Curbside Consultation in Cornea and External Disease: 49 Clinical Questions

Dedication
Contents
Acknowledgments
About the Editors
About the Associate Editor
Contributing Authors
Preface
Corneal Dystrophy
I Have a Patient With Fuchs’Endothelial Corne
al Dystroph y. Is ThereAnythi ng New to Improve Their Vision?
I Am Seeing a 64-Year-Old Woman for Catarac t Evaluatio n.The Slit-Lamp Examinatio n Is Significa nt for Anterio r Bas ementMembrane Dys trophy Affecting the Vis ual Axis and3+ Nuclear Sclerosis of the Lens in Both Eyes.How Should I Manage This Patient?
I Have a Patient With Bilateral GranularCorneal Dystroph y Who Is Strugg ling With Their Vision.What Can I Do to Help Them, Short of aPenetrating Keratoplasty?
Corneal Degeneration
What Should I Do for a Young PatientWith Mild Keratoconus?
I Have a Patient Who Is 25 Years Old WithProgressive Keratoconus. Would It Be MoreEffective to Do Cross-Linki ng With theEpi thelium On or Off in Thi s Patient?
I Have a 38-Year-Old Patient WithFairly Advanced Keratoconus. Is ThereAnythi ng I Can Do fo r Them?
A Patient With High Cylinder Has SuddenOnset of Pain, Blurry Vision, and CornealEdema. How Do I Manage This Patient?
A Patient With Eye Irritation While WearingSoft Contac t Lenses Is Noted to HaveWhite Elevated Nodules at the Limbus.Do They Need Surgery?
External Disease
I Have a Patient With Significant Facial Rosacea With Chr onic,Red, Irri tated Eyes. They Have Some Periph eral CornealNeovasculari zation and Are Struggling With Contact LensWear. How Can I Manage This Patient?
An 18-Year-Old Man Com plaining of Severe Itchy Eyes andRedness Has Diffuse Eyelid Erythema With Dry Sca ly Skin,Meibom ian Gland Dys function, 2+ Conjunctival Bulbar andPalpebral Injection, and 3+ Papillae.Does He Need Steroid Drops?
How Can I Help a 47-Year-Old WomanWho Uses Artifici al Tears 6 Times Daily andContinues to Complain of Dry Eyes?
A 43-Year-Old Woman Is Complai ning of Dry Eyes.The Exam Show s Punctat e Kerato pat hy in theInferio r Third of Her Corneas. What Is theOpti mal Management?
I Have a Patient With Significant Dry Eye.Is There Anythi ng I Can Do in the Office toHelp This Patient With Their Eye Problems
A 51-Year-Old Man Presented With Severe Pain in Both EyesUpo n Awa kening in the Morning. He Has SeenSeveral Other Ophthalmo logists With No Resolution.What Cou ld Be Going On, and How Do I Help This Patient
A 52-Year-Old Man With Obesity Com es to the OfficeCom plaining of Pain and Irritation in the Right Eye. TheExam Show s Floppy Eyelids, 3+ Papillae in the Upper TarsalConjunctiva, and Lash Ptosis. Does He Need Eyelid Surgery
A Patient Diagnosed With Bell’s Palsy 2 Days AgoPresents With Lagophthalmos and Moderate SuperficialPunctate Keratopa thy Inferiorly on the Cornea.How Should I Treat Them?
A 68-Year-Old Woman WithRheumatoid Arthritis Presents With a Red,Painful Eye and Stromal Melt at the Limbus.How Should I Treat Her?
A Patient With a Filtering Bleb Complains of Discomfort in theEye. The Bleb Is Prolap sing Onto the Cornea and an Area ofStromal Thinning and Epithelial Staining With Fluorescein IsAdjac ent to the Bleb. What Is the Optimal Management
A 53-Year-Old Woman Came to My OfficeWith Sectoral Redness and Pain in One Eye.How Should I Manage Her Eye?
A 72-Year-Old Woman Has Conjunctival Injection inBoth Eyes and Symblepha ron and Trich iasis in the Right Eye.The Right Cornea Has Moderate Punctate Staining.Sho uld I Just Pull Out the Lashes or Do a WedgeResection of the Low er Lid to Tighten It Up?
A Patient Who Suffered a Chemica l Burn in the Left Eye2 Years Ago Complains of Persistent Blurry Vision andPhotophobia. There Is Corneal Neovasc ularization andConjunctiva lization Extending 5 mm From the Limbus.Do They Need Limba l Stem Cell Transp lantation?
A 47-Year-Old Man Has a Growth in theNasal Corner of His Righ t Eye. Sho uld HisPteryg ium Be Remo ved Surgica lly?
A 67-Year-Old Woman Complains of ConstantEye Irritation. The Exam Show s Conjunctivoc halasis of theLow er Bulba r Conjunctiva. Should I Excise theRedundant Conjunctiva?
I Have a Patient With a Papi llomatous, Waxy,Conjunctival and Corneal Lesion. Should I Be ConcernedAbout Conjunctival Intraepi thelial Neoplasia?
