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There are an estimated 2–3 million emergency department (ED) visits in the United States for eye complaints. Although most patients who present to the ED have nontraumatic eye complaints, many seek treatment for eye trauma, which is a leading cause of unilateral blindness and vison impairment. Given the prevalence of eye-related emergencies, it is imperative that emergency care providers understand how to recognize and treat eye complaints to prevent permanent vision loss and disability. This article covers basic eye anatomy and physiology, discusses a systematic approach to the eye examination, and presents the evidence-based treatment of selected, common nonemergent and emergent eye complaints. For each complaint, essential history questions, examination techniques, differentials, and emergency management have been presented [ABSTRACT FROM AUTHOR]

Purpose: To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema., Methods: A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients., Results: This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation., Conclusions: The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: Since 2009, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study has been assessing in vitro antibiotic resistance for bacterial isolates sourced from ocular infections in the US. The main goal of this systematic review was to compare in vitro resistance data for ocular pathogens from published US studies with the most recently published data from the ARMOR study (2009–2018) and, where possible, to evaluate trends in bacterial resistance over time over all studies. Methods: A literature search was conducted using MEDLINE®, BIOSIS Previews®, and EMBASE® databases (1/1/1995–6/30/2021). Data were extracted from relevant studies and antibiotic susceptibility rates for common ocular pathogens (Staphylococcus aureus, coagulase-negative staphylococci [CoNS], Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae), longitudinal changes in susceptibility, and multidrug resistance (MDR) were compared descriptively. Results: Thirty-two relevant studies were identified. High in vitro resistance was found among S. aureus and CoNS to fluoroquinolones, macrolides, and methicillin/oxacillin across studies, with high rates of MDR noted, specifically among methicillin-resistant staphylococci. Data from studies pre-dating or overlapping the early years of ARMOR reflected increasing rates of S. aureus resistance to fluoroquinolones, macrolides, methicillin/oxacillin, and aminoglycosides, while the ARMOR data suggested slight decreases in resistance to these classes between 2009 and 2018. Overall, methicillin-resistant S. aureus (MRSA) prevalence peaked from 2005 to 2015 with a possible decreasing trend in more recent years. Discussion and Conclusions: Data from local and regional US datasets were generally consistent with data from the national ARMOR surveillance study. Continued surveillance of ocular bacterial pathogens is needed to track trends such as methicillin resistance and MDR prevalence and any new emerging antibiotic resistance phenotypes. Susceptibility data from ARMOR can inform initial choice of therapy, especially in practice areas where local antibiograms are unavailable. [ABSTRACT FROM AUTHOR]

To analyze the incidence of baseball-related ocular injuries, mechanisms commonly associated with precipitating trauma, and secondary visual sequelae, and explore the age and sex-specific variations in the distributions of these variables. Baseball-related ocular injuries presenting to the emergency department (ED) were identified using the National Electronic Injury Surveillance System for 2011 through 2020. Age, sex, diagnosis, mechanism of injury, visual sequela, and patient disposition were analyzed. Statistical comparisons were performed using the chi-square test and Fisher exact test. 558 ED presentations were captured, translating to an average national incidence of 1,492 events. The incidence of trauma declined notably. Most encounters involved pediatric (≤18) and male patients (82.6% and 87.6%, respectively). Patients commonly presented with contusions or abrasions (41.4%). Contact with the baseball was the most frequently mentioned mechanism of injury (87.6%). There was a significant age-related (P = 0.009) difference in the distributions of diagnoses. 7.3% of patients had a visual sequela. There was a declining incidence of baseball-related ocular injuries presenting to the ED. However, the long-term complications of injuries could not be explored. Further efforts are required to understand the implications of ocular injuries to ensure patients receive appropriate protections. [ABSTRACT FROM AUTHOR]

