12/26/2023 0 Comments Itchy eye one pupil dilated![]() ![]() The patient had no reaction to either drop (checked 45 minutes after instillation and the following day). At the subsequent visit, the patient agreed to undergo testing to determine the culprit via instillation of proparacaine in one eye and tropicamide in the other. Through a careful and extensive chart review of all past visits, it was suspected that phenylephrine might be to blame rather than proparacaine. The plan was to educate the patient of the possibility of allergic reaction on future visits and to recommend continued use of artificial tears as needed. The assessment was acute allergic conjunctivitis thought to be secondary to an AE to proparacaine OU, yet the need to rule out hypersensitivity to tropicamide and/or phenylephrine remained. Slit-lamp evaluation revealed mild blepharitis OU, trace bulbar conjunctival injection OU, and complete resolution of the keratitis OU. His best-corrected visual acuity was 20/20-2 OD and 20/20 OS. The patient was scheduled to return in 2 weeks for an anterior segment follow-up.Īt the next follow-up visit, the patient reported that his vision had returned to normal, and he had no further ocular AEs. After 3 days, he was instructed to discontinue them. Due to improving punctate epitheliopathy, the frequency of the antibiotic drops, the prednisolone, and the artificial tears was reduced to bid. Slit-lamp evaluation revealed 1+ bulbar conjunctival injection OU, intact corneal epithelium OU, and no cells or flare in the anterior chambers OU. His best-corrected visual acuity was 20/40-2 without improvement on pinhole OD and 20/50-2 with improvement to 20/30+ on pinhole OS. The patient was scheduled to return to clinic 4 days later for an anterior segment follow-up.Īt the follow-up visit, the patient reported significant visual improvement. The plan was to start the patient on antibiotic eye drops qid OU, prednisolone qid OU, and artificial tears every hour OU. The initial diagnosis was acute chemical conjunctivitis most likely due to an AE to proparacaine. Grade 2+ Filamentous Strands With Dense Superficial Punctate KeratitisĪ, Stained with fluorescein under cobalt blue light. ![]() The level of vision loss was consistent with the degree of keratitis observed OU. Due to concern for allergic reaction to tropicamide or phenylephrine, the patient was not redilated. Lens exam revealed modest nuclear sclerosis OU. Anterior chamber angles were open, but it was difficult to assess for cells and flare through the hazy corneas. The corneas had 2+ filamentous strands with dense superficial punctate keratitis bilaterally ( Figures 2a & 2b). A marked papillary reaction and 3+ bulbar conjunctival injection in both eyes (OU) also was evident. Slit-lamp evaluation revealed the lids to be lax, erythematous, and edematous in both eyes ( Figure 1). Intraocular pressures were not obtained due to concern for a possible adverse reaction to proparacaine. Pupils and extraocular motilities were unremarkable. The best-corrected visual acuity 2 days prior had been 20/20 OD and OS. The patient’s best-corrected visual acuity was counting fingers at 2 feet in the right eye (OD) and left eye (OS). At the most recent eye exam, proparacaine and fluorescein had been used for tonometry, and phenylephrine 2.5% and tropicamide 0.5% had been used for pupillary dilation. The patient noted he had experienced similar symptoms on a few other occasions following eye exams. He further compared the feeling to pins sticking in his eyes. The patient reported onset of blurred vision, which he described as looking through a fog. An 83-year-old white male presented for a red eye evaluation 2 days after having undergone a comprehensive eye exam with dilation at the Malcom Randall VAMC clinic in Gainesville, Florida. ![]()
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