Retinal Cream
DJO | Digital Journal of Ophthalmology A 79 year old man with visual changes Burton Goldstein, M.D. William Mcdowell, M.D. University of South Florida History A 79-year-old male presented with a complaint of decreased visual acuity in his left eye for the past 4 days. He also described a dirty cobweb in the left eye that was immobile. He denied flashes, scotomata, and curtains. The visual acuity OD had been count fingers for the previous 10 years secondary to a presumed branch retinal vein occlusion. He had a history of mild cataracts OU. He was diabetic but there was no history of diabetic retinopathy or other ocular disease. The patient had originally reported to his primary care physician one week earlier with complaints of increased fatigue, short-term memory loss, lower extremity weakness, and headache. He had been hunting in the Florida panhandle one week prior to the onset of his symptoms and sustained numerous mosquito bites. Examination Best-corrected visual acuity was count fingers OD, 20/40 OS. There was a RAPD on the right. IOP was 16 OU. The anterior segment was quiet OU. Bilateral posterior vitreous detachments were present, no vitreous cells. Discs were sharp and flat. Retinal vessels were wnl with no vasculitis. Maculae were dry and the periphery was attached with the following appearance. (see photos) Figure 1. Figure 2. Figure 3. Figure 4. Ancillary Testing Radiographic Studies A Humphrey 24-2 visual field OS showed nonspecific defects. The patient was hospitalized and a thorough workup was initiated. CT of the head revealed no masses or acute intracranial process. A lumbar puncture was performed. The opening pressure was normal. CSF demonstrated an elevated total protein and white blood cell count; gram stain and culture were negative. Serum titers of IgG and IgM for West Nile virus were positive Treatment The patient is currently being observed without treatment. Vision has improved to 20/30 OS and the posterior segment remained stable at both the one and three-month follow up. He continues to suffer from short-term memory loss but is improving. Differential Diagnosis The differential diagnosis of similar chorioretinal lesions includes primary ocular histoplasmosis syndrome, birdshot chorioretinopathy, multiple evanescent white dot syndrome, punctate inner choroidopathy, sarcoidosis, syphilis, lyme disease, miliary tuberculosis, intraocular lymphoma, herpes virus infection, inflammatory bowel disease and outer retinal toxoplasmosis. Diagnosis The patient was diagnosed with West Nile encephalitis. The organism responsible, the West Nile virus, is a flavivirus found in humans, birds and other vertebrates. Human cases of West Nile Virus infection in the United States for 2003 totaled 9,862 (1). The virus in now established in the western hemisphere and requires consideration in the differential diagnosis of choroiditis. Infection is usually asymptomatic but in approximately 20% of the people infected, symptoms can develop including fever, headache, fatigue, myalgias, and occasionally a skin rash on the trunk of the body. Severe infection can cause a meningitis or encephalitis picture. (2) Ocular symptoms usually begin shortly after systemic symptoms. Vision usually returns to baseline within weeks. There is no known effective treatment for systemic or ocular disease. While the infectious etiology had been identified prior to this patients presentation, it is likely many patients go undiagnosed. West Nile associated choroiditis is a potential complication of viral infection that can aid in the recognition of this condition. The ophthalmic findings in this case were consistent with several previously described cases of West Nile choroiditis. (3-7). Similar bilateral, chorioretinal, variable-sized lesions have been described in several of these reports. Findings of bilateral targetoid lesions (i.e.: hyperpigmentation surrounded by hypopigmentation) and linear hypopigmented streaks appear to be characteristic. Circular lesions range from 300-1000 microns in size and can slowly enlarge. The streak chorioretinal lesions