Aperito Journal of Ophthalmology

Unilateral anemic retinopathy is an uncommon but reversible condition. A 43-year-old female presented with right eye blurring of vision for one week duration. She also had 
menorrhagia for a year. Examination showed visual acuity of counting fingers (right eye) and 6/6 (left eye). Right funduscopy showed optic disc swelling with retinal hemorrhages, cotton wool spots, Roth’s spots, tortuous vessels and macular edema. The left fundus was normal. Systemic examination revealed severe pallor with presence of pansystolic murmur. The uterus was enlarged. Her hemoglobin level was 4.7g/dl while peripheral blood film revealed hypochromic microcytic anemia. Other blood parameters and counts were normal. Blood transfusion was performed and she underwent a myomectomy by the gynecologist. Her vision improved to 6/6 and the fundus lesions resolved within three weeks. This case highlights the uncommon findings of unilateral anemic retinopathy mimicking a central vein occlusion. Workup for this self-limiting condition should exclude lymphoproliferative 
malignancies and coagulopathies. 

Generalised exudative retinal detachment, choroidal infarction and cortical blindness are known visual threatening conditions in patients with pre-eclampsia/eclampsia. Localised macula detachment is an uncommon ocular feature in this emergency obstetric situation. A 33-year-old woman presented with features of severe pre-eclampsia at 26 weeks of gestation. She underwent an emergency lower segment cesarian section at 27 weeks with blood pressure of 180/100 during the crisis. She complained of visual loss three days after delivery. Ocular examination revealed visual acuity of 5/60 OD and 6/60 OS, and exudative detachment of macula in both eyes. The ocular findings resolved completely at three weeks post crisis, while blood pressure gradually reached normotensive level at six weeks after delivery. Acute severe rise of blood pressure in pregnant women with pre-eclampsia / eclampsia causes terminal arterial vasopasm. It leads to breakdown of blood retinal barrier and exudation of fluid into sub-retinal space. Aim of management is prioritized at stabilizing blood pressure without morbidity or mortality to both mother and fetus. We provide a literature review of similar cases from 2011 to 2017 with emphasize on blood pressure level during the crisis, sites of detachment and final visual acuity. Aggressive management of pre-eclampsia/eclampsia patients is essential. Majority had satisfactory final visual outcome. Level of blood pressure may not be related to sites of retinal detachment. A large prospective cohort is needed to evaluate this association objectively.

Langerhans Cell Histiocytosis (LCH) is a rare and variable disease process that mimics inflammatory and sometimes malignant disease. Diagnosis is challenging as it may simulate abscess, hematoma, acute dacryocystitis and neuroblastoma in young children. We describe here a case of Langerhans cell histiocytosis in a young child, who presented with right superolateral orbital swelling and proptosis. He was initially treated as subcutaneous abscess with antibiotic and partially responded for a brief duration. Subsequently, he was confirmed LCH by radiological imaging and immunohistochemical marking. Thus, clinicians should consider Langerhans cell histiocytosis in their differential diagnosis, particularly in young children with similar presentation.

Lacrimal gland abscess in a rare orbital infection.  We report a case of orbital cellulitis secondary to lacrimal gland abscess due to acute dacryoadenitis in a child. Computed 
tomography of orbit confirmed the clinical diagnosis. The aim of treatment is to prevent visual and life threatening complications of orbital cellulitis. Combination of intravenous antibiotic, surgical incision and drainage is necessary for complete resolution of the lacrimal gland abscess in a child.  

Objective: To report a case of fungal keratitis caused by Fusarium species. 

Result: A 57 year old man presented with painful blurring of vision of his left eye. There was presence of dry corneal ulcer with irregular borders, hypopyon and anterior chamber cell activity. An initial diagnosis of bacterial keratitis was made and was started on topical ceftazidime and topical ciprofloxacin. When corneal scraping revealed hyphae the diagnosis was revised to fungal keratitis and he was started on topical amphotericin B 0.15%. He developed corneal toxicity due to amphotericin B and antifungal was changed to topical fluconazole 5%. His ulcer slowly healed with a final visual acuity of 6/36. 

Conclusion: Treatment of fungal keratitis remains a challenge and the use of topical anti fungal remains a mainstay. However the side effects of corneal toxicity secondary to the medications also needs to be given importance.