Correspondence
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.1Retinal pigment epithelium apertures associated with subretinal fluid and acquired vitellifom lesions in non-neovascular age-related macular degeneration
Classic features of non-neovascular age-related macular degeneration (AMD) include drusen, drusenoid retinal pigment epithelial (RPE) detachment, and RPE atrophy. More recent studies have shown that intra- and subretinal fluid also may complicate the non-neovascular form of AMD.1Corneal limbal xanthogranuloma in Erdheim-Chester disease
Adult orbital xanthogranulomatous disease is a rare non-Langerhans cell histiocytic condition with 4 clinical subtypes: adult‐onset xanthogranuloma, adult‐onset asthma with periocular xanthogranuloma, necrobiotic xanthogranuloma (NBX), and Erdheim–Chester disease (ECD). We report, to our knowledge, the first case of ECD with limbal infiltration.Kodamea ohmeri keratitis
Kodamaea ohmeri is a yeast-like fungus and a rare but emerging pathogen.1 It has been identified as the causative organism in fungemia, funguria, endocarditis, cellulitis, and peritonitis, often with high fatality rates.1 To the best of our knowledge, there is only 1 previous report of K. ohmeri keratitis in the literature.2Rare case of extramacular choroidal macrovessel
Choroidal macrovessel (CM) is a rare, mostly unilateral vascular anomaly of the choroidal circulation.1 These abnormally large vessels may cause disturbances in the overlying retinal pigment epithelium (RPE) and the development of subretinal fluid. Some CMs can even masquerade as a choroidal tumour or parasitic infestation.1–3 Reports showing early filling of CMs during indocyanine green angiography (ICGA) suggest that most CMs are arterial in nature.1,3,4 The short posterior ciliary circulation is comprised of a medial and lateral posterior choroidal artery (PCA)5,6; the latter may represent the origin of most CMs and may explain why almost all previously reported CMs arise in the macula.Varied management of idiopathic intracranial hypertension in female-to-male transgender patients
Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, visual disturbances, papilledema, and headache. There is an association between sex hormone excess and IIH, particularly in patients undergoing hormonal therapy for gender transition.1 The increased androgen concentration during testosterone therapy for gender reassignment presents an opportunity for studying different treatment modalities. First-line treatment of IIH involves dietary changes and a carbonic anhydrase inhibitor such as acetazolamide.A masquerader epidemic: five heterogeneous ocular syphilis presentations
Syphilis is a spirochete infection transmitted through intercourse or congenital infection. Despite declining incidence since the 1990s, ocular syphilis has re-emerged in developed countries.1 We describe 5 distinct presentations of ocular syphilis to promote recognition of this increasingly prevalent disease.Wellness among Canadian ophthalmology resident physicians: a national survey
Residency is a particularly stressful and dynamic period during which learners must balance the demands of patient care, education, and personal responsibilities. Evidence of high levels of burnout among resident physicians has driven the development of initiatives and programs to help address this negative consequence of residency training. As a novel topic in the realm of medical education, more information is required to further characterize the sources of burnout and depression and the nuances of various specialities.Multiple myeloma with concurrent herpes zoster ophthalmicus: a case report
Hyperviscosity syndrome, which typically results from elevated serum levels of monoclonal protein, can present with bleeding, retinopathy, and neurologic symptoms.1 We present a case of hyperviscosity syndrome confounded by herpes zoster reactivation in a patient with newly diagnosed multiple myeloma.Delayed diagnosis of autosomal dominant optic atrophy until seventh decade of life
Autosomal dominant optic atrophy (ADOA) is the most common hereditary optic neuropathy, manifesting in approximately 1 in 50 000 people, and up to 1 in 10 000 in Denmark, owing to a founder mutation.1 Isolated ADOA typically manifests in the first 2 decades of life as bilateral painless progressive vision loss and is therefore mostly diagnosed in childhood to young adulthood. We present a series of 2 older patients, aged 63 and 64 years, who had delayed ADOA diagnosis as proband patients in their families, emphasizing the point that chronological age should not be the sole determining factor for ordering testing for ADOA in cases of unexplained optic neuropathy.Papilledema associated with COVID-19 multisystem inflammatory syndrome in children
Multisystem inflammatory syndrome in children (MIS-C), also called pediatric inflammatory multisystem syndrome, is characterized by a wide range of symptoms and can present a diagnostic challenge given its myriad presentations. On top of the more well-known inflammatory manifestations of MIS-C, recent reports have also surfaced of MIS-C causing increased intracranial pressure.1,2 MIS-C can present similarly to other systemic inflammatory disorders such as Kawasaki disease and can be especially difficult to distinguish from Kawasaki disease if a Kawasaki-like presentation is accompanied by a positive test for coronavirus disease 2019 (COVID-19).
