Peripapillary Retinal Haemorrhages in Wernicke's Encephalopathy Following Bariatric Surgery in a Young Patient.

Wernicke's encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine deficiency (vitamin B1). It is characterised classically by a triad of ophthalmoplegia, confusion, and ataxia. WE is classically associated with alcoholism but increasingly has been observed due to other causes, particularly in undernourished post-bariatric surgery patients. Herein, we describe a case of WE following laparoscopic sleeve gastrectomy in a young male patient who presented with binocular horizontal diplopia and was found to have preretinal peripapillary haemorrhages. This case raises the awareness that posterior segment findings can occur in WE but have been under-reported previously.

Ocular acne rosacea in tertiary eye center in Saudi Arabia.

PURPOSE: To report the most common presenting signs and symptoms of ocular rosacea for timely diagnosis and management. METHODS: A retrospective chart review of 23 patients with a diagnosis of acne rosacea or a non-specific diagnosis was performed at a tertiary eye hospital. Patients with lid changes such as recurrent blepharitis; meibomianitis; recurrent chalazia; facial skin change such as papules, telangiectatic blood vessels, and/or rhinophyma were included. Data were collected on patient demographics, presenting symptoms, visual acuity, dermatologic findings and treatment. RESULTS: There were 23 patients documented with acne rosacea with dermatologic facial findings associated with lid and/or corneal findings of peripheral thinning and vascularization. Two cases had a serious spontaneous peripheral corneal perforation. Most of the patients had no clinically significant change in visual acuity. CONCLUSION: The diagnosis of ocular acne rosacea was straightforward despite non-specific findings. Diagnostic delay can result in serious complications.

Toxic keratitis after use of wrongly labeled non-ophthalmic medication.

We present a 24-year-old female with trauma to her right eye. The patient was prescribed topical Tobramicin-dexamethasone eye drops but the pharmacy dispensed diclofenac diethyl amine ointment. The patient presented to the emergency room with lid edema, conjunctival injection and a corneal epithelial defect and toxic keratitis. The patient was successfully managed with copious irrigation, bandage contact lens and topical antibiotic therapy.

High-power handheld blue laser-induced maculopathy: the results of the King Khaled Eye Specialist Hospital Collaborative Retina Study Group.

PURPOSE: To report various types of maculopathy caused by momentary exposure to a high-power handheld blue laser. DESIGN: Consecutive case series. PARTICIPANTS: Fourteen eyes of 14 patients. METHODS: Patients with a history of eye exposure to a blue laser device (450 nm and a power range of 150-1200 mW) to a single institution were included. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. MAIN OUTCOME MEASURES: Analysis of the types of maculopathy and vitreoretinal pathologic features. RESULTS: All patients were young males. The most common setting for injury was accidental at play. The types of maculopathies encountered were: a full-thickness macular hole (FTMH) in 4 eyes, a premacular subhyaloid hemorrhage in 5 eyes, premacular sub-internal limiting membrane hemorrhage in 2 eyes, an outer retinal disruption at the fovea in 1 eye, an epimacular membrane in 1 eye, and a schisis-like cavity in 1 eye. Best-corrected Snellen visual acuity at presentation ranged from 20/40 to 4/200 (mean, 20/290). Only 4 eyes (29%) improved spontaneously with increase in vision, whereas 10 eyes (71%) required intervention. The latter consisted of neodymium:yttrium-aluminum-garnet hyaloidotomy in the 5 eyes with subhyaloid hemorrhage and pars plana vitrectomy (PPV) for the eyes with FTMH and epimacular membrane. All 4 FTMH were closed successfully after PPV. Final mean best-corrected visual acuity in all cases was 20/35 (range, 20/15-20/300). CONCLUSIONS: Exposure to high-power handheld laser devices can cause a variety of maculopathies that can reduce central vision permanently. Although vision may improve spontaneously, most cases require intervention. Unrestricted access to commercially available high-power handheld laser devices is dangerous and public awareness should be encouraged.

Optic Nerve Avulsion: Pattern and Etiologies at a Tertiary Eye Care Center in Saudi Arabia: An 8-Year Retrospective Study.

Purpose: Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East. Methods: The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented. Results: The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3-26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive. Conclusion: Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment.

Terror-Related Ocular Trauma in Patients Presenting to a Tertiary Eye Center in the Middle East.

