Bilateral,simultaneous, uveitis‐associated pupillary membranes

A 48‐year‐old Caucasian man with an established diagnosis of pathological ankylosing spondylitis with cervical spinal fusion and a lengthy history of acute, recurrent, anterior uveitis presented with decreased vision in both eyes. Biomicroscopic examination revealed bilateral inflammatory pupillary membranes associated with anterior uveitis to be the source of the visual compromise. Aggressive topical anti‐inflammatory and mydriatic therapy did not break the pupillary membranes and the patient ultimately underwent surgical resection of the membranes in both eyes. Vision returned to normal in one eye and was only slightly reduced in the fellow eye after a prolonged post‐operative period involving multiple ophthalmic surgical procedures. This is the first reported case of bilateral, simultaneous uveitis‐associated pupillary membranes.     

Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis

Background: Posterior blepharitis is an eyelid disease primarily of the meibomian glands. Bacteria and chronic inflammation are contributing factors for meibomian gland disease, which leads to ocular surface and tear film alterations and chronic patient symptoms. Azithromycin 1.0% ophthalmic solution is a broad spectrum topical antibiotic with anti‐inflammatory properties. The present study evaluates the efficacy of azithromycin 1.0% ophthalmic solution in the treatment of the clinical signs and symptoms, including vision‐related function, associated with meibomian gland dysfunction. Methods: In an open label study, 33 patients with meibomian gland dysfunction were treated with azithromycin 1.0% ophthalmic solution twice a day for two days, then every evening for a total of 30 days. Tear break‐up time, corneal staining, conjunctival staining, Schirmer scores with anaesthetic, meibomian gland score and patient's symptom scores were evaluated at baseline and after 30 days of treatment. The Ocular Surface Disease Index (OSDI) was administered at baseline, after two weeks of treatment and after 30 days of treatment. Results: Twenty‐six of 33 patients completed the study. Tear break‐up time and Schirmer score increased by 52.7 per cent (p < 0.0001) and 24 per cent (p < 0.05), respectively. There was a reduction in corneal and conjunctival staining by 83.2 and 67.9 per cent, respectively (p < 0.0001). Lid margin scores were reduced by 33.9 per cent (p < 0.0001). The patient's symptom score improved from 2.73 at baseline to 2.21 after 30 days of treatment (p < 0.01). The mean OSDI at baseline was 34.44. After two weeks and 30 days of treatment, the ODSI was 14.51 and 13.15 respectively (p < 0.0001). Conclusion: These results demonstrate clinically and statistically significant improvement in the signs and symptoms associated with posterior blepharitis. Based on these results, azithromycin 1% ophthalmic solution offers a viable option for the treatment of posterior blepharitis.     

The Developmental Eye Movement (DEM) test and Cantonese‐speaking children in Hong Kong SAR,China

Background: There is no published norm for the Developmental Eye Movement (DEM) Test for Cantonese‐speaking Chinese children. This study aimed to determine the normative values of this test for Cantonese‐speaking Chinese children in Hong Kong SAR and to compare the results with the published norms of English‐speaking and Spanish‐speaking children. Method: Cantonese‐speaking students aged from 6 to 11 years were tested by the DEM test in Cantonese and a digital recorder was used to record the process. The DEM scores for the 305 students were determined by listening again to the audio records after the test and computed by using the formula from the DEM manual, except that the ‘vertical scores’ were adjusted by taking the vertical errors into consideration. The results were compared with other norms that have been published. Results: Our subjects made more vertical errors than in other normative studies and adjusted vertical scores were proposed. In both adjusted vertical and horizontal scores, the Cantonese‐speaking children completed the tests much faster than the norms for English‐ and Spanish‐speaking children, the differences of the means being significant (p < 0.0001) in all age groups. Conclusion: The DEM norms may be affected by differences in languages, cultures and education systems among different ethnicities. The norms of the DEM test are proposed for Cantonese‐speaking children in Hong Kong SAR, China.     

Multiple evanescent white dot syndrome: a review and case report

Background: Multiple evanescent white dot syndrome (MEWDS) is a rare chorioretinal syndrome that usually presents with a unilateral, multifocal retinitis affecting mostly young women. The typical presentation includes multiple white spots extending from the posterior pole out to the mid‐peripheral retina, possible vitritis and a granular appearance to the fovea. Symptoms can include a prodromal flu‐like episode, photopsia, scotoma and decreased vision. Ophthalmoscopy is the most common method of diagnosing MEWDS but fluorescein angiography, electrodiagnostic testing, visual fields and optical coherence tomography can help confirm the diagnosis. MEWDS is usually a self‐limiting condition with complete visual recovery, although subsequent retinal sequellae may be possible. Case Report: A healthy 21‐year‐old myopic female presented with unilateral, sudden onset of photopsia, blurred vision and a ‘grey area’ in the temporal visual field. Initial examination found a vitritis, maculopathy and the presence of white dots in all four quadrants of the mid‐peripheral retina. A retinal ophthalmologist confirmed the diagnosis of MEWDS. Although the patient was less than compliant with the retinal specialist's recommendations, a subsequent examination found complete resolution of signs and symptoms. Conclusions: In the primary optometric setting, the uncommon syndrome known as MEWDS must be considered when the common symptoms of photopsia and blurred vision, combined with the atypical clinical presentation of white spots in the fundus appear in an otherwise healthy patient.     

Acute retinal necrosis results in low vision in a young patient with a history of herpes simplex virus encephalitis

Acute retinal necrosis (ARN), secondary to herpes simplex encephalitis, is a rare syndrome that can present in healthy individuals, as well as immuno‐compromised patients. Most cases are caused by a secondary infection from the herpes virus family, with varicella zoster virus being the leading cause of this syndrome. Potential symptoms include blurry vision, floaters, ocular pain and photophobia. Ocular findings may consist of severe uveitis, retinal vasculitis, retinal necrosis, papillitis and retinal detachment. Clinical manifestations of this disease may include increased intraocular pressure, optic disc oedema, optic neuropathy and sheathed retinal arterioles. A complete work up is essential to rule out cytomegalovirus retinitis, herpes simplex encephalitis, herpes virus, syphilis, posterior uveitis and other conditions. Depending on the severity of the disease, the treatment options consist of anticoagulation therapy, cycloplegia, intravenous acyclovir, systemic steroids, prophylactic laser photocoagulation and pars plana vitrectomy with silicon oil for retinal detachment. An extensive history and clinical examination is crucial in making the correct diagnosis. Also, it is very important to be aware of low vision needs and refer the patients, if expressing any sort of functional issues with completing daily living skills, especially reading. In this article, we report one case of unilateral ARN 20 years after herpetic encephalitis.     

Monocular nystagmus with sectoral optic nerve hypoplasia in a patient with septo‐optic dysplasia

This case depicts an unusual presentation of septo‐optic dysplasia. A four‐year‐old female presented with monocular nystagmus and temporal optic disc pallor in her left eye. Despite a normal sized optic nerve head, magnetic resonance imaging (MRI) showed a hypoplastic intraorbital and intracranial left optic nerve in the absence of a septum pellucidum. She was subsequently diagnosed with septo‐optic dysplasia with sectoral optic nerve head hypoplasia.