James F. McDonnell

Ocular complications of thermal injury: a 3-year retrospective.

BACKGROUND Diagnosis and treatment of thermal ocular injuries are often delayed because facial burns are usually associated with life-threatening injuries requiring immediate intervention. The purpose of the present study is to review the diagnosis and management of ocular complications associated with thermal burns in a tertiary care burn unit. METHODS In this retrospective study, the charts of patients admitted to the Loyola University Medical Center Burn Unit between January 1993 and January 1996 were reviewed. RESULTS Of the 1,461 patients who were admitted to the burn unit during that period, 155 (10.6%) required ophthalmic consultation. Sixty-one patients (4.2%) had ocular injury, the most common type being periorbital burn and edema followed by corneal involvement. Thirty-one of the 61 patients (51%) received consultation on the day of admission. Six of the 61 patients (10%) required surgical intervention. There was no correlation between number of days to consultation and need for surgical intervention. Patients requiring surgery were more likely to have suffered third-degree burns. CONCLUSION Because it is difficult to predict which patients suffering from thermal burns involving the eyes will require surgical intervention, ophthalmic consultation should be sought early.

BILATERAL PERIPHERAL ULCERATIVE KERATITIS ASSOCIATED WITH PYODERMA GANGRENOSUM

PURPOSE A 37-year-old Hispanic man with a history of chronic myelogenous leukemia was first seen with fever and preseptal cellulitis of this right orbit after a tooth extraction. METHODS The patient subsequently developed bilateral, severe peripheral ulcerative keratitis. He was treated with systemic antibiotics for a presumed underlying infectious cause. Several painful, necrotizing skin lesions developed over his face, trunk, and extremities. RESULTS Repeated skin biopsies of the necrotizing lesions were consistent with pyoderma gangrenosum. Both the skin lesions and peripheral ulcerative keratitis responded dramatically to systemic prednisone. CONCLUSIONS Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis.

Successful management of pediatric high anisometropia using traditional treatment methods: a case series.

Purpose To report visual results in pediatric patients with high anisometropia following aggressive amblyopia treatment using traditional methods. Methods Charts of one physician, JM, were reviewed at a major university medical center for all patients with anisometropia of eight diopters or greater. Patients ranged from children with severe unilateral high myopia due to retinopathy of prematurity to one infant with severe microphthalmos, acoria, and congenital cataract. Four patients were identified. Final Snellen acuities were reported from the patients last clinic examination. Average follow-up period was four years. Results Final visual acuities of involved eyes ranged from line Snellen 20/60 to 20/20. One patient with severe microphthalmos, congenital acoria, congenital cataract, and anisometropia of 40 diopters achieved a final Snellen visual acuity of 20/40 OS. No patients developed visual loss in the normal eye due to patching. No patients were lost to follow-up. Conclusion Based on our observations, excellent visual outcomes may be achieved in pediatric patients with high anisometropia by aggressive use of conventional occlusion and refractive methods.