42 year old with painful right eye

Posted by - Posted on 10/30/2016 23:15:04 Cornea and External diseases

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42 year old african american male presents with a painful right eye. Exam findings - Corneal epithelial staining /infiltrates, fine KPs, 1 + cells and flare with IOP of 56 mm Hg.  Based on these findings and the apperance of the conjunctiva-

1. what is the best treatment to control the IOP?

2. What is teh proposed mechanism of elevated IOP ?

3. Is there any study that you can suggest that might help in the treatment planning?

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Beau Swann 11/17/2016 22:57:46

Joshua Frenkel 11/07/2016 01:58:09

1. Treat with topical IOP drops aside from prostaglandins (contraindicated). Additional treatment would benefit from cyclogyl and systemic hsv meds (example acyclovir 400mg 5x/day)2. Elevated IOP thought to be secondary to trabeculitis as well as inflammatory cells clogging the TM3. Corneal culture as well as HSV antibody testing would help direct therapy, as a negative result would rule OUT hsv (although a positive result is not definitive due to the high prevalence of HSV in the general population. PCR for HSV DNA from an anterior chamber tap may be helpful in diagnosis if felt necessary.

Alex Yelenskiy 11/07/2016 01:22:06

1. I agree with Michael in that topical pressure-lowering drops other than prostglandins should be started. I would add that HSV-associated anterior uveitis tends to respond well to 400 mg of oral acyclovir five times per day and a cycloplegic/mydriatic agent. 2. High IOP is due to trabeculitis, as well as inflammatory cells clogging the trabecular meshwork. 3. Corneal culture and HSV antibody titers may be taken.

Michael Puente 11/02/2016 00:58:11

1. Topical pressure-lowering drops other than prostaglandin analogs (which may exacerbate the inflammation).2. Trabeculitis, with mononuclear cells blocking the trabecular meshwork.3. OCT RNFL and visual fields, as patients with recurrent glaucomatocyclitic crisis or those with OCT or HVF changes may benefit from surgical management.