Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Dacryoadenitis, Dacryocystitis, and Canaliculitis

Key Concepts Dacryoadenitis may be infectious (e.g., Staphylococcus aureus , Streptococcus pneumoniae ) or noninfectious (nonspecific orbital inflammation) in etiology. Those with infectious dacryoadenitis usually feel unwell and are febrile in contrast to those in the noninfectious group who generally feel well but have pain as their major symptom. Dacryocystitis is a result of an obstruction within the nasolacrimal sac; it may occur at any age…

Meibomian Gland Dysfunction and Evaporative Dry Eye

Key Concepts Meibomian gland dysfunction is the major cause of evaporative dry eye and often occurs in conjunction with aqueous deficiency dry eye. Expression of the meibomian gland with examination of the expressed secretion is critical to clinical diagnosis and monitoring of meibomian gland disease. Obstruction of the meibomian gland orifices is due to abnormally thickened meibum or hypertrophic keratinization of the orifices, while senescence of…

Aqueous Deficiency Dry Eye Syndrome

Key Concepts Aqueous deficiency dry eye (ADDE) refers to a deficiency of aqueous production by either the lacrimal system or the accessory glands. Any lacrimal acinar destruction or dysfunction can lead to tear hyperosmolarity and ultimately signs and symptoms of dry eye disease. Aqueous tear production is largely due to a reflex by subconscious stimulation of the ocular surface and nasal mucosa. Aqueous tear deficiency dry…

Dry Eye Overview: Classification and Treatment Algorithm

Key Concepts Although dry eye disease is clinically classified as primarily aqueous-deficient versus evaporative, there is significant overlap of these and other subtypes of ocular surface disease, often leading to poor correlation between signs and symptoms. Subjective dry eye symptoms including burning, itching, foreign body sensation, visual fluctuations, and dryness have shown poor correlation with objective tests for dry eye disease. Treatment algorithms need not be…

Eyelid Infections

Key Concepts Infections of the periocular skin may herald systemic disease and can spread to the ocular surface. Patients with cutaneous ocular herpes simplex are at risk for herpetic keratitis. Herpes zoster infection may lead to lagophthalmos, corneal hypesthesia, neurotrophic keratitis, and vision loss. The clinician should look for subtle molluscum contagiosum lesions in the presence of chronic unilateral follicular conjunctivitis. Phthiriasis palpebrarum is transmitted by…

Blepharitis: Overview and Classification

Key Concepts Blepharitis is a common but often overlooked disease with the potential to significantly alter quality of life. Blepharitis can be due to acute infection by bacteria, viruses, and parasites, or as a function of primary skin/lid disease. Modern classification categorizes blepharitis anatomically, as anterior or posterior with the gray line as the anatomic landmark, or clinically, as being secondary to infection, inflammation, or meibomian…

Malignant Eyelid Tumors

Key Concepts The eyelids are affected by skin cancer and are often overlooked when considering suspicious skin lesions. Eyelid skin cancer treatment must remove the offending lesion while preserving as much normal tissue as possible. Like all skin cancers, basal cell carcinoma is the most common type to affect the eyelids. The majority of eyelid skin cancers are the result of cumulative ultraviolet (UV) exposure; thus…

Benign Lid Tumors

Key Concepts Eyelid lesions can originate from any layer or structure within the eyelid and surrounding adnexa. Benign eyelid tumors are often diagnosed based on a characteristic appearance. Eyelid lesions in children can cause amblyopia and should be monitored closely. Vascular eyelid lesions are increasingly being treated with nonsurgical approaches. A biopsy should be performed if an eyelid lesion is not easily diagnosed based on clinical…

Malposition of the Eyelids

Key Concepts Normal eyelid apposition and movement are necessary to provide ocular surface wetting and protection. Lash–globe contact will result in corneal irritation and breakdown of the corneal epithelium. Eyelid malpositions such as floppy eyelid syndrome may be associated with other ocular (e.g., NAION and keratoconus) or systemic abnormalities (e.g., obstructive sleep apnea). Normal eyelid apposition, blinking, and closure are necessary for maintenance of a healthy…

Medical Standards for Eye Banking

Key Concepts Medical standards assure a supply of safe and efficacious tissue. Eye banks are subject to regulation by federal and state laws and the Eye Bank Association of America (EBAA) in the United States. Standards and regulations vary from country to country but tend to promote similar goals: Prevention of disease transmission (systemic and local); Suitability of tissue for its intended use; Safety of eye…

