Curbside Consultation in Cornea and External Disease: 49 Clinical Questions
Are you looking for concise, practical answers to those questions that are often left unanswered by traditional references on cornea and external diseases? Are you seeking brief, evidence-based advice for the daily examination of patients? Curbside Consultation in Cornea and External Disease: 49 Clinical Questions provides quick and direct answers to the thorny questions most commonly posed during a curbside consultation between experienced clinicians.
Dr. Frank Price Jr., joined by associate editors Dr. Marianne Price and Dr. Erik Letko, have designed this unique reference in which cornea and external disease specialists offer expert advice, preferences, and opinions on tough clinical questions commonly encountered by ophthalmologists, residents, and other health care professionals. The unique Q&A format provides quick access to current information related to cornea and external diseases with the simplicity of a conversation between two colleagues. Images, diagrams, and references are included to enhance the text and to illustrate clinical diagnoses and treatment plans.
Curbside Consultation in Cornea and External Disease: 49 Clinical Questions provides information basic enough for residents while also incorporating expert pearls that even high-volume ophthalmologists will appreciate. Refractive surgeons, general ophthalmologists, and residents alike will enjoy the user-friendly and casual format.
Some of the questions that are answered:
- A patient presents with corneal ulcer. What work-up and treatment would you recommend?
- As answered by three different specialists in the USA, Europe, and India.
- What should I do for a patient who presents with 6-D astigmatism after undergoing penetrating keratoplasty 4 months ago?
- A 63-year-old male complaining of blurry vision has 360-degree peripheral corneal stromal thinning and conjunctivalization and moderate cataract in both eyes. Does he need surgery?
- A piece of glass flew into my patients eye. The exam shows central corneal perforation <1 mm in diameter. The anterior chamber is shallow, but formed. How should I close this wound?
- A 67-year-old female complains of constant eye irritation. The exam shows conjunctivochalasis of the lower bulbar conjunctiva. Should I excise the redundant conjunctiva?
- I have a general ophthalmology practice in a remote area. When should I consider doing corneal cultures?
About the Editor
SECTION 1: CORNEAL DEGENERATION AND DYSTROPHY
Question 1: I Have a Patient With Fuchs' Endothelial Dystrophy. Is There Anything New to Improve Her Vision?
Question 2: I Am Seeing a 64-Year-Old Female for Cataract Evaluation. The Slit Lamp Examination Is Significant for Anterior Basement Membrane Dystrophy Affecting the Visual Axis and 2+ Nuclear Sclerosis of the Lens in Both Eyes. How Should I Manage This Patient?
Question 3: A 62-Year-Old Male With No History of Ocular Surgery Complains of Blurry Vision in One Eye. The Exam Shows Diffuse Corneal Stromal Edema. How Should I Work Up and Treat This Patient?
Question 4: A Patient Has Irritation in Her Nonseeing Eye. The Exam Shows Mildly Inflamed Conjunctiva and Diffuse Corneal Epithelial and Stromal Edema With Large Bullae. What Should I Recommend?
Question 5 : A Patient With Recurrent Erosion Syndrome Is Complaining of Irritation and Pain in the Right Eye That Typically Wakes Her Up Early in the Morning. What Should I Do?
Question 6: A Patient With a Filtering Bleb Complains of Discomfort in the Eye. The Bleb Is Prolapsing Onto the Cornea and an Area of Stromal Thinning and Epithelial Staining With Fluorescein Is Adjacent to the Bleb. What Is the Optimal Management?
Question 7: A 63-Year-Old Male Complaining of Blurry Vision Has 360-Degree Peripheral Corneal Stromal Thinning and Conjunctivalization and Moderate Cataract in Both Eyes. Does He Need Surgery?
Question 8: A Patient With Eye Irritation While Wearing Soft Contact Lenses Is Noted: to Have White Elevated Nodules at the Limbus. Does She Need: Surgery?
Question 9: A 22-Year-Old Female Complaining of Blurry Vision in One Eye Has Deep Sectoral Corneal Stromal Neovascularization With Stromal Infiltrate and Lipid Deposits in the Center of the Cornea. How Should I Manage This Patient?
SECTION II: EXTERNAL EYE DISEASE AND TUMORS
Question 10: How Should I Treat a Patient With Red Eye and Photophobia if My Exam Reveals Meibomian Gland Dysfunction and Foci of Subepithelial Infiltrates at the Limbus?
Question 11: How Can I Help a 47-Year-Old Female Who Uses Artificial Tears: 6 Times Daily and Continues to Complain of Dry Eyes?
Question 12: A 68-Year-Old Female With Rheumatoid Arthritis Presents With a Red,: Painful Eye and Stromal Melt at the Limbus. How Should I: Treat Her?
Question 13: A 47-Year-Old Hispanic Male Complains of a "Growth" in the Corner of His Right Eye. Does His Pterygium Need to Be Removed?
