Carotid artery dissection associated with Purtscher-like retinopathyPurtscher retinopathy was first described in 1910 by Otmar Purtscher in a man who suffered a traumatic head injury.1 Patients commonly present with a loss of visual acuity and a recent history of injury such as head trauma or chest compression.2,3 In the case of a nontraumatic injury, the terminology commonly used is “Purtscher-like retinopathy.” It is associated with various systemic diseases, including acute pancreatitis, pancreatic adenocarcinoma, thrombotic thrombocytopenic purpura, connective tissue disorders, and hemolytic uremic syndrome.
Severe chorioretinal atrophy in Boucher-Neuhauser syndromeA 51-year-old woman was seen in the neuro-ophthalmology clinic. She reported difficulties with night vision dating back to approximately age 10 and an abnormal gait since childhood, which was described as unsteady and hesitant with stiffness of both legs. Ten years previously she was noted to have nystagmus by her family practitioner and was referred to an ophthalmologist, who diagnosed her with probable retinitis pigmentosa (RP). At that time, visual evoked potentials showed delayed P100 responses bilaterally.
Wet age-related macular degeneration refractory to aflibercept but responsive to systemic everolimusA 69-year-old Caucasian woman with a history of metastatic breast cancer had been receiving injections of aflibercept every 4–8 weeks for wet age-related macular degeneration in her right eye for the past 4 years. Despite the regular frequency of the aflibercept injections, her optical coherence tomography had always demonstrated significant levels of intraretinal fluid (Fig. 1). It was decided in the past to maintain her schedule of aflibercept in order to maintain her baseline level of vision of 20/60.
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.
Concurrent cerebral toxoplasmosis and cytomegalovirus retinitis in a patient with human immunodeficiency virusA 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 manKaposi’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 cellAn 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 planusLichen 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 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.
Unilateral isolated foveal hypoplasiaA 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 donorHematopoietic 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.2
Bilateral isolated choroidal melanocytosis with isoautofluorescenceOcular 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 surgeryLeber 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 patientMantle 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 diagnosisRetinitis 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 techniqueIn 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.4
Bilateral simultaneous artificial iris implantation for post-traumatic aniridia: a case reportA 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 cystsAn 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 adenocarcinomaThe 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.
Orbital metastatic small cell carcinoma of the pancreas with optic nerve compressionSmall-cell carcinoma accounts for 18%–20% of all primary lung malignancies but has also been described as arising from the bladder, prostate, stomach, colon, and pancreas.1 Small-cell cancer of the pancreas (SCCP) is an extremely rare malignancy and represents only 0.2%–1% of all pancreatic malignancies.1,2 Here, we describe a unique case of an SCCP presenting as a metastatic lesion to an extraocular muscle causing optic nerve compression.
Structural and functional degeneration of retinal nerves in sibling carriers of a Leber’s hereditary optic neuropathy mutationLeber’s hereditary optic neuropathy (LHON)1 presents with painless bilateral or sequential vision loss caused by degeneration of the papillomacular retinal nerve fibre bundle.2 Optical coherence tomography (OCT) has demonstrated thickening of the retinal nerve fibre layer (RNFL) before and during visual decline, followed by long-term axonal degeneration.3–5 Unaffected male carriers of LHON mutations may experience mild temporal RNFL swelling.4 OCT can further detect ganglion cell complex (GCC) degeneration during disease and preceding symptom onset.
Photodynamic therapy for choroidal carcinoid metastasisCarcinoid tumours are derived from highly differentiated neuroendocrine cells that often produce biogenic amines or polypeptide hormones. They arise from various primary sites along the gastrointestinal, bronchopulmonary, and urogenital tracts and metastasize to the lymph node, liver, or bone, and only rarely to the eye and orbit. Uveal metastasis is the most common intraocular malignancy and mostly arises from breast cancer in women and lung cancer in men. Uveal metastasis from carcinoid tumours constitutes only 2.2% of all uveal metastasis.
