-based and holistic care. This is the second-part of a two-part series which focuses on the aetiology of corneal ulcers and the role of registered veterinary nurses within ocular diseases.

Efficacy of riboflavin/UV-A corneal phototherapy as stand-alone treatment for ulcerative keratitis in horses

The purpose of this study was to assess the efficacy of riboflavin/UV-A corneal phototherapy in comparison with topical antimicrobials for the treatment of corneal ulcers in horses. Nineteen horses with a diagnosis of corneal ulceration were randomised to receive either corneal phototherapy (11 horses) or topical antimicrobial therapy (8 horses). The corneal phototherapy consisted in the application of a riboflavin-enriched ophthalmic solution onto the cornea for 20 min followed by cornea UV-A irradiation at 30 mW/cm² for 3 min using a point-of-care UV-A device. A complete ophthalmological examination was performed at enrolment and then at day 1, 3, 7, 14, 21, 28, 35, 42, and 49 after treatment. The corneal ulcer was considered healed when the fluorescein staining was negative. The corneal phototherapy succeeded in the complete corneal wound healing in 91% cases (10/11 horses) by 12.7 ± 5.5 days. In the topical antimicrobial group, no horse showed improvement of the corneal ulceration (0/8; 0%) and two eyes had a corneal perforation. Six horses, due to an enlarged corneal lesion, underwent corneal phototherapy at day 14 and achieved complete wound healing by 17.2 ± 5.5 days in 83% cases (5/6). The corneal phototherapy was shown to be an effective and safe treatment for equine corneal ulcers.

Corneal ulcers part 1: aetiology and management of superficial corneal ulcers

Corneal ulceration is one of the most common ocular problems presented in first opinion practice. Ocular diseases in dogs can be distressing for both the patient and the owner, registered veterinary nurses can provide advice to distressed owners and ensure that patients are provided with evidence-based and holistic care. Part one of this two-part series discusses the aetiology and management of superficial corneal ulcers. The second part of this article will discuss deep corneal ulcers and will explore the role of registered veterinary nurses within ocular diseases.

A Prospective Study of Corneal Ulcers and Their Microbiological Profile among Patients in a Government Hospital in Ajmer, Rajasthan

BACKGROUND Significant causes of corneal blindness worldwide are ocular trauma and corneal ulceration that are often under reported. They may be responsible for 1.5 - 2.0 million new cases of monocular blindness every year. Corneal ulceration in developing countries has only recently been recognised as a silent epidemic. Infectious keratitis is one of the leading causes of blindness but in most cases these infections represent preventable or treatable ophthalmic diseases. Important predisposing factors related to corneal ulcers are trauma, chronic ocular surface disease, contact lens usage, ocular surgery, corneal anaesthetics abuse, diabetes mellitus, vitamin deficiency and immuno-deficiencies. This work is proposed to study the prevalence, clinical and lab diagnosis and management of suppurative corneal ulcer. We wanted to study the socio-demographic profile, microbiological investigation and treatment outcome of patients with corneal ulcer. METHODS This is a prospective study conducted among patients presenting with corneal ulcer at a tertiary level Government Medical College, Ajmer, Rajasthan. RESULTS Trauma comes out as a major predisposing factor for the development of corneal ulcer. 18.1 % of the study subjects had bacterial corneal ulcer and 37.7 % had fungal ulcer. More than half of the patients showed good prognosis on follow up. There was good response in most of patients, 51.2 % improved in first week which increased to 57.4 % at the time of second follow up. The most common bacterial species responsible for corneal ulcer was found to be staphylococcus followed by pseudomonas. CONCLUSIONS Bacteria and fungi are a frequent cause of ulcerative keratitis. Microbiological work up is an essential tool in the diagnosis of these infections which should not be under-rated. Timely administration of species-specific treatment certainly results in early resolution of keratitis followed by satisfactory visual outcome. Late or inappropriate treatment worsens the condition resulting in corneal perforation and increased morbidity. KEYWORDS Prospective, Corneal Ulcer, Bacterial, Fungal, Infectious