Curbside Consultation in Cornea and External Disease: 49 Clinical Questions, Second Edition

Curbside Consultation in Cornea and External Disease, Second Edition contains new questions and brief, practical, evidence-based answers to the most frequently asked questions that are posed during a “curbside consultation” between clinicians. 

Dr. David R. Hardten and associate editors Drs. Mark S. Hansen and Celine Satija have designed this unique reference in which cornea and external disease specialists offer expert advice, preferences, and opinions on tough clinical questions commonly encountered by corneal specialists, ophthalmologists, or residents. The unique Q&A format provides quick access to current information with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and illustrate clinical diagnoses and treatment plans. 

Some of the questions that are answered inside the Second Edition include: 

• I have a patient with Fuchs' Endothelial Dystrophy. Is there anything new to improve her vision?
• What should I do with a young patient with mild keratoconus?
• How can I help a 47-year-old female who uses artificial tears 6 times daily and continues to complain of dry eyes?
• A patient presents with corneal ulcer. What work-up and treatment would you recommend?
• How do I manage a patient that rubbed their eye just after LASIK? What could go wrong?
• What can I offer a patient that sustained eye trauma and loss of iris tissue?
• I have a patient with poor vision after DMEK.  What went wrong and how do I get better vision for them?

Curbside Consultation in Cornea and External Disease: 49 Clinical Questions, Second Edition provides information basic enough for residents while also incorporating expert pearls that even high-volume ophthalmologists will appreciate. Cornea specialists, general ophthalmologists, and residents alike will enjoy the user-friendly and casual format and the expert advice contained within.

Contents

Dedication
Acknowledgments
About the Editors
About the Associate Editor
Contributing Authors
Preface

Section I: Corneal Dystrophy
Question 1: I Have a Patient With Fuchs’ Endothelial Corneal Dystrophy. Is There Anything New to Improve Their Vision?
Mark S. Gorovoy, MD

Question 2: I Am Seeing a 64-Year-Old Woman for Cataract Evaluation. The Slit-Lamp Examination Is Significant for Anterior Basement Membrane Dystrophy Affecting the Visual Axis and 3+ Nuclear Sclerosis of the Lens in Both Eyes. How Should I Manage This Patient?
Sadeer B. Hannush, MD

Question 3: I Have a Patient With Bilateral Granular Corneal Dystrophy Who Is Struggling With Their Vision. What Can I Do to Help Them, Short of a Penetrating Keratoplasty?
Christopher J. Rapuano, MD

Section II: Corneal Degeneration
Question 4: What Should I Do for a Young Patient With Mild Keratoconus?
Nandini Venkateswaran, MD and Preeya K. Gupta, MD

Question 5: I Have a Patient Who Is 25 Years Old With Progressive Keratoconus. Would It Be More Effective to Do Cross-Linking With the Epithelium On or Off in This Patient?
Samuel Passi, MD and Sherman W. Reeves, MD, MPH

Question 6: I Have a 38-Year-Old Patient With Fairly Advanced Keratoconus. Is There Anything I Can Do for Them?
Martin L. Fox, MD

Question 7: A Patient With High Cylinder Has Sudden Onset of Pain, Blurry Vision, and Corneal Edema. How Do I Manage This Patient? 
Kevin R. Tozer, MD

Question 8: A Patient With Eye Irritation While Wearing Soft Contact Lenses Is Noted to Have White Elevated Nodules at the Limbus. Do They Need Surgery?
Thomas Kohnen, MD, PhD

Section III: External Disease
Question 9: I Have a Patient With Significant Facial Rosacea With Chronic, Red, Irritated Eyes. They Have Some Peripheral Corneal Neovascularization and Are Struggling With Contact Lens Wear. How Can I Manage This Patient?
Yvonne Wang, MD and Sumitra S. Khandelwal, MD

Question 10: An 18-Year-Old Man Complaining of Severe Itchy Eyes and Redness Has Diffuse Eyelid Erythema With Dry Scaly Skin, Meibomian Gland Dysfunction, 2+ Conjunctival Bulbar and Palpebral Injection, and 3+ Papillae. Does He Need Steroid Drops?
Brandon Baartman, MD

Question 11: How Can I Help a 47-Year-Old Woman Who Uses Artificial Tears 6 Times Daily and Continues to Complain of Dry Eyes?
Stephen C. Pflugfelder, MD

Question 12: A 43-Year-Old Woman Is Complaining of Dry Eyes. The Exam Shows Punctate Keratopathy in the Inferior Third of Her Corneas. What Is the Optimal Management?
Melissa Barnett, OD

Question 13: I Have a Patient With Significant Dry Eye. Is There Anything I Can Do in the Office to Help This Patient With Their Eye Problems?
Mark S. Milner, MD

Question 14: A 51-Year-Old Man Presented With Severe Pain in Both Eyes Upon Awakening in the Morning. He Has Seen Several Other Ophthalmologists With No Resolution. What Could Be Going On, and How Do I Help This Patient?
Steven E. Wilson, MD

