Correspondence
Conjunctival and periorbital petechiae presumed secondary to self-inflicted asphyxiation in a pediatric patient
The presence of petechiae of the face and conjunctiva is a well-described finding seen in strangulation injuries. These petechiae are commonly seen post-mortem in deaths by asphyxia and are consequently used in forensic analysis.1 Conjunctival and facial petechiae have also been noted to occur in nonfatal asphyxia, and their presence may be a sign that a severe strangulation injury has occurred.2 The mechanism for facial and conjunctival petechial hemorrhages in asphyxia is thought to be rupture of capillaries with little connective tissue support secondary to local pressure elevation from continued arterial flow while venous output is obstructed.Murine typhus presenting as pseudotumor cerebri
Murine typhus is an acute infection transmitted by rodent or cat fleas carrying gram-negative, obligate intracellular bacteria, Rickettsia typhi. This vector for transmission is most often carried on rodents, but opossums are thought to be a reservoir in suburban settings.1 Associated with overcrowding, pollution, and poor hygiene, murine typhus has been documented worldwide, but the majority of cases in the United States are in Texas and California.2Central retinal artery occlusion associated with Sweet syndrome
A 64-year-old Caucasian man presented with a 1-day history of acute painless vision loss in the right eye. On examination, his visual acuity was hand motions OD and 20/30 OS. His intraocular pressures were normal OU and he had a 3+ relative afferent pupillary defect OD. The anterior segment examination was unremarkable OU. Fundoscopic examination of the right eye revealed a cherry red spot (Fig. 1A). No vitreous cell, vasculitis, or chorioretinitis was noted OU. A fluorescein angiogram of the right eye showed an arterial filing line (Fig.Iris stromal defect in an infant masquerading as a tumour: the sailing iris?
Congenital iris lesions are rare and generally identified early in life.1,2 A pigmentary lesion on the iris ranges from a simple nevus or cyst to tumors including melanoma. These lesions can arise from both iris stroma and iris epithelium.2 Thorough examination as well as anterior segment imaging studies may be required to establish a diagnosis.3 Here, we report a rare case of congenital iris stromal defect masquerading as an iris tumour.Leber hereditary optic neuropathy harboring a rare m.12811 T>C mitochondrial DNA mutation
Leber hereditary optic neuropathy (LHON) is the first hereditary disease recognized to be caused by mitochondrial DNA (mtDNA) mutation.1 It is the most commonly inherited optic neuropathy resulting in bilateral visual impairment.2 More than 90% of LHON cases harbor 1 of the 3 major mtDNA mutations m.11778G>A, m.3460G>A, and m.14484T>C; however, other variants have been previously identified.3–5 We report on a case of LHON with an m.12811T>C mtDNA mutation, a rare variant mutation that has only been previously reported as a secondary mutation of LHON.Waxing and waning poppers maculopathy
Poppers are volatile aromatic liquids typically available in vials. They make a popping sound upon opening. Poppers are a member of the alkyl nitrites, chemicals with nitric oxide donor characteristics. Poppers have been a popular recreational drug for years owing to their transient euphoric, myorelaxant, and aphrodisiac effects presenting just seconds after inhalation.1,2 Although they are illegal to sell as such, they are easily obtainable, and are often sold as air fresheners online or in nightclubs.Infliximab for management of severe refractory posterior scleritis in a 9-year-old boy
Posterior scleritis (PS) is a chronic inflammatory condition of the sclera posterior to the rectus muscle insertions. PS predominantly affects adult women and is rare in children.1,2 Adult form of PS is typically associated with autoimmune systemic diseases; however, pediatric PS is mostly idiopathic with no known underlying conditions.2–4 The initial presentation of PS in children is nonspecific with painful red eye, potential vision loss, light sensitivity, and eye movement restriction, which make the diagnosis difficult.Data reporting in ophthalmology during COVID-19 pandemic: need for a Canadian registry
Registries assist public health in documenting the incidence of new infections and gathering clinical data about patients to inform clinicians on presentation and evolution of emerging diseases. This becomes even more important during the coronavirus disease 2019 (COVID-19) pandemic.Telemedicine for postoperative consultations following vitrectomy for retinal detachment repair during the COVID-19 crisis: a patient satisfaction survey
