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Fulltext Eye disease and international travel: a critical literature review and practical recommendations

Lee JJ, Forristal MT, Harney F, Flaherty GT

J Travel Med, 2023 Jun 23;30(4).
PMID: 37191043 DOI: 10.1093/jtm/taad068

RATIONALE FOR REVIEW: Eye diseases pose a significant public health and economic burden, particularly for travellers exposed to ocular hazards who may lack access to specialist eye care. This article offers an evidence-based review for travel-health practitioners, with a particular emphasis on ocular infections and trauma that are more prevalent among travellers. Providing an overview of these issues will allow travel health practitioners to comprehensively address ophthalmic considerations of travel.
METHODS: A systematic literature search was conducted on PubMed and Embase electronic databases, using keywords related to travel medicine and ophthalmology. Inclusion was based on the relevant contribution to epidemiology, aetiology, diagnostics, management and long-term consequences of travel-related eye conditions. The data were analysed using narrative synthesis.
KEY FINDINGS: This literature review highlighted that various travel-related eye conditions may occur. Travellers should be aware of the risk of travel-related ocular complications, which can arise from ocular infections, high-risk activities, high altitude and space travel. The economic and logistical challenges associated with medical tourism for ophthalmic procedures are discussed. For travellers with pre-existing eye conditions or visual impairment, careful planning may be needed to promote eye health and ensure safety of travel.
CONCLUSIONS: Travel medicine practitioners should have a comprehensive understanding of the major ocular risks associated with overseas travel, including eye infections, eye injuries and solar eye damage. Further research in this area can enhance overall wellness and alleviate the burden of ocular diseases on travellers. Evidence-based guidelines based on research can also improve the quality of care and prevent long-term vision problems.

Matched MeSH terms: Eye Infections*
Assessment of polymerase chain reaction in the detection of pseudomonas aeruginosa in contact lens-induced severe infectious keratitis

Subrayan V, Peyman M, Lek Yap S, Mohamed Ali NA, Devi S

Eye Contact Lens, 2010 Jul;36(4):201-3.
PMID: 20531205 DOI: 10.1097/ICL.0b013e3181e3efa3

PURPOSE: The aim of this study is to evaluate the role of real-time polymerase chain reaction (PCR) and conventional bacterial culture methods in the detection of Pseudomonas aeruginosa in contact lens-induced severe, partially treated corneal ulcers referred to a tertiary center.
METHODS: The study duration was 6 months. All patients with contact lens-related corneal ulcer, requiring admission during the study period were recruited. Samples from corneal scrapings were simultaneously sent at the time of admission for PCR and culture testing. An in-house real-time PCR was developed to detect the P. aeruginosa lasA gene. The results of PCR and culture were compared using McNemar's chi2 test.
RESULTS: Ten patients were recruited. The mean age was 33 years (20-45 years). All the patients had contact lens-related keratitis (>4 mm) of which eight (80%) were found positive for P. aeruginosa by PCR or culture. There was no significant difference between PCR and culture in detecting P. aeruginosa (P<0.05).
CONCLUSIONS: PCR is, at least, as good as conventional cultures in detecting P. aeruginosa. It is a rapid assay as compared with culture, and early detection enables prompt treatment thus reducing the destructive effect of the organism on the cornea.

Matched MeSH terms: Eye Infections, Bacterial/diagnosis*; Eye Infections, Bacterial/drug therapy; Eye Infections, Bacterial/microbiology
Fulltext The use of preserved bovine pericardium for emergency temporizing graft in corneal perforation

Koay AC, Yew YH, Ngo CT, Loo VP, Intan G, Chua CN

Med J Malaysia, 2008 Dec;63(5):421-2.
PMID: 19803308 MyJurnal

Corneal perforation is an ocular emergency that requires early intervention to avoid permanent visual loss from endophthalmitis or irreversible structural changes. Although tectonic keratoplasty is the best choice for patching a large perforation, a donor cornea is not always immediately available. Consequently, an alternative material is required while awaiting a donor cornea. We report the use of preserved bovine pericardium as a temporizing graft to maintain the ocular integrity in two patients with corneal perforation.

