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Mr Frank Kinsella, who is based at University Hospital Galway, said people with Down syndrome are at high risk of keratoconus.
“They are the only group of patients that get a thing called hydrops. Hydrops is a dreadful thing, we would have one maybe every two years in UHG,” he said at the recent 31st Annual Conference of Rural, Island and Dispensing Doctors in Clifden, Co Galway.
Hydrops occurs when a patient with keratoconus rubs their eyes, resulting in acute corneal failure. There is high prevalence of ocular disorders among people with Down syndrome, and current Irish guidelines recommend vision and refractive error checks at least every two years throughout life after the age of four, as well as examinations for newborns and infants.
“So the message nowadays is that any Down syndrome patient you have, say from about teens onwards, if they are fairly co-operative, should be sent in and screened for keratoconus.”
Corneal cross-linking is one of the main treatments for people with worsening keratoconus and takes about 20 minutes, increasing the strength of the cornea five-fold.
Meanwhile, Mr Kinsella remarked that there have been three eyes in Ireland lost over the past two-to-three years from ocular gonorrhoea.
Two cases were in Waterford and one in Dublin. He advised GPs that if patients present with “dreadful conjunctivitis”, it is gonococcal “until proved otherwise”.
Mr Kinsella emphasised the importance of prompt hospital admission. “If it is a hyper-acute conjunctivitis — if someone comes in with a dreadfully sticky eye, where their lids are swollen — they may have some cellulitis as well and frequently, chemosis… treat those as gonococcal until proved otherwise. They need to be admitted to hospital.
“They are so purulent, you are at nothing even trying to put drops in. They have got to be admitted, the eye cleaned every hour, cleaned out in order to get the antibiotics in… this won’t be like any conjunctivitis you’ve seen before.”