Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
Would you recommend medical therapy for asymptomatic idiopathic intracranial hypertension with completely normal visual field testing?
If this patient has asymptomatic papilledema from idiopathic intracranial hypertension, then I might focus on weight loss first, which can be curative. I would follow her visual fields closely, however, and would have a low threshold to start acetazolamide if any change in her visual fields is noted...
How do you evaluate asymptomatic patients referred for benign intracranial hypertension?
"Benign intracranial hypertension" is not really the preferred term for pseudotumor cerebri or idiopathic intracranial hypertension (IIH) anymore, as the phenomenon can lead to permanent vision loss and thus cannot be considered truly benign. Having said that, if the patient has no symptoms (no blur...
How do you evaluate patients who have panuveitis without any systemic symptoms?
Although many patients with panuveitis or another anatomic subset of uveitis might have a systemic disease such as sarcoidosis, Behcet's disease, ankylosing spondylitis, or inflammatory bowel disease, often a systemic disease is not diagnosable. A thorough history is the best way to suspect a system...
What is your approach to management of ongoing scleritis in SLE despite mycophenolate?
Around 1 out of every 50 SLE patients will develop scleritis. It is essential that the rheumatologist work closely with the ophthalmologist. We (rheumatologists) are important due to our knowledge and experience with immunosuppressants, while the ophthalmologist is essential in assessing disease act...
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
Would a patient receiving intravitreal avastin have a contraindication to prostate radiation?
There may be some systemic effects but not enough for us to hold adjuvant RT.
What is your approach to immunosuppression in patients with recurrent peripheral ulcerative keratitis or marginal keratitis who have active disease despite steroid therapy and no current evidence of rheumatologic disease?
Drs. @Dr. First Last and @Dr. First Last provide some excellent insight in their responses. In this question, it's stated the patient has active disease despite steroids. I would agree with both Drs. @Dr. First Last and @Dr. First Last that non-infectious PUK typically requires high-dose steroid (1m...
What dosing range of doxycycline do you recommend for short-term and long-term management of ocular rosacea?
Short term, Doxycycline may be used at 100mg BID for 2-4 weeks, especially in severe cases. It can then be tapered to 100mg QD once a partial clinical response is documented, but where residual disease and symptoms still exist, or to 50mg QD if there is a complete clinical response. Longterm, doses...
How would you manage scleritis perforans in a patient with seropositive rheumatoid arthritis/scleroderma overlap?
Scleromalacia perforans is a rare but sight-threatening disease that is often associated with seropositive RA. It has become less common, presumably due to more aggressive management of RA and newer medication options. Prior to biologics, it was often managed with oral prednisone and/or cyclophospha...
What screening recommendations do you provide for patients with a Nevus of Ota with ocular involvement?
Patients with Nevus of Ota are at increased risk of glaucoma. I have patients get a yearly ophthalmology exam.