Iris melanocytoma and secondary glaucoma.

Iris melanocytoma (IM) is a rare variant of iris nevus with distinctive clinical and histopathological features. A 66-year-old woman, with a history of right eye pigmented iris nevus, presented to us with a recent onset of visual acuity decrease in that eye. She had a melanocytic iris lesion with iridocorneal angle invasion, peripheral corneal adhesion, pupil corectopia, sectorial cataract and high intraocular pressure. Ultrasound biomicroscopy did not exclude malignant transformation, so excisional biopsy was performed revealing the presence of IM without signs of atypia. Subsequently, the patient underwent cataract surgery combined with iridoplasty and later an ab externo trabeculectomy. Most cases of IM remain stable and require no intervention, but in cases of unusual clinical course, with rapid growth or secondary glaucoma, surgical treatment is indicated as a diagnostic and therapeutic measure. This case report highlights the importance of a timely and multidisciplinary ophthalmological approach for a better visual outcome.

Chronic lacrimal canaliculitis - the answer to a three-year history of red eye / Canaliculite lacrimal crônica - a resposta para uma história de olho vermelho com 3 anos de evolução

ABSTRACT Chronic lacrimal canaliculitis is a rare infection of the lacrimal system, and can lead to misdiagnosis due to its overlapping presentation to other common entities. The authors report a case of lacrimal canaliculitis with a three-year history of recurrent unilateral red eye and mucopurulent discharge. Here, we describe the clinical course, surgical details, and microbial analysis of canaliculitis infection.

RESUMO A canaliculite lacrimal crónica é uma infecção rara do sistema lacrimal e pode levar a erros de diagnóstico devido à sua apresentação sobreposta a outras entidades comuns. Os autores relatam um caso de canaliculite lacrimal com história de três anos de olho vermelho unilateral recorrente e secreção mucopurulenta. Aqui, descrevemos o curso clínico, os detalhes cirúrgicos e a análise microbiológica da infecção por canaliculite.

Chronic lacrimal canaliculitis - the answer to a three-year history of red eye.

Chronic lacrimal canaliculitis is a rare infection of the lacrimal system, and can lead to misdiagnosis due to its overlapping presentation to other common entities. The authors report a case of lacrimal canaliculitis with a three-year history of recurrent unilateral red eye and mucopurulent discharge. Here, we describe the clinical course, surgical details, and microbial analysis of canaliculitis infection.

Torpedo maculopathy with an anisometropic amblyopia in a 5-year-old Caucasian girl: case report.

The aim of this study is to report a clinical case of asymptomatic female Caucasian children with torpedo maculopathy. A 5-year-old girl was referred to our clinic for routine evaluation. The ophthalmic examination revealed best-corrected visual acuity of 20/20 in both eyes, without any changes in the biomicroscopy. Fundus examination showed normal findings in one eye, whereas in the contralateral eye it disclosed, in the temporal sector of the macular region, a whitish, atrophic, oval chorioretinal lesion with clearly defined margins. Posterior evaluations documented the stability of the lesion. Torpedo maculopathy diagnosis is based on its characteristic shape and peculiar location. The differential diagnosis has to be established versus choroidal lesions (melanoma and nevus), congenital or iatrogenic hyperplasia of the retinal pigment epithelium (RPE) and particularly versus the congenital pigmented lesions associated with Gardner's syndrome.

Torpedo maculopathy with an anisometropic amblyopia in a 5-year-old Caucasian girl: case report / Maculopatia torpedo numa criança caucasiana de 5 anos de idade com ambliopia anisometrópica: relato de caso

The aim of this study is to report a clinical case of asymptomatic female Caucasian children with torpedo maculopathy. A 5-year-old girl was referred to our clinic for routine evaluation. The ophthalmic examination revealed best-corrected visual acuity of 20/20 in both eyes, without any changes in the biomicroscopy. Fundus examination showed normal findings in one eye, whereas in the contralateral eye it disclosed, in the temporal sector of the macular region, a whitish, atrophic, oval chorioretinal lesion with clearly defined margins. Posterior evaluations documented the stability of the lesion. Torpedo maculopathy diagnosis is based on its characteristic shape and peculiar location. The differential diagnosis has to be estabilished versus choroidal lesions (melanoma and nevus), congenital or iatrogenic hyperplasia of the retinal pigment epithelium (RPE) and particularly versus the congenital pigmented lesions associated with Gardner's syndrome.

Os autores descrevem um caso clínico de uma criança caucasiana, 5 anos do sexo feminino, com maculopatia torpedo. Ao exame oftalmológico apresentava uma acuidade visual corrigida de 10/10 e sem alterações à biomicroscopia. À fundoscopia apresentava uma lesão oval isolada, esbranquiçada, atrófica, unilateral, de margens bem definidas no setor temporal da região macular. Avaliações posteriores documentaram a estabilidade da lesão. O diagnóstico da maculopatia torpedo baseia-se na sua forma característica e localização peculiar. É importante o diagnóstico diferencial com lesões da coroideia (melanoma e nevo), hiperplasias congênitas ou iatrogênicas do epitélio pigmentado da retina (EPR) e com lesões congênitas associadas à síndrome de Gardner.

[Processionary (Thaumetopoea pityocampa Schiff) induced ocular lesions: case reports]. / Lesões oculares por Processionária (Thaumetopoea pityocampa Schiff): relatos de casos.

