300 Optometry, Vol 81, No 6, June 2010

accepted cause of DES. However, ocular inflammation isnow considered an underlying cause, making steroid treat-ment an alternative option for dry eye. This study exploresthe use of the low-dose soft steroids in the treatment ofDES. Specifically, is loteprednol etabonate 0.2% effectivein the treatment of DES compared with higher dosed ste-roids and artificial tears?Methods: In a randomized masked clinical trial, 8 subjectswere divided into 3 treatment groups and given differentdrops for each eye to take over 2 weeks. After a 1-weekrest period, the treatments were rotated, giving 3 treatmentperiods and 2 rest periods with examinations and surveys atthe end of each period.Results: Using t-test analysis, data from examinations wereanalyzed regarding visual acuity, tear volume, cornealstaining, grade, and intraocular pressure. Additionally,questionnaires were used to evaluate comfort, dryness,itchiness, grittiness, wateriness, and blurry vision. Minimalstatistical significance was found among these categories.Conclusion: Although this study cannot claim a significantdifference in the relief of dry eye with loteprednol etabon-ate 0.2% compared with loteprednol etabonate 0.5% and anartificial tear, the performance of loteprednol was compara-ble to that of the traditional treatment modalities, suggest-ing loteprednol etabonate 0.2% is a plausible alternativetreatment for DES.

Poster 71

Hyperbaric Oxygen Therapy and the Eye

Lynn Ueshiro, O.D., Spark Matsunaga VA Medical Center,Honolulu, Hawaii

Background: Hyperbaric oxygen therapy (HBOT) is wellknown for its treatment of decompression sickness and ar-terial gas embolism. It is less well known for its ocular sideeffects and potential for ocular treatment. It is hypothesizedthat hyperoxygenation increases the refractive index of thelens, which increases myopia without causing an increasein axial length, forward movement of the lens, accommoda-tive spasm, or change in corneal curvature. It is also hy-pothesized that hyperoxygenation of the retina via thechoroid can aid in treating ischemic diseases like CRAO.Though it is expensive, not widely available, time consum-ing, and not extensively studied, it is important for optom-etrists to be aware of the side effects and possibility fortreatment.Case Report: A 65-year-old white man patient presentedfor a refraction check. He had undergone 2 hyperbaric oxy-gen treatments for a nonhealing rectal vault. The first treat-ment lasted 3 months for 2 hours a day, 5 days a week. Thesecond treatment 5 months later was for 10 days. His ocularhistory included a ganciclovir implant OD in 2001 forCMV retinitis and cataract OU. His medical history in-cluded HIV, multiple malignancies, CKD, HTN, HLP, andpulmonary disease. His medications included HAART andothers. Visual acuities were 20/20 for each eye. Entrance

testing, biomicroscopy, intraocular pressure, and dilatedfundus examination were unremarkable. After his firsttreatment, he had a myopic shift of 1.75 D in both eyesand an increase in astigmatism of 1.25 D OS. Two monthsafter his first treatment, his refraction returned to baseline.Ten days after his second treatment, he had a similar refrac-tive shift, which continued for 4 months. Visual acuitieswere 20/20 for each eye at each visit. At last follow-up,the myopic shift increased, and visual acuities decreasedbecause of cataract progression.Conclusion: A myopic shift should be expected afterHBOT. This case reminds us to educate our patients andother physicians about the possible side effects of HBOTand to consider it for certain sight-threatening diseasessuch as CRAO. Though HBOT is currently an off-labeluse for ocular conditions, it appears to be gaining ac-ceptance because of its safety and efficacy.

Poster 72

Oral Tetracycline–Induced Bulbar ConjunctivalPigmentation

Matthew Rhodes, O.D., and Carla Engelke, O.D., SouthernArizona VA Healthcare System, Tampa, Florida

Background: Ocular, cutaneous, dental, osseous, and thy-roid pigmentation are well documented side effects of thetetracycline class of drugs, especially with long-term use.

Scleral and palpebral conjunctival pigmentation in bothminocycline and combination minocycline/tetracyclinetherapy have been suggested by numerous reports. Clini-cally visible ocular tissue pigmentation with tetracyclinetherapy alone, however, is rare. Only 2 reports of tetracy-cline-induced bulbar conjuntival pigmentation were foundin a literature search. Westin et al. reported bilateral,elevated, brownish-gray lesions near the limbus in a24-year-old after 5 years of oral tetracycline use. Morrisonet al. reported bilateral discrete, green, crystalline depositsadjacent to the temporal limbus after 2.5 years of tetracy-cline use. We present a case of bulbar conjunctivalpigmentation in a patient whose clinical presentationclosely resembled the latter report.Case Summary: A 57-year-old white man presented for aroutine eye examination. His medical history includedacne vulgaris, hypercholesterolemia, airway obstruction,and kidney and heart transplants. His medications includedatenolol, albuterol, niacin, prednisone, sirolimus, simvasta-tin, warfarin, and tetracycline 500 mg orally daily. He re-ported 6 years of tetracycline therapy but denied previousminocycline therapy. He also denied recent use of topicalophthalmic medications or any unusual pigmentation ofskin or body parts. His best-corrected visual acuities were20/20 OD and OS. Entrance testing was unremarkable. Bi-omicroscopy found numerous green, discrete, refractile de-posits within the temporal bulbar conjuntiva adjacent to thelimbus OU. No corneal or conjunctival staining was ob-served. Goldmann intraocular pressures were 13 mmHg

