Teaching of the lateral tarsal strip technique using a duct tape simulationA lateral tarsal strip is a surgical procedure commonly used in oculoplastics for the repair of entropion and ectropion. A lateral tarsal strip involves correction of horizontal lid laxity with incision at the lateral canthus. Residents may have difficulties with suture placement of the tarsal strip in the periosteum. In an effort to facilitate the surgical teaching of this technique, we propose a straightforward surgical simulation to reproduce the technique. A plastic skull model, standard duct tape, surgical instruments, and suture are needed.
Role of multimodal ocular imaging in Alport syndromeA 19-year-old man with Alport syndrome presented with diminution of vision in his left eye. Slit-lamp biomicroscopy showed an early anterior lenticonus with an anterior subcapsular cataract in his right eye (Fig. 1A) and a dense anterior polar and anterior subcapsular cataract in his left eye (Fig. 1B). Fundus photography revealed central perimacular dot-and-fleck retinopathy with a dull macular reflex or lozenge in both eyes (Fig. 1C, 1D). The flecks were better visualized on red-free imaging as a ring of fine white stippling around the macula (Fig.
IgG4-related orbital diseaseA 67-year-old man presented with a 3-week history of diplopia and left ocular pain. Examination showed limitation of abduction of the left eye. Computed tomographic scan demonstrated a soft tissue density mass in the ethmoid sinus (yellow arrow) with extension into the left orbit and infiltration of the medial rectus muscle (Fig. 1A). Incisional biopsy revealed a dense lymphoplasmacytic infiltrate (Fig. 1B), storiform fibrosis, and obliterative phlebitis (yellow arrow, Fig. 1C). Immunohistochemistry was positive for immunoglobulin 4 (IgG4; IgG4+ cells > 30/hpf and IgG4:IgG ratio > 40%) (Fig.
A practical approach to slit-lamp smartphone photographySeveral approaches to smartphone anterior segment photography that involve purchasing an adapter to attach to the slit lamp have been described in the literature. Given the frequent updates in sizes and shapes of smartphones, a practical stepwise approach to capturing high-quality images without the need for an adapter is essential. First, the illumination is set to be diffuse, using the slit-lamp integrated diffuser (Fig. 1A, 1B). The camera flash is turned off, and the slit lamp is brought into focus on the anterior segment.
Retinal racemose hemangioma characterization with multimodal imagingRacemose hemangioma is an arteriovenous vascular malformation in which the retinal vessels appear abnormally dilated. The arteries are connected with the veins directly, without the interposition of a capillary network (Fig. 1A), forming a fragile vascular mass with turbulent flow that is predisposed to thrombosis phenomena. The fluorescein angiography (Fig. 1B) shows filling of the malformation without exudation. The optical coherence tomography and the optical coherence tomography-angiography en face (Figs.
Assistant-controlled directional chandelierChandelier endoillumination has become common everyday practice for most vitreoretinal surgeons. The assistant-controlled directional chandelier is a solution to controlling, minimizing glare of, and directing the light when using a chandelier endoillumination device (Video 1, available online). With the use of readily available items within a vitreoretinal operating room setting, the Luer connector is attached to the light pipe with adhesive dressing (A). Approximately 6 mm of residual light pipe is left exposed to stop the assistant from inadvertently advancing the light pipe too deeply into the eye (B).
Corneal metallic particles after cataract surgery are safe in magnetic resonance imagingOn close inspection, tiny metallic particles are visible in all corneal incisions after cataract surgery (arrows). They appear to occur after passing cannulas or other instruments through the incisions. The presence of these particles was documented prior to undergoing magnetic resonance imaging (MRI) in 3 patients (Fig. 1A–C). No adverse events occurred during the MRI, and there was no visible artifact on the MRI images (Fig. 1D, axial T2) in the plane of the incisions. These particles appear to be innocuous and do not preclude MRI studies.
Commotio retinae secondary to fragmented intraorbital pelletsA 20-year-old man presented with multiple facial gunshot injuries. Visual acuities were 20/20 each eye, with full color vision and normal pupillary responses. Examination showed subconjunctival hemorrhage, mild anterior chamber inflammation, extensive commotio retinae involving the macula, and inferior retinal hemorrhages (Fig. 1A). Computer tomography (Figs. 1B–D) showed orbital emphysema and multiple fragmented left extraconal and intraconal pellets—one in close proximity to the posterior aspect of globe, adjacent to the optic nerve.
