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Indirect Carotid Cavernous Fistula A 72-year-old female referred to Bascom Palmer Emergency room with 4 months of progressive painless diplopia and eye redness after dental procedure. Exam revealed VA 20/25 OU with bilateral abducens palsy, and arterialization of the conjunctival vessels. Review of…

Ocular Surface Squamous Neoplasia A 65-year-old male with history of suspected glaucoma, diabetes, hypertension, and hyperlipidemia presented for a routine eye exam. Patient reported spending a lot of time in the sun. Visual acuity was 20/20 and intraocular pressure was normal in both eyes. Exam re…

Retinal Arterial Macroaneurysm 82-year-old female presented to BPEI from the Cayman Islands with 3 weeks of floaters and decreased vision in the right eye. Visual acuity was hand motion and posterior exam revealed vitreous hemorrhage, submacular hemorrhage, and a retinal arterial macroaneurysm (RAM…

HLA-B27-Associated Uveitis A 58-year-old male with a history of CAD, HTN, atrial fibrillation, and schizophrenia presented with 2 days of decreased vision, redness, and pain in the right eye. There was no trauma. Visual acuity was CF OD and IOP OD was elevated. Exam revealed a hemorrhagic hypopyon …

Myopic Traction Maculopathy A 62-year-old Asian male with history of myopia presents with decreased vision x 6 months. Found the have myopic traction maculopathy. Patient managed successfully with observation. He has had gradual worsening of vision but has not affected his quality of life. Myopic t…

Adenoviral Conjunctivitis A 31-year-old male presents with eye redness, foreign body sensation, and blurry vision in both eyes, worse in the right eye. On exam he is found to have follicular conjunctivitis in both eyes with sub epithelial infiltrates on the right cornea. His conjunctiva were cultur…

Alkaline Chemical Corneal Burn A 63-year-old male presented with decreased vision and pain after alkali chemical splash to both eyes at a utility plant. He presented with perilimbal ischemia in the right eye greater than the left, complete opacification of the right cornea and a large epithelial de…

Dislocated Intraocular Lens A 74-year-old male presented to the BPEI ER with blurred vision in the right eye for 3 days. He underwent cataract surgery in both eyes 9 years prior in Costa Rica. He denied any other prior ocular history or trauma. Exam revealed VA 20/200+1 in the right eye. IOP was wi…

Mucormycosis A 61-year-old male with interstitial lung disease status post left lung transplant on immunosuppression develops worsening left facial and periorbital swelling after dental cleaning. Symptoms are unresponsive to oral antibiotics and after three days the patient is examined by ophthalmo…

Recurrent Pterygium We present a 71-year-old male patient with multiple pterygium resection surgeries on the left eye and one on the right eye. Referred to BPEI with progressive horizontal diplopia on lateral gaze for seven months. On ocular examination revealed 20/60 vision in the left eye, restri…

Conjunctival Melanoma A 38-year-old healthy man presents with a pigmented lesion two years after onset and undergoes excisional biopsy which confirms conjunctival melanoma. Systemic work-up reveals metastasis, and the patient undergoes multiple cycles of radiation and chemotherapy. He later died of…

Retained Lens Fragment A 61-year-old male referred after complicated cataract extraction surgery (phacoemulsification). On exam he was found to have a large piece of retained nuclear fragment in the inferior vitreous. He underwent PPV along with lens exchange with anterior chamber IOL placement. He…

Normal Tension Glaucoma A 22-year-old previously healthy female from Guatemala presents as a referral for “severe glaucoma” with symptoms of intermittent headaches and gradual decline in vision most notable in the left eye. On exam the patient is found to have low-normal intraocular tension, op…

Primary Vitreoretinal Lymphoma A 77-year-old female with a history of vitritis of unknown origin and two non-diagnostic vitrectomies presented with a white plaque on the posterior capsule of her left eye after being lost to follow up for several years. Repeat vitrectomy confirmed the suspected diag…

Fungal Keratitis A 59-year-old female presented to the Bascom Palmer Eye Institute emergency room with a 7-day history of a red and painful eye, and loss of vision. The right eye exam demonstrated HM vision with a diffuse limbal-to-limbal cornea ulcer within a previous penetrating keratoplasty graf…

Ocular Cicatricial Pemphigoid An 83-year-old monocular male presented to the Cornea division, Bascom Palmer Eye Institute with bilateral decreased vision, pain redness and burning for many years getting progressively worse. Examination revealed hand motion vision, ankyloblepharon and chronic cicatr…

Autosomal Recessive RPE65-Deficient Leber Congenital Amaurosis A 17-year-old male with a biallelic RPE65 mutation resulting in autosomal recessive Leber Congenital Amaurosis is referred for evaluation for subretinal gene therapy with voretigene neparvovec-rzyl. Baseline evaluation was remarkable fo…

Extranodal Rosai-Dorfman Disease A 28-year-old male without past medical history presented with a 1 year history of painless bilateral upper lid swelling. After multimodal imaging studies, the patient underwent diagnostic orbital biopsy. The pathologic analysis of the biopsy showed a plasmacytic in…

Severe Non-Proliferative Diabetic Retinopathy with Cystoid Macular Edema A 65-year-old male with diabetic retinopathy and CME presented to the BPEI retina clinic for continued management of his chronic ocular condition. His care was complicated by an inability to submit to ocular examinations in th…

Central Serous Retinopathy A 48-year-old female presents with a history of chronically decreased vision in her right eye. Multimodal imaging reveals serous macular detachment, thickened choroid, and focal areas of late leakage on fluorescein angiography. The left eye has pigmentary changes in the p…