[Bilateral central serous chorioretinopathy post-COVID-19]. / Choriorétinopathie séreuse centrale bilatérale post-COVID-19.

Coronavirus disease (COVID-19) can result in many ocular manifestations. We report a rare case of bilateral central serous chorioretinopathy post-infection with COVID-19 in a 38-year-old woman who presented with bilateral blurred vision 1 month after infection with COVID-19. She reported fever, cough, and shortness of breath and was COVID-PCR positive. During her 10-day hospital stay, she received oxygen, antibiotics, heparin and corticosteroids intravenously and then orally. After her recovery from COVID-19, the patient developed progressive visual loss in both eyes: her corrected visual acuity was 3/10 in both eyes, the anterior segment was normal, and the vitreous was clear. Fundus examination, optical coherence tomography and fluorescein angiography showed bilateral serous retinal detachments. Her course was characterized by improvement in visual acuity and regression of the retinal detachments. Central serous chorioretinopathy can occur after COVID-19 infection due to the administration of corticosteroids; thus, ophthalmologic examination is essential to detect ocular involvement as early as possible.

[Impact of glaucoma medications and ocular surface disease on the quality of life of glaucoma patients in the district of Sousse (Tunisia)]. / Impact du traitement antiglaucomateux et de la pathologie de la surface oculaire sur la qualité de vie des patients glaucomateux dans la région de Sousse (Tunisie).

PURPOSE: To assess the impact of glaucoma treatment and ocular surface disease (OSD) on the vision-specific quality-of-life (VS-QoL) of glaucoma patients attending Farhat Hached university hospital Sousse-Tunisia. METHODS: This was a cross-sectional study enrolling one-hundred-twenty patients followed for primary open angle glaucoma. All patients successfully responded to the Arabic version of the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25). QoL was quantified in terms of scores (0-100) and correlated with the characteristics of glaucoma treatment and status of the ocular surface. RESULTS: One hundred and twenty patients were studied. The mean number of medications and instilled drops was 1.95 (1-4) and 2.69 (1-7) respectively. A total of 66.7% patients reported side effects of treatment. On examination, moderate or severe dry eye syndrome was identified in 90% of cases. A total of 16.7% of patients had superficial punctate keratopathy. The number of instilled drops per day, the use of brimonidine or oral carbonic anhydrase inhibitors, and the presence of OSD had a negative impact on the NEI-VFQ 25 scores. CONCLUSIONS: Glaucoma treatment and OSD are 2 factors potentially reducing the QoL of glaucoma patients, on which the ophthalmologist can act by optimizing treatment and regularly examining the ocular surface of glaucoma patients.

[Orbital dermoid cysts: Clinical spectrum and outcome]. / Les kystes dermoïdes orbitopalpébraux : étude clinique et résultats thérapeutiques.

INTRODUCTION: Dermoid cysts are benign congenital orbital tumors, they are classified as choristomas. Clinical manifestations vary according to location and size. MATERIALS AND METHODS: We retrospectively analyzed 43 cases of dermoid cysts surgically treated between July 1998 and March 2009. RESULTS: Mean patient age was 18.64 years. Among patients, 48.83% were male. Preseptal location was most common (41 cases). One of the two cases of intraorbital location required orbitotomy. We observed no complications or recurrence. DISCUSSION: Dermoid cysts are most often seen in young patients. The mean age of our patients was relatively high. The majority of dermoid cysts are periorbital in location. Superficial orbital dermoid cysts are more frequent, present earlier in life and are more easily identified than deep dermoid cysts. Imaging plays a major role in the management of deep orbital tumors. Complete surgical excision has remained the mainstay of treatment. CONCLUSION: Dermoid cysts are benign orbital tumors. Superficial dermoid cysts are the most common type. Deeper cysts require a more challenging diagnostic and therapeutic approach.

[Acute multifocal posterior placoid pigment epitheliopathy and central retinal vein occlusion: association in a sarcoidosis patient]. / Épithéliopathie en plaques et occlusion de la veine centrale de la rétine: une association au cours de la sarcoïdose.

Acute multifocal posterior placoid pigment epitheliopathy is a chorioretinal inflammatory disease characterized by whitish lesions with ill-defined margins, deep to the retina and concentrated in the posterior pole. We report the case of a 17-year-old man who presented with the typical findings of bilateral acute multifocal posterior placoid pigment epitheliopathy. He developed secondary central retinal vein occlusion in the right eye. Systemic manifestations and additional investigations resulted in a diagnosis of sarcoidosis.

[Senile scleral plaque associated with scleritis in a patient with rheumatoid arthritis]. / Plaque sclérale sénile associée à une sclérite chez un patient atteint d'une polyarthrite rhumatoïde.

Senile scleral plaque is an age-related, commonly asymptomatic hyaline degeneration of the sclera. We report a case of calcific scleral plaque associated with anterior scleritis in an elderly patient with rheumatoid arthritis. Response to anti-inflammatory treatment was favorable.

[Eyelid necrosis after injection of lidocaine with epinephrine]. / Nécrose cutanée palpébrale secondaire à une injection de xylocaïne adrénalinée.

Four patients (two women aged 50 and 67 years, a 36-year-old man, and a 5-year-old child) presented with necrosis of the eyelid after local anesthesia using 2% lidocaine with epinephrine. In three cases, the anesthesia was administered prior to suturing an eyelid laceration, and the necrosis involved the upper lid; in one case, the anesthesia was administered prior to temporal artery biopsy. Surgical debridement of the necrotic tissue was performed in all cases. Three patients developed a bacterial superinfection treated with systemic antibiotics with good results. Necrosis of the eyelid is a rare complication occurring after local anesthesia using lidocaine with epinephrine. Most dermatologists refrain from use of epinephrine with local anesthetics for digital blocks. Necrosis is due to prolonged vasoconstriction of arteries. It is observed especially commonly in patients at increased risk (arteritis, Raynaud's phenomenon and severe microvascular diseases). In the eyelid, few cases have been reported.

