Eyeworld

EW MEETING REPORTER 126 March 2011 suggested some treatments for an acute chemical injury by presenting a case of a patient who accidentally doused her eye with Drano. Treat- ment options included topical and oral medications to control the in- traocular pressure, cycloplegia to control pain, oral citrate or doxycy- cline to prevent corneal melt, oral vitamin C to promote healing, and 1 week of topical steroids to reduce in- flammation. Editors' note: The doctors had no finan- cial interests related to their comments. Predicting death with the anterior segment We've all heard that the eyes are the windows to the soul, but could they also allow us to see when and how we might die? W. Barry Lee, M.D., Atlanta, thinks so. Dr. Lee presented Anterior Segment Predictors of Death. "We have a lot of chances in our field to save peoples' vision, but there are also unique opportunities to save someone's life," he said. Dr. Lee's talk focused on 20 cases he has seen in practice. In one case, a 26-year-old African-American woman came to his office with ante- rior stromal haze in the cornea. The conjunctiva, when stained with flu- orescein, showed xerosis, which looks like skin. Dr. Lee said that called for a serum vitamin A levels test, which showed a deficiency. "We don't see that much vita- min A deficiency in the United States. Internationally, this is one of the main causes of death in chil- dren, but in this country, we see a lot of GI disease," he said. A differential diagnosis of hy- povitaminosis A is gastrointestinal surgery. Dr. Lee cited a study that showed 69% of patients had a vita- min A deficiency 4 years out from the surgery that utilizes a duodenal switch. Gastric bypass surgery levels are on the rise, which may lead to an epidemic of low vitamin A levels, Dr. Lee said. According to the American Soci- ety of Bariatric Surgery, in 1992 there were 16,200 gastric bypass pa- tients. By 2009, that number had jumped to a whopping 321,000 sur- geries. "This is something to be aware of if you have a patient who is having a gastric bypass procedure," he said. "It can easily be fixed with vitamin A supplementation." Practitioners have a long list of verticillata differentials—almost 20 drugs can cause it, including amio- darone, chloroquine, hydroxy- chloroquine, indomethacin, and phenothiazines. In the next case Dr. Lee pre- sented, the patient had the lipid storage disorder called Fabry's dis- ease. "Almost 50% of the time, this is picked up by us, the ophthalmolo- gists," he said, adding that other findings include renal failure, pe- ripheral neuropathy, and skin le- sions (angiokeratomas). Findings viewed through the slit lamp may include corneal verticillata, conjunc- tival tortuosity/aneurysms, spoke- like cataracts, periorbital edema, and retinal vascular tortuosity. "The spoke-like cataract is actu- ally the pathognomonic finding in Fabry's disease," Dr. Lee said. If not detected early, the accumulation of sphingolipid in the organs can kill by renal failure, or CNS vascular thrombosis/occlusion can cause an ischemic or hemorrhagic stroke or cardiac failure. "This all can be slowed down or even prevented by an enzyme supplement. The delay of 10-15 years is bad because then this can become irreversible." In a third case, a patient pre- sented with a 2-week history of a painless red spot on the iris. Vision was normal. Dr. Lee did a biopsy, Reporting live from ASCRS Winter Update, Palm Beach, Fla. by Jena Passut and Faith A. Hayden Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team. continued from page 124

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