Correspondence
Paraproteinemic keratopathy: recognizing the ocular significance
Multiple myeloma and its precursor, monoclonal gammopathy of undetermined significance (MGUS), are disorders of plasma cell proliferation and immunoglobulin production. Although an uncommon presentation, paraproteinemic keratopathy, originally called immunotactoid keratopathy,1 may be the first manifestation.2,3 Patients may present with photophobia, glare, and decreased visual acuity or remain asymptomatic with crystals and opacities detected incidentally. Optimal treatment is not yet established, but chemotherapy, superficial keratectomy, and penetrating keratoplasty (PKP) have been reported.Scleral tattoo-induced sarcoid reaction
A 31-year-old Afro-Caribbean woman presented with a 1-week history of bilateral upper and lower eyelid swelling with restriction of eye movements and reduced vision in the right eye. She had had scleral tattooing, subconjunctival injection of dye, performed 13 months earlier on the right side and 9 months earlier on left side, for cosmetic purposes. The subconjunctival dye was purple and green, respectively, and the procedure was performed in the United Kingdom.En face optical coherence tomography for diagnosis of unexplained snowflake scotoma
Ocular conditions with transitory examination findings can be challenging to diagnose, particularly when significant time has elapsed since the acute insult. One such example is paracentral acute middle maculopathy (PAMM), which may present initially with faint gray macular lesions. These lesions fade over time, leaving behind an unrevealing fundus examination and a pattern of inner nuclear layer (INL) thinning that may be difficult to appreciate with typical imaging modalities.1 In this correspondence, we highlight the use of en face optical coherence tomography (OCT) to diagnose a case of perivenular PAMM 6 months after symptom onset, when fundoscopic examination was normal and the patient had already undergone an extensive work-up without a clear diagnosis.Annular pigment ring on the posterior lens capsule: a novel examination finding in blunt ocular trauma
The effects of blunt ocular trauma can impact a wide variety of ocular structures. Trauma may cause dislodgement of iris epithelial cells, which can create a ring of iris pigment on the anterior lens capsule, a finding known as the Vossius ring.1 There has been one previously reported case of an annular pigment ring on the posterior lens capsule following blunt ocular trauma.2Junctional visual field loss: a reappraisal of nomenclature
Historically, junctional visual field loss (JVFL) has been associated with a lesion at the junction of the optic nerve and chiasm, and the most common etiologies are neoplasm and aneurysm.1,2 We present 2 cases of JVFL and review the nomenclature on the various types of scotomas associated with lesions at the junction of the optic nerve and chiasm (e.g., junctional scotoma and junctional scotoma of Traquair). Based on our review of the English-language ophthalmic literature, we believe that our cases are unique and serve to demonstrate the need for expansion of the classification of JVFL.Macular burn secondary to diode laser epilation
Laser epilation is a cosmetic procedure that is becoming more popular in the modern era. Alexandrite (755 nm), diode (810 nm), Nd:YAG (1064 nm), and intense pulsed-light (IPL; 590–1200 nm) lasers are all commonly employed for cosmetic purposes.1 Eye injuries are a serious complication of laser epilation. The increased accessibility of laser epilation devices, their use in places without the proper equipment, and their use by individuals lacking the essential training may result in injuries that result in irreversible vision loss.Evolution of benign episodic pupillary dilation to Adie's tonic pupil
Benign episodic pupillary dilation (BEPD) may cause significant concern for both patients and clinicians alike. In general, BEPD does not require any work-up or further evaluation beyond simple reassurance. We describe a case of BEPD that evolved into a typical neurologically isolated ipsilateral and idiopathic tonic pupil also known as Adie's tonic pupil. After reviewing the PubMed database in search of similar reported cases, we found that this case is a unique presentation in the English-language ophthalmic literature.Visual acuity, patient-reported outcome measures, or both? The development of an evidence-based appropriateness and prioritization tool for cataract surgery patients
Cataracts are the leading cause of blindness worldwide, with surgery as the only effective treatment.1 In Ontario, cataract patients are classified into 4 broad priority levels without clear criteria to help guide clinicians in placing patients into categories 3 and 4. Patients in these 2 categories are generally booked on a first-come, first-served basis and comprise the majority of existing waitlists.2 While visual acuity is objective standard of care and is used in society to categorize patients’ vision, it does not encapsulate other factors impacting visual function.Anaplastic spheno-orbital meningioma: rapid growth after extensive exenteration
