Connie L. Chronister

Review of external ocular disease associated with aids and HIV infection.

External ocular disease associated with human immunodeficiency virus (HIV) infection can often be overlooked by the eye care practitioner. Different types of external ocular disease can be an indication of the patients overall immune status as well as the stage of HIV infection. The external ocular sequelae of HIV infection can be of visual consequence for the patient. Eye care practitioners need to become familiar with these conditions. The diagnosis and management of the following ocular conditions associated with HIV infection are reviewed: conjunctival microvascular disease, dry eye, allergic conjunctivitis, microsporidial keratoconjunctivitis, herpes zoster ophthalmicus, herpes simplex keratitis, molluscum contagiosum, fungal keratitis, bacterial keratoconjunctivitis, and Kaposis sarcoma (KS).

Structural damage to Schiotz tonometers after disinfection with solutions.

Although Schiotz tonometry has been long ago replaced by Goldmann applanation tonometry measurement of intraocular pressure, it remains a viable clinical technique in nursing homes and other ”out of office” settings. Because Schiotz tonometers come into contact with the cornea and tear film, they must be properly disinfected to prevent cross-infection with HIV and other infectious pathogens. The Centers for Disease Control and Prevention (CDC) recommends that all eye contact devices be disinfected by a 5- to 10-min soak in one of following disinfectants: 3% hydrogen peroxide, 1:10 sodium hypochlorite (household bleach), or 70% isopropyl alcohol. The effects of these disinfectants on Schiotz tonometers have not been previously investigated. This study investigated the effects of CDC-recommended disinfectants on the structural integrity of Schiotz tonometers. The results of the study indicated that soaking in 1:10 sodium hypochlorite and 3% hydrogen peroxide damaged Schiotz tonometers and rendered them inoperable. Alcohol caused minor damage to the tonometer and was the safest of the CDC disinfectants. This study showed there is limited application of CDC infection control criteria to Schiotz tonometers due to the extensive corrosion and damage caused by hydrogen peroxide and bleach.

Congenital retinal macrovessel

Congenital retinal macrovessel is a rare condition in which anomalous retinal vessels cross the macula. Visual impairment can result if the anomalous vessels pass across the foveola, if foveolar cysts form, or if hemorrhage occurs. A now 17-year-old African-American female has an anomalous retinal vein that crossed the macular region beyond the horizontal raphe in her left eye. This patient exhibited the classic characteristics of congenital macrovessels. Her visual acuity remained unaffected after a 5-year follow-up and therefore treatment was not required.

Structural alteration of tonometer tips after repeated swabbing with disinfectants.

Our study was developed to measure the effect of swabbing on the integrity of Haag-Streit tonometer tips over time. The following solutions were used: hydrogen peroxide, dilute bleach, alcohol, phenol-phenate, and distilled water (as a control). The results show that swabbing causes surface scratching of tonometer tips after 1 year. The results also show that alcohol swabbing will lead to breakdown of the glue and warrant replacement of the tonometer tip after 2 years use.

Leber's hereditary optic neuropathy: a case report

BACKGROUND Lebers hereditary optic neuropathy (LHON) is a bilateral optic neuropathy of mitochondrial inheritance that produces significant painless, central vision loss and dyschromatopsia. LHON usually occurs in young males between the ages of 15 and 30 years and manifests an episode of subacute or acute vision loss in one eye, with the opposite eye becoming involved weeks to months later. Approximately 80% to 90% of all LHON patients are male. While the disease usually presents itself around the third decade of life, its onset ranges anywhere from 5 to 80 years. CASE REPORT We report a case of an uncooperative 12-year-old Hispanic boy who was brought to our group practice following referral from an outside optometrist for amblyopia therapy. Following the workup by the binocular vision clinician, a neuro-ophthalmic consultation was obtained, eventually leading to the diagnosis and confirmation of LHON. CONCLUSION Lebers hereditary optic neuropathy may manifest signs and symptoms that mimic common ophthalmic entities. Teenage males often are reluctant to report its subtle clinical findings, making its discovery even more challenging. LHON should be kept in mind as a possibility for anyone who manifests unexplained visual loss.

Literature review of hepatitis B : should eye care practitioners receive a hepatitis B vaccine ?

The incidence of Hepatitis B infection has been steadily increasing over the last 5 years. The current literature has established that eye care practitioners are in the high risk category for contracting and transmitting this serious viral infection. Hepatitis B Virus (HBV) is present in all bodily fluids including tears and is considered to be more easily transmitted with a higher degree of infectiousness than Human Immunodeficiency Virus (HIV). Fortunately, unlike Acquired Immune Deficiency Syndrome (AIDS), hepatitis can be prevented with a vaccine. Recent improvements in the hepatitis vaccine have made it safer and more effective. As optometrists expand their scope of practice, it becomes essential to increase the knowledge base and awareness of this clinical entity so informed decisions can be made regarding vaccination by eye care practitioners, teaching faculty, and students.

Progressive outer retinal necrosis in a patient with acquired immune deficiency syndrome

Progressive outer retinal necrosis (PORN) is a necrotising retinal infection with secondary inflammation known to affect immunocompromised patients typically seen secondary to acquired immune deficiency syndrome (AIDS). The most common aetiology is the herpes zoster virus (HZV). Combinations of intravenous and intravitreal antivirals are the mainstay of treatment. We present a case of vitreous aspirate polymerase chain reaction negative PORN that responded to antiviral treatment in a severely immunocompromised patient with AIDS.

Serologic confirmation of HIV infection.

As the number of patients with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) increases, it is important for eye care practitioners to become familiar with the serologic testing used in testing for HIV infection. These tests include: HIV-ELISA (enzyme linked immunosorbent assay), HIV-Western Blot, PCR (polymerase chain reaction) gene amplification, p24 core antigen assay, Beta 2-microglobulin levels, and CD4 lymphocyte counts. This Symposium discusses the aforementioned serologic tests and their uses in the diagnosis and management of HIV infection.