Question 14: A Patient Diagnosed With Bell's Palsy 2 Days Ago Presents With Lagophthalmos and Moderate Superficial Punctuate Keratopathy Inferiorly on the Cornea. How Should I Treat Her?
Question 15: A 43-Year-Old Female Is Complaining of Dry Eyes. The Exam Shows Punctate Keratopathy in the Inferior Third of Her Corneas. What Is the Optimal Management?
Question 16: A 42-Year-Old Female With Sectoral Redness in Her Right Eye: Complains of Irritation in One Eye, but No Pain. How Should I Treat Her Episcleritis?
Question 17: A 53-Year-Old Female Came to My Office With Sectoral Redness and Pain in One Eye. How Should I Manage Her Scleritis?
Question 18: An 18-Year-Old Male Complaining of Severe Itchy Eyes and Redness Has Diffuse Eyelid Erythema With Dry Scaly Skin, Meibomian Gland Dysfunction, 2+ Conjunctival Bulbar and Palpebral Injection, and 3+ Papillae. Does He Need Steroid Drops?
Question 19: A 72-Year-Old Female Has Conjunctival Injection in Both Eyes and Symblepharon and Trichiasis in the Right Eye. The Right Cornea Has Moderate Punctate Staining. Should I Just Pull Out the Lashes or Do a Wedge Resection of the Lower Lid to Tighten It Up?
Question 20: A 67-Year-Old Female Complains of Constant Eye Irritation. The Exam Shows Conjunctivochalasis of the Lower Bulbar Conjunctiva. Should I Excise the Redundant Conjunctiva?
Question 21: A Patient Complaining of Eye Irritation Has Moderate Meibomian: Gland Dysfunction and Trace Conjunctival Injection. Could This Be: Rosacea?
Question 22: A 49-Year-Old Male Comes to the Office With a Red Swollen Upper Eyelid. The Symptoms Started Yesterday. Should I Start Treating Him for Chalazion?
Question 23: A 13-Year-Old Female Is Complaining of an Enlarging Brown Spot on Her Eye. The Exam Shows a Flat Conjunctival Pigmented Nevus: That Is 3 mm in Diameter Surrounded by Mild Conjunctival Injection.: Should I Be Worried About Malignancy?
Question 24: A 52-Year-Old Obese Male Comes to the Office Complaining of Pain and Irritation in the Right Eye. The Exam Shows Floppy Eyelids, 3+ Papillae in Upper Tarsal Conjunctiva, and Lash Ptosis. Does He Need Eyelid Surgery?
Question 25: A 72-Year-Old Male Is Complaining of Decreased Vision. The Exam Shows Nuclear Cataract and Cortical Spoking. In the Area Above the Cortical Spokes, There Is a Pigmented Lesion of the Iris and Ectropion Uvea. Should I Arrange for Excision of the Lesion?
Question 26: A Young Patient With Recurrent Episodes of Thygeson's Keratitis Wants Me to Refill a Prescription for Topical Corticosteroids That She Uses Intermittently as Needed for Discomfort. Should I Do It?
SECTION III: INFECTION
Question 27: A Patient Presents With Corneal Ulcer. What Work-Up and Treatment Would You Recommend?
Question 28: I Have a General Ophthalmology Practice in a Remote Area. When Should I Consider Doing Corneal Cultures?
Question 29: A Corneal Infiltrate Is Unresponsive to Topical Fluoroquinolones. Could This Be Acanthamoeba?
Question 30: A Corneal Infiltrate of a Farmer Hit by a Tree Branch Is Not Clearing on Topical Fluoroquinolone Drops. What Should I Do Next?
Question 31: I Have a Patient With Shingles Over the Right Side of His Face and Around the Eye Treated With Oral Antivirals for 10 Days. Does This Protect Him From Eye Involvement?
Question 32: I Have a Patient With Herpes Simplex Dendrites. What Is the Best Plan to Minimize Both the Recurrences and Possible Scarring?
Question 33: After Recently Treated Bacterial Keratitis, a Diabetic Patient Continues to Have Persistent Stromal Ulcer Despite Bandage Contact Lens and Topical Antibiotics. What Are the Options?
Question 34: A Patient With a History of Recurrent HSV Keratitis Continues to Have: Dense Punctate Keratopathy and Visual Acuity of 20/100 Despite Hourly: Lubrication With Preservative-Free Artificial Tears. What Else Could Be: Done?
Question 35: A Patient With Red, Irritated Eyes, Tearing, and Photophobia That Started Yesterday Has Mild Conjunctival Injection and 2+ Follicles of the Palpebral Conjunctiva. When the Patient Awoke, His Eyelids Were Stuck Closed. Is This Acute Conjunctivitis?
SECTION IV: CONTACT LENSES
Question 36: My Patient Complains of Redness and Photophobia After Sleeping With Contact Lenses. The Exam Shows Diffuse Patchy Epithelial and Anterior Stromal Infiltrates. What Should I Do?
