Correspondence
Concurrent cerebral toxoplasmosis and cytomegalovirus retinitis in a patient with human immunodeficiency virus
A 35-year-old previously healthy female recently emigrated from Honduras and presented with a five-day history of sudden onset decreased vision in her right eye, pain with extraocular movements, fevers, and a 3-day history of right upper and lower extremity weakness and numbness. On exam, she was afebrile, and mental status was normal. She had no light perception in the right eye, a right relative afferent pupillary defect, right lower facial weakness, 4/5 strength of proximal and distal right upper and lower extremities, and decreased sensation in the right face, arm, and leg.Conjunctival Kaposi’s sarcoma with orbital extension in an HIV-negative man
Kaposi’s sarcoma (KS) is a vascular tumour whose development requires infection by human herpesvirus 8 (HHV-8). Although most commonly found in immunosuppressed patients, such as those AIDS, in the United States, classic KS is often found in older-aged men of European or Mediterranean ancestry without immunosuppression. Involvement of the skin of one’s extremities in classic KS is typically more common than that of viscera or mucocutaneous surfaces.Unilateral transient vision loss associated with an opacified Onodi cell
An Onodi cell, also known as a sphenoethmoidal air cell, is a posterior ethmoidal air cell that has pneumatized laterally and rarely superiorly to the sphenoid sinus and is in close approximation to the optic nerve.1 When drainage of the cell is obstructed, visual disturbances can occur by physical compression, inflammation, or a combination of the 2. Nonetheless, optic neuropathy secondary to an isolated opacified Onodi cell is rare.2–4 Herein, we report a case of episodes of unilateral, transient, and painless vision loss caused by an opacified Onodi cell secondary to a focal sinusitis.Unusual ocular presentation in a patient with lichen planus
Lichen planus is a relatively common mucocutaneous disorder of unknown etiology that is thought to be immunologically mediated. It is a chronic disorder characterized by periods of exacerbation and remission. Lichen planus has variable clinical manifestations, including the skin, oral mucosa, genital mucosa, nails, and scalp. The characteristic lesions have a well-established clinical appearance and histological features that help in establishing the diagnosis.1 Ocular involvement may occur in patients with lichen planus.Mydriasis due to Opcon-A: An indication to avoid pharmacologic testing for anisocoria
A 35-year-old woman presented to the Emergency Department with an acute, painless, dilated left pupil. Her medical history was notable for myopia and truncal herpes zoster infection that had completely resolved 2 years ago. Ocular history was significant for bilateral contact lens wear, and her preferred wetting and cleaning solution was Opcon-A (naphazoline and pheniramine). Her surgical, social, and family history and a complete review of systems were unremarkable. On examination, the visual acuity was 20/20 OU.Unilateral isolated foveal hypoplasia
A 9-year-old male was referred to the Pediatric Ophthalmology service for a suspected epiretinal membrane at the left macula. The patient was asymptomatic. His ocular, systemic medical, birth, and developmental history were all noncontributory, and he was not on any prescription medication.Conjunctival-limbal allografts in graft-versus-host disease using same HLA-identical bone marrow transplantation donor
Hematopoietic stem cell transplantation (HSCT) allows for the transplantation of multipotent hematopoietic stem cells for treatment of hematologic, immunologic, metabolic, and neoplastic diseases. Graft-versus-host disease (GVHD) is a unique complication of allogeneic HSCT in which the donor cells mount an immune response against the host cells.1 Ocular GVHD affects 60%–90% of patients with chronic systemic GVHD.2Bilateral isolated choroidal melanocytosis with isoautofluorescence
Ocular melanocytosis is a congenital hyperplasia of the melanocytes in the ocular tissues: episclera, iris, ciliary body, and choroid. It is usually unilateral but can be bilateral. It can affect the surrounding eyelids, as in oculodermal melanocytosis, or be isolated to the choroid, which is referred to as isolated choroidal melanocytosis. Isolated choroidal melanocytosis is an uncommon condition that has been reported unilaterally in a number of cases,1,2 but bilaterally in only 5 other cases in the literature.Late-onset Leber hereditary optic neuropathy presenting after intraocular surgery
