Unilateral orbital fat change.

A man in his 60s suffering from open-angle glaucoma attended a routine glaucoma follow-up complaining that his left eye has changed in appearance. On examination, there was extensive loss of orbital fat giving the appearance of a sunken in globe. A diagnosis of prostaglandin-associated periorbitopathy was made as the man had been taking a prostaglandin analogue for his glaucoma for over 4 years in his left eye only.

Raised intracranial pressure with bilateral anterior uveitis.

We report the rare case of a 5-year-old boy with an infective cause of papilloedema and bilateral uveitis secondary to Mycoplasma pneumoniae The patient presented with generalised headache and malaise. MRI showed signs of raised intracranial pressure and lumbar puncture opening pressure was 43 cmH2O.Lumbar puncture did not reveal any infective organisms. Blood tests showed raised inflammatory markers. The patient was started on prednisolone, acetazolamide and intravenous cefotaxime. Following an improvement, the patient was discharged.However, the patient re-presented 2 weeks later with bilateral anterior uveitis. With the combination of papilloedema and bilateral uveitis, M. pneumoniae infection was suspected. Tests confirmed recent mycoplasma infection. Topical dexamethasone and oral azithromycin were given and symptoms improved.Vision remained normal throughout. At 1-year follow-up, the patient remains well. The authors would like to highlight a rare infectious cause of papilloedema in young children.

Severe Cutaneous Reaction to Latanoprost Eye Drops.

PURPOSE: Latanoprost is known to have several ocular side effects, including redness of the eyelids, lengthening of the eyelashes, an increase in iris pigmentation, and dryness of the eyes that causes discomfort. There are also several rarer systemic side effects reported in the literature, including chest pain. CASE REPORT: Here we report a rare case of a patient who developed a cutaneous blistering rash on both eyelids, both sides of the neck, and the dorsum of both hands after direct contact with latanoprost eye drops. The lesions cleared following withdrawal of the eye drops. CONCLUSION: Topical latanoprost can cause severe blistering of the skin that could undermine a patient's confidence in the treating medical team. Reporting of an adverse effect is difficult when a generic topical medication is used.

Breathlessness in a drug user.

A 40-year-old heroin smoking man presented with acute onset severe shortness of breath. Radiological investigations revealed an unexpected loculated pneumothorax. Respiratory physicians inserted a chest drain which relieved his breathlessness. His exercise tolerance is much improved 6 months on. The side effects of smoking illicit substances are poorly understood. There is a growing trend for drug users to smoke rather than intravenously inject. It is therefore important for clinicians to be aware of the associated morbidity. The authors believe this is the first ever reported case of loculated pneumothorax associated with heroin smoking.

A difficult diagnosis: severe Graves' ophthalmolopathy.

An 81-year-old woman with atrial fibrillation, on warfarin, with known hyperthyroidism, was admitted to hospital following a fall with proptosis and severely restricted movements in her left eye. Medics initially thought the presentation was related to an intracranial pathology but through subsequent tests and examination, ophthalmologists diagnosed a severe case of thyroid eye disease with intense inflammation. The patient responded well to systemic steroid treatment. This case report highlights a severe rapidly progressing case of thyroid eye disease with diagnostic difficulties arising from multiple comorbidities in an elderly patient.