range from 200-1500 microns in size and begin cream colored and become hypopigmented. (8) Targetoid lesions appear to be the resolving stage of initially cream-colored circular lesions, which will eventually atrophy. Other case reports have described additional signs of West Nile ocular involvement include conjunctival hyperemia, non-granulomatous keratic precipitates, anterior chamber reaction, and occlusive retinal vasculitis, which were not found in this patient. There was no overlying retinitis, vasculitis or neurosensory detachment. It has been reported that elderly and diabetic patients are more prone to the neurologic sequelae of West Nile virus infections. (9) This patient presented with a documented case of West Nile virus infection that made the diagnosis of coincident West Nile virus choroiditis evident. However, it demonstrates the need to include such infection in the differential diagnosis of choroiditis References 1.Center for Disease Control and Prevention (CDC), Division of Vector-Borne Infectious Diseases. (2003). Available online: http://www.cdc.gov/ncidod/dvbid/westnile/surv&controlCaseCount03_detailed.htm 2.Center for Disease Control and Prevention (CDC), Division of Vector-Borne Infectious Diseases, Questions and Answers. (2003). Available online: http://www.cdc.gov/ncidod/dvbid/westnile/qa/symptoms.htm 3.Adelman R, Membreno J, et al. West Nile Virus Chorioretinitis. The Journal of Retinal and Vitreous Diseases 2003; 23: 100-101. 4.Vandenbelt S, Shaikh S, et al. Multifocal Choroiditis Associated With West Nile Virus Encephalitis. The Journal of Retinal and Vitreous Diseases 2003; 23: 97-99. 5.Hershberger, Augsburger, et al. Chorioretinal Lesions in Nonfatal Cases of West Nile Virus Infection. American Academy of Ophthalmology 2003; 1732-1736. 6.Law S, Syed J, Caprioli J, Uveits Associated with West Nile Virus Infection. Archives of Ophthalmology 2003; 121: 1648-1647. 7.Anninger W, Lomeo M, et al. West Nile Virus-associated Optic Neuritis and Chorioretinitis. American Journal of Ophthalmology 2003; Vol 136, No 6: (1183-1185). 8.Adelman R, Membreno J, et al. Clinical Findings of West Nile Chorioretinitis. Presented at the American Academy of Ophthalmology, Retina Subspecialist meeting, 2004. 9.Chan C, Tarasewicz D, et al. Epidemiological Trends and Ocular Findings Associated with West Nile Virus Infections in North America. Presented at the American Academy of Ophthalmology, Retina Subspecialist meeting, 2004. 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ContainsHand & Foot Creams products at MSN Shopping MSN Home My MSN Hotmail Shopping Money People & Chat Sign In Web search: Shopping Save this page Feedback Site map Help Home | Beauty | Books | Clothing | Computers | Deals | Electronics | Flowers | Home & Garden | Jewelry | Movies | Music | More ... Search Shopping Home > Beauty & Fragrance > Manicure & Pedicure > Hand & Foot Creams > WebVitamins.com Hand & Foot Creams Advertisement Featured Stores See all stores 110 items found Narrow your selection: Brand Jason Natural Products Kiss My Face EO Organic Fiji Organic Bath Company Alba Botanica Nature's Gate Avalon Active Organics More... Seller WebVitamins.com See all options Price range $2 - $6 $6 - $9 $9 - $10 $10 - $15 $15 - $31 $ to $ Calculated in 0.156 seconds Previous Page 1 2 3 4 5 6 7 8 of 8 Next View: List Grid Text checked items Sort by Most popular Highest user rating Lowest price Highest price Name A-Z Name Z-A Emerita Deep Hydrating Lotion, 8 oz by Emerita $9.50 Deep Hydrating Lotion, 8 oz : Emerita Deep Hydrating Body ... More Lotion: With H2OPTIMA?Stress. Sun. Wind. Even diet: All of them work against the skin?s ability to maintain an optimum moisture balance. Your skin has a deep, deep thirst. It?s a living thing, At WebVitamins.com | Details Rate it Kiss My Face Moisturizer Honey and Calendula 16 oz. by Kiss My Face $7.25 Moisturizer Honey and Calendula 16 oz. : Honey is an ... More effective hydrophilic (it attracts moisture from the air). It has been used since the days of early Egypt to prevent wrinkles and provide moisture to the skin. Greek philosophers