Added value of newer optical coherence tomography technologies in hyperphosphatemic familial tumoural calcinosisIn contrast to dystrophic calcification seen in several rare genetic disorders, such as pseudoxanthoma elasticum, generalized arterial calcification of infancy, and Keutel syndrome, hyperphosphatemic familial tumoural calcinosis (HFTC) is a rare disorder of phosphate metabolism characterized by hyperphosphatemia and primary ectopic or metastatic calcifications in various locations.1
Case of Ab Interno Trabeculectomy in Juvenile Open-angle Glaucoma with 5-year Follow-upJuvenile open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma (POAG) affecting those between 3 and 40 years of age and often with a more progressive course compared to POAG.1,2 Transmission is typically autosomal dominant with mutations identified in the myocilin (MYOC) and CYP1B1 genes.2
Deep anterior lamellar keratoplasty for an intrastromal epithelial corneal cyst: a case reportCorneal cysts, usually caused by the displacement of epithelium into the substance of the cornea, were first described in 1853.1 Congenital or traumatic factors may contribute to the formation of corneal cysts.
Management of positive dysphotopsia in a patient with prior refractive surgeryDysphotopsias are bothersome visual phenomena experienced by patients after cataract surgery (CS). Positive dysphotopsias (PD) appear as light-related artefacts in various forms, whereas negative dysphotopsias are usually a temporal darkness or shadow in the visual field.1
Implantation pearl cyst after uncomplicated clear cornea phacoemulsification mimicking an iris tumourEpithelial downgrowth (ED) is a serious, although rare, complication of ocular surgery and trauma that can result in irreversible vision loss.1–6 In the ocular surgery group, cataract surgery, especially in the extracapsular era, accounted for 86% of cases1 related to vitreous loss, persistent hypotony, capsule rupture, multiple surgeries, delayed wound healing, wound fistulas, and iris incarceration. According to the literature, 82% of cases presented within the first year after intraocular surgery1,3 with retrocorneal membrane (48%), painful glaucoma (32%), positive Seidel test (24%), corneal edema (22%), hypotony (17%), painless glaucoma (14%), iritis (11%), and iris cyst (8%).
Progressive optic nerve glioma: orbital biopsy technique using a surgical navigation systemAn 11-year-old male child presented with worsening vision in his left eye. Examination and imaging revealed a left optic nerve tumour causing mass effect and optic neuropathy, without systemic evidence of neurofibromatosis. In view of the significant risk to visual acuity, a biopsy was deferred and chemotherapy was commenced. After initial stability, continued visual decline necessitated incisional biopsy. Surgical navigation was used to facilitate minimal access surgery avoiding bone removal. The system also precluded biopsy of cystic parts of the tumour, allowing successful intraoperative frozen-section confirmation of lesional tissue.
A rare case of bilateral ocular neuromyotoniaUnilateral ocular neuromyotonia (ONM) is a rare entity, and bilateral ONM even more so, with and only 1 case having been reported previously in the literature. We present a rare case of bilateral ocular neuromyotonia whose course of treatment was complicated by side effects of carbamazepine.
Mooren’s ulcerative keratitis after systemic pegylated interferon alpha2a in chronic hepatitis CInterferon alpha (IFNα) is a subgroup of the IFN family that is involved in activation of immune responses against viral infection. IFNα2 is secreted by virus-infected cells and inhibits other cells from further infection. IFNα2 has been widely used to manage hepatitis C and multiple sclerosis.1 Although ocular complications with IFN administration occur in less than 1% of patients, they include retinal hemorrhage, cotton wool spots, cystoid macular edema, ischemic optic neuropathy, subconjunctival hemorrhage, dry eye, and Sjögren’s syndrome.
Ethambutol optic neuropathy associated with enhancement at the optic chiasmA 71-year-old woman was diagnosed with pulmonary Mycobacterium avium complex in 2006 and received multidrug treatment with ethambutol for 18 months between 2008 and 2009, with no ocular symptoms. Because of a progression in pulmonary nodules, ethambutol was restarted in 2015 at a total daily dose of 19 mg/kg along with rifampin and clarithromycin.
