An unusual case of total ophthalmoplegia

An eight-year-old male child presented with drooping of the left eyelid with a history of penetrating injury of hard palate by an iron spoon seven days ago, which had already been removed by the neurosurgeon as the computed tomography scan revealed a spoon in the left posterior ethmoid and sphenoid bone penetrating into the middle cranial fossa. On examination, visual acuity was 20/20 in each eye and left eye showed total ophthalmoplegia. Oral cavity revealed a hole in the left lateral part of the hard palate. We managed the case with tapering dose of systemic prednisolone. The total ophthalmoplegia was markedly improved in one month. Cases of foreign bodies in the orbit with intracranial extension are not unusual, but the path this foreign body traveled through the hard palate without affecting the optic nerve, internal carotid artery or cavernous sinus makes an interesting variation.     

An unusual case of painful ophthalmoplegia in a patient with rheumatoid arthritis

A 43-year-old woman with long-standing rheumatoid arthritis and systemic lupus erythematosus had pain and horizontal diplopia. Clinical symptoms were consistent with inflammation of the right superior oblique tendon sheath, but a computed tomographic scan showed no pathology. Treatment with systemic corticosteroids reduced the symptoms, but the patient was left with a persistent muscle imbalance.     

An unusual case of antimetropia

Antimetropia is a condition in which one eye is myopic and the fellow eye is hyperopic. This report describes functional and optical characteristics of a patient with a substantial degree of antimetropia.     

An unusual case of crystalline keratopathy

A 48-year-old woman developed a crystalline stromal lesion four years after a penetrating corneal graft, with few signs of ocular inflammation. An initial diagnosis of fungal keratitis was made because of the appearance of the lesion. An excisional biopsy revealed the presence of Gram-positive cocci lying between the stromal lamellae in the posterior third of the cornea. Large numbers of Gram-positive cocci were observed on light and transmission electron microscopy but no organism could be cultured from the biopsy. The replacement graft has remained clear over the subsequent two years.     

An unusual case of orbital cellulitis

Munchausen's syndrome, an unusual disorder related to malingering and hysteria, is occasionally seen by the ophthalmologist. Munchausen patients deliberately deceive and attempt to manipulate physicians 'through factitious signs and symptoms. They know they are acting, yet appear unable to control their actions. Unnecessary medical workups and inappropriate surgical interventions are common with this perplexing syndrome. An unusual case of orbital cellulitis that illustrates a number of these features is illustrated and the syndrome is reviewed.     

An unusual case of crystalline keratopathy

A 48-year-old woman developed a crystalline stromal lesion four years after a penetrating corneal graft, with few signs of ocular inflammation. An initial diagnosis of fungal keratitis was made because of the appearance of the lesion. An excisional biopsy revealed the presence of Gram-positive cocci lying between the stromal lamellae in the posterior third of the cornea. Large numbers of Gram-positive cocci were observed on light and transmission electron microscopy but no organism could be cultured from the biopsy. The replacement graft has remained clear over the subsequent two years.     

An unusual case of uveitis-glaucoma-hyphema syndrome

PURPOSE: To report a case of uveitis-glaucoma-hyphema (UGH) syndrome in which anterior chamber paracentesis led to the diagnosis of sickle cell trait. DESIGN: Observational case report. METHODS: A 43-year-old Cuban pseudophakic male was seen multiple times over a 3-year period complaining of floaters and blurry vision in his left eye. He was noted to have an inferotemporally displaced posterior chamber intraocular lens and recurrent microhyphemas with elevated intraocular pressure (IOP) readings between 29 and 46 mm Hg with each episode. He was diagnosed with UGH syndrome. Posterior chamber intraocular lens explantation and anterior chamber washout was performed. The aqueous fluid was submitted for cytopathologic examination. RESULTS: Postoperatively, the patient's symptoms resolved and he had no further hemorrhages or elevated IOP readings. Cytopathology of the aspirate revealed sickled red blood cells. CONCLUSIONS: Microscopic examination of aqueous fluid can be a valuable tool in diagnosing ophthalmic manifestations of systemic disease.     

An unusual case of melanoma-associated retinopathy

Paraneoplastic syndromes pose some of the most baffling clinical presentations encountered in medicine. Brain degenerations with accompanying dementia, peripheral neuritis and the Eaton-Lambert myasthenia gravis syndrome comprise a few examples of the clinical conditions which manifest as remote expressions of cancer. The uncontrolled expression of key proteins by cancers is thought responsible for inciting autoimmune reactions which affect the corresponding component within the host. Paraneoplastic retinopathies have been reported to occur in association with a variety of different types of cancer. Indications of retinal hypersensitivity manifest in these patients through the production of autoantibodies reactive with specific retinal cells or antigens. This form of vision loss is suspected to develop in ways similar to that proposed for other paraneoplasias, as a form of ocular hypersensitivity induced by the cancer's aberrant expression of specific retinal proteins. The subject of this report had a history of vision abnormalities linked with the surgical removal of a melanoma. The authors sought evidence of retinal hypersensitivity through a series of immunologic assays described by others to reveal a recognizable pattern of autoantibody reactions characteristic of patients with melanoma associated retinopathy, the MAR syndrome. Although autoantibodies were present, the authors were unable to identify any single retinal antigen or cell type which might represent the target of the patient's ostensibly autoimmune reactions.     

An unusual case of floppy eyelid syndrome

A 51-year-old obese man with a history of nocturnal upper eyelid eversion secondary to floppy eyelids presented with a Staphylococcus aureus corneal ulcer. No papillary conjunctivitis was present. The corneal ulcer was treated successfully. This case demonstrates the importance of ruling out spontaneous nocturnal lid eversion as a cause for unexplained ocular surface pathology and emphasizes the fact that the floppy eyelid syndrome may present in the absence of classic papillary conjunctivitis.     

An unusual case of endogenous aspergillus endophthalmitis

Endogenous aspergillus endophthalmitis is not a common entity. So far, about 25 cases have been reported in the world literature, and to the best of our-knowledge, the crystalline lens was invaded by the fungus in none of the cases, as seen in the present case. This unusual feature, coupled with the rarity of the condition in general, made it worth reporting.