referred to honey At WebVitamins.com | Details Rate it Organic Bath Body Butter Pomagranite Fig., 8oz. by Organic Bath Company $8.10 Body Butter Pomagranite Fig., 8oz. : Better Body ButterFor ... More luxuriously smooth skin, wrap yourself in the luxury of shea butter, jojoba oil, and other protective, rich oils. Essential for dry, rough or weather exposed areas like hands, elbows and feet At WebVitamins.com | Details Rate it Organic Bath Body Lotion Pomegranaite fig., 9.5oz. by Organic Bath Company $6.85 Body Lotion Pomegranaite fig., 9.5oz. : Super-hydrating ... More Body LotionThis super-hydrating lotion combines the benefits of organic white tea with rich emollient jojoba oil and therapeutic pro-vitamins. Ideal for dry, sun damaged or aging skin to restore At WebVitamins.com | Details Rate it Alba Botanica Body Lotion, Dry Skin 32oz. by Alba Botanica $13.50 Body Lotion, Dry Skin 32oz. : This maximum, therapeutic ... More formula blends certified organic aloe vera, green tea and chamomile extracts with natural plant emollients and vitamin antioxidants to soothe, nourish and revitalize dry, sensitive skin. With al At WebVitamins.com | Details Rate it Organic Bath Body Lotion Lavender/Vanilla, 9.5oz. by Organic Bath Company $6.85 Body Lotion Lavender/Vanilla, 9.5oz. : Super-hydrating Body ... More LotionThis super-hydrating lotion combines the benefits of organic white tea with rich emollient jojoba oil and therapeutic pro-vitamins. Ideal for dry, sun damaged or aging skin to restore At WebVitamins.com | Details Rate it Organic Bath Body Lotion White Tea 10oz. by Organic Bath Company $6.85 Body Lotion White Tea 10oz. : Super-hydrating Body ... More LotionThis super-hydrating lotion combines the benefits of organic white tea with rich emollient jojoba oil and therapeutic pro-vitamins. Ideal for dry, sun damaged or aging skin to restore youthful At WebVitamins.com | Details Rate it Alba Botanica Body Lotion, Original 32 oz. by Alba Botanica $11.65 Body Lotion, Original 32 oz. : This deep, nourishing drink ... More for dry, thirsty skin blends certified organic aloe vera, green tea and chamomile extracts for optimum moisture balance and therapeutic benefits.Exquisitely light, our Original Body Lotion is At WebVitamins.com | Details Rate it Organic Bath Body Polish Honey Chai, 15oz. by Organic Bath Company $8.10 Body Polish Honey Chai, 15oz. : Replenishing Body ... More PolishRefine, renew, and replenish your skin with our ultimate body polish. Made with purifying salts and organic white tea botanicals to safely remove trapped dirt and oils and leave your skin silky At WebVitamins.com | Details Rate it Organic Bath Body Butter White Tea, 8oz. by Organic Bath Company $8.10 Body Butter White Tea, 8oz. : Better Body ButterFor ... More luxuriously smooth skin, wrap yourself in the luxury of shea butter, jojoba oil, and other protective, rich oils. Essential for dry, rough or weather exposed areas like hands, elbows and feet. This At WebVitamins.com | Details Rate it Emerita Deep Cooling Lotion, 8oz by Emerita $9.50 Deep Cooling Lotion, 8oz : Emerita Deep Cooling Body Lotion ... More With ICE3 ?Sun. Wind. Hot bath. Hot flashes. Shaving. Everyday living? All of them work against your skin?s ability to maintain moisture and comfort. Your skin is a complex system, one that At WebVitamins.com | Details Rate it Kosmea Radiant Hand/Body Lotion, 125mL $20.40 Radiant Hand/Body Lotion, 125mL : Instantly hydrates the ... More body and hands at the same time giving them a gorgeous skin glow. Contains the following components: L-Carnitine At WebVitamins.com | Details Rate it Kosmea Radiant Hand/Body Lotion, 225 mL $30.60 Radiant Hand/Body Lotion, 225 mL : Instantly hydrates the ... More body and hands at the same time giving them a gorgeous skin glow. Contains the following components: L-Carnitine At WebVitamins.com | Details Rate it Organic Bath Body Polish Pomegranate, 15oz. by Organic Bath Company $8.10 Body Polish Pomegranate, 15oz. : Replenishing Body ... More PolishRefine, renew, and replenish your skin with our ultimate body polish. Made with purifying salts