Corneal ulcers in rubeola

Giant corneal keloid: case report and review of the literature

PURPOSE

To report a patient with a tumor-like corneal keloid.

METHODS

Retrospective review of clinical features and histopathologic findings.

RESULTS

A 68-year-old woman with a remote history of an orbital tumor treated with radiation developed a corneal tumor. A biopsy of the tumor showed fibrocellular tissue, and her blind painful eye was enucleated. Pathologic findings in the enucleated eye showed that the corneal mass was consistent with a large keloid.

CONCLUSIONS

A corneal keloid may clinically appear as a large corneal tumor.

Rubeola keratitis: a photographic study of corneal lesions

PURPOSE

Detailed description of the morphology of rubeola keratitis lesions is missing from textbooks and published reports. We performed a detailed analysis of rubeola keratitis lesions by using a photographic slit lamp and ophthalmic dyes.

METHODS

Thirty-four eyes of 17 male young adult patients with rubeola keratitis were examined. Patients were examined at 3.6 days after the development of rash. Ocular symptoms were recorded, and patients underwent complete ocular examination including photography of corneal lesions, with and without instillation of ophthalmic dyes (rose Bengal and fluorescein).

RESULTS

Patients complained of foreign-body sensation (88%), photophobia (65%), tearing (65%), and burning sensation (47%). Visual acuity was unaffected (26%) or mildly affected (71%). Conjunctivitis was observed in 74% and keratitis in 100% of eyes. Corneal photographs were studied, and 4 types of corneal lesions were identified: small, punctate epithelial lesions staining only with rose Bengal (100%); small, round, or larger and irregular when they coalesced epithelial defects (100%); large or tiny filaments (39%); and target lesions (100%). Target lesions appeared when both dyes were instilled. The outline of target lesions stained with rose Bengal, and they consisted of a pattern of alternating concentric zones of staining with rose Bengal and fluorescein. Keratitis was strictly confined to the epithelium and resolved gradually in all patients without the appearance of complications.

CONCLUSIONS

Rubeola keratitis in healthy young adults runs a benign course. Recognition of the specific to rubeola keratitis corneal target lesions could aid in the differential diagnosis and prevent the transmission of the disease.

A Case of Congenital Corneal Keloid

PURPOSE

To describe a case of unilateral comeal keloid and present the clinical and histopathological findings and the management.

METHODS

A 23-year-old Asian male patient was examined for a white spot on the left cornea that had been present since birth. On biomicroscopic examination, a well-demarcated vascularized comeal mass was found located nasal to the center. The pupil was displaced superiorly, and gonioscopic examination showed peripheral iridocomeal adhesion at 12 o'clock. The patient underwent penetrating keratoplasty.

RESULTS

Histopathologic study showed a variously thickened epithelial layer, an absence of Bowman's layer, subepithelial fibrovascular hyperplasia, and an absence of dermal elements. These histopathologic findings suggested a congenital comeal keloid. The central graft comea remained clear at 18 months after surgery and the patient was satisfied with the result.

CONCLUSIONS

Penetrating keratoplasty may be an effective surgical option for congenital keloids in young adult patients.

Corneal keloid

A 70-year-old man was referred to us with a 2-year, progressive, painless decrease in visual acuity in the right eye. Ocular history included extraction of a traumatic cataract with a transclerally fixated posterior chamber intraocular lens. Slitlamp examination showed a raised, white, vascularized mass covering the cornea. The lesion was removed by superficial lamellar keratectomy. Light microscopy examination confirmed the diagnosis of corneal keloid. These uncommon lesions usually develop in adults after corneal traumas, surgery, or inflammatory processes. They have also been described in children with Lowe's syndrome, Rubinstein-Taybi syndrome, and other ocular developmental disorders.

