Pediatric Case Studies

Two dramatic cases show how Avenova fits into acute treatment plans

STEVEN LICHTENSTEIN, MD, FAAP, FACS, FAAO

Is there a place for Avenova in pediatrics? For routine cases, I have many kids with flaky, itchy lids using Avenova, and it works extremely well. But for dramatic cases, like the two discussed below, Avenova can prove indispensable.

Case 1:
Preschooler’s Corneal Ulcer

A patient who was almost four years old presented with a red, irritated eye (see Figure 1). Her parents said the eye had been red for three months, and there was a “thick” discharge. The child had a similar problem a year earlier that resolved without treatment. Otherwise, the child was healthy with no medical history or known allergies.

FIGURE 1. A 4-year-old child presented with a red, irritated eye.

On her exam, her vision showed central, steady, and maintained in both eyes. She was extremely photophobic. Her extraocular movements were full and her muscle balance was orthophoric, but she had significant blepharospasm.

The slit lamp showed she had 3+ to 4+ blepharitis in the red eye’s upper and lower lids and trace blepharitis in the other eye. She was ulcerated on the upper and lower lids of the non-red eye. The conjunctiva of the symptomatic eye showed 2+ to 3+ injection, without purulent discharge.

The patient also had marginal keratitis as well as a central corneal ulcer in the visual axis. Her anterior chamber was deep without flare or cell. Her iris was round, and there were no changes in her lens.

I diagnosed the patient with severe blepharitis, presumed staph., marginal keratitis, and a central corneal ulcer. I scraped the cornea and conjunctiva, and the culture grew non-MRSA staph. aureus.

I started the patient on atropine for the blepharospasm and prescribed moxifloxacin every hour for day one because I was worried about the central corneal ulcer. The next day, the inflammation had quieted a bit, so I changed the moxifloxacin to four times a day.

I started her on Avenova twice a day and high-dose omega-3s (1500 mg, EPA 910 mg, DHA 590 mg — not gummies, which have DHA & EPA 68 mg total with 4 g sugar).

Three weeks later, the corneal ulcer was under control (see Figure 2), and I discontinued the antibiotics, but continued the Avenova twice daily. I saw her 1 month later and her lids were clear without any evidence of blepharitis or meibomian gland dysfunction. However, the family returned a few months later with the eye looking bad again, minus the corneal ulcer. They had stopped using Avenova. I started the patient back on just Avenova and it cleared within a month. To me, that’s the value of Avenova.

FIGURE 2. Three weeks later, the corneal ulcer was under control.

Case 2:
Toddler’s Complex Challenge

An 18-month-old girl with Kabuki syndrome and multiple congenital defects was referred to me in November 2014 for an “abnormal pupil.” I found that anisocoria was the only problem; everything else was normal. In March 2015, the patient returned with chalazia of both eyes. I saw two areas of posterior synechiae at 9 o’clock and 3 o’clock without any previous known infection or ocular inflammation. I started her on warm compresses, Avenova twice a day, and omega-3s.

A week later, the patient’s eye was worse (see Figure 3). She was rubbing them both a lot. The family doctor had prescribed tobramycin on the lids four times a day, so I suspected an allergic reaction and discontinued it. I increased the warm compresses to four times a day, started her on azithromycin orally, and continued the Avenova and omega-3s protocol.

FIGURE 3. A young child presents with suspected allergic reaction.

FIGURE 4. Four months later, the patient is much improved.

On April 7, I took the patient to the operating room to excise multiple chalazia. Pathology showed typical granulomatous tissue consistent with chronic chalazia and cultures showed no growth. Postoperatively, I prescribed a tobramycin/dexamethasone combination ophthalmic ointment to her lids (Tobradex, Alcon) for a week to prevent scarring. I continued the azithromycin, omega-3s, and Avenova.

Within a few weeks, the lids looked great. I instructed the patient’s mother to use Avenova when she sees a hint of redness, and she does so faithfully. She tells me that the redness goes away within a day.