Spheno-orbital meningiomas (SOMs) arise from the sphenoid bone and extend into the orbit. These tumours account for approximately 2% of all orbital lesions.1 Presenting symptoms typically include proptosis, diplopia, or optic neuropathy. Most SOMs are CNS World Health Organization (WHO) grade 1 lesions. These are generally considered benign and slow growing. A small proportion of SOMs consists of CNS WHO grade 2 lesions, whereas CNS WHO grade 3 SOMs are very rarely described. These are often called malignant meningiomas.Explantation of iris-sutured intraocular lens
We describe a simple technique for explantation of iris-sutured intraocular lens that aims to reduce the risk of posterior dislocation of the implant at the time of surgery and minimize iatrogenic iris trauma. This technique involves bimanual rotation of the intraocular lens haptic out of the iris stitch.Primitive myxoid mesenchymal tumours of infancy: first case surrounding the optic nerve
Primitive myxoid mesenchymal tumour of infancy is a rare form of sarcoma presenting in infancy.1 It was first described by Alaggio et al.2 in 2006 as a primitive mesenchymal soft tissue sarcoma without any distinctive lineage of differentiation. The tumours described initially occurred on the trunk, head, neck, extremities, chest, scalp, abdomen, back, or limbs.2,3 The tumours initially may be diagnosed as and placed under the broad umbrella of sarcomas, but immunohistochemical and genetic analyses have now categorized the tumour as a definite entity.Ciliochoroidal effusion syndrome associated with mebendazole systemic treatment
Mebendazole (Vermox; Johnson & Johnson Inc, New Brunswick, NJ) is an effective antiparasite drug used for the treatment of Oxyurus vermicularis infections (oxyuriasis).1 Although theoretically considered as a well-tolerated drug with few adverse effects, we report a unique case of transient ciliochoroidal effusion that occurred in temporal association with mebendazole therapy.Updated review: optical coherence tomography findings of the pachychoroid disease spectrum
The ocular choroid consists of 5 distinct layers: innermost Bruch's membrane, capillaries of the choriocapillaris, Sattler's layer housing medium-sized blood vessels, Haller's layer containing larger-sized vessels, and the suprachoroidal space. Pachychoroid disease spectrum (PDS) was first described by Warrow et al.1 in 2013 as a group of chorioretinal disease entities characterized by a thickened choroid exceeding 300 µm and leading to exudative and neovascular complications. However, improved multimodal imaging, including extended depth imaging optical coherence tomography (EDI-OCT), has helped characterize PDS as a spectrum of ocular phenotypes all sharing 3 common characteristics: engorged Haller's layer vessels, Sattler's layer compression, and choriocapillaris attenuation.Allergic conjunctivitis and contact dermatitis following silicone tube intubation
Lacrimal stenting systems have been used to maintain patency of the canaliculi after insults such as surgery, trauma, radiation, and chemotherapy. The first nasolacrimal stents were made of silver wire and used by Graue in 1932.1 Since then, other materials have been used, including silk, nylon, polyethylene, and polypropylene. Modern-day stents are most commonly made of silicone because this material is pliable, affordable, and widely available. Previously thought to be inert, there is evidence that silicone can elicit a foreign-body and inflammatory reaction.Laser-induced maculopathy after iris depigmentation cosmetic treatment
A cosmetic procedure that changes the colour of the eyes using laser therapy against iris melanosomes is being performed in several countries around the world. Some ophthalmologists have expressed concern about this procedure potentially causing glaucoma or uveitis.1 Exposure to laser radiation also may cause visual impairment by retinal injury, sometimes resulting in irreversible damage to the patient.2 We present the first case of a light-induced maculopathy in a patient who underwent an iris depigmentation laser treatment for electively changing the colour of her eyes.Audible blink in carotid-cavernous fistula
A carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication between the carotid artery system and the cavernous sinus. Common ocular manifestations of CCFs include pulsating exophthalmos, conjunctival chemosis, periorbital bruit, diplopia, and ophthalmoplegia.1 We report a patient with atypical CCF who presented with audible blinks and describe the possible pathogenesis of this phenomenon.Ocular findings of oculomotor apraxia/ataxia type 1