Measles blindness

Measles remains a major problem in developing countries, where it affects an estimated 30 million children a year and causes up to one million deaths annually. Measles blindness is the single leading cause of blindness among children in low income countries, accounting for an estimated 15,000 to 60,000 cases of blindness per year. There is a close synergism between measles and vitamin A deficiency that can result in xerophthalmia, with corneal ulceration, keratomalacia, and subsequent corneal scarring or phthisis bulbi. High-dose oral vitamin A supplementation is recommended for all children with measles in developing countries. Higher measles immunization coverage to interrupt measles transmission and interventions aimed at improving vitamin A nutriture of children are the main strategies to prevent measles blindness.

Clinical, surgical, and histopathologic characteristics of corneal keloid

PURPOSE

To describe the cause, diagnosis, and management of a case of bilateral corneal keloid.

METHODS

We describe a 17-year-old white boy with enlarging nontraumatic bilateral corneal scars whose growth was exacerbated by a superficial keratectomy. The patient underwent a penetrating keratoplasty (PK) in his left eye. Light and electron microscopy of the corneal button were performed.

RESULTS

The histopathologic and ultrastructural features of the corneal button were haphazardly arranged collagen fascicles with activated fibroblasts but no inflammatory cells. The clinical outcome was excellent, although there has been continuous growth of the outer margin of the initial lesion not included in the PK. This growth has not affected vision. The unoperated right corneal lesion progressively enlarged during these years.

CONCLUSION

A corneal keloid, although unusual, should be suspected in cases of enlarging white glistening avascular corneal scars regardless of a traumatic antecedent. Light and electron microscopy confirmed the diagnosis. Management is by PK when the visual axis is involved and carries an excellent prognosis.

Photorefractive keratectomy in African Americans including those with known dermatologic keloid formation

PURPOSE

To report the outcome of photorefractive keratectomy in African Americans, including those with a known history of dermatologic keloid formation.

METHODS

A retrospective analysis of African American patients who had photorefractive keratectomy at either of our institutions was undertaken to identify all patients who were at least 3 months status-post refractive surgery. The presence or absence of a history of keloid formation, as well as preoperative and postoperative measurements of uncorrected visual acuity, best-corrected visual acuity, manifest refraction, and the presence and magnitude of any postoperative corneal haze were analyzed.

RESULTS

Twelve patients (19 eyes) met the inclusion criteria and three of these patients (six eyes) had a history of keloid formation. Mean uncorrected visual acuity +/- SD for the entire study group improved from 20/369 +/- 20/270 preoperatively to 20/19.4 +/- 20/7.1 postoperatively (average follow-up, 13.8 months). All eyes had postoperative uncorrected visual acuity of 20/40 or better; 14 (74%) achieved 20/20 or better. Mean best spectacle corrected visual acuity went from 20/14.8 +/- 20/2.8 preoperatively to 20/15.5 +/- 20/3.2 postoperatively (not statistically significant). Mean manifest spherical equivalent was -4.9 +/- 3.4 diopters preoperatively and +0.03 +/- 0.55 diopters postoperatively. Eight eyes (42%) had trace to 1+ corneal haze following photorefractive surgery. A comparison of postoperative uncorrected and best-corrected visual acuities of known keloid formers with nonkeloid formers revealed no significant statistical difference.

CONCLUSIONS

African Americans may have excellent visual outcomes following photorefractive keratectomy. History of keloid formation does not appear to have an adverse effect on the outcome. These results question whether known dermatologic keloid formation should be a contraindication to photorefractive keratectomy.

A case of corneal keloid: clinical, surgical, pathological, and ultrastructural characteristics

A 69-year-old patient developed a localised, whitish, elevated, corneal lesion with a smooth and glistening surface following trauma, without evidence of corneal perforation. Twelve months later, the lesion showed evidence of slow growth. An excisional biopsy was then performed. Histopathologically, the lesion was covered by non-keratinised squamous epithelium and was comprised of randomly oriented collagen fibres containing active fibroblasts. Blood vessels were noted deep in the lesion. Ultrastructurally, the cell population was formed by fibroblasts and myofibroblasts, similar to keloids of the skin. The clinical, pathological, and ultrastructural features of the corneal lesion are compatible with a corneal keloid.