Poster Presentations 301

OU, and dilated fundus examination found only mild tortu-osity and crossing changes of retinal arteries. The conjunti-val deposits were documented with slit lamp photography.The assessment was tetracycline-induced conjunctival pig-ment deposits OU. Cessation of tetracycline therapy wasdeemed unnecessary, and the plan was to follow up in1 year to monitor for changes.Conclusion: First-generation oral tetracyclines are themost commonly prescribed oral antibiotics for acne vulga-ris, and tetracycline therapy is routinely encountered ineye care settings. Identifying tetracycline-inducedpigmentary changes will help avoid confusion with othercauses of ocular tissue pigmentation. Furthermore,cessation of the medication may prevent additionalpigmentary changes.

Poster 73

Chemotherapy-Induced Optic Neuropathy

Crystal DeLuca, O.D., Nirali Patel, O.D., Meghan Cook,O.D., Stephen Wrzesinski, M.D., Ph.D, Charles Haskes,O.D., M.S., and Nancy Shenouda-Awad, O.D., West HavenVA Medical Center, West Haven, Connecticut

Background: Imatinib mesylate (Gleevec) is a medicationthat was developed to treat chronic myelogenous leukemiaas well as gastrointestinal stromal tumors (GISTS). Themost common ocular side effect is periorbital edema. How-ever, more serious ocular side effects have been reported,including optic nerve edema, optic nerve damage, and glau-coma. Hence, it is important that optometrists be familiarwith Gleevec and its potential vision-threateningcomplications.Case Report: A 66-year-old white veteran presented to theoptometry service at West Haven VAMC for a routine eyeexamination. He presented with a chief complaint of de-creased vision OS for 3 weeks with no associated flashesor eye pain. The examination found a reduction in visualacuities from 20/20 to 20/70 OS and stable 20/20 OD.The patient also had a positive left APD and decreasedcolor vision OS 1/11. Dilated fundus examination foundan elevated edematous left optic nerve, and a visual fieldconfirmed a significant superior and mildly inferior fielddefects OS. The patient is a smoker with a history of con-trolled hypertension and hyperlipidemia. He was also re-cently diagnosed with metastatic GIST tumor treated withGleevec 3 months before presentation. Therefore, he wassent for an MRI to rule out any CNS metastasis. Comanage-ment was done with the patient’s oncologist regarding theocular finding and the possibility that it was caused byGleevec. After an extensive review of the literature andour examination findings, his Gleevec use was discontin-ued. After the termination of treatment, the patient’s visualfield improved and vision improved to 20/50 OS.Conclusion: Because of the other potential risks, such assmoking, hyperlipidemia, and hypertension, the diagnosisof nonarteritic ischemic optic neuropathy must be

considered, making this case a diagnostic dilemma. Basedon the time frame between initiation of Gleevec treatmentand vision loss in addition to the start of resolution afterdiscontinuation of this medication, the symptoms experi-enced by our patient are likely a side effect of Gleevec. Co-management with oncology has become essential in themanagement of this case to optimize visual and systemicoutcome.

Poster 74

Contamination Rate of Artificial Tears With TransientPreservatives

Soraya Keshmiri, Student, Judith Perrigin, O.D., andDavid Perrigin, O.D., University of Houston College ofOptometry, Houston, Texas

Purpose: Staphylococcus epidermidis is a concern for pa-tients because it is commonly found on the lids and lashes.Patients may touch the tip of the dropper to their lids there-fore contaminating the tip. The purpose of this study is toexamine how effective transient preservatives are at pre-venting S.epidermidis growth and how the dimensions ofthe bottle affect contamination.Method: Ten bottles each of Blink, Theratears, Refresh,Genteal, Equate, and Optive were inoculated with S. epider-midis. Half were inoculated on the tip and half inside thecap. All bottles were recapped and left at room temperaturefor 24 hours. One drop of tears was then dripped andstreaked onto 5% sheep’s blood agar. A sterile aspirationof bottle contents was also plated. All plates were incubatedand evaluated for growth, and the aperture diametersmeasured.Results: Aspirated specimens showed no growth. Growthfrom specimens obtained by dripping ranged from zero col-ony forming units (CFUs) to too numerous to count. Degreeof growth varied both within and between brands. Productsshowing the lowest mean growth were Equate (59 CFUs)and Blink (64 CFUs). Refresh (105 CFUs), Optive (134CFUs), and Genteal (155 CFUs) performed similarly toone another, whereas Theratears (307 CFUs) had the high-est mean growth. Tip aperture size was consistent withinbrands but varied between brands. Aperture diameterranged from 2.2 mm (Refresh) to 1.3 mm (Equate). Degreeof contamination did not directly correlate with aperturesize. Large and small bottles of Optive showed similargrowth, but, Equate, the product marketed in the largestbottle size showed the lowest contamination rate.Conclusion: Contamination of transient preservative artifi-cial tear bottle tips and inner caps with S. epidermidis didnot contaminate the internal contents, but did contaminatethe drops as they passed through the aperture in the waythat a patient would use the tears. This could present in-creased risk of ocular infection for patients who touch thelids and lashes with the bottle tip when applying artificialtears. The cause for the difference in growth betweenbrands was not clearly evident in this study.

(N.E.I. Grant EY007088)