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    Pearls for better diagnosis, treatment of red eye

    Consider the patient’s systemic health; harvest tissue when at all possible


    Systemic diagnosis

    Sometimes, a red eye may lead to a more serious systemic diagnosis.

    Dr. Foster told the story of a 21-year-old woman in India who had failed on therapy for conjunctivitis and episcleritis; scleritis and peripheral ulcerative keratitis were diagnosed.A scleral biopsy found granulomatous inflammation.

    Therapy for presumed tuberculosis failed, as did therapy with systemic corticosteroids. A voice change prompted an endoscopy. The patient used IV cyclophosphamide (Cytoxan) as her physicians feared she had a relapsing polychondritis.

    Dr. Foster did a consult via Skype, and noticed a striking change in the look of the patient’s nose cartilage. The patient’s parents confirmed the change had taken place in the previous 6 months.

    “Her ocular manifestations were so dramatic, little attention had been paid to the nose,” he said.

    The patient was diagnosed with Wegener’s granulomatosis, with eye, nose, lung, and tracheal involvement. The patient improved with rituximab and steroids.

    Ocular cicatricial pemphigoid

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