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Feb/Mar 2019 Quiz

History A 31-year-old female patient presented with history of gradual downward displacement of the globe over the last six months. The superotemporal mass then became palpable (Figure 1). Lateral orbitotomy was performed following CT scans (Figure 2). Figure 1. Figure...

Diagnosis and management of IV cranial nerve palsy

Aetiology: Trochlear nerve palsy can be divided into acute or congenital. Congenital trochlear nerve palsy is usually noted in childhood with development of abnormal head posture. Various pathologies can lead to acute IV nerve palsy, most commonly trauma. Other causes...

Headaches in ophthalmology (part 1)

Ophthalmologists see a large number of patients with headaches or facial pain in the ophthalmic outpatient clinics or in emergency clinics. Over two articles, I will discuss several causes of headaches, ocular manifestations and proposed management and referral options. It...

Cyanoacrylate nail glue accidentally instilled into the eye instead of eye drops

Three hundred thousand cataract operations take place each year in the UK alone and each patient will receive a four week course of drops in order to cover them for any postoperative inflammation or infection. Accidental instillation of cyanoacrylate glue...

Melanocytoma of the optic disc

Melanocytoma is a heavily pigmented lesion, composed of melanocytes and is a variant of melanocytic naevus. It classically occurs at the optic disc and is usually benign, static and asymptomatic. However, it can occasionally grow and invade the retina or...

Cytomegalovirus retinitis post intravitreal triamcinolone in an immunocompetent patient with juvenile glaucoma

Figure 1: Fundus photograph shows active CMV retinitis four weeks after IVTA in the right eye. Figure 2: Fundus photograph of the left eye with no CMV retinitis; atrophic disc as a result of juvenile glaucoma. Case report A 29-year-old...

Blurred vision post liver transplant: to blame the house cat or not?

This article outlines a case of atypical ocular toxoplasmosis associated with immunosuppression. There were two potential sources of infection in this patient and we describe how we concluded which was the most likely. Case report A 33-year-old female was referred...

Choroidal melanoma – breaking bad news

Case report A 55-year-old Caucasian female presented to her general practitioner with a three-month history of headaches and worsening blurred vision in the left eye. On further close questioning, she reported no eye pain, intermittent floaters and flashes of light...

Refractive surprise after cataract surgery caused by posterior capsular striae

Cataract removal with intraocular lens (IOL) implantation is one of the most frequently performed surgeries in current clinical practice [1,2]. New microsurgical techniques and refined IOL power calculations allow excellent refractive outcomes. Refractive surprise following cataract surgery is uncommon [1-3]...

Acute uveitis from late migration of soft lens matter 10 years post cataract surgery

A 58-year-old Caucasian male presented to the emergency eye clinic with a two-day history of a painful, red left eye and blurred vision. His past ocular history included uncomplicated left phacoemulsification cataract surgery in 2010 and left retinal detachment repair...

Retinal sequelae of high voltage electric current injury

Introduction High-voltage electrical currents may result in significant ocular complications, ranging from mild cataracts to vision-threatening retinal and optic nerve problems [1]. The severity of damage depends on various factors, including intensity and type of current, duration of exposure, entry...

Triamcinolone (TA) deposits following subcutaneous injection to treat chalazion

Chalazia are chronic lipogranulomatous inflammations of the eyelid secondary to a blocked meibomian gland. Whilst most resolve spontaneously, certain chalazia warrant treatment. Options include incision and curettage (I&C), lesion excision, intralesional steroid injections, and botox injections [1]. I&C is usually...