Optometric Physician



Vol. 24, #23 •   Monday, June 5, 2023


Off the Cuff: Cat Hair Keratitis

Last week at the end of the day, Dr. Lappin’s technician, Danae, said her eye had been irritating her for a couple days. If you’ve watched any of Dr. Epstein’s dry eye or IPL education videos that were shot in our office, you’ve seen Danae. She is almost always featured as our model dry eye patient… because she is. Anyway, she had stopped wearing her usual daily disposable contact lenses, but that seemed to make it feel worse than when she was wearing her contact lenses. Fortunately, Dr. Lappin had me come take a look.

Photo credit:
Dr. Cory Lappin - iPhone 8 slit lamp attachment

With white light, it was only visible using sclerotic scatter and appeared to be a swirly Celtic rune pattern indented in the center of her cornea. You already know what it was from the title, but what was extra interesting was that once it was stained, it looked more like those pictures of Loch Ness with loops of the hair emerging from her epithelium and other large portions submerged into the cornea. The portions of the cat hair that were still above the surface worked like a wick and stained the whole hair so even the portion embedded glowed with the Cobalt blue filter. I was able to grab one of the exposed portions and pull out a decently long grey cat hair. In doing so, the part that looped on itself acted like a cookie cutter and made a circular epithelial defect in the center of her cornea. We placed a dry amniotic membrane on it to heal it faster as well as with the hope of preventing future recurrent corneal erosions in this already known dry eye patient.

She’s all healed up and good to go now. Our best guess is that a cat hair got in her eye, which she admitted was not uncommon since the most likely culprit sleeps on her head every night; she then put her contact lens on over it, with the subsequent irritation and fast healing properties of the corneal epithelium locking it in. It just goes to show you that you don't have to look too far for interesting cases, and sometimes they actually clock in.

Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.



Effectiveness of Ketorolac-Soaked Bandage Contact Lens for Pain Management After Photorefractive Keratectomy

The objective of this prospective, randomized, double-blind, contralateral study was to evaluate the effect of ketorolac-soaked contact lenses (CLs) on postoperative pain after photorefractive keratectomy (PRK) and their potential side effects including conjunctival hyperemia and delayed epithelial healing. A total of 310 eyes of 155 patients who underwent PRK in both eyes were included in the study. After photoablation, a 0.4% ketorolac-soaked bandage CL was placed over the cornea in Group 1, while a drug-free soft bandage CL was placed over the cornea in Group 2. The postoperative pain was evaluated using a verbal numerical rating scale. The ocular redness was compared using the black pixels (veins and areas of redness) and white pixels (remaining areas) of the images. The complications and time to corneal wound healing were also recorded.

The mean pain score was significantly lower in Group 1 (2.7 ± 1.3) than in Group 2 (7.4 ± 1.4) on postoperative day 1. However, on the third postoperative day, no significant difference was found between the groups in terms of pain scores . Preoperative eye redness was 199.2 ± 16.0 pixels in Group 1 and 200.1 ± 17.6 pixels in Group 2. No statistically significant difference was found between the two groups in terms of eye redness at the postoperative 24th and 72nd hours.

Researchers concluded that soaking the bandage CL in a solution containing ketorolac 0.4% for 15 minutes significantly lowered pain scores on the first postoperative day after PRK, with no serious complications.

SOURCE: Ucar F, Kadioglu E. Effectiveness of ketorolac-soaked bandage contact lens for pain management after photorefractive keratectomy. Cutan Ocul Toxicol. 2023 Apr 20:1-6. [Epub ahead of print].



Comparative Study Evaluating the Efficacy of Topical Azithromycin Vs. Oral Doxycycline in the Treatment of Meibomian Gland Dysfunction

This study assessed the efficacy of topical azithromycin drops vs. oral doxycycline therapy in meibomian gland dysfunction. The prospective randomized trial was conducted from December 2019 to June 2020, at the Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan, and included patients of either gender, ages 26 to 42 years, with longstanding posterior blepharitis / meibomian gland dysfunction. The subjects were randomized into two equal groups. Both groups were advised to do warm compresses and lid massage three times a day for 5 minutes each for 4 weeks. In addition, group A received azithromycin 1% drops 2 times/day for 1 week, followed by once a day for 3 weeks, while group B received oral doxycycline 100mg once a day for 4 weeks. Baseline, midstream at 2 weeks and post-intervention status, including subjective symptoms, were compared.