and organic white tea botanicals to safely remove trapped dirt and oils and leave your skin silky At WebVitamins.com | Details Rate it Organic Bath Body Polish White tea, 15oz. by Organic Bath Company $8.10 Body Polish White tea, 15oz. : Replenishing Body ... More PolishRefine, renew, and replenish your skin with our ultimate body polish. Made with purifying salts and organic white tea botanicals to safely remove trapped dirt and oils and leave your skin silky s At WebVitamins.com | Details Rate it checked items Sort by Most popular Highest user rating Lowest price Highest price Name A-Z Name Z-A Previous Page 1 2 3 4 5 6 7 8 of 8 Next View: List Grid Text What's this? Search Shopping Shopping help About this site FAQ Newsletter sign-up Trends & deals Home Baby Beauty Books Car & Garage Clothing Computer Deals Electronics Flowers Furnishings Garden Gifts Health Jewelry Kitchen Movies Music Office Pets Shoes Sports Toys Video Games ©2006 Microsoft Legal MSN Privacy Advertise Images credit: Getty Images Feedback skin care products lineNature Skin Care: LBri Natural Skin Care Products for healthy, happy skin. 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These statements have not been evaluated by the Food and Drug Administration and these materials and products are not intended to diagnose, treat, cure or prevent any disease. Site Map Who Else Wants To Have Clear, Young Skin In Only 30 Days? Every offering in the L'Bri natural skin care products line strikes a perfect balance between nature and science and is formulated using only the finest natural ingredients, combined with the latest technological advances from the scientific community. Click here to see the natural skin care products now. Daily use of L'Bri Pure n' Natural Skin Care Products will help off-set the effects of free radicals in the skin caused by environmental pollutants and overexposure to the sun's ultraviolet rays, leaving you with healthier, more radiant skin. Ugly Old Prune! Click here to see what happens to your skin when you essentially suffocate it with heavy oils and/or waxes. 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Leaves skin smooth, supple, and comfortable. Only $20.00 for a three month supply. PURE ALOE VERA (BARBADENSIS) JELLY 4 oz. For all skin types. Pure unadulterated Aloe Jelly penetrates quickly to calm and soothe irritated or inflamed skin. Acts as a natural bandage to help the healing of blemished skin. Helps speed the healing of cuts, insect stings, and burns. No medicine cabinet should be without it! Only $15.00. THE ULTIMATE HAND AND BODY LOTION 8 oz. The complete treatment for hands and body that nourishes protects and repairs. Natural ingredients absorb quickly and form a protective shield to reduce moisture loss, even with frequent hand washing. Contains Aloe Vera Barbadensis, vitamins A, B2 (riboflavin), B5 (panthenol), C, D3 (cholecalciferol), Squalane and Sodium PCA. These ingredients work together to form a light, silky protective shield that never feels greasy or tacky. Don’t Let Your Hands Give Away Your Age! Only $12.50 VITAMIN E STICK WITH SUNSCREEN This fragrance free sunstick with Vitamin E and Aloe soothes, protects, and moisturizes the most sensitive areas of your face -- your lips and eye area. Great for dry chapped lips. SPF 22 Only $9.75 SUNLESS TAN Get that golden look without aging your skin! Just apply lotion over your body and in 2 to 4 hours you'll begin to develop a beautiful natural-looking, non-streaky tan that won't fade for several days. Only $15.00 SUN SCREEN LOTION SPF 15 Rely on L’Bri’s top quality, water resistant sun protection to protect you and your family against the skin’s worst enemy. Soothes your skin with natural botanicals as it protects. Leaves no greasy after feel; will not clog pores. Only $13.00 Free shipping & handling on all orders of $48 or more Your L'Bri Consultants are Ellen and Chet Day Click to Order on ounline Secure Server L'Bri 640 Perkins Dr Mukwonago, WI 53149 Toll Free: 1-800-742-8828 Tell them Ellen and Chet Day referred you! 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