Peripapillary Retinal Haemorrhages in Wernicke's Encephalopathy Following Bariatric Surgery in a Young Patient.

Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency (vitamin B1). It is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. WE is classically associated with alcoholism but increasingly has been observed due to other causes, particularly in undernourished post-bariatric surgery patients. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages. This case raises the awareness that posterior segment findings can occur in WE but have been under-reported previously.

Factors Affecting the Efficacy of Botulinum Toxin Injection in the Treatment of Infantile and Partially Accommodative Esotropia.

PURPOSE: We aimed to investigate the effect of botulinum toxin (BT) injection on the treatment of infantile and partially accommodative esotropia (PAET). METHODS: This retrospective cohort study included patients who received BT injections for infantile and PAET between January 2015 and December 2018. Treatment was considered successful if orthotropia, consecutive exotropia, or esotropia within 10 prism diopters (PD) was achieved. RESULTS: The overall success rate was 47.4%, with a mean follow-up period of 27.8 months in 403 children. BT treatment was considered successful in 37.1% of cases of infantile esotropia and 53.1% of cases of partially accommodative esotropia. The average deviation angle before starting treatment was 35.5 ± 13.9 PD. Side effects 1 week after BT injections included transient overcorrection (63.8%) and transient ptosis (41.7%). There were no significant differences in the success rates between the different doses of BT (P = 0.69). The angle of deviation at presentation was significantly associated with the success rate of BT injection (failed group, mean: 38.1 ± 15.3 PD vs. success group, mean: 32.6 ± 11.6 PD; P < 0.001). Other factors associated with higher success rates were overcorrection at 1 week and PAET, while multivariate logistic regression analysis showed that a smaller angle of deviation and overcorrection (1 week after injection) were associated with a higher success rate. CONCLUSION: A smaller angle of deviation and transient overcorrection were associated with a higher success rate, and no significant difference was observed in the success rates of different BT doses.

Olanzapine-Induced Acute Angle Closure.

BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications. Acute angle closure can be triggered by various classes of drugs, including adrenergic agonists, anticholinergics, and serotonergic medications. Here, we report a rare case of drug-induced acute angle closure glaucoma secondary to olanzapine. CASE REPORT A 59-year-old male patient of Arabian Peninsula descent, known to have schizophrenia, presented to our Emergency Department with a 3-day history of right ocular pain and decrease in vision. He was started recently on olanzapine 5 mg once daily by his psychiatrist 1 week prior to the onset of his symptoms. The diagnosis of drug-induced pupillary block was made based on clinical and radiological findings. The patient was started on topical and systemic IOP-lowering agents. A therapeutic Nd: YAG laser peripheral iridotomy for the right eye was performed. On follow-up, his symptoms alleviated and clinical examination showed significant improvement. CONCLUSIONS The reported case highlights the importance of systemic medical history in secondary acute angle closure glaucoma. Physicians from other specialties should be aware of drugs triggering pupillary block and therefore be able to educate patients about symptoms of acute angle closure glaucoma.

Intraocular Lens Dislocation into the Anterior Chamber because of Repeated Eye-Poking in a Patient with Leber's Congenital Amaurosis.

The dislocation of a posterior chamber intraocular lens (PC IOL) because of constant eye rubbing is unusual and has never been reported in a child with Leber's congenital amaurosis (LCA). A 4-year-old full-term girl with an ocular history of LCA presented to the emergency room with a single-piece PC IOL dislocated into the anterior chamber (AC) of the left eye. There was no history of trauma or any other surgical intervention. A specific behavior known as Franceschetti's oculo-digital sign is a characteristic feature of LCA; this sign consists of repeated pressing, poking, and rubbing of the eyes with knuckles and fingers to stimulate the photoreceptors. This behavior caused the dislocation of the PC IOL into the AC. The dislocated IOL was explanted, and the patient was provided with aphakic glasses.

Traumatic subhyaloid macular hemorrhage with complete resolution following Neodymium-Doped Yttrium Aluminium Garnet Laser.

PURPOSE: To report a case of traumatic subhyaloid macular hemorrhage with severe sudden vision loss treated successfully with Neodymium-Doped Yttrium Aluminium Garnet Laser (Nd:YAG laser). OBSERVATIONS: A 16-year-old boy presented to the eye clinic with acute vision loss secondary to blunt trauma by a stone to his left eye 3 days prior to consultation that caused subhyaloid macular hemorrhage. Nd:YAG laser was performed to open the hyaloid membrane and allow the blood to diffuse into the vitreous cavity and be absorbed. The patient demonstrated complete recovery as his visual acuity went from counting fingers to 20/20 within 20 days. No complications due to the treatment were reported. CONCLUSIONS AND IMPORTANCE: To the best of our knowledge, there have been no reported cases of subhyaloid macular hemorrhage treated with Nd:YAG laser in which the etiology was trauma and showed full, rapid recovery with no sequelae.