Question 15: A 52-Year-Old Man With Obesity Comes to the Office Complaining of Pain and Irritation in the Right Eye. The Exam Shows Floppy Eyelids, 3+ Papillae in Upper Tarsal Conjunctiva, and Lash Ptosis. Does He Need Eyelid Surgery?
Reza Dana, MD, MSc, MPH

Question 16: A Patient Diagnosed With Bell’s Palsy 2 Days Ago Presents With Lagophthalmos and Moderate Superficial Punctate Keratopathy Inferiorly on the Cornea. How Should I Treat Them?
Brad H. Feldman, MD and Natalie A. Afshari, MD

Question 17: A 68-Year-Old Woman With Rheumatoid Arthritis Presents With a Red, Painful Eye and Stromal Melt at the Limbus. How Should I Treat Her?
Jesse M. Vislisel, MD

Question 18: A Patient With a Filtering Bleb Complains of Discomfort in the Eye. The Bleb Is Prolapsing Onto the Cornea and an Area of Stromal Thinning and Epithelial Staining With Fluorescein Is Adjacent to the Bleb. What Is the Optimal Management? 
Sonia H. Yoo, MD and Mohamed Abou Shousha, MD, PhD

Question 19: A 53-Year-Old Woman Came to My Office With Sectoral Redness and Pain in One Eye. How Should I Manage Her Eye?
C. Stephen Foster, MD

Question 20: A 72-Year-Old Woman Has Conjunctival Injection in Both Eyes and Symblepharon and Trichiasis in the Right Eye. The Right Cornea Has Moderate Punctate Staining. Should I Just Pull Out the Lashes or Do a Wedge Resection of the Lower Lid to Tighten It Up?
David D. Verdier, MD

Question 21: A Patient Who Suffered a Chemical Burn in the Left Eye 2 Years Ago Complains of Persistent Blurry Vision and Photophobia. There Is Corneal Neovascularization and Conjunctivalization Extending 5 mm From the Limbus. Do They Need Limbal Stem Cell Transplantation?
Manachai Nonpassopon, MD; Muanploy Niparugs, MD; and Ali R. Djalilian, MD

Question 22: A 47-Year-Old Man Has a Growth in the Nasal Corner of His Right Eye. Should His Pterygium Be Removed Surgically?
Kyle Jones, MD and Jessica Chow, MD

Question 23: A 67-Year-Old Woman Complains of Constant Eye Irritation. The Exam Shows Conjunctivochalasis of the Lower Bulbar Conjunctiva. Should I Excise the Redundant Conjunctiva?
Benjamin B. Bert, MD

Question 24: I Have a Patient With a Papillomatous, Waxy, Conjunctival and Corneal Lesion. Should I Be Concerned About Conjunctival Intraepithelial Neoplasia?
Brian D. Alder, MD

Question 25: A 13-Year-Old Adolescent Girl Is Complaining of an Enlarging Brown Spot on Her Eye. The Exam Shows a Flat Conjunctival Pigmented Nevus That Is 3 mm in Diameter, Surrounded by Mild Conjunctival Injection. Should I Be Worried About Malignancy?
Frederick (Rick) W. Fraunfelder, MD

Question 26: A Patient Has Irritation in Their Nonseeing, Blind Eye. The Exam Shows Mildly Inflamed Conjunctiva and Diffuse Corneal Epithelial and Stromal Edema With Large Bullae. What Should I Recommend?
Jill S. Melicher, MD

Question 27: A Patient Had LASIK 2 Months Ago and Has Persistent Pain in the Eyes That Does Not Seem to Be Related to Surface Issues or Other Anatomical Abnormalities. How Do I Diagnose and Manage This?
Wendy Liu, MD and Konstantinos D. Sarantopoulos, MD, PhD

Section IV Infection
Question 28: A Patient Presents With Corneal Ulcer. What Workup and Treatment Would You Recommend?
Prashant Garg, MD; Celine E. Satija, MD; and David R. Hardten, MD

Question 29: A 22-Year-Old Woman Complaining of Blurry Vision in One Eye Has Deep Sectoral Corneal Stromal Neovascularization With Stromal Infiltrate and Lipid Deposits in the Center of the Cornea. How Should I Manage This Patient?
Cullen D. Ryburn, MD and Derek W. DelMonte, MD

Question 30: A Corneal Infiltrate Is Unresponsive to Topical Fluoroquinolones. Could This Be Acanthamoeba?
Elmer Y. Tu, MD

Question 31: A Corneal Infiltrate of a Farmer Hit by a Tree Branch Is Not Clearing on Topical Fluoroquinolone Drops. What Should I Do Next?
Erik Letko, MD

Question 32: I Have a Patient With Shingles Over the Right Side of Their Face and Around the Eye Treated With Oral Antivirals for 10 Days. Does This Protect Them From Eye Involvement?
Celine E. Satija, MD and David R. Hardten, MD

Question 33: I Have a Patient With Herpes Simplex Dendrites. What Is the Best Plan to Minimize Both the Recurrences and Possible Scarring? 
Penny Asbell, MD, MBA; Michael Wallace, MD; and Daniel Brocks, MD