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.
Childhood glaucoma in neonatal Marfan syndrome resulting from a novel FBN1 deletionMarfan syndrome (MFS) is an autosomal dominant genetic disorder of the connective tissue. The majority of MFS cases involve mutations in the FBN1 gene encoding the protein fibrillin-1. Fibrillin-1 is a protein found in the extracellular matrix that is incorporated into the final structure of microfibrils.1 In 25% of cases, the disorder occurs sporadically.2 The most common clinical manifestations resulting from MFS are musculoskeletal, cardiovascular, and ophthalmic. Patients with MFS often present with tall stature, arachnodactyly, and scoliosis, but the severity of the disease varies.
Subconjunctival injection of bevacizumab for recurrent conjunctival papilloma: a case reportConjunctival papilloma is an acquired benign neoplasm of the conjunctiva and is caused by human papillomavirus, which mostly develops in middle-aged males and often appears as sessile or pedunculated lesions.1–3. The recurrence of conjunctival papilloma is common and has a recurrence rate of >10%.1–3 The conventional therapeutic options include surgical excision and cryotherapy for eradication, but usually conjunctival papilloma recurs, and repeated excisions may lead to ocular surface damage.4,5 Topical interferon, topical mitomycin C, and oral cimetidine are therefore used as adjuvant treatments.
Persistent pediatric primary canaliculitis associated with congenital lacrimal fistulaPrimary canaliculitis is an uncommon infection of the lacrimal canaliculus. It is frequently misdiagnosed as chronic conjunctivitis or dacryocystitis, which results in delayed or improper treatment. The challenge of treatment is to eradicate the causative pathogens on the basis of maintaining the canalicular patency.1 We present a refractory case of primary upper canaliculitis associated with congenital lacrimal fistula.
Eye drop safety seal causing ocular irritation following cataract and vitrectomy surgeryApplying medication directly to the eye was first reported in ancient cultures, and modern pharmacotherapy with eye drops is likely to have begun when pilocarpine and atropine were isolated as therapeutics in the late 19th century.1 Since then, eye drops have been used as a primary delivery method for many classes of medications. Just as with oral medications,2 patients have difficulty remembering the names, frequencies, and dosages of the eye drops they are taking.3 In addition, effective administration of drops can be difficult, especially for patients with problems with dexterity or low vision.
Intraretinal macular hemorrhage due to high-power handheld blue laserWe recently reported various forms of maculopathies related to high-power handheld blue laser injury. This included subhyaloid/subinternal limiting membrane hemorrhage, epiretinal membrane, foveal schisis-like changes, outer retinal disruption, and full-thickness macular hole.1 Here we present a new manifestation of blue laser–induced maculopathy.
Optic nerve hypoplasia in a patient with a de novo KIF1A heterozygous mutationKinesin superfamily proteins (KIFs) are molecular motors that use microtubules as a “rail” to transport membrane vesicles and organelles, protein complexes, and messenger RNAs (mRNAs). KIF1A drives the microtubule plus end toward the axon terminal, which is most prominent in polarized cells, including neurons, and is fundamental for neuronal function and survival. Kinesins have long been implicated in the pathogenesis of axonal neuropathies. We report a child with a de novo KIF1A gene mutation who was found to have bilateral optic nerve hypoplasia and atrophy.
Case series: Merkel cell carcinoma of the eyelidMerkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine malignancy hypothetically derived from a precursor common to keratinocytes and Merkel cells.1 Only 5% to 10% of MCCs involve the eyelids and the periocular region,2 of which fewer than 100 cases have been reported to date.3,4 Here, we present 3 new patients with MCC of the eyelid and discuss diagnostic considerations.
Chandelier scleral buckling for retinal detachment in Stevens-Johnson syndromeA 40-year-old uniocular man presented with a 2-week history of a sudden decrease in vision in the left eye. Visual acuity was light perception with inaccurate projection of rays OD and counting fingers at 1 m, N48 OS. The patient had a history of loss of vision in the right eye 30 years previously because of postvaricella (chicken pox) Stevens-Johnson syndrome. The right showed a total leucomatous corneal opacity (Fig. 1). The left eye showed a vascularized corneal scar involving the nasal two-thirds of cornea, with superficial punctate keratitis.
