Examination «

Examination

The patient’s uncorrected visual acuity was 20/400 OD and hand motion OS. Her vision improved with a pinhole to 20/200 OD, but not in the left eye.

Slit lamp examination revealed diffuse, grade 4 superficial punctuate keratitis in both eyes and a 1.5 x 2.5-mm central epithelial defect with Descemet’s folds and corneal edema in the left eye. There were no significant signs of ocular inflammation or stromal involvement. Both eyes had trace conjunctival injection and grade 2 meibomian gland dysfunction (MGD). Her tear meniscus height measured 0.2 microns. Tear osmolarity was 326 mOsm/L OD and 339 mOsm/L OS.

After ocular surface evaluation, I applied a cotton wisp strand to the cornea. In this test, what condition do you think I sought to pinpoint?

○	a. Corneal hypoesthesia/anesthesia Yes, innervation is important for maintaining the normal structure and function of the cornea, and reduced corneal sensitivity can be associated with epithelial defects in many corneal diseases.¹ With her history of viral infection and diabetes and the nonhealing nature of the epithelial defect, I suspected impairment of corneal sensation in this patient. Aragona P, Stilo A, Ferreri F, et al. Effects of the topical treatment with NSAIDs on corneal sensitivity and ocular surface of Sjögren's syndrome patients. Eye (Lond). 2005;19(5):535-9.
○	b. Decreased tearing reflex No, I did not consider tearing reflex pertinent to this patient’s condition. Please select again.
○	c. Loose adhesion of the epithelium This was not my consideration. Please select again.
○	d. Incomplete blink This was not my consideration although it is an important finding to evaluate. Please select again.

Paul Karpecki, OD, FAAO, works in Corneal Services and is clinical research director at the Kofﬂer Vision Group in Lexington, KY. He is a consultant for Bausch + Lomb and Bio-Tissue Inc.

Shire Test Prep

Examination

After ocular surface evaluation, I applied a cotton wisp strand to the cornea. In this test, what condition do you think I sought to pinpoint?

Eye Care Professionals Only