Sclerokeratouveitis and lens dislocation in a patient with genital ulcer: was the great imitator imitated?

Uveitis is the most common ocular manifestation of syphilis, while scleritis is rare. A case of nodular scleritis, peripheral keratitis and uveitis in a patient with genital ulcer is presented in this report. This patient had a clinical profile suggestive of syphilis, though the serology was negative for treponemal antibodies. Other possible differential diagnosis imitating syphilis are discussed.

Medical treatment of crystalline lens dislocation into the anterior chamber in a patient with Marfan syndrome.

We report the case of a 32-year-old male with spontaneous crystalline lens dislocation into the anterior chamber with corneal touch and increased intraocular pressure. The case was handled in a conservative way: before bringing the patient to supine position, pharmacological pupil dilation with tropicamide plus phenylephrine was performed. One drop was instilled every 15 min for 1 hour. Once the posterior displacement of the lens behind the iris was confirmed, 2 % pilocarpine was used to reverse pupil dilation. The patient remained on topical 2 % pilocarpine and 5 % sodium chloride solution.

Outcomes of nonsurgical management and efficacy of demecarium bromide treatment for primary lens instability in dogs: 34 cases (1990-2004).

OBJECTIVE: To determine outcome of initial conservative management for primary lens luxation and evaluate topically administered demecarium bromide miotic treatment for prevention of anterior lens luxation, glaucoma, and vision loss in dogs. DESIGN: Retrospective case series. ANIMALS: 34 dogs with primary lens luxation. PROCEDURES: Medical records of affected dogs were reviewed for times to anterior luxation, luxation of the lens in the opposite eye, development of glaucoma, and vision loss. RESULTS: At 4 to 6 weeks and at 3 months after diagnosis of lens instability (subluxation or posterior luxation), 100% (34/34 and 29/29, respectively) of conservatively managed eyes retained vision. At 1 year after diagnosis of lens instability, 80% (16/20) of conservatively managed eyes retained vision, and at 2 years after diagnosis of lens instability, 11 of 19 conservatively treated eyes retained vision. The only significant effect of miotic treatment was to delay anterior lens luxation in eyes with lens instability. Miotic treatment did not significantly affect the time from anterior lens luxation in 1 eye to anterior luxation in the other eye, time to onset of glaucoma, or time to loss of vision in eyes with an unstable lens. CONCLUSIONS AND CLINICAL RELEVANCE: Prophylactic topically administered miotic treatment may be effective at delaying anterior luxation of an unstable lens in eyes affected by primary lens instability. Conservative medical management of dogs with primary lens instability is a reasonable alternative to surgical removal of a subluxated or posteriorly luxated lens via intracapsular lens extraction.

Myopia, hypotony, and lenticular shift following strabismus surgery.

A 5-year-old girl had hypotony, myopia, and anterior displacement of the lens-iris diaphragm following routine strabismus surgery. This constellation of findings suggests that surgical manipulation of the intact sclera produced a limited effusion involving the supraciliary space. Following cycloplegia, these findings resolved over several weeks, suggesting that this rare complications is self-limited and associated with a good prognosis for recovery.

Homocystinuria treated with pyridoxine.

Four cases of homocystinuria with lens luxation have been examined. As judged from the plasma amino acid pattern, they all responded well on pyridoxine treatment. Two of them discontinued the treatment on their own, and one of these died at the age of 17 years. The lens luxation progressed in one case despite adequate treatment. Scanning electron microscopy of one lens revealed partly broken zonules, abnormal zonular attachment, and a spongy appearance of the capsule proper. Hoping that adequate treatment will reduce more serious complications such as thromboembolism in these patients, it is concluded that an early diagnosis largely depends on the ophthalmologist, who should perform the silver-nitroprusside test, specific for homocystinuria, in all patients with non traumatic lens luxation.