Embolic Central Retinal Artery Occlusion Detected with Point-of-care Ultrasonography in the Emergency Department.

BACKGROUND: Ocular emergencies account for 2-3% of all emergency department (ED) visits. Sonographic evaluation of the eye offers a very useful diagnostic tool in the ED. In the ED setting, ocular ultrasound could identify a retinal detachment, or a massive vitreous hemorrhage, and the training for emergency medicine practitioners is quite easy. CASE REPORT: An 84-year-old woman presented to our ED with a painless acute vision loss in her right eye. Immediate bedside emergency ocular ultrasound was performed, and it showed a retrobulbar hyperechoic material, suggestive of an embolus within the central retinal artery. Fluorescein angiography showed limited and sluggish filling of the retinal arteries after injection of fluorescein, and optical coherence tomography demonstrated a decrease in the reflectivity and thickness of the inner retinal layers. The final diagnosis was embolic central retinal artery occlusion (CRAO). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Among the causes of acute loss of vision, CRAO is associated with systemic vascular disease. The importance of visible retinal emboli has been well documented due to its association with increase in mortality. A rapid evaluation of the central retinal artery could be a simple tool to identify an embolus, and this could lead to a rapid treatment. The evaluation of central retinal artery is a less defined setting in emergency physician bedside ultrasound, but the identification of CRAO could lead to a rapid acceleration in diagnosis and treatment of a potentially life-threatening disease.

Effect of voriconazole on a corneal abscess caused by fusarium.

PURPOSE: To describe a case of corneal abscess caused by Fusarium solani that did not respond to common antifungal agents. METHOD: Case report. RESULTS: Twenty days after accidental contact with vegetation, a 56-year-old man presented with a corneal abscess. Corneal ulceration developed and a perforating keratoplasty was performed. After a microbiological examination, the diagnosis of F. solani infection was made. Systemic and topical amphotericin B and fluconazole were prescribed, with no results. A new abscess formed on the transplanted graft and a wound leak developed. We administered topical and systemic voriconazole. No side-effects were observed. The choroidal detachment and the surgical transplant recovered completely in 20 days. A vascular leukoma developed at the site of the transplanted corneal abscess. CONCLUSION: From a functional point of view, another corneal transplant will be necessary. Voriconazole was effective in treating a severe keratomycosis caused by F. solani that was resistant to other topical and systemic antifungal agents.