Optometry Insight By Abubakar

Adenoviral Keratoconjunctivitis Leads to Persistent Ocular Surface Damage

Up to 18 months following infection, patients demonstrated substantial goblet cell loss, squamous metaplasia and measurable tear film instability, likely contributing to dry eye symptoms.

According to the study authors, these findings have several clinical implications: “First, patients recovering from AKC should be counseled about the potential for long-term dry eye symptoms and the need for continued follow-up. Second, early and aggressive anti-inflammatory treatment during the acute phase might potentially reduce the degree of goblet cell loss and subsequent dry eye development, although this hypothesis requires further investigation.” Lastly, they wrote, “long-term management strategies, including artificial tears, antiinflammatory agents and mucin secretagogues, may be necessary in patients with persistent symptoms.”

Read more: https://www.reviewofoptometry.com/article/adenoviral-keratoconjunctivitis-leads-to-persistent-ocular-surface-damage

Acute Dacryocystitis:

Acute dacryocystitis is an acute bacterial infection of the lacrimal sac, usually secondary to nasolacrimal duct obstruction (NLDO).
It results in painful swelling at the medial canthus of the eye.

Etiology (Causes)

Most common bacteria

Staphylococcus aureus

Streptococcus pneumoniae

Less common: H. influenzae, Pseudomonas, anaerobes

Predisposing factors

Nasolacrimal duct obstruction (primary acquired NLDO)

Trauma

Nasal/sinus diseases

Deviated nasal septum

Post-viral inflammation

Clinical Features / Presentation

Symptoms

Sudden onset swelling near the medial canthus

Severe pain

Redness and tenderness

Epiphora (excessive tearing)

Discharge — mucopurulent

Low-grade fever sometimes present

History of recurrent tearing before acute attack

Signs

Erythematous (red), warm, tender swelling over the lacrimal sac area
(just below the medial canthus)

Edematous skin — tense and shiny

Pressure on sac → purulent reflux through the punctum
(if canaliculi are patent)

Preauricular lymph nodes usually not enlarged (unlike viral conjunctivitis)

No periorbital involvement unless complicated

Important Clinical Point

Swelling does NOT extend above the medial canthal tendon
(helps differentiate from preseptal/orbital cellulitis)

Differential Diagnosis

Preseptal cellulitis

Orbital cellulitis

Lacrimal sac mucocele

Nasolacrimal duct obstruction without infection

Canaliculitis (infection of canaliculus)

Complications (If untreated)

Lacrimal sac abscess

Fistula formation

Preseptal cellulitis

Orbital cellulitis (rare but dangerous)

Cavernous sinus thrombosis (VERY rare)

Chronic dacryocystitis

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Investigations

Mainly clinical, but may use:

Culture & sensitivity of discharge

CBC (if systemically ill)

Imaging (CT orbit) only in severe or atypical cases

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Management

1. Acute phase treatment

A. Medical treatment

Warm compresses 3–4 times/day

Systemic antibiotics (most important):

Co-amoxiclav

Cephalexin

Clindamycin (if penicillin allergy)

Topical antibiotics (supportive):

Tobramycin

Moxifloxacin

B. Pain control

NSAIDs or paracetamol

C. Avoid

Probing during acute infection (risk of spreading infection)

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2. If abscess forms

Incision and drainage (I&D) over the sac area

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3. Definitive treatment

Once the acute infection settles:

DCR — Dacryocystorhinostomy

The definitive cure

Creates a new pathway between lacrimal sac and nasal cavity

If DCR not possible

Dacryocystectomy (DCT) (removal of sac)—rare, for elderly or non-functional sac.
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This B-scan ultrasonography image shows various posterior segment pathologies of the eye. Let’s explain each labeled part:

1. Retinal Detachment (RD) →

The bright, folded membrane seen extending into the vitreous cavity represents the detached retina.

It’s typically seen as a highly reflective V- or funnel-shaped structure that moves with eye movement.

The detachment separates the sensory retina from the underlying retinal pigment epithelium (RPE).

2. Rhegma →

“Rhegma” means a retinal tear or break.

It allows liquefied vitreous to enter beneath the retina, leading to rhegmatogenous retinal detachment.

On B-scan, the rhegma may be visible as a focal discontinuity at the site of detachment.

3. Cellularity (+) →

Indicates vitritis or vitreous inflammation/hemorrhage, seen as low-to-moderate internal echoes in the vitreous cavity.

This means there are inflammatory cells, blood, or exudates floating in the vitreous gel.

4. Lamellar Choroidal Detachment →

Seen as a smooth, dome-shaped, thick reflective line beneath the detached retina.

It represents the separation between the choroid and sclera due to fluid or blood accumulation in the suprachoroidal space.

It often accompanies severe hypotony, inflammation, or trauma.

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Vitritis (with B-scan explanation)

Definition:
Vitritis is the inflammation of the vitreous humor, the clear gel that fills the space between the lens and the retina in the eye.
It occurs due to the presence of inflammatory cells, proteins, or debris in the vitreous cavity, leading to a vitreous haze or opacity.

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Causes:

Infectious:

Toxoplasmosis

Cytomegalovirus (CMV) retinitis

Tuberculosis

Syphilis

Endophthalmitis

Non-infectious:

Sarcoidosis

Intermediate uveitis

Autoimmune uveitis

Post-operative or post-traumatic inflammation

Clinical Features:

Floaters (moving black dots or cobweb-like shadows)

Blurred or hazy vision

Mild eye discomfort

Decreased visual acuity

Fundus view may be obscured due to vitreous haze

B-Scan Ultrasonography Findings (when fundus is not visible):

Low to medium reflective echoes seen within the vitreous cavity (represent inflammatory cells or debris)

The vitreous shows mobile echoes that move with eye movement

In severe vitritis, the echoes may appear dense or clumped, sometimes mimicking vitreous hemorrhage

Retina remains attached (helps differentiate from retinal detachment).

Treatment:

Corticosteroids (topical, periocular, or systemic depending on severity)

Antibiotics/antivirals if infection is present

Immunosuppressive therapy for autoimmune causes

Pars plana vitrectomy in resistant or severe cases

1. Retinal detachment — Separation of the retina from the underlying tissue (choroid), causing vision loss if not treated.

2. Intraretinal cyst — A fluid-filled pocket or swelling within the layers of the retina, often due to retinal disease or degeneration.

3. Hyalid detachment — Separation of the posterior hyaloid membrane (part of the vitreous) from the retina, commonly seen with aging or after vitreous changes.

White Cane Safety Day 16 October 2025.
Purpose of this Day:
1.Promoting Awareness
2.Celebrating Achievement
3.Advocating for inclusion
4.Raising Visibility
5.Empowering Individual