Early-onset ataxia with oculomotor apraxia or oculomotor apraxia/ataxia type 1 (AOA-1) is a recessive progressive neurodegenerative disease that is clinically characterized by progressive diffuse ataxia, dysarthria, hand and head tremors, chorea, and dystonia.1 The onset may occur as growth retardation primarily between the ages of 1 and 20 years. Cognitive impairment, mental retardation, peripheral axonal neuropathy, distal atrophy, superficial and deep sensory insufficiency, and hypo-/areflexia are seen in the progression of the disease along with movement disorders.Painful vision loss in Leber hereditary optic neuropathy with novel ND1 variant mimicking optic neuritis
More than 90% of Leber hereditary optic neuropathy (LHON) cases are caused by 1 of 3 primary mitochondrial DNA mutations.1 They are MT-ND4 (m.11778G>A, p.Arg340His), which accounts for ∼70% of all cases; MT-ND6 (m.14484T>C, p.Met64Val); and MT-ND1 (m.3460G>A, p.Ala52Thr) found in genes coding protein subunits of NADH dehydrogenase (complex I) of the electron transport chain, resulting in defective energy production.2 Most patients with LHON presents with sudden unilateral painless vision loss followed by fellow-eye involvement within weeks to months.Determination of the size of the stripping area using trypan blue in Descemet's stripping only
In recent years, corneal endothelial transplantation has become a standard procedure in the surgical management of Fuchs endothelial corneal dystrophy (FECD).1 Despite the recent development of effective surgical techniques, corneal endothelial transplantation is still associated with many complications, including transplant rejection, graft dysfunction, postoperative complications, and the scarcity of donor grafts.Follicular lymphoma isolated to the superior oblique muscle
A 76-year-old female presented with bilateral peripheral visual field constriction. She had a past medical history of left common iliac vein stenting secondary to compression from the iliac artery, left lower extremity deep vein thrombosis requiring angioplasty, bilateral lower extremity lipodermatosclerosis, hyperlipidemia, vitamin D deficiency, diverticulitis, and generalized anxiety disorder. Her regular medications included apixaban, clopidogrel, venlafaxine, and montelukast. She denied smoking or alcohol use.Surgical management of a recurrent hereditary benign intraepithelial dyskeratosis lesion involving a Boston keratoprosthesis
The Boston keratoprosthesis (Kpro) can provide vision in high-risk keratoplasty eyes (i.e., neovascularization, limbal stem cell deficiency [LCSD]), where normal keratoplasty invokes a high likelihood of failure. Because of increased risks of melts, keratitis, and endophthalmitis, Kpro eyes need close monitoring with close inspection of the front plate optical stem–keratoplasty junction. One disease entity in which management via Kpro has not been described previously is hereditary benign intraepithelial dyskeratosis (HBID).Double anterior chamber following deep anterior lamellar keratoplasty with endothelium-on donor tissue
Deep anterior lamellar keratoplasty (DALK) is a well-established technique for corneal transplantation because of its lower risk of postoperative graft rejection than penetrating keratoplasty.1 One possible complication of DALK is the formation of a double anterior chamber (AC). During surgery, a microperforation of the Descemet's membrane (DM) may create a channel that allows aqueous fluid to enter the host–donor interface, forming a pseudo–anterior chamber. Double ACs are typically observed in the immediate postoperative period.Acute suppurative bacterial dacryoadenitis with abscess formation in a child
Acute suppurative bacterial dacryoadenitis (ASBD) is an uncommon ophthalmic condition that is rare in the pediatric population. Rarely, ASBD may progress to the formation of a lacrimal gland abscess that, in the absence of timely and effective management, poses a risk of ophthalmic and neurologic complications. This typically involves systemic antibiotics, and particularly in paediatric cases, definitive management may involve surgical incision and drainage.Metastasis of endometrial carcinoma to the ocular adnexa
A 61-year-old female was referred by her oncologist for a rapidly enlarging, painful erythematous mass in the region of the left medial canthus, first noticed 1 month prior. She reported no change in vision, no epiphora, and no discharge from the eye. She had been using warm compresses and gentle massage to no effect. She had no past ocular history. Her past medical history was notable for metastatic endometrial carcinoma with metastases to lung and femur, for which she had completed numerous rounds of chemotherapy and radiation as well as total abdominal hysterectomy with bilateral salpingo-oophrectomy years prior.Bilateral primary squamous cell carcinoma of the conjunctiva