Matched MeSH terms: Eye Infections, Fungal/surgery
Fulltext Ophthalmomyiasis from Chrysomyia bezziana (screwworm fly)

Alhady M, Zabri K, Chua CN

Med J Malaysia, 2008 Aug;63(3):269-70.
PMID: 19248710
Matched MeSH terms: Eye Infections, Parasitic/diagnosis*; Eye Infections, Parasitic/surgery
First report of equine Setaria digitata (von Linstow 1906) infestation in Malaysia

Peng TL, Armiladiana MM, Ruhil HH, Maizan M, Choong SS

Vet Parasitol Reg Stud Reports, 2019 08;17:100310.
PMID: 31303218 DOI: 10.1016/j.vprsr.2019.100310

The occurrence of Setaria digitata in a horse is reported for the first time in Malaysia. An 8-year-old Thoroughbred cross mare was referred to the University Veterinary Clinic with the primary complaint of corneal opacity and excessive eye discharge. After initial treatment with Terramycin eye ointment, corneal opacity cleared partially to reveal a moving thread-like cylindrical worm in the anterior chamber of the eye. The parasite was successfully removed surgically, and examination under the light microscope revealed that the isolated worm (length = 45 mm) was a 5th stage larva of S. digitata based on morphological criteria. Confirmation of the species of the worm was through molecular methods. The 12S rRNA gene was PCR-amplified, and the purified amplicon was directly sequenced. Phylogenetic analyses revealed that the isolated roundworm showed 100% sequence similarity with that of S. digitata in NCBI GenBank database (Accession no.: KY284626.1). This report is the first confirmed case of equine ocular setariasis by S. digitata in Malaysia. The current study provides evidence that S. digitata is an etiological agent of ocular infection and its presence in Malaysia.

Matched MeSH terms: Eye Infections, Parasitic/diagnosis; Eye Infections, Parasitic/parasitology; Eye Infections, Parasitic/surgery; Eye Infections, Parasitic/veterinary*
Fulltext The Jarisch-Herxheimer reaction in ocular syphilis

Fathilah J, Choo MM

Med J Malaysia, 2003 Aug;58(3):437-9.
PMID: 14750386

A patient with ocular syphilis is presented. She experienced deterioration in vision following the commencement of treatment due to a Jarisch-Herxheimer reaction. This is a transient febrile illness that can occur in patients after the first adequate dose of an anti-microbial drug to treat infectious diseases such as syphilis, Lyme disease and relapsing fever. However, a Jarisch-Herxheimer reaction occurring in a patient receiving treatment for ocular syphilis can be serious, resulting in the rapid loss of vision.

Matched MeSH terms: Eye Infections, Bacterial/drug therapy*
Herpes Zoster Ophthalmicus with Orbital Apex Syndrome-Difference in Outcomes and Literature Review

Lim JJ, Ong YM, Wan Zalina MZ, Choo MM

Ocul Immunol Inflamm, 2018;26(2):187-193.
PMID: 28622058 DOI: 10.1080/09273948.2017.1327604
Matched MeSH terms: Eye Infections, Viral/diagnosis*; Eye Infections, Viral/drug therapy; Eye Infections, Viral/virology
Fulltext Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges: A case report

Abu Talib DN, Yong MH, Nasaruddin RA, Che-Hamzah J, Bastion MC

Medicine (Baltimore), 2021 Apr 09;100(14):e25459.
PMID: 33832156 DOI: 10.1097/MD.0000000000025459

RATIONALE: Endogenous fungal endophthalmitis (EFE) is a sight-threatening complication of systemic fungemia. As the prevalence rises, treatment remains a challenge especially when there is a failure in first-line treatment or drug-resistant fungus. This case report studies a case of chronic EFE, focusing on the diagnostic procedures, treatment options, monitoring parameters and the treatment outcome.
PATIENT CONCERNS: A 64-year-old man with underlying well controlled diabetes mellitus was treated with 2 weeks' course of intravenous antifungal fluconazole for pyelonephritis as his blood culture grew Candida albicans. Concurrently, he complained of 3 months of bilateral painless progressive blurring of vision. At presentation, his visual acuity (VA) was light perception both eyes. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes.
DIAGNOSIS: He was diagnosed with EFE but the condition responded poorly with the medications.
INTERVENTIONS: He was treated with intravitreal (IVT) amphotericin B and fluconazole was continued. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. Postoperatively, vision acuity was 6/24, N8 right eye and 2/60, N unable for left eye with extensive left macular scar and hole. Vitreous cultures were negative. He received multiple IVT amphotericin B and was started on topical steroid eye drops for persistent panuveitis with systemic fluconazole. Ocular improvement was seen after switching to IVT and topical voriconazole. Despite this, his ocular condition deteriorated and he developed neovascular glaucoma requiring 3 topical antiglaucoma agents. Panretinal photocoagulation was subsequently performed.
OUTCOMES: At 3 months' follow-up, his vision acuity remained at 6/24 for right eye and 2/60 for the left eye. There was no recurrence of inflammation or infection in both eyes.
LESSONS: Voriconazole could serve as a promising broad spectrum tri-azole agent in cases of failure in first-line treatment or drug-resistant fungus.

