John Sheppard

By Rachel Dandar and John Sheppard

The primary goal of this chapter is to discuss the nuanced but prevalent clinical presentation of the patient with concurrent diagnoses of dry eye and allergic conjunctivitis. First, we discuss the epidemiology of dry eye disease and allergic conjunctivitis. We briefly discuss allergic blepharoconjunctivitis, a closely related entity with a different treatment focus. We thereafter discuss novel therapies, including loteprednol, varenicline nasal spray, reproxalap, and drug-eluting daily disposable soft contact lens. Lastly, we discuss a few biologic agents that hold promise for vernal and atopic keratoconjunctivitis, two forms of allergic eye disease that are more aggressive and can result in severe vision loss.

Part of the book: Recent Advances in Dry Eye Disease

By Brian A. Bird, Albert Y. Cheung and John D. Sheppard

The primary focus of this book chapter is to investigate and discuss the impact of corneal disease and how various types of corneal pathology can affect the surgeons preop, intraop and post op management when considering cataract surgery for a patient. Cataract surgery is known to exacerbate ocular surface diseases like dry eye, HSV, inflammatory conditions like ocular cicatricial pemphigoid, SJS, peripheral ulcerative keratitis, Moorens ulcer and endothelial disease like Fuch’s dystrophy secondary to intraoperative endothelial cell loss. Preoperative treatment including optimization of the corneal surface, antiviral prophylaxis in HSV keratitis, quiescence of inflammation and preoperative diagnostic evaluation of endothelial cell counts may all play a role in postoperative outcomes. Corneal disease may also impact intraoperative considerations in cataract extraction to include the use of scleral tunnels or even Extracapsular Cataract extraction techniques, for example, in patients with Mooren’s ulcer to decrease corneal melt. More commonly corneal disease consequently provides a poor view for the surgeon and unfavorable post op visual acuity for the patient. Consideration of staged keratoplasty and cataract surgery vs. combined “triple procedure” have both been shown as reasonable treatment options. Postoperative considerations include management of endothelial cell loss during surgery and minimizing postoperative eye drops and medicomentosa.

Part of the book: Cataract