Squamous cell carcinomas (SCCs) of the conjunctiva are rare, with an estimated incidence of 1–2.8 per 100 000 people per year.1 SCC is the most frequently occurring malignant epithelial tumour of the conjunctiva.2 Here we present a case of a patient presenting with 2 distinct primary carcinomas of the conjunctivae over a 3-year period.Retro-orbital alveolar soft-part sarcoma in a 76-year-old female: case report and review of the literature
Alveolar soft part sarcoma (ASPS) is a rare mesenchymal neoplasm that represents less than 1% of all sarcomas.1 Orbital ASPS is extremely rare, representing only 5%–15% of all cases of ASPS.2 The average age at presentation of orbital ASPS is 13.5–17.8 years. A recent review of the literature suggests there are fewer than 70 documented cases of primary orbital ASPS.1Sebaceous cell carcinoma presenting as ocular Marjolin ulcer following immunosuppression for a chemical burn
Marjolin ulcer is a term used to describe malignancy that originates from chronically inflamed, ulcerated, or scarred tissue.1 The potential for malignant transformation of ocular surface chemical injuries to a Marjolin ulcer is not well recognized.2 In fact, this progression may be accelerated by the immunosuppressive treatments often used to control the postburn cicatrizing process. This report presents an ocular Marjolin ulcer following an alkali burn that was diagnosed histopathologically as sebaceous carcinoma.Secondary pseudotumour cerebri syndrome in children: clinical characteristics and long-term outcomes
Pseudotumour cerebri syndrome (PTSC) is characterized by elevated intracranial pressure (ICP) with the absence of an intracranial mass, hydrocephalus, or abnormalities in cerebrospinal fluid composition. PTSC can be primary (also known as idiopathic intracranial hypertension) or secondary. We recently published an article summarizing the clinical characteristics and visual outcomes for primary PTSC in children.1 The purpose of this correspondence is to report the clinical characteristics and long-term outcomes in a concomitant cohort of children with secondary PTSC from the same institution over the same time period.Evidence of nocturnal hypotension in an inpatient prior to an episode of classic NAION
Nonarteritic anterior ischemic optic neuropathy (NAION) is a known cause of acute, painless, monocular vision loss in patients with small cup-to-disc ratios and at least 1 vascular risk factor.1 The etiology has been debated, although Hayreh et al.2 have hypothesized that nocturnal hypotension impairs perfusion to the optic disc causing ischemia to the optic nerve. Despite evidence supporting this via retrospective monitoring of diurnal changes in blood pressure (BP) with Holter monitoring in patients with prior outpatient episodes of NAION, this BP change has not been documented at the time of the event.Preserved retinal sensitivity following spontaneous regression of soft drusen
Soft drusen are the clinical hallmark of intermediate age-related macular degeneration (AMD) and a major risk factor for late-stage disease. Soft drusen usually increase in size, area, and confluence with aging.1 Their natural life cycle may involve retinal pigment epithelium (RPE) changes, collapse, and macular atrophy or spontaneous regression.2 Pharmacologic and laser photocoagulation treatments intended to induce drusen regression have yet to show visual benefit.1,3 Early treatment of intermediate AMD before progression to macular atrophy and/or neovascular complications is an area undergoing intense study and would be a breakthrough.Late-onset diffuse lamellar keratitis after treatment with cenegermin
Cenegermin 0.002% ophthalmic solution (Oxervate, Dompe, Boston, Mass.) is a recombinant human nerve growth factor (NGF) that has been a promising novel topical treatment dosed 6 times daily for 2 months to treat neurotrophic keratitis (NK).1,2 NK is a degenerative ocular disease characterized by reduced or absent corneal sensation. One iatrogenic etiology of NK, for which cenegermin has garnered interest, is after laser in situ keratomileusis (LASIK).3Symptomatic iris varix with enlargement following argon laser
Iris varix is a rare iris lesion that may be mistaken for a malignant neoplasm.1 Thirty-six cases have been described since 1975, most treated by resection without recurrence, although spontaneous regression has been reported.2 Most varices have been described as large, lobulated, well-circumscribed black or red lesions of the iris that may be associated with spontaneous hemorrhage, although smaller varices have been described as prominent, elongated, and tortuous vessels.2,3 Although benign, iris varices may be of sufficiently suspicious appearance as to warrant a detailed work-up to exclude other etiologies such as hemangiomas or melanomas.Intraocular pressure fluctuations in a professional woodwind musician with advanced glaucoma
