Purpose: To report a case of adult ocular leech infestation.Case report: A 67-year-old male presented to the emergency department of Farabi Eye Hospital with the complaint of bloody tear. Slitlamp biomicroscopy of left eye revealed bloody lashes, bloody tear and a large black green foreign body attached to the inferotemporal bulbar conjunctiva. One cc of lidocaine 2% was injected directly to the body of leech. 10 minutes after injection, removal with forceps was retried.Conclusion: Ocular leech infestation must be considered as a differential diagnosis of bloody tear and HEMORRHAGIC CONJUNCTIVITIS. Removal of leech after direct injection of lidocaine to its body seems to be a safe method.

Background: Enterovirus 70 (EV70) and Coxsackievirus A24 variant (CA24v) are the etiologic agents of acute HEMORRHAGIC CONJUNCTIVITIS (AHC). The two viruses were isolated in early 1970s in Japan and Singapore, respectively. EV70 was responsible for two pandemics and several outbreaks worldwide affecting millions of people. CA24v has been responsible for several outbreaks of AHC especially in the Southeast Asian countries. Despite reports from Mediterranean region and Middle East there are no records of EV70 or CA24v infections in Iran. We conducted a serologic study to obtain such information. Material and Methods: Blood samples were collected from 66 donors in Tehran, Iran. Serum was separated under sterile conditions, stored below 20°C until shipped on dry ice to the Enterovirus Research Centre, Mumbai, India. LLC-MK2 and HeLa cell lines were used for testing samples for antibodies against EV70 and CA24v, respectively. Virus neutralization test was carried out in microtitre plates using serial two-fold dilutions of serum and 100TCID50 of the viruses. The highest serum dilution' that neutralized the virus infectivity completely was taken as the titre of antibody in the serum. Results: 68% (44/66) sera showed presence of neutralizing antibodies against EV70. Individuals in all age groups showed presence of EV70 antibodies the youngest donor was 4 years old. There was no difference in proportion of anti-EV70 antibody positive samples among men and women. Interestingly, antibodies against CA24v were absent in all the 65 serum samples tested. Conclusions: Iranian population has been exposed to EV70 infections during recent years but not to CA24v. A systematic study of disease burden due to viral AHC in Iran is warranted.    

Background: Enterovirus 70 (EV70) and Coxsackievirus A24 variant (CA24v) are the etiologic agents of acute HEMORRHAGIC CONJUNCTIVITIS (AHC). The two viruses were isolated in early 1970s in Japan and Singapore, respectively. EV70 was responsible for two pandemics and several outbreaks worldwide affecting millions of people. CA24v has been responsible for several outbreaks of AHC especially in the Southeast Asian countries. Despite reports from Mediterranean region and Middle East there are no records of EV70 or CA24v infections in Iran. We conducted a serologic study to obtain such information.Material and Methods: Blood samples were collected from 66 donors in Tehran, Iran. Serum was separated under sterile conditions, stored below -20°C until shipped on dry ice to the Enterovirus Research Centre, Mumbai, India. LLC-MK2 and HeLa cell lines were used for testing samples for antibodies against EV70 and CA24v, respectively. Virus neutralization test was carried out in microtitre plates using serial two-fold dilutions of serum and 100TCID50 of the viruses. The highest serum dilution that neutralized the virus infectivity completely was taken as the titer of antibody in the serum.Results: 68% (44/66) sera showed presence of neutralizing antibodies against EV70. Individuals in all age groups showed presence of EV70 antibodies the youngest donor was 4 years old. There was no difference in proportion of anti-EV70 antibody positive samples among men and women. Interestingly, antibodies against CA24v were absent in all the 65 serum samples tested.Conclusions: Iranian population has been exposed to EV70 infections during recent years but not to CA24v. A systematic study of disease burden due to viral AHC in Iran is warranted.

CONJUNCTIVITIS is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of CONJUNCTIVITIS, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered. Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral CONJUNCTIVITIS remains to be the most common overall cause of CONJUNCTIVITIS. Bacterial CONJUNCTIVITIS is encountered less frequently and it is the second most common cause of infectious CONJUNCTIVITIS. Allergic CONJUNCTIVITIS is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic CONJUNCTIVITIS as the underlying etiology. Effective management of CONJUNCTIVITIS includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment.