Research

Published Research

Comparación del funcionamiento clínico de dos lentes de silicona e hidrogel usadas como lentes venda tras cirugía LASEK
(Capítulo 10). En Cirugía Refractiva: soluciones ópticas a sus fracasos. Ed. A. López Alemany, Ulleye. Xàtiva, 2006; 87-92 (ISBN 84-930828-4-8
Pérez Gómez, I., Chadwick, L., Frangouli, A., Doyle, S., O'Donnell, C.

PRK in patients with a keratoconic topography picture. The concept of a physiological "displaced apex syndrome"
Doyle SJ, Hynes E, Naroo S, Shah S, British Journal of Ophthalmology: 80, 25-29, 1996

The epithelial flap for photorefractive keratectomy
S. Shah, A R Sebai Sarhan, S J Doyle, C T Pillai, H S Dua - British Journal of Ophthalmology 2001; 85, 393-396 (April) - Read Here>

Prediction of Refractive Outcome in Penetrating Keratoplasty for Keratoconus
Doyle SJ, Harper C, Marcyniuk, Ridgway AEA: Cornea, 15(5), 441-445, 1996

Emmetropisation, axial length, and corneal topography in teenagers with Down's Syndrome
Stephen J Doyle, John Bullock, Cath Gray, Allison Spencer, Cliff Cunningham. British Journal of Ophthalmology, 82, 793-796, 1998

Corneal Temperature Changes during Photorefractive Keratectomy
Betney S, Morgan P, Doyle SJ, Efron N.     Cornea, 16(2): 158-161, 1997

Acute corneal erosion from the use of anti-misting agent in swimming goggles
Doyle SJ, British Journal of Ophthalmologv; 78: 419, 1994 - Read Here>

Results of Excimer Laser Retreatment of Residual Myopia after Photorefractive Keratectomy
Chatterjee A, Shah S, Bessant DA, Doyle SJ,    Ophthalmology, 104(8): 1321-1326, August 1997

Proceedings of the Nidek International Excimer Laser Users meeting, December 4-6, 1996, Aswan, Egypt. -
Journal of Refractive Surgery -Vol 13, 5, August 1997 - various papers. - Read Here>

Reduction in Intraocular Pressure after Excimer Laser Photorefractive Keratectomy - Correlation with Pre-treatment Myopia
Chatterjee A, Shah S, Bessant D, Naroo SA, Doyle SJ,    Ophthalmology, 104(3), 355-359 March 1997

Epithelial Debridement for Secondary hyperopia following myopic excimer laser photorefractive keratectomy
Shah S, Chatterjee A, Doyle SJ, Bessant DA, Journal of Cataract and Refractive Surgery, Vol 24, Jan 1998

Contact lens management of Keratectasia after LASIK for myopia
Claire O'Donnell, Lynne Welham and Stephen Doyle,  Eye and Contact Lens Vol 30 No 3 2004

Posters in congresses:   

  • Refractive results for Nidek EC-5000 using a new algorithm in 488 eyes
  • Induced astigmatism by spherical photorefractive keratectomy corrections
  • Effect of Age on final refractive outcome for 2346 patients following PRK
  • Patient motivation in PRK and contact lenses: Is PRK only for contact lens failures (with S Shah, P Morgan, S Naroo, A Chatterjee, D Bessant)

Links

Refractive Surgery Sites

The amount of information on LASIK and LASEK is truly staggering and much of is is good quality. You can Google for LASIK and I have put in a few below, in no particular order or merit. Some have extensive links pages of their own. A lot of the information comes from the States. If you got this far on your own then I am sure that you can find more than enough information  to keep you happy!

  1. Visualase - the clinic where I do most of my refractive surgery.
  2. Lasik Institute - this is a very comprehensive American site on Lasik. It is funded by an educational grant from Summit Inc., one of the laser manufacturers, but seems to be independent of them. There is a particularly interesting discussion you can find via their links page between two groups of surgeons on the pros and cons of simultaneous bilateral lasik (the general norm in the USA)
  3. "Wikipedia" - Quite a nice entry and has a lot of links at the bottom of the page
  4. British Society for Refractive Surgery - Professional body of Ophthalmologists and Optometrists in the UK. Good article on the state of refractive surgery in 2002
  5. FDA - USA Food and Drug Administration site on LASIK - official government site
  6. Eye Surgery Education Council - an initiative established by the American Society of Cataract and Refractive Surgery (ASCRS), to which I belong,  Like all American sources there is more about LASIK than LASEK, although there is a swing back to surface ablation in the USA in recent times.
  7. All About Vision - USA commercial site
  8. The Royal College of Ophthalmology has a section for patients on laser refractive eye surgery. This is excellent and unbiased, and has just been updated (April 2003)
  9. www.lasik-eyes.co.uk - This is a UK site collecting various patients' experiences at different clinics. 

