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Pseudoangiomatous Retinal Gliosis A 54-year-old Hispanic male presented with decreased vision in the right eye over 3 months. Dilated fundus exam of the right eye showed a geographic area of chorioretinal alteration in the far temporal periphery at 9 o’clock, a gliovascular retinal mass superiorl…

Pseudoangiomatous Retinal Gliosis (PARG) A patient with known history of a chronic inferior rhegmatogenous retinal detachment (RD) of the left eye (OS) presented to the Bascom Palmer Eye Institute (BPEI) emergency department (ED) complaining of new floaters OS. On examination the patient had a visu…

Pseudophakic Bullous Keratopathy with Prior Descemet Membrane Tears due to Forceps Trauma A patient with a history of forceps trauma at birth and amblyopia of the left eye who presents with persistent corneal edema 1 year after uncomplicated cataract surgery. Initial visual acuity was 20/200, intra…

Pseudoxanthoma Elasticum A patient with no past ocular history presented to the emergency department complaining of decreased vision in both eyes for 3-4 days. Exam was notable for a visual acuity of 20/25 in the right eye and 20/20 in the left eye. Intraocular pressures were 12 and 12. External ex…

Pulled-in-Two Syndrome A 61-year-old female with longstanding left sixth nerve palsy secondary to meningioma that was resected. Her visual acuity OD was 20/20, OS 20/40. Her traction testing OS revealed severe restriction to abduction. She had visual confusion with superimposition of the images tha…

Punctate Inner Choroidopathy A patient presented to the Bascom Palmer emergency room complaining of seeing a fixed gray spot out of the right eye for two weeks. Past history was unremarkable. Vision was 20/70 OD and 20/30 OS. Intraocular pressure and pupils were normal. The anterior exam was normal…

Pythium Insidiosum Keratitis An 83-year-old otherwise healthy female was referred to the BPEI ER for a progressive corneal ulcer. Exam in the left eye was notable for hand motions vision, normal IOP, and severe corneal ulcer associated with hypopyon and scleral extension. B-scan ultrasonography of …

Radiation Optic Neuropathy A patient with a history of skull base meningioma status-post gamma knife radiation presented with three weeks of decreased vision in both eyes. She had no light perception in the right eye and a visual acuity of 20/50 in the left. Magnetic resonance imaging of the brain …

Radiation Optic Neuropathy A patient with a history of proton beam therapy for a chordoma near the clivus presented with 1 week of blurry vision in the left eye. On presentation, patient’s exam was notable for a visual acuity of 20/25 in the right eye and 20/50 in the left eye. Intraocular pressu…

Radiation Retinopathy A patient with past medical history of CNS lymphoma treated with chemotherapy but refractory and necessitating radiation therapy later presented to ophthalmology with slight decrease in vision. On examination, found to have cotton wool spots in both eyes. Fluorescein angiogram…

Radius-Maumenee Syndrome A 15-year-old male presented with elevated intraocular pressure of the left eye. Gonioscopy revealed blood in Schlemm’s canal. Fundoscopic examination and subsequent ophthalmic imaging confirmed a diagnosis of glaucoma in the left eye. Neuro-imaging was normal without sig…

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…

Refractory Full Thickness Macular Hole A patient presented with a “black central spot” in the right eye. The past ocular history included an idiopathic full thickness macular hole in the right eye that had undergone pars plana vitrectomy with internal limiting membrane peel two times. The left …

Residual Ametropia, Symptomatic Higher Order Aberration A patient who presents for refractive surgery evaluation. They were noted to have no ocular pathology and was deemed a good refractive surgical candidate. Patient underwent uncomplicated bilateral laser in situ keratomileusis, however the pati…

Restrictive Strabismus and Brown Syndrome Secondary to Graves’ Disease A 68-year-old male with restrictive strabismus and Brown syndrome with extraocular movement restriction secondary to TED. He was on clinical trial for Teprotumumab 302 and had prior RAI ablation. His visual acuity OD is 20/20,…

Restrictive Strabismus Secondary to a Large Encapsulated Non-Valved Glaucoma Drainage Implant Fibrotic Capsule A patient with a history of primary open angle glaucoma of both eyes and myopic degeneration with amblyopia and chronic poor central vision of the right eye presented with elevated intraoc…

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…

Retina Vasculitis, Leprosy A 56-year-old man referred to the BPEI for intermediate uveitis and retinal vasculitis. Examination revealed 20/25 vision in both eyes and trace vitreous cells in both eyes. Ocular coherence tomography showed no macular edema. Fluorescein angiogram showed retinal vasculit…

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…

Retinal Arteriole Occlusions Secondary to Silicone Microembolization A patient with a history of mid-brain syndrome and silicone gluteal injection 12 years prior presented to the emergency department complaining of floaters in the right eye for the past week. Exam was notable for visual acuity of 2…