Ocular hypertension secondary to high endogenous steroid load in Cushing's disease.

This case report describes a 35-year-old Caucasian man who was referred to the glaucoma clinic with high intraocular pressure (IOP) after routine optometrist assessment. He was diagnosed with ocular hypertension (OHT) and the management plan was for monitoring without treatment. Three months later, he presented to the endocrine clinic with symptoms of Cushing's disease and was diagnosed with an adrenocorticotropic hormone secreting pituitary microadenoma. His symptoms preceded his presentation at both departments by 5 years. He underwent definitive surgical treatment of his adenoma via transsphenoidal resection. At 1-year follow-up in glaucoma clinic, it was noted that his IOP had normalised. Due to his high endogenous cortisol level at diagnosis, long disease duration, the pattern of IOP rise and subsequent normalisation after treatment, it is suggestive that his OHT is secondary to his Cushing's disease. There are infrequent reports of this association in published literature.

Sequential right then left acute dacryoadenitis in Crohn's disease.

A 41-year-old woman presented with painful swelling of the lateral aspect of the right upper lid along with ipsilateral conjunctival injection. Her right eye had limited abduction and pain on attempted lateral gaze. Funduscopy was normal. Medical history included Crohn's disease treated with sulphasalazine and azathioprine. White blood cell count, erythrocyte sedimentation rate and C reactive protein were raised. CT of orbits revealed right-sided lacrimal gland enlargement, with signs of abscess formation within it. She was treated initially with intravenous antibiotics for 3 days and then switched to orals but it took 2 weeks for full resolution of symptoms. Eight months later, she presented again with signs of acute left-sided dacryoadenitis, not responding at all to oral antibiotics after 3 days. She was subsequently started on oral steroids, and her symptoms resolved within 48 h. Steroids were tapered without any recurrence after a period of 6 months.

The incidence of ptosis following extracapsular and phacoemulsification surgery: comparison of two prospective studies and review of the literature.

We prospectively compared 120 patients who underwent either phacoemulsification or extracapsular cataract (ECCE) surgery to establish the incidence of postoperative ptosis between the two techniques. Of the 120 patients, 60 underwent ECCE (unpublished data 1989) and 60 had phacoemulsification. Data was collected prospectively on upper and lower margin reflex distance, upper lid skin crease and levator function, preoperatively and 6 weeks postoperatively. Photographs were taken pre and postoperatively and examined by a blinded observer. At 6 weeks, ptosis was present in 18% of ECCE patients compared with 0% in the phacoemulsification group. By changing from ECCE to phacoemulsification the incidence of postoperative ptosis has reduced. The possibility to induce postoperative ptosis remains, potential mechanisms are discussed.

A national survey of the management of congenital nasolacrimal duct obstruction in the United kingdom.

PURPOSE: To survey national variation in the management of congenital nasolacrimal duct obstruction, particularly the timing of intervention and the use of nasolacrimal intubation, nasal endoscopy, and assistance from an ear, nose, and throat surgeon at different stages of management. METHODS: A telephone survey was conducted of 100 ophthalmologists in the United Kingdom who were involved in the management of congenital nasolacrimal duct obstruction. A sequential management protocol was established for each, including the nature of procedures, their timing, and the use of nasal endoscopy and ear, nose, and throat surgeons. RESULTS: Of those surveyed, 49% use the dye disappearance test for diagnosis. Eighty-four percent suggest lacrimal sac massage to parents. No surveyed ophthalmologists perform "office" probing or balloon dilation. Seventy-four percent perform initial probing after 1 year, with 25% using nasal endoscopy. If symptoms persist, 64.5% (60 of 93) repeat the probing, whereas 35.5% (33 of 93) intubate the lacrimal system. The use of nasal endoscopy increases to 50.5% (47 of 93). By the third intervention, 77.6% (45 of 58) perform lacrimal intubation, with 72.4% (42 of 58) using nasal endoscopy. All opt for dacryocystorhinostomy as the fourth intervention and 28.3% (13 of 46) perform this procedure themselves, whereas 71.7% (33 of 46) refer the patient to another practitioner. In total, 65% (65 of 100) use tubes at some stage of management, 58% (58 of 100) make some use of nasal endoscopy, and 33% (33 of 100) involve ear, nose, and throat surgeons. CONCLUSION: Based on the results of this survey, huge variation exists in the management of congenital nasolacrimal duct obstruction in the United Kingdom. Most ophthalmologists intervene soon after patients reach 1 year of age. The rate of nasal endoscopy increases with successive interventions, especially to aid with nasal intubation, either alone or with the assistance of ear, nose, and throat surgeons.

