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Neurotrophic Keratitis A patient presented to the Bascom Palmer Eye Institute’s emergency room with acute on chronic left eye pain. The history was notable for a left petroclival chondrosarcoma that had been resected with post-operative, left-sided cranial nerve 5, 6, 7 and 8 palsies. The patient…

Gonococcal Preseptal Cellulitis, Gonococcal Conjunctivitis A 21-year-old female presented to the hospital with 5 days of right eye redness, swelling, discharge and pain. Exam revealed VA OD 20/70, painful EOM and severe conjunctival chemosis and discharge, and eyelid swelling. CT scan revealed righ…

This patient presented with left-sided CN 5, 6, 7, and 8 palsies leading to multiple emergency visits for corneal erosions and infectious corneal ulcers. Prior treatment was with amniotic membrane discs, superficial keratectomy with EDTA, botox tarsorrhaphy, and a surgical ertractor reinsertion wit…

Slit lamp photo with dilated epi-scleral veins. Fundus photo with retinal hemorrhages. FA with severe non perfusion, leakage from the disc, and laser scars. MRI/MRA demonstrates left distal precavernous/proximal cavernous ICA fistula into the cavernous sinus with arterialized flow. There is resulta…

Increased intracranial pressure leading to bilateral optic nerve edema. Grade 5 is considered when all vessels are partially obscured by edema.

Squamous Cell Carcinoma of the Lacrimal Sac A patient presented to the emergency department for a history of tearing on the right eye and medial canthal mass. He had a history of chronic sinus pain for months, initial examination was notable for increased tear lake on the right eye, along with an i…

This patient presented with 1 month of left eyelid swelling. MRI showed infiltration in the periorbital soft tissues. Absolute CD4 count was 27 and the diagnosis was made with immunohistochemistry positive for HHV8. The patient was started on HAART therapy, the local lesions were treated with nitro…

The patient presented with an enlarging lower eyelid lesion for 2 months. There was irregular pigmentation without ulceration or madarosis. Biopsy confirmed an intradermal nevus.

Orbital Venous Lymphatic Malformation A patient presented to the ER complaining of 2 days of increasing pain and swelling behind the left eye. Of note the patient reported that as a teenager he was previously treated for an orbital tumor. On exam he was found to have massive proptosis, hyperglobus …

A patient with orbital venous lymphatic malformation causing massive proptosis. MRI demonstrates an enhancing, T1 hypointense, T2 hyperintense, lobulated mass with small blood-fluid levels in the left medial orbit compressing the globe and causing bony deformation of the bony orbit. Surgical specim…

Sebaceous Carcinoma, Concern for Muir-Torre Syndrome Our patient presented with a greater than one year history of a non-resolving right eyelid mass that began to hemorrhage due to accidental trauma. Exam was remarkable for and extensive multi-lobar ulcerated mass found along the right lower lid al…

Presumed Rhino-Orbital Mucormycosis A patient with a past medical history of PCOS and type 2 diabetes mellitus presented to an outside hospital six weeks pregnant with right sided facial pain and periorbital swelling. Ophthalmology was consulted for sudden, progressive vision loss in the right eye.…

Intraorbital Foreign Body A patient presented with right eye redness, swelling, and diplopia for 6 weeks after a dirt bike accident, where his right eye hit a tree branch. He underwent imaging and evaluation at an outside institution which revealed orbital fractures, but no evidence of an orbital f…

Intraorbital Foreign Body Intraorbital foreign bodies most commonly present with an ocular or penetrating injury. However, when the globe is not involved, the presentation of an intraorbital foreign body can be subtle. Here, we present a case of a 21-year-old female with right upper and lower lid s…

Ocular Cicatricial Pemphigoid An elderly patient with a past ocular history of biopsy-negative cicatrizing conjunctivitis with symblepharon in both eyes, dry eye syndrome, myopic degeneration, and bilateral pseudophakia presented with right eye pain and itching for 3 days. She reported no associate…

Leukemic Retinopathy A patient with no significant past medical history presented to BPEI ER complaining of blurry vision in the left eye for two weeks. On fundus exam, he had hemorrhages in multiple layers of the retina, venous dilation and tortuosity, and Roth spots. CBC was obtained which reveal…

Fundus photos showing sheathing of the major and minor vasculature. Fluorescein angiography with small vessel vasculitis with diffuse temporal non-perfusion.

The patient presented with a RAM and sub-macular hemorrhage. Treatment was with pars plana vitrectomy, sub-retinal tissue plasminogen activator injection and 26% SF6 gas. The hemorrhage resolved with some photoreceptor changes, but no fibrosis and the patient regained 20/40 vision.

A 40-year-old female with headaches, hearing loss and a superior scotoma in the right eye. Fundus photo with multiple inferior branch retinal artery occlusions. Angiography with non-filling of the inferior arterioles and capillary dropout in the area of the infarct. MRI showed scatter FLAIR lesions…