The most recent World Health Organization (WHO) report on the coronavirus disease 2019 (COVID-19) pandemic confirms a total of 4 013 728 cases, with a death toll of 278 993.1 The staggering number of deaths has thrust us into embracing telemedicine within ophthalmology, with the increased use of video and telephone consultations, to reduce the risk of virus transmission.2 At our tertiary eye unit, we continue to provide a 7-day-a-week emergency retinal surgical service; however, our postoperative review has been modified to include telephone consultations, rather than face-to-face patient contact.Follicular dendritic cell sarcoma: a novel orbital tumour
Follicular dendritic cell sarcoma is a rare neoplasm of lymphoid cells predominantly found in lymph nodes and rarely in extranodal locations. We report the first case of follicular dendritic cell sarcoma occurring in the orbit.Multimodal imaging of sclerochoroidal calcification associated with choroidal neovascular membrane
Sclerochoroidal calcification is a benign condition typically diagnosed in asymptomatic, older, white adults, which can simulate other more serious conditions such as choroidal melanoma, metastasis, or lymphoma.1 It is characterized as yellow or yellow-white single or multifocal lesions typically found in the superotemporal quadrant near the vascular arcades, which can be unilateral or bilateral.1 Although sclerochoroidal calcification is most often idiopathic, systemic testing at the time of diagnosis is required to exclude associated disorders of calcium-phosphorus metabolism.Bilateral interstitial keratitis as the presenting manifestation of systemic lupus erythematosus in a child
Interstitial keratitis (IK) is defined as a nonsuppurative inflammation of the corneal stroma with associated cellular infiltration and vascularization commonly caused by infections or rheumatologic conditions. Although extremely rare, IK may be seen with systemic lupus erythematous (SLE). We present the first case of a child without known history or symptomatology of rheumatologic or infectious disease presenting with bilateral IK that ultimately led to a diagnosis of SLE.Continuity of ophthalmology education during a pandemic by combining video conferencing application with a slit-lamp camera
The on-going coronavirus disease 2019 (COVID-19) outbreak has dramatically changed the way of work and communication in health care. As of March 22, 2020, public hospitals in Israel have ceased to provide nonurgent office-based visits and surgeries, and the presence of faculty and residents is kept to a minimum. Clinical departments’ staff is commonly divided into separate teams, to diminish their vulnerability in case of exposure to COVID-19 carriers. Worldwide, quarantine and social distancing regulations have now put new barriers between ophthalmologists, their patients, and their colleagues.Treatments for inherited retinal degenerations are coming to Canada: brief update on a new standard of care for inherited retinal degenerations
The last 25 years brought a spectacular amount of knowledge on the genetic basis of inherited retinal disorders and a paradigm shift on how they can be managed. We entered the era of gene therapy for inherited retinal degenerations (IRDs).Intraorbital foreign body giant cell granuloma secondary to a gelatin sponge
Gelatin-based sponges are water-insoluble hemostatic agents derived from purified porcine skin and gelatin granules. These sponges are approved for placement against mucosalized surfaces and within soft tissues.1,2 Herein, the authors report a case of an orbital foreign body giant cell granuloma secondary to a gelatin sponge.Conservative management of periorbital necrotizing fasciitis caused by methicillin-resistance Staphylococcus aureus
Necrotizing fasciitis (NF) of the periorbital region is a rare occurrence, though has been shown to cause severe facial disfigurement, blindness, and death.1,2 We report a case of community-acquired methicillin-resistant Staphylococcus aureus (MRSA)–associated periorbital NF in a 25-year-old woman, who presented with left eye and nostril redness and swelling after picking a pimple on her nose a few days prior. She had no significant medical history and was not diabetic. She was initially diagnosed with facial cellulitis and commenced on antibiotics, but returned 2 days later with worsening cellulitis, bilateral leg pain and redness, and shortness of breath.Capnocytophaga sputigena as a cause of severe orbital cellulitis and subperiosteal abscess in a child
Orbital cellulitis is an infection of the soft tissues lying behind the orbital septum. The etiologic agents differ across age group, but gram-positive cocci colonizing the skin and the nasopharynx, such as Staphylococcus and Streptococcus species, are most commonly identified in children. Haemophilus influenzae, a gram-negative facultative anaerobe, was frequently identified before the introduction of the Haemophilus vaccine in 1985. We report the case of a 15-year-old man who presented with a severe orbital cellulitis complicated by a subperiosteal abscess (SPA) secondary to Capnocytophaga sputigena.A case of multifocal presumed solitary circumscribed retinal astrocytic proliferation lesions in the same eye
Presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) is a recently described retinal tumour that is a distinct entity from other white lesions of the retina such as astrocytic hamartoma and acquired astrocytoma.1 The exact origin of these lesions is of some debate within the literature as no histological diagnosis exists to date.2,3 These lesions are not associated with tuberous sclerosis complex or related syndromes and can be distinguished from astrocytic hamartomas with imaging.Canadian ophthalmology resident experience during the COVID-19 pandemic
The ongoing worldwide pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has greatly affected our lives. At the time of writing this report, there have been 18 166 298 confirmed cases and 690 953 deaths worldwide owing to SARS-CoV-2, with 118 966 cases and 8995 deaths in Canada.1Branch retinal vein occlusion as the presenting feature of germ cell tumour
Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy. RVO stands as one of the common causes of visual morbidity and blindness in the elderly population. RVO can be classified into central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) based on the site of vascular occlusion. The incidence of BRVO is generally higher than the incidence of CRVO. Systemic hypertension, hyperlipidemia, and increased body mass index are important risk factors for BRVO in young patients,1 similar to older population.Serous retinal detachment following bronchoscopy-induced hypertensive emergency
Flexible bronchoscopy is a widely used procedure with multiple therapeutic and diagnostic uses. Although considered fairly low risk, ocular complications including subconjunctival hemorrhage and Valsalva retinopathy1 have been reported. We present a case of serous retinal detachment (SRD) that was primarily caused by a hypertensive emergency occurring during bronchoscopy.Retinal ganglion cell loss in postmortem tissue of Alzheimer disease, glaucoma, and healthy normal subjects
Loss of retinal ganglion cells (RGCs), the hallmark of glaucoma (GL), is also thought to occur in patients with Alzheimer disease (AD).1,2 Structural measures derived with optical coherence tomography have been used as proxies for RGC estimates in GL3,4 and AD,5 both independently and in comparative studies.6,7 Although optic nerve damage in GL8,9 and AD10 has been reported in postmortem tissue, quantification in the retina is limited to the use of generic techniques, such as Nissl staining in the ganglion cell layer,11,12 which label all nuclei and not specifically RGCs.Anterior uveitis following collagen crosslinking in a patient with X-linked chronic granulomatous disease
A 14-year-old boy of Middle Eastern heritage with X-linked chronic granulomatous disease (CGD) was referred to the cornea clinic for keratoconus. He had no history of uveitis. He had been diagnosed with CGD 6 years ago after suffering pneumonia requiring broad-spectrum intravenous antibiotics. He had no significant infections since starting prophylactic antibiotics and antifungals. His mother stated that he “constantly rubs his eyes.” His mother was a CGD carrier and also had keratoconus. No other family members had CGD or keratoconus.Access, an unintended consequence of virtual continuing medical education during COVID-19: a department's experience at the University of Toronto
Coronavirus disease 2019 (COVID-19) has irreversibly affected the lives of millions of people globally; to control its spread, many activities including clinical care have been limited to essential services.1 Continuing medical education (CME) activities in many specialities, however, have expanded and even flourished by moving to online platforms, allowing for broader interactions across hospitals, organizations, and borders. In this perspective, we highlight what we believe is the most important benefit to come from the rise in virtual CME during the pandemic drawing from our own department's experience, namely, increased access to those who have historically been excluded from traditional CME activities.Paracentral acute middle maculopathy following high-intensity interval training
High-intensity interval training (HIIT) is a cardiovascular exercise strategy that combines short bursts of intense anaerobic exercise with quick recovery periods. There are significant cardiovascular, metabolic, and mental health benefits associated with HIIT.1 Furthermore, this exercise regimen is correlated with better macular and optic nerve head capillary perfusion, microvascular remodelling, and decreased size of the foveal avascular zone in the long-term.1,2
