Septic Superior Ophthalmic Vein Thrombosis in a Prothrombotic Adolescent Patient.

A 14-year-old boy presented to the emergency room with 5 days of fever and periorbital edema and erythema refractory to 4 days of augmentin and clindamycin. Examination revealed normal visual acuity, mild left periorbital edema and erythema, and a (-)1 supraduction deficit, concerning for orbital cellulitis. CT imaging revealed pansinusitis, orbital cellulitis with subtle orbital fat stranding, and a dilated superior ophthalmic vein with concern for thrombosis. This was confirmed on subsequent magnetic resonance venography. He was treated with intravenous antibiotics and enoxaparin with significant improvement in 24 hours. Standard hypercoagulable workup revealed positive lupus anticoagulant and cardiolipin of unclear significance; on genetic sequencing, he was found to have a homozygous mutation of the 4G variant of plasminogen activator inhibitor-1. Plasminogen activator inhibitor-1 homozygosity is a rare predisposing hypercoagulable state. This case highlights the importance of hematologic and genetic studies in adolescent patients with superior ophthalmic vein thrombosis, particularly those with mild presentation.

Spinal Ewing Sarcoma Metastatic to Bilateral Orbits.

A 39-year-old woman with primary spinal Ewing sarcoma and known lung metastases presented with painless bilateral decreased visual acuity over a 1-month period. Examination revealed bilateral disc edema. MRI of the brain/orbits showed metastatic lesions to the dura and bilateral orbits. Venous sinus thrombosis extending to the jugular vein was also noted. To the authors' knowledge, this is the first case of bilateral orbital metastasis and papilledema secondary to Ewing sarcoma and related hypercoagulability.

Cilioretinal Artery Occlusion as the Presenting Manifestation of Left Atrial Myxoma.

Purpose: This work reports a case of left atrial myxoma presenting with cilioretinal artery occlusion. Methods: A case report is discussed. Results: A 57-year-old man was referred for acute vision loss in the left eye after a workup including electrocardiogram, magnetic resonance imaging of the brain without contrast, computed tomography angiography of the head and neck, erythrocyte sedimentation rate, and C-reactive protein had negative results. Examination revealed cilioretinal artery occlusion with visible emboli. Because an echocardiogram was not performed, the patient was referred to the emergency department. Echocardiogram revealed a large left atrial mass prolapsing into the left ventricle. The mass was excised, and pathology showed myxoma. Conclusions: This is the first case to our knowledge of isolated cilioretinal artery occlusion as the initial presentation of an atrial myxoma. Thorough and complete workup was crucial to averting further morbidity and mortality.

Inferior Rectus and Inferior Oblique Muscle Transections with Medial Rectus Muscle Partial Avulsion, following Metal Hook Injury.

Avulsion or transection of three extraocular muscles following trauma is a rare finding, and there are few case reports and series discussing the approach to surgical repair. The authors report a case of a penetrating metal hook injury resulting in partial avulsion of a medial rectus muscle and transection of the inferior rectus and inferior oblique muscles. This case highlights the importance of identification and primary repair of a complete inferior rectus muscle transection and a partial medial rectus muscle avulsion with an excellent functional outcome.

Orbital cellulitis with choroidal detachment following strabismus surgery in an adult.

We report the case of a 76-year-old man who presented with left eye pain, eyelid swelling, and restricted extraocular motility 3 days after strabismus surgery. Computed tomography of the orbits did not show drainable abscesses, but magnetic resonance imaging on postoperative day 9 showed choroidal detachment with retrobulbar abscess and dural enhancement despite broad-spectrum intravenous antibiotic use. Following incision and drainage of the abscess, which grew methicillin-resistant Staphylococcus aureus, the patient showed improvement in visual acuity, pain, and extraocular motility. This is the first report of choroidal detachment occurring in the setting of orbital cellulitis after strabismus surgery.