Ciliochoroidal detachment following pure sulfur hexafluoride injection in Descemet stripping automated endothelial keratoplastyDescemet stripping automated endothelial keratoplasty (DSAEK) is an effective and safe treatment for Fuchs dystrophy and pseudophakic corneal edema, among other ocular conditions.1–3 The most common complication of this surgical procedure is graft detachment, which may be effectively resolved in most cases by rebubbling with air or gas (or both) to reposition the graft.1–3
Haller cells: A risk factor for spontaneous orbital floor fracture?Orbital floor fractures most commonly occur as a consequence of trauma through either buckling or hydraulic forces acting on the orbit. Spontaneous orbital floor fractures have been described in the literature usually in the setting of thyroid eye disease (TED). We present the case of a patient with a history of a spontaneous floor fracture associated with anteriorly displaced ethmoid air cells. We propose a pneumatic mechanism of spontaneous floor fracture in patients with Haller cells.
Immunoglobulin G4–related dacryocystitisImmunoglobulin G4 (IgG4)–related dacryocystitis is a rare condition characterized by elevated serum IgG4 levels and IgG4-positive lymphoplasmacytic infiltration in the lacrimal sac.1 In the periocular region, IgG4-positive lymphoplasmacyte infiltration commonly occurs in the lacrimal gland, extraocular muscles, orbital soft tissues, and the infraorbital nerve.1 Clinicopathologic characteristics of IgG4-related dacryocystitis are not fully understood. Herein, we report the case of a patient with IgG4-related dacryocystitis.
Treatment of choice for patients with EGFR mutation–positive non-small cell lung carcinoma presenting with choroidal metastases: radiotherapy or TKIs?It is not uncommon for patients with non-small cell lung cancer (NSCLC) to develop choroidal metastases (CM). External beam radiotherapy (EBRT) has traditionally been considered the treatment of choice for CM as it offers high response rates and quick relief of symptoms. However, new targeted treatments can offer an effective, alternative treatment strategy for patients harbouring specific genetic abnormalities.
Hantavirus retinitis and concurrent hemorrhagic fever with renal syndromeHantavirus infection of the retina has not been reported in the literature. We describe the first case of presumed hantavirus retinitis and concurrent hemorrhagic fever with renal syndrome (HFRS), which presented with typical symptoms of HFRS and subsequent vision loss because of posterior necrotizing retinitis.
Corneal etching in femtosecond laser-assisted cataract surgeryFemtosecond laser technology can be used in cataract surgery to perform the capsulotomy, lens fragmentation, and corneal incisions. Compared to traditional cataract surgery, femtosecond laser-assisted cataract surgery (FLACS) can offer potential advantages such as enhanced intraocular lens centration1,2 and decreased phacoemulsification power.3,4 However, the potential for increased utility and safety over conventional techniques has not been definitively established.5,6 Though FLACS is generally a safe procedure, complications can include suction loss, anterior capsule tears or tags, posterior capsule rupture, dropped nuclei, or vitreous loss.
Eyelid fungal infections are rare, and often associated with predisposing factors. We present the case of a child with an ulcerated lesion of fungal etiology on the eyelid.An 8-year-old male presented with right periocular swelling, redness, pain, watering, and sloughing of skin over the lower eyelid of 3 weeks’ duration. As per his parents, the child had a history of probing for right congenital nasolacrimal duct obstruction conducted elsewhere, immediately after which the signs and symptoms occurred. However, no further details were available regarding the procedure. He had received intravenous cephalosporins elsewhere for the lesion but had showed no improvement.