Ocular injuries and unintended exposures involving electronic nicotine delivery systems (ENDS), also known as e-cigarettes, have been reported. However, trends and characteristics of ENDS-related ocular exposures at the population level are not well documented. This study was designed to describe trends and characteristics of ENDS-related ocular exposure cases reported to poison control centers (PCCs) in the U.S. We computed descriptive statistics of ENDS-related ocular exposure cases reported to PCCs between January 1, 2010 and December 31, 2019, including number of cases per year and the distribution of characteristics of those cases. We also summarized case narrative review findings. A total of 1,393 ENDS-related ocular exposure cases were reported to PCCs during the study period. Overall number of cases increased from two in 2010 to a peak of 389 in 2014, followed by a steady decline in 2015–2018. Of the 1,393 cases, 42.5% occurred among individuals aged 25 years and older; 20.4 and 17.7% occurred among young adults aged 18–24 years and children younger than five years, respectively. Nearly one quarter (23.8%) of the individuals experiencing ocular exposure sought or were recommended to seek medical attention. Case narrative review found that 59 of 127 (46.5%) cases were due, at least in part, to incorrect use or handling of the products. Our study shows that more than 1,000 ENDS-related ocular exposure cases were reported to PCCs during the study period. Many of these cases involved young children; nearly half were due, at least in part, to incorrect use or handling of the products. Future efforts to prevent these exposures may focus on improving the awareness of the potential harmful effects of ENDS products and the importance of appropriate handling of ENDS products. Health care professionals may play an important role in educating patients and improving surveillance of ENDS-related ocular exposure cases. [ABSTRACT FROM AUTHOR]

This epidemiological study examined ocular and orbital lymphomas in the United States from 1995 to 2018, using data from the North American Association of Central Cancer Registries database of 87,543 patients with ocular and adnexal malignancies. We identified 17,878 patients (20.4%) with ocular and orbital lymphomas, with an age-standardized incidence rate (ASIR) of 2.6 persons per million (ppm). The incidence was the highest in the orbit (ASIR = 1.24), followed by the conjunctiva (ASIR = 0.57). Non-Hodgkin B-cell lymphoma was the most prevalent subtype (85.4%), particularly marginal-zone lymphoma (45.7%). Racial disparities were noted, with Asia-Pacific Islanders showing the highest incidence (orbit, 1.3 ppm). The incidence increased significantly from 1995 to 2003 (Average Percent Change, APC = 2.1%) but declined thereafter until 2018 (APC = - 0.7%). 5-year relative survival (RS) rates varied, with the highest rate for conjunctival lymphoma (100%) and the lowest for intraocular lymphoma (70.6%). Survival rates have generally improved, with an annual increase in the 5-year RS of 0.45%. This study highlights the changing epidemiological landscape, pointing to initial increases and subsequent decreases in incidence until 2003, with survival improvements likely due to advancements in treatment. These findings underscore the need for further research to investigate the root causes of these shifts and the declining incidence of ocular lymphoma., (© 2024. The Author(s).)

Nail glue often consists of a mixture of alcohol, cyanoacrylate, or photo-bonded methacrylate. Ocular exposures to nail glue may result in potentially serious clinical effects, and patients may be treated at healthcare facilities. The objective of this study was to characterize ocular nail glue exposures treated at United States emergency departments. Data were obtained from the National Electronic Injury Surveillance System, a database of consumer product-related injuries collected from approximately 100 United States hospital emergency departments. Ocular nail glue exposures reported during 2000–2019 were identified by reviewing all records with product code 0909 (Adhesives) and with "nail" and "glue" or "nail" and "adhesive" in the Narrative field. A total of 498 ocular nail glue exposures were identified, resulting in a national estimate of 18,402 exposures. Of the estimated exposures, the age distribution was 14.1% 0–5 years, 15.1% 6–12 years, 14.3% 13–19 years, and 56.6% 20 years or older; 87.5% of the patients were female. The nail glue was mistaken for eye drops in 20.8% of the cases, splashed into the eye in 15.0% cases, and rubbed into the eye in 3.3% cases. The most commonly reported clinical effects were 41.8% foreign body, 33.8% corneal abrasion, and 11.0% conjunctivitis. The most common circumstance leading to ocular nail glue exposures treated at United States emergency departments involved nail glue being mistaken for eye drops. The most frequently reported clinical effects were the presence of a foreign body, corneal abrasion, and conjunctivitis. [ABSTRACT FROM AUTHOR]