Retinal vasculitis after intravitreal injection of brolucizumabAn 82-year-old man with age-related macular degeneration presented with painful vision loss in the right eye 42 days after his third brolucizumab injection (Beovu, Novartis, Basel, Switzerland). Visual acuity was light perception (baseline, 20/150). Examination revealed moderate to severe vitritis, arterial sheathing, diffuse arterial and venous narrowing, and perivenular hemorrhages (Fig. 1A,1B). Fluorescein angiography demonstrated extensive arterial and venous filling defects with peripheral nonperfusion (Fig.
Retinal crystalline lesions in pseudoxanthoma elasticumAn 11-year-old healthy boy was evaluated for incidental retinal crystalline lesions. Visual acuity was 20/20 in both eyes. Fundus examination of the right (A) and left (B) eyes demonstrated multiple crystalline bodies (blue arrows) scattered throughout the midperipheral and peripheral retina, a peau d'orange pattern of retinal pigment epithelial (RPE), alterations in the temporal retina (white arrow), and angioid streaks (yellow arrow) around the optic nerve on fundus autofluorescence imaging (C).
Management of a large metal intraocular foreign bodyA 49-year-old man had been seen 1 month prior by a general ophthalmologist for a healing corneal abrasion. On examination, there was a dense vitreous hemorrhage and a subtle iris transillumination defect suspicious for an occult intraocular foreign body (IOFB; Fig. 1A). A computed tomography scan confirmed an IOFB that extended from the inferior posterior iris to the posterior pole (Fig. 1B). Intraoperatively, the traumatic cataract was removed along with the ruptured capsular bag (Video 1, available online).
Management of a dislocated 3-piece intraocular lens with an iris prosthesis in situA 33-year-old man with a past injury of the left eye involving iris loss and choroidal rupture in 2002, presented with 1-month history of spontaneous blurry vision. On examination he had a dislocated 3-piece Ophtec (Netherlands) intraocular lens (IOL) in the vitreous with an iris prosthesis (Human Optics, Germany) dislocation sutured at 9:00 o'clock and poorly attached at 3:00 o'clock (Supplementary Video 1). The already kinked IOL was cut and explanted (A), and a secondary IOL inserted and fixated to the sclera behind the iris prosthesis using a Yamane technique (B).
Secondary vasoproliferative tumor in adult-onset Coats diseaseA 20-year-old woman noted a 1-month history of floaters in her left eye. Ultra-widefield multicolor imaging and fluorescein angiography (Figure A, B) showed classic findings of Coats disease (telangiectasia, exudation, subretinal fluid, and peripheral nonperfusion) and an additional yellow-red dome-shaped mass of 3 mm thickness that corresponded to a secondary vasoproliferative tumor encircled by gravitating lipid exudation. Coats disease usually occurs in children but can affect older patients.
Third nerve palsy due to influenza A infectionA previously healthy 38-year-old woman presented with new onset left ptosis and diplopia. Two days prior, she developed nasal congestion, cough, fever, and myalgias. Examination revealed left ptosis and a limitation of elevation, depression, and adduction of the left eye (50% of normal). Pupils were equal sizes and reactive to light, and the remainder of the neurological examination was normal. Magnetic resonance imaging with gadolinium revealed mild enhancement (Fig. 1A) and an increased size and T2 signal (Fig.
Traumatic retinal detachment and macular hole due to exercise resistance band injuryA 20-year-old sustained a resistance band injury after adopting a home-workout routine during pandemic gym closures. He presented with an inferior retinal detachment due to a large, jagged, equatorial retinal tear; a full-thickness macular hole; and a shallow superior retinal dialysis Figure I. He underwent vitrectomy, and because of the extensive commotio, there was inadequate laser uptake. With silicone oil tamponade, laser was completed postoperatively Figure II. Following silicone oil removal, the macular hole is closed Figure II and the vision has improved from 20/400 to 20/60.
Shield-shaped cataract in severe atopic dermatitisA 32-year-old woman presented with a progressive decrease of vision in right eye and bilateral and severe skin eczema. The best-corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. The patient was previously diagnosed with atopic dermatitis. On slit-lamp examination, a shield-shaped anterior capsular cataract was observed, as well as an important anterior blepharitis. Although posterior subcapsular cataracts are more frequent in atopic dermatitis, shield-shaped cataracts are more specific to this disease.