[Oculopalpebral and facial synkinesis associated with ptosis: epidemiological, clinical, and therapeutic features]. / Les syncinésies oculo-facio-palpébrales associées au ptosis : aspects épidémiologiques, cliniques et thérapeutiques.

Synkinetic movements of the upper eyelids may be noted in association with movements of either extraocular muscles or other muscles of the face. Patients with oculopalpebral or facial-palpebral synkinesis may also have ptosis of the involved eyelid. The clinical and therapeutic features of this association are specific. We mainly distinguish two forms of synkinetic movements, characterized either by the elevation of the ptotic eyelid such as in Marcus Gunn phenomenon and in the Fuchs sign or by the falling of the upper lid such as in Marin Amat syndrome. Many surgical techniques have been used to correct the blepharoptosis and the synkinetic movement. Levator resection is often advocated for correction of blepharoptosis with a mild degree of synkinesis. However, when the ptosis is major, eyelid lag is a possible outcome. For moderate or major synkinesis, bilateral frontalis suspension with disinsertion of the levator has been suggested. This procedure generally provides satisfactory cosmetic results.

Les keratites amibiennes

L'objectif de cette revue generale est de decrire les caracteristiques des agents responsables des keratites amibiennes; les principes de leur diagnostic positif ainsi que les modalites de leur traitement.Les keratites amibiennes surviennent dans la majorite des cas chez des porteurs de lentilles de contact. Les manifestations cliniques peuvent etre atypiques. Les prelevements; en particulier corneens; permettent de rechercher les amibes par des examens directs et des cultures ou d'identifier leur acide desoxyribo- nucleique par reaction de polymerisation en chaine; cette derniere technique etant plus sensible. La microscopie confocale; permet par ailleurs; de rechercher in vivo des kystes amibiens. Le traitement medical; peut etre institue en cas de forte suspicion clinique du diagnostic. Les protocoles therapeutiques de premiere intention se basent sur l'association de collyres presentant une activite kysticide; le plus souvent un biguanide et une diamidine; pendant plusieurs semaines. Le pronostic visuel est lie a la severite du tableau initial et au delai de mise en route d'un traitement efficace. Les sequelles visuelles peuvent etre invalidantes d'ou l'interet de porter un diagnostic precoce

Uveitis responding on gluten free diet in a girl with celiac disease and diabetes mellitus type 1.

A 9-year old girl with a history of diabetes mellitus type 1, presented with visual loss of the left eye. The right eye examination was unremarkable. Slit-lamp examination revealed few small and fine keratic precipitates. We noted 2+ flare in the vitreous. There was no choroiditis, papillitis or retinal vasculitis. No aetiology was found. The patient was treated by topical and systemic corticosteroids without any improvement. Celiac disease was discovered by the presence of celiac antibodies in the work-up of joint pain and diabetes mellitus type 1. Antiendomysium antibodies and anti-transglutaminase antibodies were both positive. A small bowel biopsy confirmed celiac disease. A gluten free diet was set up and corticosteroids were tapered off. Recovery of the uveitis was obvious during gluten free diet and normalized within two months.

[Orbital metastasis from cutaneous melanoma]. / Métastase orbitaire d'un mélanome malin cutané.

PURPOSE: We report the case of a patient presenting with a one-sided orbital metastasis from a cutaneous melanoma, and analyze clinical features, diagnostic difficulties and prognosis of such metastasis. CASE REPORT: We report the case of a woman aged 70 years, who presented with a right one-sided proptosis associated to a decrease of the vision. The clinical features were: visual acuity at 2/10, an axile proptosis and a papillary sectorial temporal atrophy. The computed tomography (CT) disclosed an intraorbital mass with double tonality, rounded and well limited driving back the optic nerve and erasing the limits of the lateral rectus muscle. The orbital magnetic resonance imaging (MRI) showed an intra-conal fusiform mass with an heterogeneous signal in T1 and T2, heightening intensely and heterogeneously after the injection of Gadolinium. Otherwise, the patient presented with an associated respiratory failure, and thoracic CT has disclosed diffuse metastases. It was then noted that a cutaneous melanoma of the left foot had been operated ten years before. The patient died during the following month. DISCUSSION: The cutaneous melanoma is a rare cause of orbital metastasis. The diagnosis is often easy, when a primitive tumor is known, but it remains uncertain for a long time. CONCLUSION: Orbital metastases from cutaneous melanoma are rare, generally occurring at the late stage of the disease with a life expectancy not passing one year.

[Craniofacial fibrous dysplasia: a case report]. / La dysplasie fibreuse cranio-faciale. A propos d'un cas.

Fibrous dysplasia is classified among benign bone tumors. It is a bone development anomaly characterized by hamartoma proliferation of fibrous tissue within the medullary bone, with secondary bony metaplasia, producing immature, newly formed and weakly calcified bone, without maturation of the osteoblast. It can be monostotic or polyostotic. The craniofacial localization occurs in 10%-25% of cases in monostotic forms and in 50% of cases in polyostotic forms. Fibrous dysplasia essentially affects children and young adults, with no sex preference. Its diagnosis is not always straightforward because the functional symptomology is often absent or not specific. Medical imagery is necessary and in difficult cases a bone biopsy. The major complication of the illness remains sarcomatous degeneration. Only symptomatic forms are treated. We report an observation of craniofacial fibrous dysplasia affecting a child and discovery of proptosis, with no other ocular or general functional signs.