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EW SHOW DAILY 24 ASCRS Symposia Tuesday, April 21, 2015 started 10 days previously. She was diagnosed with contact lens over- wear and was started on topical fourth-generation antibiotics and frequent lubrication. Sixty percent of the audience recommended a switch to fortified antibiotics, while 14% said they would add a topic or oral antiviral medication. Another 14% said they would observe, and 12% said they would add topical corti- costeroid. One key consideration is that a young person's understanding of proper hygiene is different than someone who is older, and that makes the younger person more susceptible to infection, said Marjan Farid, MD, Irvine, Calif. Presenters then discussed follow up to the case, noting that the pa- tient showed no improvement and had developed multiple infiltrates. Dr. Farid recommended the use of confocal microscopy, and Dr. Kim discussed the possible diagnosis of Acanthamoeba keratitis, which can resemble herpes simplex virus. "You want to try and diagnose these as early as you can," he said. "They may not respond well, and you may require more aggressive therapy." Panelists also discussed the possibility of treatment with CXL if the infection worsened (52% of the audience agreed). Other treatment options were continuing present therapy or proceeding with thera- peutic penetrating keratoplasty. EW Editors' note: Drs. Holland and Kim have financial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, N.J.), and various other ophthalmic companies. by Vanessa Caceres EyeWorld Contributing Writer Meibomian gland dysfunction (MGD) Like EBMD, MGD is something that clinicians need to monitor more frequently prior to surgery, panel- ists said. "We have to change our pattern of examining patients," said Thomas John, MD, Tinley Park, Ill. Instead of examining the cornea first, he believes physicians should first examine the lid margin and tear meniscus to check for ocular surface issues like MGD, and then perform the cornea exam. Of the treatment options given, 58% of the audience said they would recommend the use of omega-3 supplements and artificial tears and demonstrate lid hygiene. Another 31% would use topical azithromy- cin and/or oral doxycycline. Other treatment options given were ther- mal pulsation therapy and intense pulsed light therapy. Corneal collagen crosslinking (CXL) Another case presented during the symposium focused on the role of CXL to treat keratoconus. A majority of attendees—72%—said they would recommend CXL for any patient showing signs of progression, while 15% said they would recommend it for all keratoconus cases. Ten per- cent said they don't know enough about CXL to recommend it, and 2% said they would not advise it due to lack of evidence. Corneal ulcer Drs. Holland and Kim presented the case of a 14-year-old female with pain and decreased vision that panelists a "red flag" to challenge something that was said. Here are a few cases discussed during "Pardon the Ophthalmolo- gy." EBMD Panelists said not to ignore EBMD as patients continually demand crisper postop vision. "We're paying atten- tion to this more, as it can affect cat- aract outcomes," Dr. Holland said. Topography can also be beneficial in helping to diagnose EBMD preop- eratively, panelists said. Fifty-seven percent of the audience said they would treat the sample EBMD case with phototherapeutic keratectomy, while another 34% said they would use lubrication and hypertonic sa- line. Other treatment options given were anterior stromal puncture and ignoring the EBMD. A t Sunday's symposium "Pardon the Ophthalmol- ogy: Hot Topics in Cornea and External Disease," attendees and panelists alike weighed in on how they would handle tricky cases. The symposium followed the format of the popular ESPN sports show "Pardon the Inter- ruption." Ed Holland, MD, Cincin- nati, and Terry Kim, MD, Durham, N.C., moderated the symposium. Drs. Holland and Kim presented a variety of challenging cases that involved everything from dry eye to epithelial basement membrane dystrophy (EBMD) to fungal in- fections to corneal scarring. With each case, a few treatment options were given, and attendees used their response devices to weigh in on their preferred choice. Panelists also discussed how they would handle the case, and occasionally, Drs. Holland and Kim would throw "Pardon the Ophthalmology" presents rapid-fire cases Dr. Holland and Dr. Kim moderate "Pardon the Ophthalmology: Hot Topics in Cornea and External Disease."

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