Full thickness posterior globe perforation managed with laser photocoagulationA 22-year-old male patient was urgently referred following an all-terrain vehicle (ATV) accident. On presentation, the patient had extensive bilateral periorbital fractures. Dilated fundus exam of the right eye demonstrated a full-thickness chorioretinal and scleral perforation infero-nasal to the optic disc with mild vitreous hemorrhage (Fig. 1A). Laser photocoagulation was performed around the perforation site. Three months after the injury, the patient had visual acuity of 20/20 in his right eye with complete resolution of the vitreous hemorrhage.
Lens capsule rupture in a nonaccidental traumaHere we present an image of the lens capsule rupture of the left eye of a 6-month-old female believed to be a victim of nonaccidental trauma. Grossly, the lens of the left eye appears irregular in shape compared with the lens of the right eye), showing this is unlikely artifactual or due to tissue processing. The image demonstrates a capsule break with distinct scrolling pattern at the edge. There are numerous hemorrhages of varying sizes in all retinal layers with rare blood cells seen in the vitreous cavity, as well as the optic nerve hemorrhage, not pictured.
Corneal myxoma after pressure washer injuryA 71-year-old man presented with an enlarging left eye lesion, 6 years after pressure-washer injury. Examination showed a lobulated, gelatinous lesion with associated cornea neovascularization, obscuring the fundus (A). The fellow eye was normal. High-frequency ultrasound confirmed that the lesion was anterior to the corneal stroma (B). Lesion excision resulted in improved vision, but with residual cornea edema (C). Histopathology demonstrated loose mesenchymal tissue with stellate fibroblasts and scattered thin-walled vascular structures, consistent with corneal myxoma (hematoxylin-and-eosin stain, original magnification, × 200) (D).
Bilateral retinal detachment imaged by Mirante color photography and retro mode illuminationA highly myopic 45-year-old man with bilateral rhegmatogenous retinal detachments was imaged using Mirante Scanning Laser Ophthalmoscope (SLO) device by Nidek (Nidek Co, Ltd., Gamagori, Nidek). (A, B) The widefield color fundus photographs show the full extent of the retinal detachment in both eyes and peripheral retinal breaks. A large horseshoe tear and a smaller tear are observed superotemporally (A), whereas a single break is observed superotemporally (B). The prominent corrugations/retinal folds associated with the detachment are clearly evident.
Knobloch syndrome: a rare cause of paediatric retinal detachmentKnobloch syndrome is a very rare disease characterized by the following triad: occipital defect, high myopia, and retinal detachment. It is caused by COL18A mutation, inherited in an autosomal recessive pattern.
Rare case of anterior lenticonusA 17-year-old girl presented with defective vision in both eyes. On ocular examination, she showed anterior lenticonus in both eyes with normal fundus and an “oil droplet reflex” on retroillumination (Fig. A, B). Lenticonus is characterized by conical protrusion of the anterior or posterior lens surface. Posterior lenticonus is more common than anterior and is usually unilateral. Anterior lenticonus is often bilateral and is usually associated with Alport syndrome. Alport syndrome results in renal failure, which can be avoided by early diagnosis and prompt referral.
Creating aerosolized droplets in phacoemulsificationA wetlab was set up using porcine eyes, an artificial anterior chamber maintainer, and an Alcon Infiniti phacoemulsification system (Fort Worth, TX; Fig. A). Colouring dye was placed in the irrigation fluid for easy identification of droplets on a white paper surface surrounding the eye. During simulated phacoemulsification, droplet/aerosol production occurred when the irrigation ports were in the incision, but not when they were entirely within the anterior chamber. A similar study, using cadaveric eyes and a 2.2 mm phacoemulsification sleeve, also found that no droplet/aerosol was produced when instruments were held entirely within the anterior chamber.
Diffuse spontaneous intraretinal hemorrhages in familial retinal arteriolar tortuosityA 51-year-old healthy woman presented with a 3-month history of bilateral scattered scotomas. There was no history of anticoagulant use, Valsalva, or trauma. Family history was noted for episodic retinal hemorrhages of unknown cause in her mother.
Exotropic bilateral internuclear ophthalmoplegia following a superior cerebellar artery aneurysm clippingA 62-year-old man developed binocular diplopia during hospitalization for an upper-gastrointestinal bleed 1 month after clipping of a superior cerebellar artery aneurysm. Gradient echo showed punctate microhemorrhage at the level of left inferior colliculus (Fig. 1). Motility examination revealed primary gaze left hypertropia (presumed skew deviation) with bilateral exotropia, adduction deficits, and dissociated horizontal abducting nystagmus and downbeat component with intact convergence, consistent with an exotropic bilateral internuclear ophthalmoplegia (EBINO; see Video).