PURPOSE: Injuries caused by explosive materials are associated with severe ocular morbidity and visual impairment. This study aims to document the ophthalmic morbidity of terrorist-related severe injuries at a tertiary eye care center in the Middle East and report specific injury patterns. METHODS: In a noncomparative, interventional, retrospective case series, the visual outcomes were evaluated of 36 patients treated at a tertiary eye center in the Middle East for terrorist-related injuries from January 2003 to December 2019. Data were collected on age, gender, involved eye, initial examination of ocular injuries, associated systemic injuries, presenting visual acuity, anterior and posterior segment examinations, and the type of injury (open vs. closed globe). RESULTS: Among the 36 patients (32 males; average age, 28.1 years), 28 (77.8%) sustained trauma to one eye and 8 (22.2%) to both eyes. Despite multiple surgical procedures (average 3.1 surgeries), all patients suffered a severe visual loss. Final visual acuity of no light perception was recorded in 28 (77.8%) eyes and both eyes of 5 patients (13.9%). CONCLUSION: Ophthalmic morbidity from terrorist-related injuries may be devastating, and the vast majority of patients experience a permanent loss of vision.

Anterior Segment Injury by a High-Power Handheld Blue Laser Device.

PURPOSE: To report a case of severe anterior segment inflammation secondary to exposure to a high-power blue laser device. METHODS: Case report. RESULTS: A 14-year-old male presented with redness, pain and decreased vision in his left eye after exposure to blue laser. Examination indicated severe conjunctival injection associated with 4+ cells in the anterior chamber with fibrinous reaction. The posterior pole was normal. CONCLUSION: Blue laser devices are easily available through the Internet. These devices can cause devastating ocular injuries. National safety guidelines are required to regulate use.

Ocular Munchausen's Syndrome induced by introduction of ant's particles into the conjunctival fornices.

Munchausen's Syndrome is a factitious disorder in which patients manipulate physicians through misrepresented signs and symptoms. The authors describe an 18-year-old woman with self-induced inoculation of ant's particles inside her conjunctival fornices of both eyes. The crushed particles was confirmed to be crushed ant's particles. Munchausen Syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnoses when ocular abnormalities cannot be explained. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist.

Paintball related ocular injuries: First case report in Saudi patients.

Paintball is a popular recreational sport. This case series describes three Saudi patients exposed to paintball ocular injuries with sever ocular trauma. Two patients developed hyphema and traumatic cataract and one patient had vitreous hemorrhage, choroidal detachment, commotio retinae and retinal tear. All patients require surgical intervention. Final best corrected visual acuity was 20/200, 20/30 and 20/50 respectively. Paintball related ocular injuries can result in severe visual loss and in most of the time requires surgical intervention. Most injuries occur in under-supervised settings and are easily preventable. Our main aim was to increase awareness among local ophthalmologists and eye professionals about this new game. Improved safety measures and appropriate public education could prevent such serious ocular injuries.

Ocular manifestation of Ichthyosis.

PURPOSE: Ichthyosis is a rare dermato-ocular disease. This study evaluates the presenting ocular signs, symptoms, complications and prognosis of ichthyosis in a case series from Saudi Arabia. METHODS: A retrospective chart review was performed for 11 patients with ichthyosis who presented to King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, over the last 20 years. RESULTS: The most common presenting ocular diagnosis was ectropion of both the lids. Two patients developed corneal perforation with poor prognosis. Most of the patients underwent skin grafting to repair eyelid ectropion. The visual prognosis was excellent because timely surgical interventions were performed. Hence the rate of corneal complications such as perforation was low. CONCLUSION: The most ocular presentation of ichthyosis is ectropion of both the upper and lower lids. Despite good visual prognosis, there were some devastating corneal complications such as perforation with unpredictable outcomes.

Corneal Epitheliopathy After Trauma by Fake Snow Powder in a 7-year-old Child.

Fake snow is a polymer of sodium polyacrylates used in games and celebrations. Despite the product leaflet that indicates safety, contact with the ocular surface can cause injury. We report a case of a child with corneal epitheliopathy due to a chemical burn injury after ocular surface contact with fake snow. The case was managed with epithelial debridement and a bandage contact lenses and topical antibiotics with complete resolution.

Full-Thickness Macular Hole Secondary to High-Power Handheld Blue Laser: Natural History and Management Outcomes.

