Meeting News CoveragePerspective

Speaker: Minor surgeries may be effective in the treatment of ocular surface diseases

WAILEA, Hawaii — Office and minor surgical procedures may be effective in the treatment of patients with ocular surface diseases who do not respond to medical treatment, a speaker said here.

“Ocular surface diseases are very common in clinical practice. Medical therapies are certainly first-line treatment and can be helpful,” Christopher J. Rapuano, MD, at the Hawaiian Eye 2015 meeting.

Christopher J.
Rapuano

Rapuano discussed four ocular surfaces diseases and how he treats them in his clinical practice: molluscum contagiosum, vernal keratoconjunctivitis, superior limbic keratoconjunctivitis and partial limbal stem cell deficiency.

Rapuano recommends using curettage to treat molluscum contagiosum because it is an easy in-office procedure to do that can typically be done without anesthesia.

One of the biggest problems with vernal keratoconjunctivitis is presence of a shield ulcer. If the shield ulcer is white and fibriotic and has a calcified appearance, these will not heal well with medical therapy, he said.

“The only way to get those [ulcers] to heal is aggressive scraping. You can do it right in the office. Topical anesthesia, lid speculum and then scrape until you get down to Bowman’s membrane. Once you have a smooth area, the ulcers will generally heal with medical therapy at that point,” Rapuano said.

Superior limbic keratoconjunctivitis can be treated with lubricants, cyclosporine, steroids, mass cell stabilizers, punctal plugs, silver nitrate solution, and conjunctival cautery or conjunctival recession, he said.

“Conjunctival cautery can be done in the exam room. You need a pretty cooperative patient to do this. Balloon up the superior conjunctiva with lidocaine and apply the cautery over the large area of abnormal epithelium,” Rapuano said.

Partial limbal stem cell deficiency can be treated with selective epithelial debridement, he said.

“At the slit lamp, remove the abnormal epithelium. You are not directly treating the limbal stem cell deficiency, but you are allowing the good epithelial cells to migrate over to clear the visual axis and get them good vision again,” Rapuano said. by Nhu Te

Disclosure: Rapuano reports no relevant financial disclosures.

WAILEA, Hawaii — Office and minor surgical procedures may be effective in the treatment of patients with ocular surface diseases who do not respond to medical treatment, a speaker said here.

“Ocular surface diseases are very common in clinical practice. Medical therapies are certainly first-line treatment and can be helpful,” Christopher J. Rapuano, MD, at the Hawaiian Eye 2015 meeting.

Christopher J.
Rapuano

Rapuano discussed four ocular surfaces diseases and how he treats them in his clinical practice: molluscum contagiosum, vernal keratoconjunctivitis, superior limbic keratoconjunctivitis and partial limbal stem cell deficiency.

Rapuano recommends using curettage to treat molluscum contagiosum because it is an easy in-office procedure to do that can typically be done without anesthesia.

One of the biggest problems with vernal keratoconjunctivitis is presence of a shield ulcer. If the shield ulcer is white and fibriotic and has a calcified appearance, these will not heal well with medical therapy, he said.

“The only way to get those [ulcers] to heal is aggressive scraping. You can do it right in the office. Topical anesthesia, lid speculum and then scrape until you get down to Bowman’s membrane. Once you have a smooth area, the ulcers will generally heal with medical therapy at that point,” Rapuano said.

Superior limbic keratoconjunctivitis can be treated with lubricants, cyclosporine, steroids, mass cell stabilizers, punctal plugs, silver nitrate solution, and conjunctival cautery or conjunctival recession, he said.

“Conjunctival cautery can be done in the exam room. You need a pretty cooperative patient to do this. Balloon up the superior conjunctiva with lidocaine and apply the cautery over the large area of abnormal epithelium,” Rapuano said.

Partial limbal stem cell deficiency can be treated with selective epithelial debridement, he said.

“At the slit lamp, remove the abnormal epithelium. You are not directly treating the limbal stem cell deficiency, but you are allowing the good epithelial cells to migrate over to clear the visual axis and get them good vision again,” Rapuano said. by Nhu Te

Disclosure: Rapuano reports no relevant financial disclosures.

    Perspective

    This was a great presentation by Christopher J. Rapuano, MD, showing a variety of office procedures that can be performed by general ophthalmologists to quickly address common corneal and external eye diseases. All too often, we as physicians ask patients to tolerate conditions like molluscum contagiosum, partial limbal stem cell deficiency and SLK when we can instead offer a minor procedure that will lead to fairly quick and painless resolution. I would encourage every colleague to become familiar with these techniques.

    • John A. Hovanesian, MD, FACS
    • OSN Cataract Surgery Section Editor

    Disclosures: Hovanesian has no relevant financial disclosures.

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