Ocular hypertension and fluctuations in intraocular pressure (IOP) are critical modifiable risk factors for the development and progression of glaucoma. Transient IOP elevations while playing wind instruments have been observed in musicians with1 and without2,3 glaucoma. However, the comparative effect of trabeculectomy surgery on IOP fluctuations during wind instrument performance has not been previously described.Ischemic cranial nerve 6 palsy and lipemia retinalis in a patient with hypertriglyceridemia
Severe hypertriglyceridemia can occur as a primary (genetic) disorder or secondary to diabetes mellitus, hypothyroidism, alcohol use, or medications. Ophthalmic signs of hypertriglyceridemia include xanthomas, xanthelasmas, and corneal arcus.1 However, atypical presentations also can occur. Prior case reports describe presenting symptoms of intermittent vision loss due to associated hypertensive retinopathy or blurry vision from secondary central serous chorioretinopathy or branch retinal vein occlusion.Superior limbic keratoconjunctivitis following ptosis repair
Superior limbic keratoconjunctivitis (SLK) is an inflammatory condition of the superior bulbar conjunctiva, tarsal conjunctiva, and upper cornea of unknown etiology. The pathogenesis of SLK is unclear, although it has been linked to mechanical microtrauma, deficiencies in tear film quality, and immunologic dysregulation.1Meningococcal B vaccine-associated papillophlebitis and cilioretinal artery occlusion
Vaccine-induced optic neuritis is a known subtype of optic neuritis that has been reported following the administration of various types of vaccines, both viral and bacterial. Ocular symptoms vary significantly and can result in permanent vision loss. There has been only one case of optic neuritis following meningococcal B vaccine (Bexsero; GlaxoSmithKline, London, UK) administration that was reported on the Vaccine Adverse Event Reporting System (2016, VAERS ID 686394), but the details of the event are not thoroughly explained.Marjorin ulcer (squamous cell carcinoma) in a temporal artery biopsy wound
It is well recognized that postoperative and traumatic wounds and scars are susceptible to malignant degeneration, most commonly to squamous cell carcinoma (SCC).1 This phenomenon can occur months to decades after the inciting trauma.1 We describe a case arising from a temporal artery biopsy (TAB) site, demonstrating the importance of considering skin malignancy in any nonhealing incision. Informed consent for publication of this patient's case was obtained, adhering to the Declaration of Helsinki principles.Ultra-wide-field retinal imaging in tetralogy of Fallot before and after cardiac surgery
Congenital heart disease can be classified physiologically into 3 categories: volume overload, cyanotic, and obstructive. Cyanotic congenital heart disease (cCHD) includes lesions with right-to-left shunts or mixing abnormalities (e.g., transposition of the great vessels, persistent truncus arteriosus, tetralogy of Fallot).1 Tetralogy of Fallot (ToF) encompasses a variety of anatomic abnormalities, including a large and unrestrictive ventricular septal defect, right ventricular outflow tract obstruction, overriding of the aorta, and right ventricular hypertrophy.Traumatic direct carotid cavernous fistula following partial maxillectomy
Carotid cavernous fistula (CCF) is a rare traumatic complication that can occur following iatrogenic interventions.1 We report a case of direct CCF (type A) developing following partial maxillectomy with the Le Fort I approach. This case report adheres to the ethical principles outlined in the Declaration of Helsinki as amended in 2013.Acute retinal necrosis from herpes simplex virus type 2: a case series
Acute retinal necrosis (ARN) is a potentially blinding condition characterized by rapidly progressive peripheral retinal necrosis with occlusive vasculopathy and prominent inflammatory reaction.1,2 Identification of a viral etiology can be done with polymerase chain reaction (PCR) testing of intraocular fluid, and prompt management is necessary to preserve vision. ARN caused by herpes simplex virus 2 (HSV-2) is rare, and our understanding is based on a few small case series.3 Here we present three cases of HSV-2 ARN in immunocompetent hosts with a prolonged clinical course of systemic and intravitreal antivirals.Delayed-onset abducens nerve palsy following parafalcine meningioma complicated by subdural hematoma
Meningiomas are slow-growing, benign brain tumors accounting for approximately 20% of primary intracranial masses.1 They may remain asymptomatic for long periods of time and can present with headaches, seizures, and other more site-specific symptoms. Although they are highly vascular structures, meningiomas do not typically produce subdural hematoma (SDH).2 Only 38 cases of meningioma associated with acute SDH have been reported in the English literature.1 We report a delayed-onset abducens nerve palsy due to an SDH associated with a parafalcine meningioma.Migratory orbital inflammation in rheumatoid arthritis