PURPOSE: To report the natural history and management outcomes of full-thickness macular hole (MH) caused by momentary exposure to a high-power handheld blue laser device and highlight the dangers of such easily available devices. DESIGN: Retrospective consecutive case series. METHODS: A chart review of all patients presenting with full-thickness MH from exposure to blue-light high-powered lasers from January 2012 to May 2014 at 2 institutions was performed. Evaluation included a full ophthalmic examination, fundus photography, macular spectral-domain optical coherence tomography, and fundus fluorescein angiography. The main and secondary outcomes were MH closure and final visual acuity, respectively. RESULTS: There were 17 eyes of 17 patients with full-thickness MH. Best-corrected Snellen visual acuity (BCVA) at presentation ranged from 20/30 to 2/200 (mean: 20/210). The MH minimum diameter ranged from 168 µm to 620 µm (mean: 351 µm). Fourteen eyes underwent pars plana vitrectomy, internal limiting membrane peeling, and gas or silicone oil tamponade. Eleven of the 14 (78.6%) operated eyes had complete closure of the macular hole. Of the 3 unoperated eyes, only 1 eye with the smallest macular hole (minimum diameter: 168 µm) closed spontaneously with observation. Final BCVA in all cases had a mean of 20/62 (range: 20/20-4/200). CONCLUSION: Full-thickness MH can result from momentary exposure to high-power handheld laser devices. While spontaneous closure may occur in rare cases, most cases require early surgical intervention. Vitrectomy may be successful in closing the macular hole with visual acuity improvement in most of the cases.

External ophthalmomyiasis: A case report.

Ophthalmomyiasis is an infestation of the eye with larvae of most common sheep nasal botfly (Oestrus ovis). We describe a case of ophthalmomyiasis in a 50-year-old man who presented with ocular foreign body sensation, redness and tearing. The causative larvae were removed in the emergency room and sent to laboratory for identification. The patient symptoms improved after topical treatment with antibiotics-steroid combination therapy.

Retained periorbital and intracranial air-gun pellets causing sclopetaria and visual loss.

Three healthy males presented on separate occasions to the emergency room at the King Khaled Eye Specialist Hospital (KKESH) after sustaining trauma by air-gun pellets. Clinical examination indicated sclopetaria in all the cases. The foreign bodies (air-gun pellets) were imbedded in different locations (subconjunctival, intraorbital, and intracranial). All cases resulted in a profound and permanent visual loss. The management of this traumatic injury is discussed and concurs with the published literature.

Histopathologic findings in two cases with history of intrastromal corneal ring segments insertion.

Intrastromal corneal ring segments (INTACS) implantation for mild myopia or keratoconus is simple and effective in most cases. Rarely, major complications can occur due to implantation. In this case report, we present two examples of possible intraoperative and postoperative complications of INTACS. The first case had histopathologic documentation of Descemet's membrane perforation as an intraoperative complication and the second case had accumulation of foamy histiocytes along the lamellar channels which has not been previously reported. These complications suggest further study is required on the long term effect of INTACS implantation on corneal tissue.

Medulloepithelioma of the ciliary body: the delay in diagnosis and frequent initial mismanagement.

OBJECTIVE: Medulloepithelioma is a rare intraocular embryonal neuroepithelial tumour. The study aims at identifying the causes for the delay in diagnosis and treatment. DESIGN: A retrospective study of all cases with histopathologic diagnosis of medulloepithelioma over a period of 25 years. PARTICIPANTS: Six patients with intraocular tumour in 6 eyes. METHODS: A data collection sheet is used for clinical and radiologic information based on charts review. The histologic sections are reviewed by a single pathologist. RESULTS: All cases presented initially in childhood with equal sex distribution. There was a delay of up to 5 years until final diagnosis and management. The most common clinical findings were high intraocular pressure and/or cataract in 4 cases, visible mass/uveitis/iris neovascularization and buphthalmos each presenting in 50% of the patients. The diagnosis was established clinically in 2 cased and by ultrasound in 4 cases. The tumour was mostly malignant (4/6) and 2 cases were classified as teratoid (1 benign and 1 malignant). All patients were successfully treated by enucleation with a follow-up period up to 18 years. CONCLUSIONS: Medulloepithelioma is a rare intraocular tumour often misdiagnosed and treated as glaucoma or uveitis. Ultrasonography is a useful additional tool for diagnosis. Enucleation seems to be an appropriate method of treatment specially when diagnosis is delayed and malignancy is suspected. Ophthalmologists need to be more familiar with this tumour to allow early clinical recognition and diagnosis.