June 29, 2016

Restoring Health to the Ocular Surface

published on June 29, 2016 by Thomas Blue, OD

Almost a year ago, a 73 year-old woman presented for an emergency visit at our office. Her history was positive for dry eye syndrome, and keratoconjunctivitis, for which she had been prescribed Restasis® BID, and artificial tears PRN. She also reported that over the last several years, she had experienced repeated episodes of painful, red eyes, accompanied by blurred vision. Topical steroid treatments temporarily reduced the severity of her symptoms, however recurrences continued to present.

Her medical history included rheumatoid arthritis, hypertension and osteoarthritis, for which she was receiving ongoing treatment. She was working full-time and engaged at her computer station eight hours daily, which undoubtedly contributed to the severity of her symptoms.

The day of her emergency visit, her presentation of ocular symptoms was as follows:

  • Pain both eyes.
  • Foreign body sensation, tender eyelids.
  • Light sensitivity.
  • Foggy, blurry vision.
  • Discharge and watering.

Initial Examination:

  • BVA   OD 20/25-   OS 20/40
  • SPK 2+ OU>OS
  • Significant fluorescein staining corneas both eyes.
  • Notable conjunctival lissamine green staining both eyes.
  • Thin tear film, dispersion incomplete, very rapid tear break up time.
  • Significant conjunctival injection.
  • Blepharitis with profound lid injection, swelling, and meibomian gland drop-out.

At the conclusion of her initial visit, we discussed our recommendations and treatment goals. Due to its anti-inflammatory and pro-healing characteristics, we recommended Prokera® to restore health to the corneal surface, as well as for concurrent treatment to reduce the inflammation of the eyelids. Treatment began with application of a Prokera Slim to the left eye. We also prescribed 100 mg Doxycycline qd for 14 days, lid hygiene, and daily moist heat to initiate treatment of her blepharitis.

The patient returned one week later, and we removed the Prokera Slim. She was much more comfortable, her BVA OS was 20/25-, and upon examination there was minimal corneal staining, and minimal conjunctival injection. A Prokera Slim was applied to the right eye one week later and upon removal seven days later, BVA was OD 20/25+, OS 20/25-. We recommended resumption of RESTASIS BID, non-preserved artificial tears, ongoing lid treatments, triglyceride formulary Omega 3 qd and follow up in two weeks.

We saw her in follow up two weeks, one month, and again in six months. Her BVA acuities were 20/20 OU, her corneas looked remarkably clear, and her eyelids looked healthier. She has not experienced any recurrence of episodes similar to her original visit. Needless to say, she is very pleased and her quality of life has improved. We credit Prokera for such positive results and restoring her ocular surface. This is genuinely a feel-good story on both sides of the chair.

To learn more about how cryopreserved products like Prokera Slim can help patients, read a recent paper published entitled Accelerated Restoration of Ocular Surface Health in Dry Eye Disease by Self-Retained Cryopreserved Amniotic Membrane.

Thomas Blue, OD is in private practice in Del City, Oklahoma, as part of Mid-Del Vision Source. His anterior segment treatment background and observations in caring for residents in nursing homes throughout the state, led Dr. Blue to focus on the detection and prevention of the evolution of ocular surface conditions.

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