Correspondence
Infectious keratitis as the presenting sign of giant cell arteritis
Giant cell arteritis (GCA) is a medium-to-large vessel vasculitis that usually presents with headache, loss of vision, jaw claudication, and scalp tenderness. We report a case of biopsy-consistent GCA presenting as an infectious bacterial keratitis. To our knowledge, this is the first such case reported in the English-language ophthalmic literature.Thrombotic thrombocytopenic purpura in chronic myelogenous leukemia
Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by the pentad of microangiopathic hemolytic anemia, thrombocytopenia with purpura, acute kidney injury, neurologic abnormality with fluctuating mental status, and fever.1,2 It has an incidence ranging from 3.7 to 11 cases per million and risk factors that include female gender, Afro-Caribbean ancestry, and obesity.2 The prevailing pathophysiologic theory for TTP asserts that patients have a deficiency or defect in A disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), a protease that cleaves large multimers of von Willebrand factor.Leber hereditary optic neuropathy: 41-year interval between fellow eye involvement
Leber hereditary optic neuropathy (LHON) is an inherited mitochondrial disorder that typically presents in young men with painless, subacute, bilateral (simultaneous or sequential) central vision loss.1,2 Most cases have nonsimultaneous involvement of the contralateral eye in an interval less than 1 year.2,3 However, there are reports of loss of vision in the fellow eye over 1 year later. To date, the longest interval between affected eyes is 18 years.4 We present a patient with an interval of 41 years.Abducens nerve palsy and ipsilateral Horner syndrome as the presenting finding of carotid cavernous fistula
An 84-year-old female with history of hypertension and hyperlipidemia presented with nontraumatic left eyelid edema, erythema, and ptosis followed by acute painless binocular horizontal diplopia. Best corrected visual acuity was 20/20 OD and 20/30 OS. The OD pupil measured 4 mm in the dark and 2 mm in the light, and the OS pupil measured 3 mm in the dark and 2 mm in the light. No relative afferent pupillary defect was detected. There was a 50 prism diopter esotropia in primary gaze and an abduction deficit of –4 OS (Fig.Presumed ischemic optic neuropathy
Nonarteritic anterior ischemic optic neuropathy (NAION) is a relatively common cause of acute, painless vision loss in patients typically older than 50 years. Presentation is often associated with predisposing vasculopathic risk factors, but has also been reported as a complication of pregnancy. We describe a young, healthy female with disc drusen who suffered bilateral NAION due to postpartum blood loss. To our knowledge this is the first such case to be reported in the English-language ophthalmic literature.