Orbital metastases from breast cancer ( BC) are rare, but often debilitating. BC accounts for nearly half of metastases to the orbit. Orbital metastases may be discovered years after the initial diagnosis of BC, and are rare at initial presentation. A search of the institutional data base at an academic cancer center identified BC patients who developed or presented with orbital metastases from 2000 to 2013. Baseline characteristics, treatment modalities, survival and treatment responses were collected from the electronic medical record. There were 20 patients identified with orbital metastases (0.7% of all BC cases). The median age at diagnosis of BC was 49 years; 80% had estrogen positive disease. The interval between the initial diagnosis of BC and the presentation of orbital metastases was 8.5 years (0-19 years). Orbital disease was the initial presentation of BC in two cases. Three patients developed bilateral orbital metastases and seven had accompanying brain metastases. The most common presentation was decreased vision (55%), followed by diplopia (25%). The median survival after orbital metastases was 24 months. Thirteen patients (65%) received local radiation therapy. Of those radiated, 90% reported improvement of orbital symptoms. Other treatments included intraocular bevacizumab, surgery, and systemic therapy. Orbital metastases tend to occur in estrogen receptor positive disease and are often found years after BC onset. Orbital metastases may be associated with the development of brain metastases. Radiotherapy is the preferred local therapy and had high symptom control in this cohort. Oncologists should be aware of the signs of orbital metastases and the treatment options. [ABSTRACT FROM AUTHOR]

Nepafenac ophthalmic suspensions, 0.1% (NEVANAC ® ) and 0.3% (ILEVRO™), are topical nonsteroidal anti-inflammatory drug (NSAID) products approved in the United States, Europe and various other countries to treat pain and inflammation associated with cataract surgery. NEVANAC is also approved in Europe for the reduction in the risk of postoperative macular edema (ME) associated with cataract surgery in diabetic patients. The efficacy against ME suggests that topical administration leads to distribution of nepafenac or its active metabolite amfenac to the posterior segment of the eye. This article evaluates the ocular distribution of nepafenac and amfenac and the extent of local delivery to the posterior segment of the eye, following topical ocular instillation in animal models. Nepafenac ophthalmic suspension was instilled unilaterally in New Zealand White rabbits as either a single dose (0.1%; one drop) or as multiple doses (0.3%, one drop, once-daily for 4 days, or 0.1% one drop, three-times daily for 3 days and one morning dose on day 4). Nepafenac (0.3%) was also instilled unilaterally in cynomolgus monkeys as multiple doses (one drop, three-times daily for 7 days). Nepafenac and amfenac concentrations in harvested ocular tissues were measured using high-performance liquid chromatography/mass spectrometry. Locally-distributed compound concentrations were determined as the difference in levels between dosed and undosed eyes. In single-dosed rabbit eyes, peak concentrations of locally-distributed nepafenac and amfenac showed a trend of sclera > choroid > retina. Nepafenac peak levels in sub-samples posterior to the eye equator and inclusive of the posterior pole (E-PP) were 55.1, 4.03 and 2.72 nM, respectively, at 0.25 or 0.50 h, with corresponding amfenac peak levels of 41.9, 3.10 and 0.705 nM at 1 or 4 h. By comparison, peak levels in sclera, choroid and retina sub-samples in a band between the ora serrata and the equator (OS-E) were 13- to 40-fold (nepafenac) or 11- to 23-fold (amfenac) higher, indicating an anterior-to-posterior directional concentration gradient. In multiple-dosed rabbit eyes, with 0.3% nepafenac instilled once-daily or 0.1% nepafenac instilled three-times daily, cumulative 24-h locally-distributed levels of nepafenac in E-PP retina were similar between these groups, whereas exposure to amfenac once-daily dosing nepafenac 0.3% was 51% of that achieved with three-times daily dosing of 0.1%. In single-dosed monkey eyes, concentration gradients showed similar directionality as observed in rabbit eyes. Peak concentrations of locally-distributed nepafenac were 1580, 386, 292 and 13.8 nM in E-PP sclera, choroid and retina, vitreous humor, respectively, at 1 or 2 h after drug instillation. Corresponding amfenac concentrations were 21.3, 11.8, 2.58 and 2.82 nM, observed 1 or 2 h post-instillation. The data indicate that topically administered nepafenac and its metabolite amfenac reach pharmacologically relevant concentrations in the posterior eye segment (choroid and retina) via local distribution, following an anterior-to-posterior concentration gradient. The proposed pathway involves a choroidal/suprachoroidal or periocular route, along with an inward movement of drug through the sclera, choroid and retina, with negligible vitreal compartment involvement. Sustained high nepafenac concentrations in posterior segment tissues may be a reservoir for hydrolysis to amfenac. [ABSTRACT FROM AUTHOR]