Goggles Problem

Goggles Problem


Goggles Problem

Acute corneal erosion from the use of anti-misting agent in swimming goggles

The number of ways that the human cornea can be injured by physical or chemical agents is extremely variable and sometimes bizarre(1,2). We describe here one such occurrence.

Case Report

A 63 year old man, a keen long-distance swimmer, presented in the casualty department just after completing a 2 hour swim in Lake Bala in Wales. When he had finished the swim and removed his goggles, he found that his left vision was very blurred and he began to notice that it was also painful and gritty. On examination, he was found to have a total epithelial erosion of his left cornea. The right eye was completely normal. The corneal epithelium healed uneventfully over 48 hours although he had occasional grittiness over the next few weeks.

Preceding his swim, he had sprayed the inside of his goggles with "Calotherm", a widely available anti-misting agent (Calotherm International, Raymond House, Beckenham Business Centre, Kent House Lane, Beckenham, BR2 1WA). This is an aqueous solution containing less than 15% Ethoxylated long chain primary alcohols and less than 5% Isopropanol in a pump-action, air-propelled container. As far as he remembers, he followed the manufacturer's instructions by allowing the agent to evaporate to dryness. However, the rims of his goggles were composed of an absorbent sponge material and it is quite likely that he sprayed them as well. He was quite keen to use plenty of spray on the basis that "more of it would work better". The anti-misting agent was recommended to him by a friend and he had only recently begun to use it. He had experienced a similar, less severe episode, also after the use of "Calotherm", a few months previously following an hour long swim off Lanzarote. This was diagnosed as conjunctivitis by a local, emergency doctor and treated with antibiotic drops. He has no previous eye history of eye trauma and there is no corneal dystrophy.

Comment

Although the patient is, understandably, not willing to undergo a controlled trial to elucidate the problem further, we are fairly certain that his unusual erosion was caused by alcohol fumes evaporated from his goggles. In a confined space and over a long period of time they could clearly cause epithelial damage as described.

The commonest cause of alcohol damage to the cornea is that due to imperfectly cleaned tonometer heads(3). A similar problem also occurs with hydrogen peroxide(4). Aerosol damage is usually by direct accidental spray damage(5) but can also be malicious(6). In this case the propellant was compressed air by the action of the hand pump and any ocular toxicity must be from the agent alone rather than the propellant, which in other aerosols can be butane or fluorocarbon derivatives. Our patient has now gone back to the old remedy for demisting: spitting on the inside of the goggles before swimming.

We advise, therefore, that swimmers or other people using enclosed goggles for prolonged periods (eg welders) and using "Calotherm" or similar anti-misting agents, should make sure that they are dry in all elements before use. Neither should they use an excessive amount.

References

  1. DeRespinis PA; Prohman LP; Microwave popcorn--ocular injury caused by steam (letter) N Engl J Med Oct 25 1990 323 (17) p1212
  2. Chang PC; Soong HK; Barnett JM; Corneal penetration by tarantula hairs (letter) Br J Ophthalmol Apr 1991 75 (4) p253-4
  3. Soukiasian SH; Asdourian GK; Weiss JS; Kachadoorian HA; A complication from alcohol-swabbed tonometer tips. Am J Ophthalmol Apr 15 1988 105 (4) p424-5
  4. Pobrebniak AE; Sugar A; Corneal toxicity from hydrogen peroxide soaked tonometer tips. (Case Report) Arch Ophthalmol Nov 1988 106 (11) p1505
  5. Ben-Nissan D; Savir H; Ocular injury by artificial snow spray Harefauh Dec 2 1990 119 (11) p370
  6. Klyve P; Tear gas and eye injuries Tidsskr Nor Laegeforen Jan 29 1992 112 (2) p203-5

© S J Doyle and British Journal of Ophthalmology

Research Papers

Research Papers