Triple-hit lymphoma of the cavernous sinusDiffuse large B-cell lymphoma (DLBCL) is the most common non–Hodgkin-type lymphoma in adults, and the myriad of clinical presentations is well known to neuro-ophthalmologists.1 Traditionally, DLBCL was treated with standard chemotherapy, including R-CHOP (i.e., rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Newer cytogenetic, fluorescent in situ hybridization (FISH), and next-generation sequencing (NGS) techniques, however, have shown the presence of genomic abnormalities that have significant treatment and prognostic implications.
Mydriasis due to Opcon-A: An indication to avoid pharmacologic testing for anisocoriaA 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.
Cerebellopontine angle astrocytoma producing Bruns nystagmus mimicking vestibular schwannomaCerebellopontine angle (CPA) extra-axial lesions (e.g., classically the vestibular schwannoma) may cause a characteristic neuro-ophthalmologic sign known as the Bruns nystagmus, a gaze-evoked horizontal nystagmus when looking away from the lesion and a gaze-paretic type nystagmus when looking toward the lesion. In contrast, intra-axial exophytic CPA astrocytomas are rare and, to our knowledge, have not been reported in the English-language ophthalmic literature previously as a cause of Bruns nystagmus.
Retrobulbar hemorrhage and prasugrelRetrobulbar hemorrhage (RBH) is the accumulation of blood in the orbit behind the globe. Although some hemorrhages are minor and do not result in significant mass effect, an RBH is an ophthalmologic emergency requiring immediate surgical intervention. An RBH manifests as acute ipsilateral orbital pain and proptosis and can be variably associated with loss of vision, ophthalmoplegia, subconjunctival hemorrhage, and increased intraocular and intraorbital pressure.1 Most cases of RBH are traumatic or postsurgical, but some occur spontaneously in patients with bleeding diatheses.
Acute myelogenous leukemia presenting with uveitis, optic disc edema, and granuloma annulare: Case reportAlthough ocular manifestations of the acute leukemias have been reported commonly, the majority of these reports refer to acute lymphoblastic leukemia rather than Acute myelogenous leukemia (AML).1 Uveitis is a rare finding with AML. In cases in which uveitis has been reported as a manifestation of AML, it has been identified most commonly as a sign of relapsing or progressing AML rather than as the initial presenting finding of previously undiagnosed AML.2–6 We report a patient with AML who presented with uveitis, optic disc edema, and an additional suggestive skin finding of granuloma annulare (GA).