Case Reports in Ophthalmology最新文献

Introduction: Bilateral hemorrhagic hypopyon, also known as candy cane hypopyon, is an extremely rare presentation which we report as a unique case in association with intraocular mantle cell lymphoma (MCL).

Case presentation: A 63-year-old white male presented with a 3-week history of conjunctival injection OS that was unresponsive to erythromycin ointment and topical steroids, in the setting of recently discovered diffuse lymphadenopathy and malaise. On presentation, he was found to have bilateral hemorrhagic hypopyon. Lymph node biopsy was diagnostic of MCL, and subsequent anterior chamber paracentesis confirmed intraocular MCL. The patient was put into remission with intravitreal rituximab injections, systemic chemotherapy, and external beam radiation.

Conclusion: Cases of MCL with ocular involvement typically involve ocular adnexal structures, and seldom involve the uvea. Furthermore, this patient represents an extremely unusual case in his presentation with a hemorrhagic hypopyon.

Introduction: Phlyctenular keratoconjunctivitis is an inflammatory condition arising from a type IV hypersensitivity reaction, presenting with inflamed nodules on the conjunctiva and cornea. Scleritis is a severe ocular inflammation linked to systemic diseases, potentially vision threatening, and involving immune responses similar to phlyctenular keratoconjunctivitis. This case report discusses a patient with a history of herpes simplex virus (HSV)-2 infection who primarily developed phlyctenular conjunctivitis and later progressed to nodular scleritis.

Case presentation: A 66-year-old female presented with pain, redness, and a foreign body sensation in her left eye for 2 days. Initial treatment for epidemic keratoconjunctivitis with tobramycin-dexamethasone improved her symptoms. However, 3 weeks later, she developed a conjunctival phlyctenule. Diagnostic tests, including blood work and conjunctival swabs, were conducted. While most tests were negative, HSV-2 IgG was positive. The patient failed topical corticosteroid monotherapy; however, she responded to oral valacyclovir. Follow-up examinations showed significant improvement, with resolution of the conjunctival phlyctenule and nodular scleritis, and her best-corrected visual acuity returned to 20/20.

Conclusion: This case highlights the importance of considering HSV-2 in atypical presentations of phlyctenular conjunctivitis and scleritis. The patient's response to antiviral therapy underscores the potential role of HSV-2 in such ocular inflammation. Thorough infectious workups and alternative treatment approaches are crucial in managing unconventional cases. Experimental treatments based on laboratory findings can be valuable for patients preferring conservative management, emphasizing the need for close follow-up and personalized care in ocular inflammatory diseases.

Introduction: A 16-month-old girl presented with bilateral germline retinoblastoma, with advanced retinoblastoma in the right eye and severe orbital retinoblastoma in the left eye. Patients typically receive treatment with the multimodal protocol consisting of chemotherapy, surgery, and radiotherapy, which has improved survival.

Case presentation: Our patient elected for medical management with systemic chemotherapy instead of enucleation or exenteration. She received three blocks systemic chemotherapy consisting of vincristine sulfate, etoposide phosphate, and carboplatin, with irregular intervals between blocks over 3 years, due to poor compliance. Following chemotherapy, she had tumor regression in both eyes and no signs of active disease 13 years later.

Conclusion: This case represents an interesting favorable outcome of orbital retinoblastoma management with systemic chemotherapy alone despite inconsistency versus conventional multimodal protocol.

[This corrects the article DOI: 10.1159/000527320.].

Introduction: Conjunctival melanoma (CM) is a rare but potentially lethal ocular malignancy that arises from melanocytes in the conjunctiva. Its clinical presentation can mimic other more common conjunctival lesions, such as squamous cell carcinoma (SCC), leading to diagnostic challenges.

Case presentation: We present a case of CM initially misdiagnosed as conjunctival SCC due to overlapping clinical features.

Conclusion: CM presenting as nonpigmented, conjunctival tumor is a diagnostic challenge. Clinicians should maintain a high index of suspicion for conjunctival melanocytic or amelanotic lesions, particularly those with atypical features.

Introduction: Rhabdomyosarcoma is the most common neoplasm of skeletal myoblast-like cells in children aged 5-8 years. It typically occurs in the head, neck region, genitourinary tract, retroperitoneum, and extremities.

Case presentation: An 8-year-old boy complained of a lump under his left eye that he had felt for the past 4 years. Initially small, it gradually grew larger although there were no accompanying symptoms of redness, pain, itching, or eye movement disorders, and no history of trauma. Visual acuity in the left eye was measured at 6/15, with pinhole correction improving to 6/6, while the right eye was 6/6. Intraocular pressure in both eyes was 15 mm Hg. Anterior segment examination of the left eye revealed a mass on the lower eyelid with hard consistency, no erythema, no tenderness, with a flat surface, immobility, and all aspects of the conjunctiva, cornea, pupil, and lens appearing normal. A contrast computed tomography scan showed a solid mass measuring 2.1 × 1.9 × 1.9 cm, suggesting a left inferior eyelid mass. The patient underwent surgical excision of the tumor under general anesthesia. Histopathological examination confirmed the diagnosis of embryonal rhabdomyosarcoma. The patient was scheduled for chemotherapy.

