Lids And Conjuctiva

Introduction

Several distinct signs can identify conjunctival and lid inflammation. The actual presentation depends on the nature of the causative agent and others. A patient come to clinic after a year of her first visit with the same symptoms; burning and discomfort when using her contact lens, specifically at the morning. After the comprehensive exam and ocular health assessment signsreveal papillas, conjunctival injection-red eye, crust on lid margins, being diagnose with allergic conjunctivitis and blepharitis. Patient never come to her last schedule follow up.

Case Report

Patient, 24year-old, latin female, present to our clinic on September 9, 2011. Patient comes to clinic complaining about itching when using contact lens at morning. Also she wants a new prescription ofcontact lenses. She reported that she has good vision with her actual spectacle prescription. Patient’s ocular history reports blur vision without spectacle or contact lens. The contact lens patient uses are Acuvue Oasis monthly, cleaning solution Biotrue and Blink for daily drops. The patient’s last eye exam was September 2010, one year before for a new spectacle and contact lens prescription. Heractual prescription was given September 2010 and she uses prescription since she was ten years old. Patient medical history reveals environmental allergy to dust, odors, pollen. Patient reports having sinusitis occasionally and uses Claritin-D non-drowsy and Sudaphed as needed. Last medical exam was September 2011 for symptoms of sinusitis. Patient admits to drink socially approximately three tofour beers per week. Family ocular history reports cataracts and glaucoma in some family members. Blood pressure was measure 112/65 mmHg RA. Patient was oriented to time, place and person.
Her visual acuity was 400/3’ at distance and 20/20 at near both OD and OS without correction. Pinhole visual acuity report 20/40 OD and @0/50 OS. Corrected visual acuity was 20/20 OD and OS using her actualprescription of -3.75 DS OU. Pupils were equally round and reactive to light, no afferent pupil defect was noted OU. Cover test report orthophoria at distance and 4^ exophoria at near. Extraocular muscles moves smooth, accurate, full and extensive in all gazes OD, OS and OU. Stereo Acuity was performed revealing 20 secs of arc using Randot Stereo Test. Confrontation fields was full finger count OU.Color vision test was performed with Ishihara, 13/13 OD, OS. Near point of convergence was 13/12/17 and near point of accommodation was 9.09 diopters OU. Anterior segment evaluation with the slit lamp revealed oily scales on eyelashes and lid adnexa OU; redness and papillas +3 on superior conjunctiva also redness on nasal cantus of bulbar conjunctiva, OU; pannus on top of cornea OU; both iriswere flat and healthy; lens clear and anterior chamber deep and quiet, OU. Von Herrick angles were 4X4 OU. Before taking the intraocular pressure one drop of propacaine OU was instilled and then performed goldmann tonometry: 14 mmhg OU. Ophthalmoscope reveals optic nerves with cup to disc ratio of .3/.3 OU. The neuroretinal rims were healthy, intact, and salmon-pink color, disc margin distinct withsome pigmentation. Retinal vessels appeared normal with a ratio of 2/3 OU. Positive venous pulsation in both eyes presented. Macula had positive foveal reflect with no abnormal macular findings. Vitreous and media clear. Dilation exam was not performed because she came alone and driving.
Keratometry values were 45.5 @180/46.00 @090 cc -0.50 MCC OD; 45.25@180/45.75 @090 cc -0.50 MCC OS.Refraction was performed obtaining as a result in the objective -5.00-0.25 X180 OD, VA 20/20; -3.75-0.50 X180 OS VA 20/20. Monocular subjective refraction -3.75 DS OD VA 20/20; -3.25-0.50 X180 OS VA 20/20. After performing binocular balance the result for refraction was -3.25 DS OD VA 20/20; -3.25-0.25 X180 OS VA 20/20. After performing trial frame to confirm the results patient was given with a...