Eye Banking: Structure and Function

Key Concepts Successful eye banking requires the collaboration of ophthalmologists and eye banking professionals. The steps involved in providing ocular tissue for transplantation include donor screening, authorization, tissue recovery, tissue preservation and storage, tissue evaluation, tissue processing, determination of donor eligibility, and distribution. Donor screening involves reviewing medical records and interviewing knowledgeable historians regarding medical and social history. Tissue recovery includes verifying authorization, body identification, ocular…

The Red Eye

Key Concepts Taking a thorough history in a patient with red eye is paramount; it is important to identify the risk factors, the duration of the redness, and whether there is unilateral or bilateral involvement. Pain and vision loss in the context of red eye are symptoms that can signify a more serious disease process. Acute or subacute causes of red eye are more likely to…

Corneal Deposits

Key Concepts Corneal deposits can be classified by the layer where they are found in the cornea: superficial, stromal, and deep stromal. Corneal deposits can also be classified by their color: pigmented, nonpigmented, and retractile Heavy metals such as silver, copper, and gold can be deposited in the cornea. Systemic diseases can be diagnosed initially on the basis of the observation of corneal deposits. Examples include…

Evaluation of Recurrent Corneal Erosions

Key Concepts Recurrent corneal erosion (RCE) syndrome is a common clinical entity that can be frustrating to both patients (due to cyclical symptoms) and treating clinicians (due to difficulty in diagnosis and treatment). Although most patients can be diagnosed based on history alone, certain patients will require a thorough ocular examination and additional diagnostic testing to make a diagnosis. In general, the clinician should divide RCE…

Evaluation of the Corneal Ulcer

Key Concepts The term cornea ulcer can refer to a wide variety of infectious and noninfectious entities. The evaluation of a corneal ulcer requires a stepwise approach including history, examination, laboratory testing, and careful analysis of this data to guide management. A directed history can identify risk factors for particular causes of ulceration. A detailed examination can identify features suggestive of particular etiologies. Corneal smears and…

Peripheral Corneal Disease

Key Concepts The peripheral cornea’s proximity to the limbus and conjunctival lymphoid tissue predisposes it to unique pathologies that are distinct from the avascular central cornea. The peripheral cornea is particularly susceptible to inflammation related to systemic autoimmune diseases, including rheumatoid arthritis, granulomatosis with polyangiitis, inflammatory bowel disease, polyarteritis nodosa, and others. Management of peripheral corneal ulceration is usually dependent on treating the underlying systemic inflammatory…

Congenital Corneal Opacities: Diagnosis and Management

Key Concepts In order to properly evaluate congenital corneal clouding, a thorough history and examination must be performed with a low threshold to obtain an examination under anesthesia. Ancillary testing with A-scan ultrasound biometry, B-scan ultrasonography, ultrasound biomicroscopy, and anterior segment optical coherence tomography may be helpful. STUMPED is a useful mnemonic for categorizing the many causes of congenital cloudy corneas. This mnemonic will be utilized…

Anterior Segment Optical Coherence Tomography

Key Concepts Optical coherence tomography (OCT) can provide micron-level high-resolution images of the cornea and anterior segment without touching the eye. Anterior segment OCT can map the corneal and epithelial thicknesses; both are useful for keratoconus screening and classification of corneal irregularities. Anterior segment OCT can visualize laser in situ keratomileusis (LASIK) flaps for LASIK evaluation, refractive surgery enhancement, or LASIK complication management. Anterior segment OCT…

High-Resolution Ultrasound

Key Concepts Ultrasound biomicroscopy (UBM) has proven a valuable tool for ophthalmologists when the cornea has lost its transparency or other media opacities obstruct the view of the anterior segment. In UBM, perpendicularity indicated by reflective echoes from the corneal epithelium, endothelium, and anterior and posterior lens capsule is critical for best results. UBM is useful in the evaluation of anterior segment lesions of the cornea,…

Clinical Applications of Confocal Microscopy

Key Concepts In vivo confocal microscopy (IVCM) is a high-resolution imaging technique that enables microscopic examination of the ocular surface with good histopathologic correlation. IVCM is useful for the early diagnosis and monitoring of infectious keratitis from fungi and Acanthamoeba with high sensitivity and specificity. The in vivo evaluation of nerve terminals allows identification of the relationship between corneal neuropathic compromise and systemic involvement in diseases such as…