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Epithelial Downgrowth A patient with a history of bilateral corneal transplants, glaucoma drainage device, and iris cysts presented with gradually decreasing vision after surgical removal of the cyst and cataract surgery in that eye. The patient was diagnosed with epithelial downgrowth and underwen…

Corneal Decompensation Corneal decompensation in the setting of glaucoma surgery is a complex entity that is poorly understood. Endothelial cell loss occurs from both the glaucoma itself and from the placement of intraocular glaucoma devices. This decline in endothelial cells occurs via direct and …

Conjunctival Squamous Cell Carcinoma, Keratoacanthoma Type A patient presented with a rapidly enlarging lesion of the nasal conjunctiva of the left eye. The past ocular history was significant only for bilateral surgical removal of cataracts with intraocular lens placement. The patient had a past m…

Conjunctival Keratoacanthoma Keratoacanthoma (KA) is an epithelial tumor characterized by rapid, abundant growth and a potential for spontaneous resolution. It typically occurs on the skin in sun-exposed areas such as the face, neck, and hands. Rarely it can occur on the conjunctiva and vulvar regi…

Conjunctival Amyloidosis A 48-year-old male with no PMH or POH presented to clinic with painless ptosis OD>OS noticed by his wife for several months. Visual acuity was 20/25 in each eye with unremarkable ocular vitals. Large, yellow-pink, fleshy lesions were noted on the superior bulbar conjunct…

Conjunctival Amyloid Conjunctival amyloid is an uncommon ocular finding but important to consider in the differential of conjunctival lesions. We present a case of a patient who was referred for evaluation of a potential ‘malignant’ conjunctival tumor. On exam she was found to have a yellow, mo…

Juvenile Xanthogranuloma A baby was referred for a new-onset subconjunctival lesion in the right eye. He was found to have a thickened, yellow corneoscleral lesion and hyphema, presumed to be ocular juvenile xanthogranuloma (JXG). He was started on topical steroids as empiric treatment, with initia…

Juvenile Xanthogranuloma Patient presented to the BPEI emergency room with tearing and light sensitivity of the right eye for 1 month. Examination revealed grimace-to-light vision, soft to palpation intraocular pressure, and hyphema. Skin examination revealed yellowish raised skin lesions on the ne…

Ocular Metastatic Cutaneous Melanoma A patient with metastatic cutaneous melanoma to the eye was referred to BPEI glaucoma service for elevated IOP. Examination revealed 20/125 vision and IOP 31 mmHg on multiple glaucoma drops. Gonioscopy revealed a diffuse melanomatous membrane and pigment accumul…

Extra-Parenchymal Neurocysticercosis (NCC) A patient presented with blurry vision and headaches for 6 months. He was found to have grade 5 papilledema with hemorrhages. MRI brain/orbits showed bilateral flattening of the posterior sclera with intraocular protrusion of the optic nerve head and promi…

Juvenile Psammomatous Ossifying Fibroma An 18-year-old female presented with blurry vision, headaches for 4 months. She was diagnosed to have papilledema on an outside eye exam and referred to BPEI. Her visual acuity was 20/20 OD, 20/100 OS. Additionally, she was noted to have junctional scotoma on…

Granular Cell Tumor A patient was referred by an outside ophthalmologist for evaluation. The patient reported having headaches, double vision, and eye bulging for 3 months. Her exam was notable for restricted extraocular movements in her left eye on abduction and adduction. Her slit lamp exam was n…

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…

Acute Myeloid Leukemia A previously healthy child presented with bilateral periorbital edema, right greater than left proptosis, with generalized facial swelling and copious nasal discharge, not improved on antibiotics. Imaging revealed multiple extraconal soft tissue masses in the orbits bilateral…

Orbital Rhabdomyosarcoma - Recurrence A young patient with notable past ocular history of orbital rhabdomyosarcoma, s/p chemotherapy with vincristine, dactinomycin, and cyclophosphamide, and proton beam radiation presented to Bascom Palmer ED with 2 days of blurry vision and “seeing everything gr…

Conjunctival Melanoma Two darkly pigmented patients with a diagnosis of conjunctival melanoma by an outside provider are presented here. Case 1 presented with a large jet black conjunctival lesion that was present for nearly 12 years. This lesion was biopsied by an outside provider and interpreted …

Metastatic Melanoma; Side Effect of Immune Checkpoint Inhibitor A patient with a history of recurrent metastatic conjunctival melanoma presented with a left upper lid orbital lesion and pigmented lesion in the medial fornix. The original conjunctival melanoma was originally excised in an outside ce…

Orbital Sarcoidosis A patient presented with three months of left eye swelling and pain. He was found to have periorbital firmness and fullness, proptosis, and conjunctival chemosis. He underwent computed tomography imaging of the orbits with contrast, which demonstrated an ill-defined, irregular a…

Melanocytoma with Vitreous Seeding A patient with 7 years of blurry vision in the right eye presents to clinic for evaluation. He reports no recent acute changes in vision and no precipitating events in the past. He noticed the blurry vision incidentally while driving when he covered his left eye. …

PAM and OSSN This case presents a 67-year-old gentleman who was referred for a pigmented lesion. The HR-OCT suggested that this was not simply a small area of PAM, but rather demonstrated an epithelial hyper-reflectivity and thickening with an abrupt change from normal to mildly thickened epitheliu…