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Truly Foreign “Foreign Body”

Truly Foreign “Foreign Body”. Tim Blankenship, 3 rd Year Intern UMSL College of Optometry. 23 y/o Caucasion Female. Chief Complaint: “My eye hurts”; “I got something in it yesterday taking out the trash” Foreign Body Sensation: “It feels like something is still in my eye”

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Truly Foreign “Foreign Body”

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  1. Truly Foreign “Foreign Body” Tim Blankenship, 3rd Year Intern UMSL College of Optometry

  2. 23 y/o Caucasion Female • Chief Complaint: “My eye hurts”; “I got something in it yesterday taking out the trash” • Foreign Body Sensation: “It feels like something is still in my eye” • Redness/Tearing: “My eye has been red and watering since yesterday after I got something in it” • Hx: Unremarkable

  3. Questions to ask Emergency Red Eye Patients????? • What are Differential Diagnosis at this point?

  4. Differential Diagnosis • Corneal Foreign Body • Corneal Abrasion • Recurrent Corneal Erosion • Corneal Infiltrate/Ulcer

  5. Entrance Tests • VA OD 20/30 OS 20/20 • Pupils: PERRLA -APD • EOMs: FROM OU • Confrontations: FTFC OU

  6. SLEx • Cornea: Superior central punctate staining OD; OS clear • Conj: Moderate diffuse injection of bulbar conj with more severe superior sectoral injection OD; OS clear • Lids: Moderate papillae on superior palpebral conj OU • AC: No Cells/Flare

  7. 2nd Differential Diagnosis • Atopic Keratoconjunctivitis (with a possible early shield ulcer) • Itch???? • 2 new cats a couple of weeks ago • Superior Limbic Keratoconjunctivitis of Theodore • Thyroid disease Hx • Pt reports “mother and brother have thyroid disease” • Floppy Eyelid Syndrome • Obstructive sleep apnea • Pt reports “no sleep apnea or snoring” • Pt stated she sleeps on her back

  8. Superior Limbic Keratoconjunctivitis of Theodore • Chronic ocular surface disease with episodes of recurrent inflammation of superior cornea and limbus as well as superior tarsal and bulbar conj • Occurs primarily in females ages 30-55 • Typically Bilateral • Usually resolves within a period of years

  9. Superior Limbic Keratoconjunctivitis of Theodore • Pathophysiology • Autoimmune and Mechanical mechanisms postulated • Systemic Associations • Thyroid Disease • Collagen Vascular Disease

  10. Superior Limbic Keratoconjunctivitis of Theodore • Signs • Papillary hypertrophy of superior tarsus • Hyperemia of superior bulbar conj • Superior punctate epithelial erosions • Keratinized conjunctival epithelial cells • Superior filamentary keratoconjunctivitis (40% of SLK patients) • Keratoconjunctivitis sicca (25-50% of SLK patients)

  11. Superior Limbic Keratoconjunctivitis of Theodore • Symptoms • FB sensation • Red Eye • Pain • Burning • Tearing • Mild photophobia • Possible mucus discharge

  12. Treatment • Mild • Artificial Tears • Punctal Occlusion • Moderate to Severe • Silver Nitrate 0.5% solution: applied with contton tip applicator for 10-20sec to superior bulbar and palpebral conj; may be adminisitered on a weekly basis • If silver nitrate is unsuccessful then cautery or surgical resection • Counsel patients as to the recurrent nature of the disease • Corticosteroids offer little help for this recurrent condition (chronic use discouraged)

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