Matched MeSH terms: Eye Infections, Fungal/diagnosis*; Eye Infections, Fungal/therapy*
Dirofilaria causing eye infection in a patient from Malaysia

Rohela M, Jamaiah I, Hui TT, Mak JW, Ithoi I, Amirah A

Southeast Asian J. Trop. Med. Public Health, 2009 Sep;40(5):914-8.
PMID: 19842373

Human dirofilariasis caused by Dirofilaria immitis and Dirofilaria repens have been reported in Malaysia. This is the fourth reported case of dirofilariasis caused by D. repens. The patient was a Chinese male from Kuching Sarawak, Malaysia who presented with a one day history of redness and itchiness over the temporal aspect of his left eye. A worm was seen and later removed from beneath the conjunctiva under local anesthesia and based on the morphological characteristics, it was identified as an immature Dirofilaria repens.

Matched MeSH terms: Eye Infections, Parasitic/parasitology*
Transvitreal migration of a Toxocara larva resulting in a second chorioretinal granuloma

Sivaratnam D, Subrayan V, Ali NA

Jpn. J. Ophthalmol., 2008 Sep-Oct;52(5):416-417.
PMID: 18991049 DOI: 10.1007/s10384-008-0569-z
Matched MeSH terms: Eye Infections, Parasitic/diagnosis; Eye Infections, Parasitic/parasitology*; Eye Infections, Parasitic/therapy
Fulltext Bacterial and fungal keratitis in Upper Egypt: in vitro screening of enzymes, toxins and antifungal activity

Gharamah AA, Moharram AM, Ismail MA, Al-Hussaini AK

Indian J Ophthalmol, 2014 Feb;62(2):196-203.
PMID: 24008795 DOI: 10.4103/0301-4738.116463

This work was conducted to study the ability of bacterial and fungal isolates from keratitis cases in Upper Egypt to produce enzymes, toxins, and to test the isolated fungal species sensitivity to some therapeutic agents.

Matched MeSH terms: Eye Infections, Bacterial/drug therapy; Eye Infections, Bacterial/microbiology; Eye Infections, Bacterial/epidemiology*; Eye Infections, Fungal/drug therapy; Eye Infections, Fungal/microbiology; Eye Infections, Fungal/epidemiology*
Fulltext Role of intravitreal/intracameral antibiotics to prevent traumatic endophthalmitis - Meta-analysis

Thevi T, Abas AL

Indian J Ophthalmol, 2017 Oct;65(10):920-925.
PMID: 29044054 DOI: 10.4103/ijo.IJO_512_17

Traumatic endophthalmitis is a devastating condition that can occur following an open globe injury and result in loss of vision. The use of prophylactic antibiotics is empirical as most surgeons fear complications associated with the same. No systematic review has been performed in English on the role of intravitreal/intracameral antibiotics in preventing traumatic endophthalmitis. We searched for randomized controlled trials and controlled clinical trials comparing intracameral/intravitreal antibiotics with placebos on PubMed, Google Scholar, Science Direct, and Cochrane Library using keywords open globe/trauma/penetrating/perforating injuries endophthalmitis. The last search was on 5 May 2017. We included patients of all ages with open globe injuries who received intracameral/intravitreal antibiotics, regardless of the dose. Quality of the trials was assessed using Cochrane collaboration tools to assess the risk of bias. The main outcome measures were endophthalmitis and visual acuity. We included three trials. Overall, intravitreal/intracameral antibiotics were noted to significantly reduce the occurrence of endophthalmitis in open globe injuries (relative risk [RR] 0.19, 95% confidence interval [CI] 0.06-0.57). The use of intravitreal/intracameral antibiotics did not have an effect in improving visual acuity (RR 1.17, 95% CI 0.61-2.23). Two trials (Narang 2003; Soheilan 2001) were observed to have no significant effect on visual acuity while another trial (Soheilan 2007) did not list visual acuity as part of its objectives. Intracameral/intravitreal antibiotics reduce the risk of endophthalmitis in open globe injuries; although, there was no improvement in the visual acuity. We, therefore, recommend the use of intravitreal/intracameral injections in open globe injuries to prevent this devastating complication.

Matched MeSH terms: Eye Infections, Bacterial/etiology; Eye Infections, Bacterial/prevention & control*