YAG laser membranotomy for sub-inner limiting membrane hemorrhage due to ruptured macroaneurysmA 65-year-old hypertensive woman was monitored owing to a macular macroaneurysm in the right eye (OR). She reported partial sudden vision loss in the preceding 2 days. Her corrected visual acuity was <0.05 in the OR and 1.0 in the left eye. Slit-lamp biomicroscopy and fundoscopic examination of the OR revealed initial cataract and preretinal hemorrhage over the macular region, macroaneurysm near the upper temporal arch, and local hard exudates (Fig. 1A). The diagnostic hypothesis was the ruptured macular macroaneurysm, with optical coherence tomography indicating sub-inner limiting membrane (ILM) hemorrhage (Fig.
Blossoming vision: unusual donor tissue configuration in a jaundiced cornea tissueA patient underwent a left phacoemulsification, intra-ocular lens (IOL) insertion, and Descemet membrane endothelial keratoplasty (DMEK). The donor tissue had excellent endothelial cell count and was compliant with regulatory screening protocols. The donor patient died from hepatic failure and was noted to be severely jaundiced, consistent with the diffuse yellow tinge found in the corneal stroma. A standard 8 mm DMEK peeling was initiated uneventfully, with the tissue being more robust and stiffer than normal.
A 360-degree peripapillary hyper-reflective ovoid mass-like structure (PHOMS)A 31-year-old woman developed papilledema from idiopathic intracranial hypertension. Enhanced-depth imaging optical coherence tomography (EDI-OCT) excluded optic disc drusen (ODD) but was notable for a peripapillary hyper-reflective ovoid mass-like structure (PHOMS), contiguous 360 degrees around the optic disc, forming a 3-dimensional torus (i.e., donut) (Fig.) Radial sections through the right optic nerve head are shown in the left column; a PHOMS is seen at each of the twelve clock-hours of the peripapillary region in the middle column and duplicated and shaded yellow in the right column.
Roth spots as debut of multiple myelomaA previously healthy 42-year-old man complained of sudden visual loss in the left eye 1 day before the consultation. Funduscopic examination showed the right eye with dilatation and tortuosity of the veins, multiple Roth spots, flame-shaped and dot-blot intraretinal hemorrhages. Optic nerve and foveola showed no alterations (Fig. 1.1). The left eye showed similar characteristics but with more abundant and confluent hemorrhages. A preretinal hemorrhage was present on the macula, which explains the sudden loss of vision (Fig.
Lid abscess associated with personal protective eyewear in a COVID-19 medical unitA 23-year-old nurse working in a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ward presented with a 1-week history of left upper brow and eyelid swelling and discharge from the upper brow. She had manicured her eyebrows with tweezers approximately 1 month before, but denied other trauma, sinus symptoms, or prior use of an eyebrow ring. She was clinically diagnosed with an eyelid abscess and started on trimethoprim/sulfamethoxazole and amoxicillin/clavulanic acid. Computed tomography imaging was not performed because the physical examination demonstrated only superficial findings.
Massive orbital teratomaThis 41-year-old woman had a left eye mass that slowly enlarged from a grain-sized lesion of the eyelid at birth to the present fist-sized mass in the orbit (Fig. 1A). The left eye was blind since birth. She had no prior ophthalmic treatment. On examination the left eye had no light perception, and no recognizable globe structure was seen in the interpalpebral area or on magnetic resonance imaging (Fig. 1B). At surgery, exenteration was performed for the 8 cm × 6 cm lesion, which weighed 300 g (Fig.
Retinal involvement in severe noncerebral malariaA 20-year-old male patient complained of reduced vision after being admitted to a hospital in Bangladesh with 5 days of fever associated with convulsions and anemia (hematocrit 11%). Uncorrected visual acuity was 20/80 OD and 20/64 OS. Bedside dilated ophthalmic examination, registered using a portable fundus imaging device (Kowa Genesis-D), revealed white-centred hemorrhages in 4 quadrants, diffuse disc pallor, and preretinal macular hemorrhages in both eyes. The patient was diagnosed with malarial retinopathy, an ocular manifestation of Plasmodium falciparum infection.