UNLABELLED: The Processionary (Thaumetopoea pityocampa Schiff), is an endemic insect of pine and cedar trees, existing both in rural and urban areas. Ocular toxicity, once rare due to the efficacy of eradication methods, is caused by the insects' hair and is expected to be more frequent with its recrudescence. We report two clinical cases and review the epidemiology of Processionary and its eye injuries. Case 1: a 64 year-old patient complained of red eye and foreign body sensation after being gardening. She had a BCVA of 0.5 and biomicroscopy revealed an epithelial erosion, flare (++), Tyndall (+++) and the presence of a setae in the deep corneal stroma. Case 2: a 28 year-old patient complained of severe pain in the right eye and hyperemia after having had contact with a caterpillar. He presented with a BCVA of 0.6, Tyndall (+++) and multiple filaments (over 20) at different depths in the cornea. Case 3: a 23 year-old patient refers to the ER with foreign body sensation and constant lacrimation in the right eye after having been completing military exercises in an urban park. He presented a BCVA of 0.3, multiple epithelial erosions in the nasal half of the cornea that cove-red multiple orange strands and an anterior chamber reaction (Tyndall +). Therapy was initiated with topical steroids and symptomatic surveillance. Ocular toxicity due to Processionary hairs, whose movement occurs preferentially towards the posterior pole, includes early signs (conjunctivitis, keratitis, and uveitis) and late signs (cataract, pars planitis, vitritis, and retinitis). The 3 cases presented had early lesions, having fully recovered from the inflammatory condition after 6 months. However, inactive setae were still visible in the corneal stroma. Intraocular migration, which can occur years after the initial episode, is possible and might be severe, thus requiring a life-long surveillance. CONCLUSION: Processionary recrudescence has been observed, both in rural and urban areas. It is therefore imperative to be familiar with eye injuries caused by the insect and its treatment.

Lesões oculares por Processionária (Thaumetopoea pityocampa Schiff): relatos de casos / Processionary (Thaumetopoea pityocampa Schiff) induced ocular lesions: case reports

A Processionária (Thaumetopoea pityocampa Schiff), vulgarmente conhecida como "lagarta do pinheiro" é um inseto dos pinheiros e cedros, endêmico em meios rurais mas também em meios urbanos. A toxicidade ocular, rara nas últimas décadas pelo desenvolvimento de métodos de erradicação eficazes, é provocada pelos seus pelos e prevê-se mais frequente com o recrudescimento deste inseto. Revemos a epidemiologia da Processionária e as suas lesões oculares a partir de 3 casos clínicos. Caso 1: Doente de 64 anos recorre ao Serviço de Urgência (SU) com olho direito vermelho e sensação de corpo estranho após prática de jardinagem. A observação revela AVODc: 0,5, erosão epitelial, presença de um filamento no estroma corneano profundo, flare (++) e Tyndall (+++). Caso 2: Doente de 28 anos, recorre ao SU por dor intensa no olho direito acompanhada de hiperemia após contato com lagarta. Apresenta AVODc: 0,6 e Tyndall (+++) com presença de múltiplos filamentos (mais de 20) a diferentes profundidades da córnea. Caso 3: Doente de 26 anos, recorre ao SU por sensação de corpo estranho e lacrimejamento constante no olho direito, após realizar exercícios militares num parque urbano. Apresenta AVODc: 0,3, múltiplas erosões epiteliais puntiformes na metade nasal da córnea que recobriam filamentos de cor laranja e Tyndall (+). Foi instituída terapêutica com corticoide tó­pico e vigilância sintomática a cada um dos casos. A patologia ocular por Processionária decorre da toxicidade dos seus pelos, cuja migração ocorre preponderantemente no sentido intraocular. Inclui por isso lesões precoces (conjuntivite, queratite e uveíte) e tardias (catarata, pars planite, vitreíte e retinite). Os casos apresentados possuíam lesões iniciais, tendo recuperado totalmente do quadro inflamatório após seis meses mas mantendo os pelos inativos no estroma corneano. A gravidade destes casos prende-se à possibilidade de migração intraocular, que pode ocorrer anos após o episódio inicial, obrigando a uma vigilância ao longo da vida. CONCLUSÃO: O recrudescimento da Processionária, tanto em meios rurais como urbanos, justifica o conhecimento das lesões oculares que pode causar e o seu tratamento.

The Processionary (Thaumetopoea pityocampa Schiff), is an endemic insect of pine and cedar trees, existing both in rural and urban areas. Ocular toxicity, once rare due to the efficacy of eradication methods, is caused by the insects' hair and is expected to be more frequent with its recrudescence. We report two clinical cases and review the epidemiology of Processionary and its eye injuries. Case 1: a 64 year-old patient complained of red eye and foreign body sensation after being gardening. She had a BCVA of 0.5 and biomicroscopy revealed an epithelial erosion, flare (++), Tyndall (+++) and the presence of a setae in the deep corneal stroma. Case 2: a 28 year-old patient complained of severe pain in the right eye and hyperemia after having had contact with a caterpillar. He presented with a BCVA of 0.6, Tyndall (+++) and multiple filaments (over 20) at different depths in the cornea. Case 3: a 23 year-old patient refers to the ER with foreign body sensation and constant lacrimation in the right eye after having been completing military exercises in an urban park. He presented a BCVA of 0.3, multiple epithelial erosions in the nasal half of the cornea that cove­red multiple orange strands and an anterior chamber reaction (Tyndall +). Therapy was initiated with topical steroids and symptomatic surveillance. Ocular toxicity due to Processionary hairs, whose movement occurs preferentially towards the posterior pole, includes early signs (conjunctivitis, keratitis, and uveitis) and late signs (cataract, pars planitis, vitritis, and retinitis). The 3 cases presented had early lesions, having fully recovered from the inflammatory condition after 6 months. However, inactive setae were still visible in the corneal stroma. Intraocular migration, which can occur years after the initial episode, is possible and might be severe, thus requiring a life-long surveillance. CONCLUSION: Processionary recrudescence has been observed, both in rural and urban areas. It is therefore imperative to be familiar with eye injuries caused by the insect and its treatment.