Question 37: A Young Patient Has Best Spectacle-Corrected Visual Acuity of 20/30 OD and 20/25 OS, and Retinoscopy Shows Scissor Reflex. Is This Keratoconus?
Question 38: What Should I Do for a Patient Who Wears Soft Contact Lenses and Complains of Dry and Itchy Eyes?
Question 39: How Should I Manage a Patient With Keratoconus Who Cannot Tolerate Hard Gas-Permeable Contact Lenses?
Question 40: A Long-Time Soft Contact Lens User Complains of Eye Irritation and Has Superficial Punctate Keratopathy in the Area of Corneal Apex. Is This a Poor Contact Lens Fit?
Question 41: A Long-Time Soft Contact Lens User Complains of Eye Irritation and Has: Superficial Punctate Keratopathy in the Superior Cornea and Limbus.: What Should I Do?
SECTION V: TRAUMA
Question 42: A Piece of Glass Flew Into My Patient's Eye. The Exam Shows Central Corneal Perforation <1 mm in Diameter. The Anterior Chamber Is Shallow, but Formed. How Should I Close This Wound?
Question 43: My Patient Was Splashed With Cement in Both Eyes. He Has Red, Irritated Eyes and Blurry Vision. The Exam Shows Debris on the Conjunctiva and Under the Lids, Diffuse SPK in the Right Eye, and Central Corneal Epithelial Defect in the Left Eye. What Should I Watch For?
Question 44: A Tire Blew Up in Front of My Patient's Face. He Complains of Eye Irritation. The Exam Shows Multiple Tiny Foreign Bodies 100 to 200 µm in Diameter Embedded in the Conjunctiva and Cornea. Does He Need Surgery?
Question 45: A Patient With a Chemical Burn in the Right Eye 6 Months Ago Complains of Blurry Vision and Photophobia. He Has an Area of Corneal Neovascularization and Conjunctivalization Extending 4 mm From the Limbus. Does He Need Limbal Stem Cell Transplantation?
SECTION VI: POSTOPERATIVE
Question 46: What Should I Consider for a Patient With a Corneal Transplant Who Presents With a Red Eye and Photophobia?
Question 47: How Should I Manage an Intraocular Pressure Spike of 43 mm Hg in a Descemet's Stripping Endothelial Keratoplasty Patient Who Is Taking One Drop of Pred Forte 1% Daily?
Question 48: I Was Asked to Assume Follow-Up of a Patient 5 Months After Penetrating Keratopolasty for HSV-Related Scar. How Should I Manage: This Patient?
Question 49: What Should I Do for a Patient Who Presents With 6-D Astigmatism After Undergoing Penetrating Keratoplasty 4 Months Ago?
"We can highly recommend the book to anyone involved in the diagnostic work-up and treatment of common and complex corneal and external diseases, who is looking for practical guidelines in his/her clinical routine."
-D. Kook and P. Kook, Graefes Archives for Clinical and Experimental Ophthalmology
About the Editor
Francis W. Price, Jr., MD, founder and medical director of Price Vision Group in Indianapolis, IN, is an internationally recognized ophthalmic surgeon and recipient of the Senior Achievement Award from the American Academy of Ophthalmology. He has authored over 100 peer-reviewed publications and has been principal investigator on over 80 clinical studies of ophthalmic devices, medications, and surgical techniques. He is also an inventor and holds several patents for ophthalmic devices. Dr. Price is a graduate of Indiana University Medical School and completed a fellowship in cornea and external disease at Tulane University. He has been active in developing and teaching endothelial keratoplasty techniques to hundreds of surgeons from around the world.
About the Editors
Marianne Price, PhD is executive director of the Cornea Research Foundation of America in Indianapolis, IN. She holds a PhD in Medical and Molecular Genetics from Indiana University School of Medicine. A respected scientist and author, Dr. Price has made presentations to vision care audiences around the world. She is a member of the American Academy of Ophthalmology and serves on the Board of Prevent Blindness Indiana, the Indiana University Kelley School of Business—Women MBA’s Alumni Advisory Board, and the Scientific Programs and Research Committees of the Eye Bank Association of America. She and Dr. Francis Price are recipients of Melvin Jones Fellow Awards from the Lions International Foundation and Vision Awards from the Corneal Dystrophy Foundation.
Erik Letko, MD dedicates his career to the improvement of treatment and surgical techniques for a spectrum of corneal conditions. He graduated from Charles University 1st School of Medicine in Prague, Czech Republic, where he also completed his ophthalmology
residency and cornea fellowship. He received extensive training as a fellow in Cornea, External Eye Diseases, and Ocular Immunology at the Massachusetts Eye and Ear Infirmary, Harvard Medical School. He completed a second residency in ophthalmology
at Casey Eye Institute in Portland, OR. Dr. Letko participated in over 30 clinical studies and authored or co-authored over 25 peer reviewed articles and 10 book chapters. He serves as a reviewer for ophthalmology journals and lectures in the United States and abroad.