ABSTRACT
A 78-year-old man with angle closure glaucoma and on treatment with oral anticoagulants, underwent phacoemulsification. An early acute suprachoroidal hemorrhage (SCH) occurred and the surgical wound was rapidly sutured without complete soft lens matter removal, nor insertion of intraocular lens. The SCH was managed conservatively and it resolved in 5 weeks; the intraocular pressure was 35 mm Hg despite maximal medical treatment. Secondary soft lens matter removal followed by intraocular lens implantation combined with XEN45 was then performed. After 7 days the patient developed a potentially "kissing" choroidal touch due to significant delayed SCH. This was treated with surgical drainage. Significant suprachoroidal bleeding can occur after minimally invasive glaucoma procedures. Patients on anticoagulant therapy may require careful monitoring while planning glaucoma surgery.
Subject(s)
Choroid Hemorrhage/therapy , Glaucoma Drainage Implants/adverse effects , Glaucoma, Angle-Closure/surgery , Aged , Anti-Bacterial Agents/therapeutic use , Antihypertensive Agents/therapeutic use , Choroid Hemorrhage/etiology , Combined Modality Therapy , Glaucoma, Angle-Closure/physiopathology , Glucocorticoids/therapeutic use , Humans , Intraocular Pressure/physiology , Lens Implantation, Intraocular , Male , Minimally Invasive Surgical Procedures , Phacoemulsification/adverse effects , Suction , Tonometry, Ocular , Visual Acuity/physiologyABSTRACT
BACKGROUND: Duane's retraction Syndrome is a congenital form of strabismus characterized by horizontal eye movement limitation and globe retraction with palpebral fissure narrowing in attempted adduction. It may be associated with co-existing ocular and systemic pathologies. Crocodile tears, or a paradoxical gustatory lacrimal reflex can be either congenital or acquired. The congenital cases typically are associated with Duane's syndrome in most of the cases. CASE: We present in our case report, uncommon case of bilateral Duane's syndrome with bilateral crocodile tears - both of which can be assumed to be of probably central origin. Though several cases have been reported, there are very few from the Indian subcontinent. Here, we also review the literature of the syndrome with crocodile tears. CONCLUSION: All cases of Duane's retraction syndrome warrant a thorough screening for coexisting ocular and systemic abnormalities. Ours is a classic report of bilateral Duane's syndrome with bilateral congenital crocodile tears, the coexistence of these two anomalies emphasising the aetiology to be anomalous innervation occurring at central level i.e. is brain stem.
Subject(s)
Duane Retraction Syndrome/complications , Lacrimal Apparatus Diseases/etiology , Lacrimal Apparatus/diagnostic imaging , Tears/metabolism , Child , Duane Retraction Syndrome/diagnosis , Female , Humans , Lacrimal Apparatus/metabolism , Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus Diseases/metabolism , Visual AcuityABSTRACT
Mycetoma is a chronic granulomatous infection. Lower extremities are commonly involved. A 20-year-old male came with complaints of multiple sinuses on scalp, left eyelid swelling with a sinus and dystopia, since one year. On examination there was relative proptosis in left eye of 2 mm. Computed tomography scan showed soft tissue swelling of the pre-septal area of the left upper eyelid with orbital involvement. Magnetic resonance imaging showed increased left orbital volume and evident dystopia. Microbiology testing of the erosive scalp and lid lesions showed genus Nocardia, suggestive of actinomycetoma. This case is presented as it shows an unusual involvement of the orbit.
