No abstract

Recurrent corneal erosion syndrome is a debilitating condition for which there are many treatment options with varying rates of success. One treatment of interest in recent years is the combination of oral doxycycline and topical corticosteroids, both of which have been shown to inhibit key metalloproteinases important to disease pathogenesis. To assess the efficacy of this treatment, we conducted a retrospective single-observer case series involving all patients with recurrent corneal erosion syndrome who were treated at a community-based clinic with oral doxycycline and topical corticosteroid between January 2000 and July 2007. Twenty-one patients were identified. All received oral doxycycline 50 mg twice daily and topical fluoromethalone 0.1% three times daily for at least 4 weeks. At 8 weeks post commencement of treatment, 15/21 patients (71%) were symptom free. All but one of these patients reported an improvement in symptoms. Of those patients not lost to follow up, 15/18 patients (83%) and 11/15 patients (73%) denied any symptoms suggestive of relapse at 6 and 12 months, respectively. Among the patients in remission was one who had responded poorly to other treatments including ocular lubricants, epithelial debridement, serum eyedrops, anterior stromal puncture, and phototherapeutic keratectomy. Treatment of recurrent corneal erosion syndrome with the combination of oral doxycycline and topical corticosteroid is effective. It may help patients with recurrent corneal erosion syndrome who have failed other forms of treatment. This non-invasive treatment modality should also be considered as the first treatment option when conservative management with ocular lubricants fails.

Cold liquid ingestion may precipitate episodes of dysphagia and chest pain in patients with spastic esophageal motility disorders. The effect of hot liquids on esophageal symptoms, esophageal peristalsis, and clearance and any potential therapeutic benefit in such patients has not been examined. Using esophageal scintigraphy and manometry, we have investigated the effects of hot water swallows on dysphagia, chest pain, and esophageal motility and clearance in patients with esophageal motility disorders. We studied 48 men and women with intermittent dysphagia to both solids and liquids, chest pain, and/or regurgitation. All patients underwent upper endoscopy, barium swallow, and esophageal manometry using standard techniques. Esophageal scintigraphy assessed esophageal transit time (ETT) and retrograde intraesophageal movement of bolus at baseline (22 degrees C) and after hot (60 degrees C) water swallows. Esophageal manometry assessed the amplitude and duration of esophageal contractions in response to baseline and hot water swallows. Patients were followed clinically for as long as 6 months to assess symptomatic response. We found that baseline esophageal scintigraphy revealed a mean ETT of 48.5 seconds; after hot water swallow, mean ETT was 27.8 seconds (p < 0.001). The number of secondary peaks at baseline was 3.5; after hot water swallow, it was 2.1 (p < 0.001). Baseline esophageal manometry showed a mean esophageal body contraction amplitude of 188 mm Hg (mean duration, 11.8 seconds) in response to wet swallows and 125 mm Hg (mean duration, 5.7 seconds) with hot water swallows (p < 0.001). Clinically, 28 (58%) of 48 patients noted significant (>50%) improvement of their symptoms and have been ingesting hot water or other hot liquids regularly with their meals. We conclude that hot water accelerates esophageal clearance, decreases the amplitude and duration of esophageal body contractions, and improves symptoms in patients with esophageal motility disorders. Because of its safety and simplicity, it may have an important role in the management of these chronic conditions.

Crystalline keratopathy can be successfully treated by the Nd:YAG laser. We present two cases of crystalline keratopathy managed this way. A 36-year-old female contact lens wearer presented with crystalline keratopathy following recent treatment with topical steroids and antibiotics for a corneal abscess. In this case crystalline keratopathy developed despite the intensive topical antibiotic treatment. A 55-year-old man with a history of acne rosacea, chronic myelomonocytic leukaemia, asthma and Crohn's disease presented with crystalline keratopathy following an episode of infectious keratitis. Treatment with the Nd:YAG laser to the area of involvement was instituted in both cases. Noticeable resolution occurred within days, with subsequent full recovery. No side-effects from the use of the Nd:YAG laser were noted. There have been only two cases previously reported using this treatment modality.