Bilateral cilioretinal artery occlusions in giant cell arteritisAn 82-year-old man presented with painless sequential vision loss of his right eye (OD). Ten days earlier, he presented to another hospital for left eye (OS) vision loss. His vision was Light perception only OD and No light perception OS. Fundoscopy demonstrated bilateral cilioretinal artery occlusions with chalky white optic disc swelling OS (Fig. A, B). Although he denied symptoms of giant cell arteritis (GCA) and had normal inflammatory markers, his clinical examination was suspicious for GCA, which was confirmed by temporal artery biopsy.
Reticular keratic precipitatesA 56-year-old woman with Treponema pallidum haemagglutination test and venereal disease research laboratory–positive syphilitic panuveitis presented with a vision of counting fingers close to face and an intraocular pressure of 36 mm Hg in the left eye. Slit-lamp examination of the left cornea was clear with fine, arborizing pigment in a reticular pattern on the corneal endothelium with a few surrounding old keratic precipitates (KPs) in Arlt's triangle (see Fig. 1).
Asymptomatic familial bilateral severe retinal vascular tortuosityA 15-year-old girl and her 40-year-old mother presented with abnormal fundi, with significant tortuosity of the retinal vessels in both eyes. They were asymptomatic and had no other abnormal findings. Furthermore, systemic complications were not confirmed. Familial retinal arteriolar tortuosity (FRAT) is a rare hereditary disease that is very similar to that observed in our patients. The condition of our patients differs from FRAT in that it was accompanied by severe venous tortuosity. No similar cases have been previously reported.
Ophthalmic artery occlusion after dermal fillers injectionA young female patient developed left-sided headache, periorbital pain, and acute loss of vision within a few minutes after receiving left-sided nasal hyaluronic acid dermal fillers. Visual acuity of her left eye was no light perception, with a grade 4 relative afferent pupillary defect. Posterior segment examination revealed marked edema of the posterior pole with absence of cherry-red spot, suggestive of an iatrogenic ophthalmic artery occlusion. Multiple emboli (A, arrows) were seen within the central retina artery and branching arterioles.
Fibrin membrane pupillary block after cataract surgery in a patient with diabetesA 52-year-old man with diabetes presented with a flat anterior chamber in the right eye on the 30th postoperative day after manual small-incision cataract surgery. His best-corrected visual acuity was 20/40. Slit-lamp examination (Fig. 1) showed clear cornea with a flat anterior chamber. Posterior chamber intraocular lens was in the bag and in position posteriorly. Fibrin membrane was seen attached to the pupillary margin, causing complete pupillary block. The finding was confirmed with an ultrasound biomicroscopy (Fig.
Medial orbital dermoid cystThis healthy 35-year-old woman presented with a 2-year history of painless, progressive proptosis in the right eye. There was no lid retraction or dysthyroidism. Her acuity, pupils, confrontation field, motility, and ocular examination findings were normal. Orbital computed tomography showed a large well-circumscribed retrobulbar cyst with intraluminal contents near the ethmoidal-maxillary suture line. The cyst was drained through a transcaruncular incision. Keratin contents and hair were removed, and the inner lining was cauterized with bipolar.
Bilateral curvilinear chorioretinal streaksA 46-year-old Caucasian woman presented with distorted vision in both eyes. Visual acuity was 20/25 OD and 20/50 OS. Fundus examination showed bilateral concentric chorioretinal streaks (Fig. A, B), which were hyperfluorescent on fluorescein angiography (Fig. C, D). The scars had formed in a curvilinear pattern called Schlaegel lines associated with multifocal choroiditis and panuveitis (MCP). She developed choroidal neovascularization (CNV) and was treated with photodynamic therapy. Her visual distortions resolved and vision improved to 20/20 OD and 20/25 OS.
Scleral needling techniqueScleral needling technique is a novel, safe, and simple alternative to suturing for effectively securing leaking sclerotomies in microincision vitrectomy surgery. After air–fluid exchange and trocar cannula removal (A), air bubbles are visualized at the site of wound leakage by dripping balanced salt solution over the open sclerotomy (B). A closed 30-gauge needle syringe is perpendicularly inserted full thickness through the sclera adjacent to the scleral opening and removed immediately (C). The wound is then pressed with a blunt cannula.
Labyrinth opacification of intraocular lensThe image corresponds to an opacified intraocular lens composed of hydrophilic acrylic material, causing important impairment of visual function in the patient. There are many reports of opacified lens composed of different materials, but it seems to affect hydrophilic acrylic lenses in most cases.
