Unilateral Choroidal Granuloma and a Pupillary Abnormality in a Case of Miliary Tuberculosis: A Dilemma for the Physician.

A young woman presented to the emergency with acute paraplegia and vision loss. She was diagnosed two months ago as a case of miliary tuberculosis with involvement of the chest and brain and therefore was on anti-tuberculosis treatment (ATT). She developed a decrease in vision and her treating physician suspecting optic neuropathy altered the regimen so as to omit Ethambutol and replaced it with Streptomycin. This treatment could not be continued with the advent of the COVID-19 pandemic as it required a hospital visit. On admission, she gave a history of inconsistent treatment and the ophthalmology evaluation showed decreased vision in the left eye, a relative afferent pupillary defect (RAPD), and a large solitary choroidal tubercle at the posterior pole of the same eye. The right eye was normal. On discussion with the treating physician, the standard four-drug ATT was reinstituted. Through our case report, we wish to highlight a challenging situation wherein the vision loss and pupillary abnormality with a background of ATT led to the change of treatment that would have required either daily hospital visits or other arrangements to be made to provide the same at home. This modified regimen not only proved to be challenging for the patient and caregivers but also may have played a role in the newer onset of further complications secondary to an irregular treatment regime.

The eye: A lifesaver! An unusual case of Anemic Retinopathy secondary to Malnutrition and its recovery.

A 22-year-old female was admitted with fever,disorientation and sudden decrease of vision in the emergency. Her evaluation showed tachycardia of 100/min and blood pressure of 90/70 with severe pallor. Her fundus examination showed findings of massive preretinal haemorrhage and Roth spots primarily restricted to the posterior pole. The ophthalmologist's findings were strongly suspicious of retinopathy associated with Haemoglobinopathies, blood tests revealed her to have a hemoglobin of 1.8 gm/dL and other reports suggestive of severe B12 and Folate deficiency. She also had systemic findings of gross anemia. After ruling out other causes of anemia she was finally diagnosed as a case of Megaloblastic anemia with decreased vision and retinopathy as a very noteworthy feature. She was treated with blood transfusions and B12 and Folate supplementation which showed a prompt response in the resolution of haemorrhages and once stable was discharged home.

Penicillium on the Iris! An Unusual Presentation and Cause of Postoperative Anterior Uveitis.

Intraocular fungal infections may not present solely as postoperative anterior uveitis or as a focal anterior segment lesion. The present study describes a 50-year-old woman with well-controlled diabetes who presented with postoperative anterior uveitis three months after uncomplicated cataract surgery. A fuzzy lesion was observed on her iris. The patient underwent an anterior chamber wash and removal of the lesion, followed by intracameral treatment with voriconazole. Culture of the lesion showed that it was a species of Penicillium. The patient has remained stable after treatment. Three aspects of this case were unusual: a fungal lesion of unusual etiology and location, inflammation restricted to the anterior segment despite a fungal background, and the excellent response to treatment with a very favorable outcome.