Question 34: I Have a Patient With Diabetes Who Had Infectious Keratitis With a Bacterial Etiology, But Now After the Infection Has Cleared, I Can’t Get the Epithelium to Heal. How Can I Best Manage This?
Shelby Anderson, OD and Ahmad Fahmy, OD

Question 35: I Have a Patient With Material in the LASIK Interface at Day 1. What Do I Need to Look for to Diagnose and Manage This Problem?
Deepinder K. Dhaliwal, MD, L.Ac and Tarika Thareja, MD

Question 36: A Patient With Red, Irritated Eyes, Tearing, and Photophobia That Started Yesterday Has Mild Conjunctival Injection and 2+ Follicles of the Palpebral Conjunctiva. When the Patient Awoke, Their Eyelids Were Stuck Closed. Is This Acute Conjunctivitis?
Andrea Blitzer, MD and Marian Macsai, MD

Section V Corneal Refractive
Question 37: My Patient Underwent LASIK Previously and Now Is Interested in Cataract Surgery. What Is the Most Appropriate Formula for IOL Calculations? Would They Be a Good Candidate for a Multifocal IOL? What About After Corneal Cross-Linking?
Brent Kramer, MD and Mitch Ibach, OD

Question 38: I Have a Patient With a Phakic IOL That Now Has a Cataract. What Special Methods Do I Need to Use to Manage This Patient?
Nikolas Raufi, MD and Terry Kim, MD

Question 39: How Do I Manage a Patient Who Rubbed Their Eye Just After LASIK? What Could Go Wrong?
Majid Moshirfar, MD; James R. Barnes, BS; Grant C. Hopping, MD; and Yasmyne C. Ronquillo, MD, MSc, JD

Question 40: My Patient Recently Had LASIK, But I Noticed New Epithelial Cells in the Flap Interface. When Do I Lift the Flap to Treat Epithelial Ingrowth and What Is the Best Method?
Zachary Zavodni, MD

Section VI Trauma
Question 41: A Piece of Glass Flew Into My Patient's Eye. The Exam Shows Central Corneal Perforation < 1 mm in Diameter. The Anterior Chamber Is Shallow But Formed. How Should I Close This Wound?
Roberto Pineda, MD and Ramon Joaquim Hallal Jr, MD

Question 42: My Patient Was Splashed With Cement in Both Eyes. They Have Red, Irritated Eyes and Blurry Vision. The Exam Shows Debris on the Conjunctiva and Under the Lids, Diffuse SPK in the Right Eye, and a Central Corneal Epithelial Defect in the Left Eye. What Should I Watch for?
Bennie H. Jeng, MD

Question 43: What Can I Offer a Patient Who Sustained Eye Trauma and Loss of Iris Tissue?
Walter T. Parker, MD

Section VII Postoperative
Question 44: A Patient Who Had Been Doing Well After DMEK Presents With New Corneal Edema. What Should I Do?
Yuri McKee, MD, MS

Question 45: How Should I Manage an Intraocular Pressure Spike of 43 mm Hg in a Patient With DMEK Who Is Taking 1 Drop of Pred Forte 1% Daily?
Laura Voicu, MD and Krishna Surapaneni, MD

Question 46: A Patient Is 5 Months After Corneal Transplant for a Corneal Scar and Now Has a New Epithelial Defect That Is Part on the Graft and Part on the Host Cornea. How Should I Manage This Patient?
Gary Legault, MD

Question 47: What Should I Do for a Patient Who Presents With 6.0 Diopters of Astigmatism After Undergoing Penetrating Keratoplasty 24 Months Ago?
Elaine Zhou, MD and Zaina Al-Mohtaseb, MD

Question 48: I Have a Patient With Poor Vision After DMEK. What Went Wrong, and How Do I Get Better Vision for Them?
Bryan S. Lee, MD, JD

Question 49: I Have a Patient Who Had Prior Verisyse IOL Implantation 20 Years Ago, and They Now Present With Posterior Synechiae, Moderate Cataract, a Shallow Anterior Chamber, and New Corneal Edema. How Should I Best Help This Patient With Their Vision?
Daniel Terveen, MD; Vance Thompson, MD; and John Berdahl, MD

Financial Disclosures
Index

About the Editors

David R. Hardten, MD is a cornea, refractive, and anterior surgery subspecialist in Minnesota. He teaches at many national and international meetings, and he highly values his involvement in resident and fellow teaching. He has served in leadership positions in many national ophthalmology organizations.

Mark S. Hansen, MD is an anterior segment surgeon at Minnesota Eye Consultants. He is the fellowship director of the cornea and glaucoma fellowship program and enjoys teaching. He also participates in international ophthalmology trips and works to train local residents and surgeons in Central America. He is on the board of directors for a nonprofit organization, Central American Eye Clinics.

Celine E. Satija, MD is a clinical cornea fellow at Tufts University New England Eye Center and Ophthalmic Consultants of Boston. She graduated from Princeton University with her undergraduate degree, after which she attended Tulane University School of Medicine. She completed her ophthalmology residency at the University of Minnesota.