Frontal Bone Infarctions Masquerading as Bilateral Orbital Cellulitis in a Patient with Sickle Cell Disease.

Repeated vaso-occlusive crises (VOCs) are the hallmark of sickle cell disease (SCD). These repeated crises can lead to bone infarcts, necrosis, and, over time, degenerative changes in the bone marrow. Orbital complications in SCD patients are infrequent and usually present as orbital cellulitis. We report the appearance of orbital bone infarction intraoperatively in the case of an 18-year-old Saudi male patient who has been diagnosed with SCD and presented with severe headaches and generalized body aches. He was admitted with a case of SCD with acute VOC and started on the hospital sickle cell protocol. During the admission, the patient developed bilateral periorbital swelling and left inferior dystopia secondary to bilateral frontoparietal bone infarction, which was evident on the magnetic resonance imaging.

Ophthalmia nodosa secondary to multiple intraocular caterpillar hairs in a 2-year-old girl.

A 2-year-old girl presented with pain, itching, photophobia, and tearing in her left eye. These symptoms started after contact with a caterpillar. The patient was initially taken to another hospital, where the local ophthalmologist prescribed topical prednisolone acetate 1%, a topical antibiotic, and cyclopentolate 1% eye drops. However, 3 weeks later, the patient presented to our hospital with no symptomatic improvement. Slit-lamp examination showed moderate conjunctival injection and diffuse superficial punctate corneal epithelial erosions with numerous caterpillar hairs embedded in the bulbar and tarsal conjunctiva, and in the superficial and deep corneal stroma, extending into the anterior chamber (AC). In addition, the AC had 2+ cells with caterpillar hairs on the iris surface. The lens was clear, and the fundus examination was normal. The patient underwent AC wash and setae removal under general anesthesia; this was repeated 4 months later when symptoms recurred owing to retained setae. There was no evidence of any additional setae or ocular inflammation in 8 months of follow-up, and symptoms resolved completely. Caterpillar hairs can migrate intraocularly and induce an ocular inflammatory response. Immediate and thorough irrigation, continued scrupulous examinations for any retained setae, and meticulous setae extraction are crucial for treating this condition.

Outcomes of Scleral-fixated Intraocular-lens in Children with Idiopathic Ectopia Lentis.

PURPOSE: The purpose of the study was to review the safety and stability of scleral-fixated intraocular lens (IOL) 2 years after implantation in children with idiopathic ectopia lentis (EL). METHODS: This retrospective case series enrolled children with EL managed between 2011 and 2015 at a tertiary eye hospital in the eastern of Saudi Arabia. Data were collected on age, gender, vision, isolated or syndromic pathology, intraoperative and postoperative complications, spherical equivalent refraction, and final best-corrected visual acuity (BCVA). RESULTS: The series included 18 eyes of 11 children with EL (6 males and 5 females). There were 7 bilateral and 4 unilateral cases. The median age was 3.5 years (25% quartile 1 year; range: 1-8 years). Preoperatively, fixation was absent in 3 eyes, 8 eyes were fixating but vision could not be recorded. In the remaining seven eyes, median distant visual acuity was 0.1 (25% quartile: 0.08). The median postoperative follow-up was 24 months (25% quartile, 7 months). Complications included two eyes with iris capture and one eye with lens subluxation requiring re-implantation. Postoperative BCVA was better than 20/60 in 15 (83%) eyes. At last follow-up, 6 eyes required myopic correction, 1 eye was emmetropic, and 11 eyes were hypermetropic. One eye with glaucoma was managed medically. CONCLUSION: Scleral fixated IOL in eyes of young children with EL had good visual outcomes and high stability. However, there is a high incidence of residual refractive error.