Ultrastructural study of a corneal keloid

A 69-year-old man developed keloid overgrowth on his left cornea in response to an injury from a fingernail. The lesion was removed by superficial lamellar keratectomy and was studied by electron microscopy, and light microscopy after immunoperoxidase staining for actin. The surgical specimen revealed disorganised, anteriorly atrophied and posteriorly vascularised connective tissue stroma. The epithelium was oedematous, thin, non-keratinised, and contained cells with features of myoblastic differentiation. Stromal fibroblasts were found in several distinct ultrastructural forms including young active fibroblasts, myofibroblasts, inactive fibroblasts (fibrocytes) and fibroblasts with prominently fibrillar cytoplasm. Fibroblasts with glycogen storage and/or pseudonuclear inclusions were also seen. Macrophages and lymphocytes were scattered in the stroma, and intact nerves were also present. An irregular 2-65 microns band of 10 nm filament meshwork existed at the posterior border of the keloid stroma, and deep localised patches of climatic degeneration were detected.

Bilateral keloid-like myofibroblastic proliferations of the cornea in children

Two 6-month-old white boys developed localized multifocal white nodules of the anterior corneal stroma without evidence of antecedent trauma, inflammatory disease, or familial occurrence. The first patient had bilateral lesions initially; the second patient initially had unilateral involvement followed by a corneal nodule in the second eye at 11 years of age. Light and electron microscopic studies of the lesions in both patients were similar and disclosed stromal nodules composed of proliferating myofibroblasts, activated fibroblasts, and haphazardly arranged fascicles of collagen. Immunohistochemical studies revealed that the spindle cells within the nodules expressed immunoreactivity for vimentin and alpha-smooth muscle actin. Management options for these slowly progressive corneal lesions include lamellar versus penetrating keratoplasty and topical corticosteroids.

Management and prevention of ocular viral and chlamydial infections

A majority of cases of preventable and/or curable ocular morbidity and blindness are caused by ocular infections. They may account for 70 to 90% of all ocular morbidity seen by family doctors, general practitioners, health centers, and local ophthalmologists in both developed and developing countries. Unfortunately, most health authorities and doctors, including ophthalmologists, consider these diseases to be of little or no importance because they are not fully aware of the high prevalence of these infections and the blinding sequelae which may occur following incorrect diagnosis and treatment. Also, they are not aware of the social and economic impact of these infections in the absence of proper management and implementation of preventive measures. In this review, we examine present knowledge of chlamydial and common viral ocular infections. We discuss the problems of diagnosis, management, and prevention and propose solutions relevant to developed and developing countries.

Rubeola keratitis

Twenty-seven young adult patients with rubeola were evaluated during the acute contagious phase of their disease. Koplik's spots were present in all patients. Conjunctivitis was present in 15 of the 27 (56%), and photophobia was present in 14 of the 27 (52%). Bilateral epithelial keratitis was present in all 27 patients. This keratitis, in otherwise healthy young adults, as in healthy children, was a benign process and required no medical therapy. The epithelial lesions were very slow to resolve completely and continued to be seen at the slit lamp after the patients had become asymptomatic. Ophthalmologists may be more involved in the future in diagnosing the ocular lesions of measles (and in making the initial diagnosis of rubeola) because of the changing nature of the susceptible population group in the United States.

Corneal ulceration following measles in Nigerian children

Acute corneal ulceration in malnourished children is the commonest cause of childhood blindness in Northern Nigeria and usually develops after measles. Other severe diseases in malnourished children rarely precipitate corneal ulceration. A survey in a school for blind children showed that 69% of the children were blind from corneal disease, and a survey of children with corneal scars showed that at least 42% were caused by ulceration after measles. The clinical appearance of the active ulcers was very varied. The serum retinol-binding protein and prealbumin levels in children with corneal ulcers following measles were below normal, but a group of malnourished children without eye complaints following measles were found to have even lower levels. Thus a specific deficiency of vitamin A does not appear to be the primary cause of these ulcers, though it may be a contributory one. A specific measles keratitis and secondary herpes simplex infectious may be local factors contributing to this ulceration, and there is nearly always a background of protein calorie malnutrition. Racial factors may also be of some significance.