Inflamed nonlimbal scleral dermoid masquerading as nodular scleritis.

A 5-year-old boy presented with unilateral, focal superonasal conjunctival injection in the absence of vision changes or trauma. He was treated with a topical steroid for possible phlyctenule or episcleritis, but the lesion progressed to an elevated nodule, raising concern for nodular scleritis with no evidence of posterior involvement. Systemic work-up for underlying inflammatory conditions was unremarkable. There was some improvement in the level of injection with topical steroid, topical fluoroquinolone, and oral nonsteroidal anti-inflammatory drugs, but the nodular lesion persisted. Excisional biopsy revealed an inflamed dermoid cyst in the sub-Tenon's space.

Limitations in imaging common conjunctival and corneal pathologies with fourier-domain optical coherence tomography.

PURPOSE: To describe the limitations of Fourier-domain optical coherence tomography (OCT) in imaging common conjunctival and corneal pathology. MATERIALS AND METHODS: Retrospective, single-center case series of 40 patients with conjunctival and cornea pathology. RESULTS: Fourier-domain OCT imaged laser in situ keratomileusis (LASIK) flaps in detail, including its relation to other corneal structures and abnormalities. Similarly, in infectious or degenerative corneal disorders, Fourier-domain OCT successfully showed the extent of infiltration or material deposition, which appeared as hyper-reflective areas. In cases with pterygium, the underlying cornea could not be imaged. All cases of common conjunctival pathologies, such as nevus or pinguecula, were successfully imaged in detail. Nevi, scleritis, pterygium, pinguecula, and subconjunctival hemorrhage were hyper-reflective lesions, while cysts and lymphangiectasia were hyporeflective. The details of the underlying sclera were not uniformly imaged in conjunctival pathologies. Fourier-domain OCT imaged the trabeculectomy bleb in detail, whereas the details of structures of the anterior chamber angle were not routinely visualized in all cases. CONCLUSIONS: Light scatter through vascularized, densely inflamed, or thick lesions limits the imaging capabilities of Fourier-domain anterior segment OCT.

Interstitial keratitis secondary to severe hidradenitis suppurativa: a case report and literature review.

PURPOSE: To report a patient who presented with bilateral interstitial keratitis in association with severe hidradenitis suppurativa. METHODS: Case report. RESULTS: An 18-year-old African American woman with severe active hidradenitis suppurativa of the axillae and groin presented with a 2-week history of bilateral blurry vision. On examination, best-corrected visual acuity was counting fingers in the right eye and 20/70 in the left eye. Slit-lamp examination revealed diffuse vascularization of the corneal stroma with surrounding infiltrates bilaterally. In the left eye, corneal thinning and an epithelial defect were present in an area of infiltrate. Our clinical impression at that time was bilateral interstitial keratitis with secondary bacterial keratitis in the left eye. Topical therapy, prednisolone acetate 1% in the right eye, and ofloxacin in the left eye, was instituted. A systemic workup, including antinuclear antibody, rheumatoid factor, Lyme titer, cytoplasmatic staining antineutrophil cytoplasmic antibodies, perinuclear staining antineutrophil cytoplasmic antibodies, erythrocyte sedimentation rate, Venereal Disease Research Laboratory, rapid plasma reagin, basic metabolic panel, angiotensin-converting enzyme level, and a chest x-ray was negative. Topical steroids were used in the left eye after resolution of the bacterial keratitis. The interstitial keratitis responded to topical steroids and remained in remission after steroid taper. However, bilateral interstitial keratitis recurred coincident with a severe flare of hidradenitis suppurativa within 1 month of discontinuing the topical steroids. A course of subcutaneous adalimumab injections (40 mg/mL every 2 weeks) for hidradenitis suppurativa was implemented. Both her dermatological and ocular conditions responded to this therapy and have remained in remission through 7 months of follow-up. CONCLUSIONS: Hidradenitis suppurativa is a rare cause of bilateral interstitial keratitis. Patients may experience simultaneous exacerbations of both dermatological and ocular manifestations. Systemic treatment with adalimumab can improve both dermatological and ocular conditions.