Orbital inflammatory disease is associated with several etiologies.1 Ocular manifestations of rheumatoid arthritis (RA), such as keratoconjunctivitis sicca, have previously been noted in the literature;2,3 however, migratory orbital inflammation is rare.Use of ripasudil for rapid resolution of acute hydrops in keratoconus
Acute corneal hydrops (CH) is characterized by marked stromal edema from the influx of aqueous humour through a tear in Descemet membrane.1 It is predominantly seen in patients with corneal ectasia and reported in up to 3% of patients with keratoconus.1,2 CH presents with an acute decrease in visual acuity, photophobia, and pain.1 Conservative management of CH includes topical hypertonic saline solution, cycloplegics, topical corticosteroids, topical antibiotics, and a bandage soft contact lens if needed for comfort.Unilateral vision loss in a patient with essential thrombocythemia
Essential thrombocythemia is a chronic myeloproliferative neoplasm that develops when megakaryocytes in the bone marrow produce an excess number of platelets.1 This chronic hematologic disorder is associated with a number of thrombotic and embolic complications, and prior cases of vision loss have been documented.1–6 We describe a rather unique case of essential thrombocythemia presenting with unilateral vision loss in a patient.Cotton-wool spots in patients with migraine
Cotton-wool spots (CWSs) refer to localized accumulations of axoplasmic debris in the retinal nerve fibre layer that result from interruption of ganglion cell axon organelle transport.1 The histologic hallmark is the cytoid body, which represents the terminal swelling of a disrupted ganglion cell axon that has expanded and accumulated mitochondria and other organelles and subcellular material.1 In an otherwise healthy person, even a single CWS is considered abnormal, and it is recommended that investigations for underlying systemic disease be initiated.Treatment of an orbital pseudomeningocele through an eyelid incision
Pseudomeningoceles (PMs) occur from extravasation of cerebrospinal fluid (CSF) into soft tissue secondary to a dural tear.1–3 Unlike a true meningocele, which is lined by arachnoid tissue, PMs are associated with the formation of a fibrous capsule.2 Although PMs can form due to surgical insults to the dural covering of the brain or spine, they can also occur secondary to trauma or congenital abnormalities.1,2 Clinical symptoms usually arise when there is mass effect on the surrounding structures.Experiences from a national webinar with recently matched Canadian ophthalmology residents for medical students
Canadian medical students interested in ophthalmology must participate in the Canadian Residency Matching Service (CaRMS) R-1 match,1 where they are assessed based on their academic and extracurricular profile (such as medical school performance record, custom résumés, volunteerism, leadership, research, reference letters, personal letters, and interviews) before they enter residency training. The most recent residency application cycle, completed in April 2021, brought medical students unique challenges secondary to the coronavirus disease 2019 (COVID-19) pandemic, such as canceled visiting electives, virtual interviews, limited clinical exposure, and limited in-person interaction with program faculty and residents.Use of topical allogenic fresh-frozen plasma drops in the treatment of ligneous conjunctivitis
Ligneous conjunctivitis is a rare inflammatory condition characterized by chronic and recurrent deposition of fibrin-rich pseudomembranes on the palpebral conjunctiva.1 Firm membranes with a characteristic ‘woody’ induration usually occur bilaterally presenting since childhood.1,2 The formation of fibrinous pseudomembranes is caused by a mutation in the PLG gene, leading to deficient levels of type 1 plasminogen.1 Plasminogen is a precursor of plasmin, a molecule involved in the degradation of fibrin.Varicella-zoster virus-induced orbital apex syndrome with superior ophthalmic vein occlusion and malignant intraocular pressure rise
Orbital apex syndrome from varicella-zoster virus (VZV) is extremely rare, and approximately 20 patients worldwide have been reported with this condition.1 We report a patient with VZV-associated orbital apex syndrome and unusual malignant intraocular pressure rise from superior ophthalmic vein (SOV) thrombosis.Intravenous tocilizumab in the treatment of resistant optic perineuritis
Optic perineuritis (OPN) is a rare orbital inflammatory disease that mainly involves the optic nerve sheath and surrounding tissues. It is accompanied by eye pain and various levels of optic nerve dysfunction, such as decreased vision, visual field defect, and positive afferent pupillary defect. In contrast to optic neuritis, OPN is not a self-limited disease and always requires treatment.1