Introduction: Ocular complaints represent a sizeable burden to emergency departments, accounting for an estimated 2.4 million ED visits annually. We sought to characterise visits associated with ocular injury and examine factors contributing to inpatient admission.Methods: We searched the Nationwide Emergency Department Sample between 2006 and 2011 and identified cases in which patients presented with a primary or secondary diagnosis of ocular trauma. We described these cases according to age, sex, external mechanism of injury, payer status, and identified relationships between these variables. Logistic regression models were employed to identify crude and adjusted relative odds of admission to inpatient status based on patient demographics, mechanism of injury, payer status, and the existence of multiple injuries.Results: Between 2006 and 2011, a total of 5541,434 visits were made to EDs in the United States with a primary or other diagnosis of ocular trauma; ocular trauma was the primary diagnosis in 77.9% of these cases. Overall, mean age at presentation was 33.8 years and the majority of patients were male (64.8%). Male sex, older age, being struck by or against an object, the existence of multiple injuries, and Medicaid as a primary payer were all associated with significantly higher odds of hospital admission.Discussion: The distribution of primary external mechanism of injury suggested that individuals are at higher risks for different injury types at each successive stage of life. Age and injury mechanism were correlated with odds of admission to inpatient status, with the highest odds among older adults who had been injured by being struck by or against an object.Conclusions: Ocular injury plays a substantial role in the ED. Further work is necessary to determine whether developing and implementing age- and sex-appropriate prevention strategies could reduce the incidence of ocular injury and reduce morbidity related to these types of injuries. [ABSTRACT FROM AUTHOR]

Since 1991, 53 cases of canine ocular onchocerciasis have been reported in the literature worldwide, 43 of these were from Greece, five from Hungary, and five from the western United States. Information on the histopathologic features of canine ocular onchocerciasis is limited. We describe the histopathologic features of canine ocular onchocerciasis in two dogs from California that presented clinically with firm episcleral nodules and uveitis unilaterally. Pertinent literature and pathogenesis are reviewed; recognizable clinical features and treatment are discussed. The cases presented were diagnosed via histopathology of the enucleated globes and episcleral granulomas at the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW). Positive identification of adultOnchocercawithin episcleral granulomas was made based on light-microscopy features. Histopathologic examination of both globes revealed episcleral parasites surrounded by granulomas containing few to moderate numbers of eosinophils. Other sequelae, in both cases, included lymphoplasmacytic uveitis, preiridal fibrovascular membranes, peripheral anterior synechiae, retinal degeneration, and optic nerve head cupping. Both male and female worms were present, as werein uteromicrofilariae in both cases. Worms in both cases were tentatively identified asOnchocerca lienalis. Ocular onchocerciasis should be a differential consideration in cases of canine conjunctival nodules or periorbital swelling, particularly in dogs from the western United States. [ABSTRACT FROM AUTHOR]

Purpose: Soccer participation within the United States continues to increase, necessitating consideration of the various injuries that may occur. The present study analyzes trends in the incidence of ocular injuries secondary to soccer trauma, the associated mechanism, and related visual sequelae, and quantifies age- and sex-specific differences in the distributions of these variables., Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) was queried for soccer-related ocular injuries from 2010 through 2019. Data exclusively focused on the globe were selected, and information regarding age, sex, specific diagnosis, mechanism of injury, and visual sequelae were acquired. Significance was calculated using the chi-squared test., Results: 628 NEISS entries were evaluated, extrapolating to a national average incidence of approximately 1580 soccer-related ocular injuries per year. There were a relatively static number of events during the ten-year time period of study. The most common diagnoses were contusions or abrasions (36.1%); among records with a reported mechanism of injury, the most common was contact with the soccer ball (80.9%). Visual sequelae were noted in a significant minority of patients (15.4%). Patients ≤18 and males comprised the majority of visits (68.2% and 70.2%, respectively). Significant sex- and age-specific differences were observed in the distributions of diagnoses., Conclusions: There are serious visual consequences associated with soccer-related ocular injury. Despite the existence of eye protection, there remain no regulations requiring its consistent use. Therefore, among all parties involved (e.g., players, families, and physicians), there remains a need to increase education regarding the potential ocular dangers associated with the sport.