A 13-Year-Old Adolescent Girl Is Complaining of anEnlarging Brown Spot on Her Eye. The Exam Sho ws a FlatConjunctival Pigmented Nevus Tha t Is 3 mm in Diameter,Surrounded by Mild Conjunctival Injection. Sho uld I BeWorried Abo ut Malignancy?
A Patient Has Irritation in Their Nonseeing, Blind Eye.The Exam Shows Mildly Inflamed Conjunctiva andDiffuse Corneal Epithelial and Stromal Edema WithLarge Bullae. Wha t Should I Recommend?
A Patient Had LASIK 2 Months Ago and Has PersistentPain in the Eyes Tha t Does Not Seem to Be Rela ted toSurface Iss ues or Other Anatomical Abnormal ities.How Do I Diagnose and Manage This?
A Patient Presents WithCorneal Ulcer. What Workup andTreatment Would You Recommend?
A 22-Year-Old Woman Complaining of Blurry Vision in OneEye Has Deep Sectoral Corneal Stromal Neova scularizationWith Stromal Infiltrate and Lipid Deposits in the Center of theCornea. How Sho uld I Manage This Patient?
A Corneal Infiltrate Is Unresponsive toTopica l Fluoroqui nolones. Could This Be Aca
nthamoeba ?
A Corneal Infiltrate of a Farmer Hit by aTree Branch Is Not Clearing on Topica lFluoroquinolone Drops. Wha t Should I Do Next?
I Have a Patient With Shi ngles Over theRight Side of Their Face and Around the EyeTreated With Oral Antivirals for 10 Days.Does This Protect Them From Eye Involvement?
I Have a Patient With Herpes SimplexDendrites. What Is the Best Plan to MinimizeBoth the Recurrences and Possib le Scarring
I Have a Patient With Diabetes Who Had Infectious KeratitisWith a Bacterial Etiology, But Now After theInfection Has Cleared, I Can't Get the Epi thelium to Heal.How Can I Best Manage Thi s?
I Have a Patient With Material in the LA SIKInterface at Day 1. What Do I Need to Lookfor to Diagnose and Manage This Problem?
A Patient With Red, Irr itated Eyes, Tear ing, andPhotophobia That Star ted Yesterday Has Mild ConjunctivalInjection and 2+ Follicles of the Palpebra l Conjunctiva.When the Patient Awoke, Their Eyelids Were Stuck Closed.Is This Acute Conjunctivitis?
Corneal Refractive
My Patient Underwent LASIK Previousl y and Now Is Interestedin Cataract Surgery. What Is the Most App ropriate Formul afor IO L Calcul ations? Woul d They Be a Good Candidate for aMul tifocal IO L? What About After Corneal Cross -Linking?
I Have a Patient With a Phakic IOL That NowHas a Cataract. What Special Metho ds Do INeed to Use to Manage Thi s Patient?
How Do I Manage a Patient WhoRubbed Their Eye Just After LAS IK?What Could Go Wrong?
My Patient Recently Had LA SIK, But I Noticed New EpithelialCells in the Flap Interf ace. When Do I Lift the Flap to TreatEpithelial Ingrowth and What Is the Best Method?
Trauma
A Piece of Glass Flew Into My Patient’s Eye.The Exam Shows Central Corneal Perforation < 1 mm inDiam eter. The Anterior Cham ber Is Shallow But Formed.How Should I Close This Wound?
My Patient Was Splashed With Cement in Both Eyes.They Have Red, Irr itated Eyes and Blurr y Vision. The Exam ShowsDebr is on the Conjunctiva and Under the Lids, Diffuse SPK inthe Right Eye, and a Central Corneal Epithelial Defect in theLeft Eye. What Should I Watch for?
What Can I Offer a Patient Who SustainedEye Trauma and Loss of Iris Tiss ue?
PostOp erative
A Patient Who Had Been Doing Well AfterDMEK Presents With New Corneal Edema .What Should I Do?
How Should I Manage anIntraocular Press ure Spi ke of 43 mm Hgin a Patient With DMEK Who Is Taking 1 Dropof Pred Forte 1% Daily?
A Patient Is 5 Months After Corneal Transplant for aCorneal Sca r and Now Has a New Epithelial DefectThat Is Part on the Graft and Part on the Host Cornea.How Should I Manag e This Patient?
What Should I Do for a Patient Who PresentsWith 6.0 Diopters of Astigmatis m After UndergoingPenetrating Keratoplasty 24 Months Ago?
I Have a Patient With Poor VisionAfter DMEK. What Went Wrong, andHow Do I Get Better Vision for Them?
I Have a Patient Who Had Prior Verisyse IOLImpl antation 20 Years Ago, and They Now Present WithPosterior Synechi ae, Moderate Cataract, a Shall owAnterior Chamber, and New Corneal Edema.How Should I Best Help Thi s Patient With Their Vision?
Financial Disclosures