Imaging the inferior oblique using optical coherence tomographyAn 81-year-old woman presented for a routine follow-up of her dry age-related macular degeneration (Fig. 1A). She had normal eye balance and no history of strabismus. Optical coherence tomography (OCT) radial scan, using Triton OCT (Topcon, Tokyo, Japan), showed a round area behind the sclera, slightly inferior to the macula in her right eye (Fig. 1B, 1C). The vertical cuts (Fig. 1D) showed its fascicular organization. The morphology and position suggest that this structure was the inferior oblique muscle.
Severe vernal keratoconjunctivitis complicated by anaesthetic abuseA 22-year-old man with a history of atopy and vernal keratoconjunctivitis presented for a nonhealing complete corneal epithelial defect of the right eye (Fig. A, B). Biomicroscopy was notable for giant papillae on everted lids (Fig. C). Infectious etiologies were ruled out. The patient disclosed a 2-week history of daily topical anaesthetics use. A diagnosis of severe vernal keratoconjunctivitis complicated by anaesthetic abuse was made. Despite outpatient treatment, he presented 1 month later with a dense sterile stromal infiltrate (Fig.
Insidious transpalpebral fistula secondary to scleral buckleA 78-year old man was referred to the emergency eye clinic with a 3-month history of pain, discharge, and redness from the right upper eyelid. He had attended the ophthalmic emergency department 7 times in the past year, having been diagnosed with recurrent infective conjunctivitis. He had a history of right retinal detachment surgery that was repaired with scleral buckle and cryotherapy over 10 years ago with subsequent vitrectomy and silicone oil insertion. Of note, the scleral buckle was left in situ at the time of his second operation.
Floriform cataractA 6-year-old girl presented with decreased vision in the right eye detected during a school-screening program. The best-corrected visual acuity was 20/120 in the right eye and 20/20 in the left eye. On retro-illumination, there were petal-shaped opacities arranged in a flower-like pattern. Prominent embryonic suture lines separating the petals completed the “floriform” pattern. A peripheral circular zone of lenticular haze with a few spokes or “riders” was also present. She was diagnosed as having a floriform cataract, a rare subtype of congenital cataract with an autosomal dominant inheritance.
Capsular delamination of the crystalline lens and iridoschisisCapsular delamination or true exfoliation of the lens is a relatively rare disorder and describes a condition in which there is a thin, fluttering capsular membrane on the anterior surface of the lens. Slit-lamp microscopy of an 81-year-old man shows localized superior iridoschisis and dense cataract with a circular scrolled leaf of the anterior capsule floating in the anterior chamber (Fig. 1A). The intraocular pressure was 23 mm Hg. Anterior segment image of swept-source optical coherence tomography clearly shows the splitting of the superficial lamella with an attached floating flap waving in the anterior chamber (Fig.
Arterioarterial collaterals due to a prepapillary vascular loopA 57-year-old male with floaters in the left eye for 3 weeks presented to our institute. He reported recurrent vitreous hemorrhages in this eye since childhood. The right fundus was unremarkable. The left fundus demonstrated a prepapillary vascular loop (PVL) and retinal vascular anastomoses crossing the temporal raphe (Fig. 1). Ultra-wide-field fluorescein angiography disclosed arterial filling of the PVL and peripheral arterioarterial collaterals without leakage.
Berger's space hemorrhage missing the visual axisA 30 year-old female was hit in the left eye with a toy, resulting in a hyphema. Blood was noticed to be trapped in Berger's space (potential space between the lens and vitreous) as the hyphema cleared (Fig. 1). Surprisingly, the visual axis was spared despite the boat-shaped hemorrhages seen on retroillumination, and vision had improved from 20/150 to 20/25. No retinal tears nor detachments were found. Berger's space blood is considered to be a type of vitreous hemorrhage. With a clear traumatic cause and symptom improvement, this patient was observed.
Congenital sessile angiomaA 14-year-old Hispanic girl recently emigrated from Honduras presented for right eye redness; an incidental left eye conjunctival vascular lesion was noted. Neither the patient nor her parents had noticed the left eye lesion previously. Our diagnosis is a congenital sessile angioma, measuring 7.2 mm × 5 mm (W × H). There are no signs of other systemic or syndromic processes occurring, and the patient is neurologically intact. The right eye was noted to have meibomian gland dysfunction.