Orbital Inflammatory Syndrome and Anterior Uveitis: A Case Series.

PURPOSE: To describe four cases of orbital inflammatory syndrome (OIS) with associated anterior uveitis that have presented within 2 years to our practice. METHODS: Charts of patients diagnosed with OIS from June 2013 to May 2015 were reviewed. RESULTS: Four patients, three children and one adult, presented with orbital swelling, pain, and varying degrees of vision loss. Treatment with intravenous methylprednisolone resulted in significant symptomatic improvement in all cases initially; when symptoms recurred, the patients had evidence of anterior uveitis. With continued systemic therapy and the addition of topical prednisolone, the patients all achieved control of their uveitis and OIS and are well controlled with regular outpatient follow-up. CONCLUSIONS: Reports of OIS-associated with uveitis are relatively rare. The presentation of three pediatric patients and one adult patient to the same practice with OIS and secondary uveitis within a 2-year period may indicate that the association is underreported.

Examiner Handedness and the Effects on Intraocular Pressure Readings Using the Tono-Pen XL.

PURPOSE: To assess the effect of examiner handedness on intraocular pressure (IOP) readings using the Tono-Pen XL in eyes without corneal pathology or previous ocular surgeries. PATIENTS AND METHODS: Patients 18 years of age or older were included in this prospective study. Participants who had a history of corneal conditions or other characteristics that would prevent reliable IOP measurements were excluded. Five experienced examiners, 2 right-hand dominant and 3 left-hand dominant, took bilateral IOP measurements with a Tono-Pen XL. Each participant was tested by 2 examiners, 1 left-handed and 1 right-handed, in a random order. The time between each examiner's measurements was 15 minutes. A paired t test was used to compare IOP differences between "near" (right eye for right-hand or left eye for left-hand dominant examiner) and "far" (right eye by left-hand or left eye by right-hand dominant examiner) measurements for each eye. RESULTS: Forty-six participants with a mean age of 33.8 years (±12.8) were enrolled. No significant difference in IOP between near and far eyes was found (IOP difference=IOPfar-IOPnear=-0.11 [±2.74] mm Hg; P=0.70). Right-hand dominant examiners consistently measured significantly higher IOP (0.83±2.03 mm Hg; P=0.008) compared with left-hand dominant examiners, regardless of the relative position of the eye with respect to the examiner. CONCLUSIONS: The results suggest that IOP readings are not influenced by the positioning of the patient relative to the dominant hand of the examiner.

Orbital Infarction due to Sickle Cell Disease without Orbital Pain.

Sickle cell disease is a hemoglobinopathy that results in paroxysmal arteriolar occlusion and tissue infarction that can manifest in a plurality of tissues. Rarely, these infarcted crises manifest in the bony orbit. Orbital infarction usually presents with acute onset of periorbital tenderness, swelling, erythema, and pain. Soft tissue swelling can result in proptosis and attenuation of extraocular movements. Expedient diagnosis of sickle cell orbital infarction is crucial because this is a potentially sight-threatening entity. Diagnosis can be delayed since the presentation has physical and radiographic findings mimicking various infectious and traumatic processes. We describe a patient who presented with sickle cell orbital crisis without pain. This case highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease or of African descent born outside the United States in a region where screening for hemoglobinopathy is not routine, even when the presentation is not classic.

Malaria retinopathy and cerebellitis in a 9-year-old boy in the United States.

Malarial retinopathy is characterized by retinal whitening, vessel change, and hemorrhages usually associated with a white center. We present the case of a 9-year-old boy who presented with a systemic Plasmodium falciparum infection, hemorrhagic cerebellitis and malarial retinopathy characterized by "fire flare" hemorrhages (scleral icterus with subconjunctival hemorrhages), Roth spot-like hemorrhages, and subhyaloid hemorrhage. To our knowledge, this is the first reported case of hemorrhagic cerebellitis secondary to P. falciparum infection in the United States.

Risk factors associated with retinal hemorrhage in suspected abusive head trauma.

PURPOSE: To determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects. METHODS: Records of children aged 0-3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case-control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors. RESULTS: A total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories). CONCLUSIONS: Retinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage.