Yani Zdravkov
Clinic of Ophthalmology, University Hospital Alexandrovska, Medical University-Sofia, Medical Faculty, Department of Ophthalmology, Sofia, Bulgaria

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Bleach-Associated Uveitis: A Case Report Gueorgui Markov; Yani Zdravkov; Alexander Oscar
Sriwijaya Journal of Ophthalmology Vol. 6 No. 1 (2023): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v6i1.97

Abstract

Introduction: Chemical ocular injuries represent ophthalmologic emergencies with potentially blinding complications. Burns with alkalis tend to be more serious due to deeper tissue penetration as a result of colliquative necrosis. Uveitis is usually observed in higher grades of burns with significant alterations in the anterior segment of the eye. This study aimed to report a case of late-onset unilateral uveitis following a mild alkali burns with sodium hypochlorite (bleach). Case presentation: A 64-year-old Caucasian woman reported that 3 weeks ago, she had an accident with bleach coming in contact with both eyes. At that time, she had emergency ocular irrigation with saline to both eyes, and she had also used artificial tears for about a week. Besides bilateral conjunctival hyperaemia and punctate corneal epithelial erosions, no other complications had been noted. Her symptoms had subsided in several days. Upon presentation to the clinic, reduced best-corrected visual acuity was observed in both eyes to 20/30, which was attributed to age-related cataracts, normal intraocular pressure, normal conjunctiva in both eyes, the clear cornea in the right eye (OD) and several white, round, middle-sized granulomatous keratic precipitates in the left eye (OS), without epithelial and stromal alterations. The anterior chamber of OS demonstrated a 0.5+ cellular reaction. The remaining ocular status was normal. Conclusion: Based on the history of chemical ocular injury, the lack of systemic diseases and the mild form of ocular inflammation, no additional diagnostic tests were offered. The patient was started on topical dexamethasone phosphate for 1 month with an initial dose of one drop four times daily, which led to remission.
Post-Streptococcal Uveitis: A Narrative Literature Review Gueorgui Markov; Yani Zdravkov; Alexander Oscar
Sriwijaya Journal of Ophthalmology Vol. 6 No. 1 (2023): Sriwijaya Journal of Ophthalmology
Publisher : Department of Opthalmology, Faculty of Medicine, Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjo.v6i1.104

Abstract

Streptococcus spp. are gram-positive bacteria and common human pathogens and commensals, causing diseases of various organs in children and adults. They are etiological factors of scarlet fever, pharyngitis, tonsillitis, pneumonia, endocarditis, erysipelas, impetigo, meningitis, necrotising fasciitis, and sepsis, among others. The post-streptococcal syndrome is a presumed autoimmune condition that has been associated with rheumatism, reactive arthritis, glomerulonephritis, and erythema nodosum. This literature review aimed to describe post-streptococcal uveitis in clinical practice. The onset of the immune-mediated complications has varied from 7 to 35 days post-infection. The ocular complications present mainly in the form of blepharoconjunctivitis. There are anecdotal case reports of episcleritis. Keratitis is another possible complication. Preseptal or orbital cellulitis has also been described. Uveitis has been a much rarer finding, and it is hypothesized that the pathogenesis is immune-mediated rather than due to intraocular bacterial infection. Post-streptococcal uveitis has been described in cases of both group A and group B infections. The onset of uveitis has been from 1 week to 36 months after the infection. Post-streptococcal presents mostly as nongranulomatous, bilateral anterior uveitis with a good prognosis and affects mostly young people. Nevertheless, all anatomic types of intraocular inflammation have been observed. The common denominators between the varying clinical pictures appear to be the history of streptococcal infection, most frequently pharyngitis, an elevated anti-streptolysin O titer, and in the more recent studies-the raised anti-deoxyribonuclease antibodies. Furthermore, there has been a generally good therapeutic response to corticosteroids. Few cases have required immunomodulation with methotrexate, mycophenolate, and adalimumab.