Conclusions: Orbital rhabdomyosarcoma typically presents with sudden onset and rapid proptosis, without a history of trauma or respiratory tract infections. The embryonal subtype is the most common and has a better prognosis with combined therapy including surgery, chemotherapy, and radiation. In low-resource settings, early clinical suspicion and thorough physical examination are vital, as limited access to medical tools can complicate management. Treatment should be adapted based on available resources, and regular follow-up is essential to monitor outcomes and ensure optimal care. Any swelling in children should be carefully examined for early detection and effective intervention.

Introduction: Ophthalmomyiasis externa, which is caused by Oestrus ovis larvae, is a parasitic eye infestation that is prevalent in tropical and subtropical regions. It occurs in rural settings and is associated with risk factors, such as poor sanitation and underlying health conditions. Reports on this disease in Saudi Arabia are rare.

Case presentation: A 30-year-old man from a rural area in Riyadh presented with severe left eye irritation and redness after being hit by an insect. Examination revealed seven motile larvae, which were identified as O. ovis, on the conjunctiva. The larvae were mechanically removed, and the patient was treated with topical antibiotics. On follow-up, four additional larvae were found and removed. Symptoms resolved completely, with no further larvae detected on subsequent follow-up.

Conclusion: Thorough history and examination are essential for the diagnosis of ophthalmomyiasis, especially in rural areas. Early detection and intervention are vital to prevent serious complications. This case highlighted the importance of awareness among healthcare providers.

Introduction: Pituitary adenomas are benign tumours that can lead to visual loss through compression of the optic chiasm. Patients with pituitary adenomas often present with visual field defects (commonly bitemporal hemianopia), but some may be asymptomatic. In such cases, abnormalities may only be detected through visual field testing or optical coherence tomography (OCT) of the ganglion cell-inner plexiform layer (GCIPL), which may provide a more sensitive method for detecting such abnormalities.

Case presentation: A 72-year-old man was incidentally found to have binasal OCT-GCIPL thinning during a routine eye examination. Visual acuity was 20/20 in both eyes. Pupils were equal and reactive without a relative afferent pupillary defect. His Humphrey 24-2 SITA-Fast visual field test results were normal. A magnetic resonance imaging (MRI) revealed a nonenhancing (cystic) sellar/suprasellar mass measuring 1.7 cm craniocaudal by 2.1 cm anteroposteriorly, without associated optic chiasm compression. The lesion was suspected to be either a cystic pituitary adenoma or a Rathke's cleft cyst. Follow-up examination 1 year later showed all findings remained stable, including an unchanged visual acuity, visual fields, OCT-GCIPL, and MRI.

Conclusion: The binasal thinning observed on OCT-GCIPL in this case, despite the absence of chiasmal compression on MRI, is suggestive of previous compression of the optic chiasm. This case highlights the potential for spontaneous regression of pituitary adenomas and underscores the importance of OCT-GCIPL as a vital tool for detecting optic chiasmal damage.

Introduction: The aim of the study was to report a unique case with excellent clinical outcomes after late endophthalmitis following Descemet's membrane endothelial keratoplasty (DMEK) surgery requiring donor graft removal without replacement.

Case presentation: A 67-year-old female with a prior ocular history of bilateral cataract surgery, Fuchs endothelial dystrophy, and pseudophakic DMEK in the left eye presented with endophthalmitis 2 months after keratoplasty. DMEK graft removal without replacement with an intracameral washout, pars plana vitrectomy, intracameral, and intravitreal antibiotics resulted in an excellent visual outcome (20/25).

Conclusion: This is a unique case of late endophthalmitis following DMEK surgery requiring graft removal and pars plana vitrectomy with excellent visual recovery without donor replacement.

Introduction: Central retinal artery occlusion (CRAO) is a serious ophthalmic disease predominantly affecting older individuals with cardiovascular risk factors. While most cases are attributed to thrombus formation from atheromatous plaques or cardioembolic events, trauma-related CRAO, though rare, presents unique diagnostic and therapeutic challenges.

Case presentation: A 47-year-old woman with multiple controlled comorbidities presented to the emergency department with right eye pain and erythema following a traumatic injury involving a knitting needle. Initial examinations revealed hand motion visual acuity in the right eye, a partial thickness scleral laceration, and conjunctival laceration, which were surgically repaired. Postoperatively, she developed blurred vision, hyphema, and signs of CRAO, prompting anterior chamber paracentesis. OCT imaging revealed marked hyperreflectivity and thickening of the inner retinal layers, indicating significant ischemic damage. Despite normal inflammatory markers, the patient's visual acuity gradually improved from 2/10 to 5/10 with intervention and eventually reached 10/10 with myopic correction after the hyphema resolved.

Conclusion: The case emphasizes the necessity of early recognition and intervention in managing traumatic CRAO to mitigate irreversible retinal damage. It underscores the need for enhanced diagnostic and therapeutic strategies as understanding the condition's pathophysiology advances.