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Bleb Leak A patient with past ocular history of trabeculectomy for juvenile open angle glaucoma and DSAEK for Fuch’s endothelial corneal dystrophy presented to the emergency room with left eye blurred vision and redness. The patient was diagnosed with acute graft rejection. The patient was starte…

White Cataract with Pre-existing Posterior Capsule Rupture from Intravitreal Injection A patient who underwent an intravitreal anti-vascular endothelial growth factor injection developed a white cataract after his procedure. Careful examination and ultrasonography revealed a white cataract with a p…

Ocular Cicatricial Pemphigoid A patient with a past medical history significant for biopsy-proven ocular cicatricial pemphigoid (OCP) was referred for cataract evaluation in the right eye. At presentation, her vision in the right eye was hand motion, and she had been off systemic immunosuppression …

Achromobacter Xylosoxidans Endophthalmitis A 79-year-old male with history of Fuchs endothelial dystrophy of both eyes s/p penetrating keratoplasty of both eyes (1980s), repeat penetrating keratoplasty of left eye (2018) and regmatogenous retinal detachment of left eye s/p repair with silicon oil w…

Bilateral Dense White Cataracts This is a patient with significant complex medical history who presented with hand motion vision secondary to bilateral dense white cataracts. Due to high anesthesia risk given the severity of medial comorbidities including an implanted left ventricular assist device…

Nontuberculous Mycobacterial Keratitis A patient with past ocular history of uncomplicated pterygium surgery develops mycobacterial keratitis which progresses to a descemetocele. After worsening on topical antibiotics to the point of nearly perforating, the patient undergoes rose-Bengal photodynami…

Keratitis Due to Severe Sinonasal Disease with Underlying Granulomatosis with Polyangiitis A young patient with no known prior medical history presents with decreased vision and pain in the right eye. On presentation, patient’s exam was notable for visual acuity of 20/150 in the right eye and 20/…

Acanthamoeba Keratitis A patient presented to the BPEI emergency room with left eye redness and pain for 2 weeks. He had been diagnosed with HSV keratitis by an outside provider but had no improvement on valacyclovir. The vision was 20/20 in the right eye and 20/60 in the left eye, and intraocular …

Ocular Surface Squamous Neoplasia An elderly patient with a diffuse ocular surface squamous neoplasia (OSSN) of the left eye is treated with cycles of Interferon, 5 Fluorouracil and Mitomycin C topical chemotherapy without improvement. Due to high out-of-pocket costs and epiltheliopathy after 7 mon…

A patient with bilateral corneal edema and elevated intraocular pressure due to cosmetic iris implants. Slit lamp photos showing left worse than right corneal edema, with distortion of native iris behind the implant. High resolution ultrasound biomicroscopy showing iris implant resting in the angle…

Ocular cicatricial pemphigoid with symblepharon in both eyes.

Ocular Cicatricial Pemphigoid An elderly patient with severe ocular cicatricial pemphigoid (OCP) and immunosuppressed with mycophenolate mofetil has previously lost the right eye due to corneal perforation and choroidal hemorrhage resulting in evisceration. After 5 years of quiescence, his left eye…

A patient presented with blurred vision in the left eye. Examination showed corneal neovascularization and lipid deposition inferiorly. Anterior segment OCT revealed significant corneal stromal thinning with descemetocele. Treatment was with a with an optical penetrating keratoplasty with corrected…

Terrien Marginal Degeneration Our patient presented with progressive decreased vision in the left eye and was found to have significant thinning of the inferior cornea associated with corneal neovascularization and lipid deposition, which was worse in the left than the right eye. Inflammatory lab w…

Stickler Syndrome This presentation describes a teenage patient who presented with bilateral retinal detachments. He has a strong family history of Stickler Syndrome. Additionally, there is a family history of multiple types of cancers, specifically GI cancers. The patient underwent an exam under a…

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 …

Peripheral crescentic ulceration and thinning along limbus from 0600 to 1200 with superior neovascularization associated with pain. Treatment was initially with lubrication, antibiotic, systemic steroids, vitamin C, and doxycycline. Ultimately, the patient needed conjunctival recession with AMT pla…