Metastatic Lung Cancer Masquerading as Endophthalmitis.

A 41-year-old man presented to the emergency department with a painful and red left eye associated with chronic vision loss. He had a history of homelessness and polysubstance abuse including intravenous drug use. Fundus examination revealed several cream-colored lesions encroaching on the macula of the right eye, and a total retinal detachment with secondary neovascular glaucoma in the left eye. Further work-up with imaging and endobronchial ultrasound-guided fine needle aspiration revealed stage IV epidermal growth factor receptor (EGFR) mu- tant (L858R) lung adenocarcinoma with brain, bone, adrenal, lymph node and bilateral choroid- al metastases. Herein we present a case of metastatic lung cancer masquerading as endophthalmitis.

Aircrew and Handheld Laser Exposure.

BACKGROUND: Laser devices are ubiquitous in everyday operations. These devices pose a hazard to the eye and numerous injuries have been documented. However, there lies a misunderstanding in the propensity to damage aircrews' eyes during an exposure. Patient encounters and article review is presented in hopes to raise awareness that aircrew laser exposure at altitude, outside of critical phases of flight, is a distraction and not a threat. Also, to propose a change to Air Force policy regarding such exposures and further educating flight surgeons. METHODS: An electronic medical record (EMR) search at a deployed clinic was performed from July 2016 through Jan 2017. The "reason for visit" column was perused for any reference to the eye and laser exposure. Subsequently, the patient encounters were scrutinized specifically for eye injury, optometry visit, color of laser, and suspension of flight duties. All members were military aircrew spanning loadmasters, boom operators, and pilots. No protective lenses or other forms of optics were employed at time of exposure. RESULTS: There were 21 encounters reviewed; 1 patient was seen twice due to 2 separate instances. Of the encounters, 14 were green lasers, 6 did not comment, and 1 indicated white. Zero acute injuries were discovered. DISCUSSION: Patients were needlessly sent for further examination and prohibited from performing their duties. Following military patient encounters and civilian literature regarding laser injury, the evidence highly supports the hypothesis that hand-held laser exposure in flight from a ground base does not engender eye injury. More emphasis should be placed on recognizing the laser threat as a distraction or disruption to critical phases of flight, and a policy change may be in order for the USAF laser exposure guide.Dietrich KC. Aircrew and handheld laser exposure. Aerosp Med Hum Perform. 2017; 88(11):1040-1042.

Fighter Pilot with Recurrent Central Serous Chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) is usually a self-limiting condition; however, there is potential for recurrence and permanent visual defects. Aviation demands perfect vision to minimize risk to pilots and aircraft. Consequently, this ailment disqualifies pilots and pilots to be. CASE REPORT: A fully trained fighter pilot with 1260 h in fighter airframes has been contending with central serous chorioretinopathy in the right eye over the course of 3 yr. The condition was diagnosed after the member presented with visual disturbances. His course was followed with multiple treatment modalities: watchful waiting, micropulse laser, and rifampin. His disease responded well with rifampin, but was ultimately stopped secondary to elevated liver enzymes. Micropulse laser failed to resolve subretinal fluid. Ultimately the pilot is left with a chronic area of CSC without visual defects and faces career termination. DISCUSSION: Uncompromised vision is inherently crucial in aerospace careers, especially that of a fighter pilot. With persistent CSC resistant to treatment, there is a risk for progression to permanent visual disturbances and/or defects. Safety concerns of authority figures overseeing pilots and aircraft are warranted. However, the concern could be mitigated in air frames that require two pilots. Another factor partially responsible for ending his career is the fear of G force affecting his prognosis. The author is not aware of any other studies illuminating the effects or consideration of excess G force on subretinal fluid in CSC. This is an area that requires further study. Dietrich KC. Fighter pilot with recurrent central serous chorioretinopathy. Aerosp Med Hum Perform. 2016; 87(10):901-905.