Hemorrhagic retinopathy as the presenting manifestation of sarcoidosis.

BACKGROUND: The diagnosis of ocular sarcoidosis is particularly challenging in patients who present with atypical clinical findings and no evidence of systemic disease. We describe a patient whose initial clinical manifestation of sarcoidosis was a unilateral hemorrhagic retinopathy. METHOD: Clinicopathologic case study. RESULTS: The diagnosis of sarcoidosis in this patient was delayed for over a year principally because of the atypical retinal findings and because repeated chest X-rays and serum angiotensin covering enzyme (ACE) levels were normal. Surgical enucleation of the eye once it was blind revealed a large noncaseating granuloma of the ciliary body. Inflammation and thrombosis of several large caliber retinal veins and a single branch of the retrolaminar hemicentral retinal vein were found. CONCLUSIONS: Major retinal branch vein occlusion and hemi-central retinal branch occlusion are rare complications of ocular sarcoidosis. Normal serum ACE levels do not exclude the diagnosis of ocular sarcoidosis even in patients with considerable amounts of intraocular granulomatous inflammation.

Ocular effects and detection in tears of aerosolized intranasal cocaine and fluorescein.

Ocular effects of intranasal cocaine were investigated. Twenty-nine outpatients from an otolaryngology clinic received 1 mL of aerosolized cocaine 4% (40mg) in each nostril. Intraocular pressure, corneal sensitivity, pupil size, and tear cocaine concentration were assessed before and after cocaine administration. Pupil size was unchanged; intraocular pressure increased in 75% of patients (not statistically significant). Corneal sensitivity decreased by 11% (P less than .05). Cocaine, however, was not detectable in tears using high-performance liquid chromatography. Since corneal sensitivity decreases after intranasal cocaine administration, it may travel retrograde through the nasolacrimal duct. In addition, three pathways of pharmacologic absorption using fluorescein were explored because of its ease of detection. We measured tear fluorescein concentrations in five patients undergoing intravenous angiograms with fluorescein 25% and in six patients who received aerosolized fluorescein 2% intranasally. Fluorescein concentration was 29 times higher per mg dose in intranasal subjects. This finding suggests that reflux occurs through the nasolacrimal duct.

Intermittent intraocular thrombin as an adjunct to vitrectomy.

The use of intraocular thrombin to control intraoperative hemorrhage is presented in two cases, one involving severe ocular trauma, the other severe proliferative diabetic retinopathy. The technique of intermittent boluses of 100 units/ml of thrombin in BSS Plus solution has certain advantages over the constant infusion mode of delivery. The ability to quickly manipulate the flow offers a distinct advantage in controlling the intraocular pressure and total amount of thrombin delivered. This is achieved by a simple and uncomplicated modification of the standard gravity infusion controlled by the surgical assistant.