Inflammatory Granulomatous Corneal Disease: Ocular Granuloma Annulare.

Granuloma annulare is a well-known skin disease characterised by small papules arranged in a ring around a lesion with a normal atrophic centre. It may have variable clinical presentations and associations. Herein, we describe its novel ocular association with inflammatory granulomatous corneal disease (IGCD). It was observed in a young patient diagnosed with granuloma annulare. His symptoms included blurring of vision associated with photophobia in both eyes. There was marked stromal oedema with corneal haze at variable depths and mild anterior chamber flare. It resolved completely with topical steroids. This case discusses a unique manifestation of multisystemic IGCD with granuloma annulare that may co-exist with skin lesions. To the best of our knowledge, this unique entity has not been described in the literature previously.

Rectus muscle pseudo-adherence syndrome.

Purpose: To describe a clinical entity called "rectus muscle pseudo-adherence syndrome" following buckling surgery. Methods: A retrospective data review was undertaken to analyze the clinical profile of strabismus patients who had developed it following buckling surgery. Between 2017 and 2021, a total of 14 patients were identified. The demography, surgical details, and intraoperative challenges were reviewed. Results: The average age of the 14 patients was 21.71 ± 5.23 years. The mean pre-op deviation was 42.35 ± 14.35 prism diopters (PD) of exotropia, and the mean post-op deviation was 8.25 ± 4.88 PD of residual exotropia at 26.16 ± 19.53 months follow-up. Intraoperatively, in the absence of a buckle, the thinned-out rectus adhered to the underlying sclera with much denser adhesions along its margins. When there was a buckle, the rectus muscle adhered to the outer surface of the buckle again, but less densely, with marginal union into the surrounding tenons. In both scenarios, due to the absence of protective muscle coverings, the rectus muscles were naturally adsorbed onto the immediately available surface in the presence of active healing by the tenons. Conclusion: While correcting ocular deviations following buckling surgery, a false sense of an absent, slipped, or thinned-out rectus muscle is very much possible. This is due to active healing of the muscle with the surrounding sclera or the buckle in a single layer of tenons. This is the rectus muscle pseudo-adherence syndrome, where the culprit is the healing process and not the muscle.