Ocular infections--diagnosis.

The identification and understanding of subtle signs in the ocular and periocular region will usually result in an accurate diagnosis without extensive investigations. The natural history of these diseases makes it possible for general practitioners to manage conjunctivitides, lid infections, and dacryocystitis if the conditions are not complicated by intraocular or corneal involvement. Endophthalmitis or infected corneal ulcers require urgent referral-any delay, even a matter of hours, can result in progression of the disease such that a successful outcome may be impossible. Because of the extreme sensitivity of vision as a monitor of corneal or intraocular changes, and the ease with which pathological processes can actually be seen, the identification and diagnosis of ocular infections and their appropriate treatment are relatively easy and extremely rewarding. The results of treatment are usually observable within 24 hours. All patients with suspected ocular and periocular infections ought to be reviewed in one day, and referred if they are not responding to treatment as expected

Conjunctivitis.

Most cases of conjunctivitis are either viral in origin, which makes them extremely contagious and usually self-limited, or bacterial, which usually requires topical antibiotic therapy. Prolonged follicular conjunctivitis should be considered chlamydial in origin and requires systematic antibiotic therapy

Treatment of pterygia in Queensland

All practising ophthalmologists in Queensland completed a written survey on their current methods of treatment of pterygia. The indications for surgical removal, in decreasing order of importance, were mainly size, symptomatic complaints, cosmetic appearance and activity. Most surgeons graded pterygia into a variety of classifications. The most common form of treatment for primary pterygia was simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together followed by bare sclera technique, and simple excision plus thiotepa drops. For recurrent pterygia simple excision plus beta-irradiation was the most common form of treatment, followed by simple excision plus thiotepa drops and simple excision plus mobilisation of conjunctiva and suturing conjunctival free edges together. A third of the ophthalmologists electively avoid cautery use during pterygium surgery, while almost a quarter of the ophthalmologists attempt to polish the corneal and limbal region. When beta-radiation or Thiotepa is used there is a general consensus on the dosage for each of these. Seventeen per cent of ophthalmologists said they had not encountered any complications after pterygium surgery with the remainder quoting corneoscleral necrosis from beta-radiation and Tenon's granuloma as the most common complications. It would appear that there is no consensus on the best way to treat pterygia in Queensland, which probably reflects the lack of scientific proof for one method being superior to another

Efficacy of a training programme designed to teach cervical smear screeners to identify ocular surface squamous neoplasia using conjunctival impression cytology

Ocular surface squamous neoplasia (OSSN) is a recently proposed term introduced to encompass both intraepithelial neoplasia and invasive squamous cell carcinoma of the conjunctiva and cornea. A teaching programme incorporating at manual, slide sets, and an evaluation test was developed. The aim was to teach experienced cervical smear screeners to evaluate ocular surface specimens collected by conjunctival impression cytology, with a minimum of individual tuition. The use of the manual was well accepted and half of the original six candidates were able to master the new skill adequately within 8 h. It was considered that the differences between the cytology of OSSN and the equivalent lesions of the uterine cervix are sufficient to prevent some experienced screeners acquiring these skills rapidly

Steroid sensitive Acanthamoeba keratitis

A 44-year-old woman with proven Acanthamoeba keratitis was successfully treated medically with resultant 6/9 vision. During the treatment, repeated attempts to titrate the patient off topical corticosteroids resulted in recurrent flare-up of inflammatory keratitis from which Acanthamoeba could not be recultured. It is suggested that steroid administration during the course of Acanthamoeba keratitis may need to be withdrawn extremely slowly to avoid the recurrence of what appears to be an immunological corneal reaction