Synergistic innervational downshoot: a distinct vertical dysinnervation pattern and its unique managementSynergistic divergence (SD), first described by Barany et al.1 and later studied electromyographically by Wilcox et al.,2 is a rare but well-established horizontal congenital cranial dysinnervation disorder (CCDD).3–12 In addition to unusual synergism affecting horizontal muscles, there are many reports in the literature regarding anomalous vertical synergism.7,10–12 In 1996, Weinacht et al. described synergistic innervations between lateral rectus (LR) and ipsilateral vertical acting muscles under vertical Duane’s retraction syndrome.
Microcystic macular edema in a case of tobacco–alcohol optic neuropathyMicrocystic macula edema (MME) is characterized by hyporeflective spaces limited to the inner nuclear layer of the parafoveal region.1 It is distinguished by foveal sparing. MME is believed to be caused by retrograde Müller cell degeneration, although trans-synaptic degeneration and vitreous traction may be involved.2,3 First described in multiple sclerosis, MME is seen in various inflammatory and noninflammatory optic neuropathies as well as other retinal pathologies (Table 1).4,5 Diagnosis is made on the basis of optical coherence tomography (OCT) demonstrating characteristic changes in the parafoveal region.
Atypical transient subretinal exudation following photodynamic therapy for chronic central serous retinopathy: a case reportCentral serous retinopathy (CSR) is a common ocular disease of young and middle-aged adults that affects men more than women. It manifests as the accumulation of central subretinal fluid (SRF) with or without the presence of retinal pigment epithelial detachment (RPED) and is often associated with reduced visual acuity (VA) or metamorphopsia.1 Most cases of idiopathic CSR resolve spontaneously; however, chronic cases in which the SRF persists longer than 3 months may require treatment.2 In cases of CSR with a focal leak, retinal laser photocoagulation may be an appropriate treatment option to accelerate the resorption of SRF and improve VA.
Inverted conjunctival papilloma: a certainly underestimated high-risk lesion for carcinomatous transformation—a case reportConjunctival papilloma is a benign epithelial tumour arising from the conjunctival epithelium. This tumour most often shows an exophytic growth pattern, and more rarely an inverted growth pattern. Since the first description of this entity by Streeten et al. in 1979, 10 cases of inverted conjunctival papillomas have been described in the literature.1 Moreover, inverted conjunctival papilloma is suspected to have a greater tendency for malignant transformation, but only 1 case of carcinoma occurring in this lesion has been described.
Inadvertent implantation of an iStent in the supraciliary space identified by ultrasound biomicroscopyImplantation of an iStent (Glaukos Corp, Laguna Hills, Calif.) in patients with open-angle glaucoma who are undergoing cataract surgery has gained popularity in recent years. The iStent is a 1 mm by 0.3 mm, heparin-coated, surgical-grade titanium stent that is implanted ab interno in Schlemm’s canal, creating a trabecular bypass to enable reduction of intraocular pressure (IOP).1,2 Its effectiveness is equivalent to the IOP-lowering effect of at least 1 glaucoma medication,2,3 and it has a good safety profile.
Infiltration of hydrogel implant into the sclera with calcification: a case report with histologic findingsHydrogel implants, introduced in 1979,1 were once believed to be the ideal scleral buckling material due to their pliability, ability to stimulate fibrous capsule production, and low risk for infection from both lack of dead space and the potential to absorb and release hydrophilic medications steadily.2 Despite its biocompatibility, several unforeseen long-term complications of hydrogel scleral buckle have been reported since the 1990s.1,2 We present a case of an extruding hydrogel implant with fragments embedded in the sclera wall, resulting in scleral rupture during surgical removal.
Staged endonasal-external resection of esthesioneuroblastoma involving the nasolacrimal duct and lacrimal sacEsthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant neoplasm of the sinonasal cavity. It is believed to arise from the basal neural cells of the olfactory mucosa.1 The typical location is the superior nasal vault and resection usually involves anterior skull base approaches, either conventional or endoscopic.2 Here, we describe a case of ENB involving the middle and inferior meatus with extension into the nasolacrimal duct and lacrimal sac.