Diffuse corneoscleral limbal neuromas with prominent corneal nerves in multiple endocrine neoplasia syndrome type IIB.

This report describes a 7-year-old boy with multiple endocrine neoplasia type 2B who presented to the ophthalmology department because of peripheral corneal changes. In addition to prominent corneal nerves and eyelid neuromas, the patient was found to have substantial corneoscleral limbal thickening with corneal neovascularization.

Acute suprachoroidal haemorrhage post-tenecteplase thrombolysis for myocardial infarction: management considerations.

We report a case of a 63-year-old man who received intravenous tenecteplase as thrombolytic therapy for an inferior ST elevation myocardial infarction. Three hours later he complained of blurred vision in the right eye and on examination had sustained a suprachoroidal haemorrhage. With conservative treatment the haemorrhage resolved, leading to a normalisation of visual acuity. To the authors' knowledge, no case reports exist of this rare complication following intravenous tenecteplase. We discuss implications for further thrombolysis and anticoagulation.

Retinopathy of prematurity in twin-twin transfusion syndrome.

The authors present the first reported case of retinopathy of prematurity in twin-twin transfusion syndrome. A 31-year-old woman gave birth to twins at 31 weeks' gestation. The pregnancy had been complicated by twin-twin transfusion syndrome and had been managed with two amnioreductions and laser ablation of the interplacental blood vessels. The donor twin, born at 1,310 g, had threshold retinopathy of prematurity and underwent argon laser retinal photocoagulation treatment. The recipient twin (1,775 g) did not show any evidence of retinopathy of prematurity.

Rapid measurement of corneal diameter in children: validation of a clinic-based digital photographic technique.

Measuring corneal diameter is often difficult in infants, but its importance in certain circumstances cannot be overstated. Most available techniques for obtaining corneal diameter measurement are threatening to the child: the gold standard measurement technique relies on calipers and a ruler and necessitates general anesthesia for most children under the age of 7 years. Consequently, this important element of the pediatric eye examination is often not performed in clinic. We describe and prospectively validate a digital photographic technique for measuring corneal diameter, which is easy to perform, quick, nonthreatening, and provides an accurate corneal diameter measurement.

Morning glory disk anomaly with ipsilateral capillary hemangioma, agenesis of the internal carotid artery, and Horner syndrome: a variant of PHACES syndrome?

We describe a 6-week-old girl with a right upper lid capillary hemangioma, ipsilateral morning glory disk anomaly, microphthalmos, Mittendorf dot, and Horner syndrome. The ipsilateral internal carotid artery was also found to be absent. To our knowledge, this is the first patient to be reported with this group of findings. We suggest that this represents an overlap between morning glory disk and intracranial vascular abnormalities, a recognized association, and PHACES syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye, and sternal abnormalities). We discuss the common embryological basis for these abnormalities, which point to a widespread but highly variable disorder of mesodermal differentiation.

Bilateral endophthalmitis after bilateral sequential phacoemulsification.

An 81-year-old woman had uneventful bilateral sequential phacoemulsification using a separate sterile technique for each eye. Despite this, early culture-positive postoperative endophthalmitis developed. Management included bilateral intravitreal antibiotic agents, and the patient achieved an excellent visual outcome. To our knowledge, this is the third reported case of bilateral endophthalmitis after bilateral sequential phacoemulsification and the first reported case in which a separate sterile technique was used in each eye.

Vitreous phenotype: a key diagnostic sign in Stickler syndrome types 1 and 2 complicated by double heterozygosity.

We describe the clinical findings in two patients with double heterozygosity, both involving Stickler syndrome. In case 1, the proposita had Albright hereditary osteodystrophy which was inherited from her mother and type 1 Stickler syndrome which was a new mutation. The combination of manifestations from the two syndromes had resulted in initial diagnostic confusion. Diagnosis of the latter syndrome was made only following ophthalmic examination which documented the presence of a membranous vitreous anomaly characteristic of type 1 Stickler syndrome. Subsequent confirmation was achieved by mutation analysis of the COL2A1 gene. The propositus in case 2 inherited Treacher Collins syndrome paternally and type 2 Stickler syndrome maternally. The overlap of facial anomalies may have resulted in a more severe phenotype for the patient. The diagnosis of Stickler syndrome in the propositus was confirmed initially by vitreous assessment and later by demonstration of mutation in the COL11A1 gene. These two patients highlight the key role of vitreous examination and vitreoretinal phenotyping in the differential diagnosis of Stickler syndrome and its subtypes in cases where the clinical picture is complicated by double heterozygosity.