Of the 60 subjects enrolled, there were 30 (50%) in each of the two groups; 32(53.3%) males and 28 (46.4%) females. While all 30 (100%) the participants in group A completed the trial without any adverse reaction to medication, 8 (26.7%) in group B quit midstream owing to anorexia/nausea and gastrointestinal discomfort. Compared to baseline, reduction in both subjective and objective features of the disease in both groups were noted regardless of gender. No significant difference was evident in symptoms healing rate and improvement in foreign body sensation between the groups. Group A treatment improved eye redness, while group B proved better with respect to meibomian glands obstruction healing and corneal staining.

Both topical azithromycin and oral doxycycline were effective and had their own advantages regarding symptomatic improvement in the treatment of meibomian gland dysfunction

SOURCE: Ahmad A, Rehman M. Comparative study evaluating the efficacy of topical azithromycin versus oral doxycycline in the treatment of meibomian gland dysfunction. J Pak Med Assoc. 2023;73(5):995-9.


Morphological and Functional Assessment of the Tear film and Meibomian Glands in Keratoconus

This study evaluated the morphological and functional state of the meibomian glands (MG) in keratoconus patients. One hundred eyes of 100 keratoconus patients and 100 eyes of 100 age-matched control subjects were included. Ocular Surface Disease Index (OSDI) scores, non-invasive break up time (NIBUT), findings of meibography, staining with fluorescein of the ocular surface, tear film break-up time (TBUT), and Schirmer I test were documented in all patients’ eyes and control eyes, and were compared between the groups .

The mean TBUT and NIBUT were significantly lower, corneal staining and OSDI scores were statistically greater in the keratoconus group. The mean meiboscore, partial gland, gland dropout and gland thickening scores for upper/lower eyelids were significantly greater in keratoconus patients than controls. The NIBUT measurements significantly correlated with MG loss in upper/lower eyelids (p<0.05). The severity of keratoconus seemed to correlate with meiboscore, partial gland, gland thickening scores in upper/lower eyelids.

This data suggested that corneal ectasia in keratoconus is related to alterations in ocular surface, tear film function and MG morphology. Early screening and treatment of MG dysfunction may improve ocular surface quality and allow for better disease management in keratoconus patients.

SOURCE: Uçakhan ÖÖ, Özcan G. Morphological and functional assessment of the tear film and meibomian glands in keratoconus. Eur J Ophthalmol. 2023 May 18. [Epub ahead of print].




Industry News

Study: Nanodropper Delivers Smaller Drops Than Standard Bottles

The findings of a recent study reveal that the drops delivered from the Nanodropper Adaptor were 62.1% smaller than those administered from standard bottles. This equated to 2.6-fold increase in the number of drops in a 2.5 milliliter bottle. Researchers wrote that the Nanodropper eyedrop bottle adaptor can significantly reduce drop volume and increase the overall number of drops dispensed compared with stock eyedrop bottles, which potentially may limit ocular toxicity and prolong bottle use. Read more.

Thea Pharma Launches Preservative Freedom Coalition

Thea Pharma launched the Preservative Freedom Coalition to encourage use of preservative-free topical ophthalmic medications. In addition to Thea, founding members include: The Glaucoma Foundation, The Intrepid Eye Society, National Medical Association Ophthalmology Section and Real World Ophthalmology. Read more.

Optos Introduces Ultra-widefield Color Image Modality

Optos is expanding the optomap ultra-widefield (UWF) retinal imaging modalities available with the California FA device to further assist eyecare professionals in disease management and treatment planning. In addition to optomap color rg (red/green), sensory red-free, choroidal, autofluorescence (AF), fluorescein angiography and indocyanine green angiography modalities, the company announced its ultra-widefield color rgb (red/green/blue) image, captured simultaneously with the optomap color rg image. Learn more.

Prevent Blindness to Celebrate 115th Birthday, Marks June as Cataract Awareness Month

The group is marking its birthday by declaring it Prevent Blindness Day. Read more. In addition, June is Cataract Awareness Month. Read more.












Journal Reviews Editor:
Katherine M. Mastrota, MS, OD, FAAO

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