Comprehensive imaging studies of nasolacrimal duct obstruction secondary to maxillary sinus surgeryNasolacrimal duct obstruction (NLDO) can be caused by injury during maxillary sinus surgery.1–5 Most cases of NLDO are transient, and permanent NLDO rarely occurs.1 Previous studies demonstrated radiological findings of secondary NLDO caused by maxillary sinus surgery.4,5 However, findings from other imaging studies, including dacryoendoscopy and nasal endoscopy, have not yet been comprehensively elucidated in patients with permanent secondary NLDO.
Case of Actinomyces lacrimal sac abscess mimicking malignancyPrimary lacrimal sac malignancy is rare, but it is associated with significant morbidity and mortality.1,2 Classically, these tumours present as firm masses at or above the medial canthal tendon. However, this classic presentation may result from an unexpected outcome when complicated by comorbid patient factors, such as immunosuppression.
Fibrovascular corneal mass: A rare initial sign of rheumatoid arthritisThe association between rheumatoid arthritis (RA) and ocular inflammation is well recognized.1,2 The ocular inflammation may occur after the onset of RA, during the active phase of the disease, or, rarely, even precede the diagnosis of RA. Herein, we would like to report a novel and rare case of fibrovascular corneal mass manifesting as the sole initial sign of RA.
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.
Pott’s puffy tumour presenting as a necrotic eyelid lesionA 79-year-old otherwise healthy female presented to the emergency department with a 2-day history of a painful, necrotic left upper eyelid lesion. The lesion began 10 days earlier as a painless left upper eyelid “cyst” that enlarged and subsequently ruptured with purulent, foul-smelling drainage. The lesion then became crusted, necrotic, and painful. There was no history of skin cancer, weight loss, fever, night sweats, or recent illness. The patient also revealed that she had completed a short tapering course of oral systemic steroids prescribed by an outside physician after the onset of the initial lesion.
Recurrent hyphema following iStent surgery managed by surgical removalThe trabecular microbypass stent or iStent (Glaukos Corporation, Laguna Hills, Calif.) is the smallest implantable device inserted ab interno into Schlemm’s canal for the management of glaucoma.1 To our knowledge, there have been no reported cases of recurrent hyphema after iStent placement. We present a rare case of recurrent hyphema after iStent placement and describe the surgical technique for iStent removal with subsequent resolution of the hyphema and preserved visual acuity.
Treatment of grade IV diffuse lamellar keratitis with oral doxycycline and topical 10% sodium citrateDiffuse lamellar keratitis (DLK) or the Sands of Sahara syndrome is a relatively new syndrome, first described in 1998.1 DLK is a self-perpetuating sterile inflammation of the cornea characterized by the appearance of a diffuse, multifocal, polymorphonuclear (PMN) infiltration in the flap interface. It may be associated with redness, tearing, pain, photophobia, and a decline in central vision. DLK is usually noted within the first 5 days after LASIK surgery.2–5 However, it may occur after any intervention in which a lamellar incision has created an interface through the stromal tissue.
A case of delayed-onset recurrent hyphema after iStent surgeryGlaucoma is the leading cause of irreversible blindness worldwide, projected to affect 80 million patients by 2020.1 Glaucoma progression is linked to increased intraocular pressure (IOP), and evidence suggests that decreasing IOP can preserve visual fields.2,3
Subtenon triamcinolone for cystoid macular edema due to retinitis pigmentosa unresponsive to oral acetazolamideRetinitis pigmentosa (RP) is characterized by progressive loss of photoreceptor function because of mutations in over 100 gene loci. Patients may present with nyctalopia and/or progressive visual field loss initially. Later in the course of the disease, cystoid macular edema (CME) is an important cause of central vision loss in up to 49% of patients.1 As RP patients have only a limited reserve of photoreceptors, the impact of CME on their quality of life is tremendous compared to patients with other retinal pathologies.
In-the-bag intraocular lens exchange 13 years after refractive lens extractionMost postoperative refractive surprises requiring subsequent intraocular lens (IOL) exchange occur in patients who have had previous myopic LASIK correction1 or those who have axial lengths less than 22.00 mm or greater than 25.00 mm.2
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).