Leber hereditary optic neuropathy (LHON) is a retinal ganglion cell degeneration characterized by bilateral, typically sequential, acute/subacute central visual loss. This maternally inherited condition arises from point mitochondrial DNA (mtDNA) mutations, and more than 90% of affected individuals harbour 1 of 3 primary mtDNA variants, m.11778G>A, m.14484T>C, or m.3460G>A.1 Intriguingly, (i) the majority of subjects harbouring mtDNA mutations do not develop visual symptoms, (ii) a striking number of LHON patients have no family history, and (iii) there is significant male predominance (male:female, ~3:1).Mantle cell lymphoma: conjunctival mass in a female patient
Mantle cell lymphoma (MCL) is a rare neoplasm in the ocular adnexa, accounting for 3%–5% of conjunctival B-cell non-Hodgkin lymphomas (NHL).1,2 Conjunctival MCL typically presents in male patients in the eighth decade and is often advanced at the time of presentation.3 Treatment typically consists of chemotherapy or radiation, although the prognosis is poor.4 The authors present a rare case of conjunctival MCL in a female patient. Collection and evaluation of protected patient health information complied with the Health Insurance Portability and Accountability Act.Unilateral retinitis pigmentosa: clinical and electrophysiological diagnosis
Retinitis pigmentosa (RP) is a group of hereditary disorders characterized by gradual atrophy and cell death of the photoreceptors and adjacent cell layers of the retina, the common feature of which is progressive deterioration in vision. Initial presenting symptoms of the disease include night blindness, with gradual deterioration of the light-sensitive cells of the retina, causing diminution of vision in daylight in the later stages. Presentation is bilateral and symmetrical.Transscleral fixation of a toric intraocular lens by a slipable suture technique
In keratoplasty, astigmatic correction is crucial for achieving a favourable visual outcome. Several procedures have been introduced for astigmatic correction, including astigmatic keratotomy,1 wedge resection,2 and excimer laser refractive surgery.3 Each of these procedures have limitations, including unpredictable refractive outcomes, technical difficulty, expenses, and potential complications.4Bilateral simultaneous artificial iris implantation for post-traumatic aniridia: a case report
A blunt ocular trauma may lead to sequelae of aniridia and aphakia. Such presentations may need complex reconstructive surgery. Aniridic patients frequently experience symptoms of decreased visual acuity, diplopia, glare, photophobia, and cosmetic discrepancy. A reconstructive procedure may prove to be challenging when there is loss of capsular support or when minimal iris remnant is present. Oltra et al.1 reported one case of bilateral traumatic aniridia for which coloured contact lenses were offered because patient was asymptomatic.Clinical evaluation of a novel surgical technique (large cross incision) for conjunctival cysts
An acquired conjunctival cyst may occur spontaneously or after ocular surgery or trauma.1 Chief complaints are foreign-body sensation or cosmetic issues. Although simple needle aspiration might be an easy choice for the treatment of conjunctival cysts, such an approach may be associated with frequent recurrence of the cysts. Typically, a simple resection can resolve the problem; however, incomplete resection may also result in recurrence of the lesion. Moreover, identification of the cyst margin can be difficult because of poor visualization of the cyst capsule.Choroidal metastasis arising from esophageal adenocarcinoma
The majority of choroidal metastasis in the eye arises from primary tumours of the breast, lung, prostate, and gastrointestinal tract primary sites but rarely from the esophagus.1–4 Recently, a few cases have been reported that may coincide with the increasing incidence of Barrett’s esophagus and associated esophageal adenocarcinoma.1,2,5 We present a case of esophageal adenocarcinoma that initially presented with signs and symptoms of choroidal metastasis.