We tested all samples from patients with ocular toxoplasmosis sent to the Palo Alto Medical Foundation Toxoplasma Reference Laboratory from June 2004 through August 2010 for serologic evidence of recent Toxoplasma gondii infection. Of 205 patients aged 10–96 years, 11.7% had recent infection. Many people develop ocular disease soon after T. gondii infection. [ABSTRACT FROM PUBLISHER]

Chronic graft-versus-host disease (GVHD) can be associated with significant morbidity, in part because of nonreversible fibrosis, which impacts physical functioning (eye, skin, lung manifestations) and mortality (lung, gastrointestinal manifestations). Progress in preventing severe morbidity and mortality associated with chronic GVHD is limited by a complex and incompletely understood disease biology and a lack of prognostic biomarkers. Likewise, treatment advances for highly morbid manifestations remain hindered by the absence of effective organ-specific approaches targeting "irreversible" fibrotic sequelae and difficulties in conducting clinical trials in a heterogeneous disease with small patient numbers. The purpose of this document is to identify current gaps, to outline a roadmap of research goals for highly morbid forms of chronic GVHD including advanced skin sclerosis, fasciitis, lung, ocular and gastrointestinal involvement, and to propose strategies for effective trial design. The working group made the following recommendations: (1) Phenotype chronic GVHD clinically and biologically in future cohorts, to describe the incidence, prognostic factors, mechanisms of organ damage, and clinical evolution of highly morbid conditions including long-term effects in children; (2) Conduct longitudinal multicenter studies with common definitions and research sample collections; (3) Develop new approaches for early identification and treatment of highly morbid forms of chronic GVHD, especially biologically targeted treatments, with a special focus on fibrotic changes; and (4) Establish primary endpoints for clinical trials addressing each highly morbid manifestation in relationship to the time point of intervention (early versus late). Alternative endpoints, such as lack of progression and improvement in physical functioning or quality of life, may be suitable for clinical trials in patients with highly morbid manifestations. Finally, new approaches for objective response assessment and exploration of novel trial designs for small populations are required., (Copyright © 2021 The American Society for Transplantation and Cellular Therapy. All rights reserved.)

Purpose : Identify genes associated with ocular sarcoidosis (OS). Methods : We genotyped 1.1 million genetic variants to identify significant OS associations, defined as those that achieved p < 5 × 10 -8 in a genome-wide comparison of OS cases to healthy controls in our European- or African-American cohorts (EA, AA). Potential functional roles of all associated variants were assessed. Results : Eight significant non-HLA variants were found in AA OS cases compared to healthy controls and confirmed as at least suggestive when comparing OS to non-OS cases. Seven of these were within MAGI1 and include transcription factor binding sites and expression quantitative trait loci. Our EA cohort, while showing similar effect sizes at variants within MAGI1 , had no significant variants. Association analysis of HLA-DRB1 alleles confirmed association to OS in EA to *04:01. Conclusion : Our results support organ-specific genetic risk in OS in a compelling candidate, MAGI1 , known to be associated with barrier function and autoimmunity.

Background: Information on risk factors, epidemiology, and clinical characteristics of sebaceous carcinoma (SC) is limited., Objective: We sought to analyze trends in SC in the United States from 2000 through 2012., Methods: We used data from the 18 registries of the Surveillance, Epidemiology, and End Results (SEER) Program from 2000 to 2012 to calculate the cause of death, relative frequencies/incidences, 5-/10-year Kaplan-Meier survival, hazard ratios, and incidence rates for SC. Each parameter was analyzed by age, location of occurrence (ocular/extraocular), race, sex, and SEER registry., Results: Overall incidence was 0.32 (male) and 0.16 (female) per 100,000 person-years. Incidence significantly increased, primarily because of an increase among men. Incidence among whites was almost 3 times the rate among non-whites. Male sex (P < .0001), black race (P = .01), and extraocular anatomic location (P < .0001) were associated with significantly higher all-cause mortality. However, overall case-specific mortality for SC decreased significantly., Limitations: Underregistration of patients in SEER registries, lack of verification of individual diagnoses, and low levels of staging data because of low stage-classification rate are limitations., Conclusions: The overall incidence of SC is increasing significantly. Male sex, black race, and extraocular occurrences are associated with significantly greater mortality., (Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)