A 58-year-old Malay lady, presented with gradual loss of vision in the right eye for 1 month duration. It was associated with right sided headache, nausea and vomiting. Patient had a history of contact with tuberculosis patient. On examination, visual acuity in right eye was no perception of light with presence of relative afferent pupillary defect. The left eye visual acuity was 6.0/7.5. There was a total restriction of extraocular movement in all direction (frozen eye) in the right eye. Both anterior segments were unremarkable. Fundoscopy in both eyes showed normal appearance of optic disc and retinal vessels. Other cranial nerves were normal. Lungs were clear and had no lymphadenopathy. Chest radiograph was normal. Erythrocyte sedimentation rate was elevated by 35 mm/h and Mantoux test was positive (20 mm). MRI of brain and orbit demonstrated thickening and irregularity of the right optic nerve on axial view with doughnut sign on coronal view. Patient was diagnosed to have optic perineuritis secondary to tuberculosis. She was treated with anti-TB drugs. Systemic corticosteroid was commenced after 2 weeks. The visual acuity was improved to hand motion after 1 month with almost complete resolution of extraocular movement.

·AIM: To report cases of carotid cavernous fistula in post traumatic patients successfully treated with coil embolization.·METHODS: Two cases of direct carotid cavernous fistula (CCF) underwent successful coil embolization. Both patients presented with clinical features of CCF following motor vehicle accident at two weeks and four months. One patient had good visual acuity with raised intraocular pressure (IOP) and the other had poor vision with borderline IOP. The diagnosis was confirmed with cerebral angiography. Coil embolization were performed in both cases.·RESULTS; After the procedure the vision was back to normal and IOP came down to normal range without anti-glaucoma. The features of CCF were also resolved, which included proptosis, ophthalmoplegia, chemotic conjunctiva, orbital bruit and fundus changes.·CONCLUSION: Carotid cavernous fistula should be diagnosed and treated early to prevent serious ocular complication of vision loss. Endovascular embolization is the current treatment of choice.

·AIM: To present a case of Coats' disease in adult and to illustrate the retinal findings.·METHODS: A case report.·RESULTS: A 63 years old Malay man, a known case of diabetes mellitus, presented with one year history of painless and progressive reduced vision in the right eye. Right eye visual acuity was counting finger 2 feet while left eye best corrected visual acuity was 6/12. Right fundus showed presence of extensive subretinal exudates at the temporal part of the posterior pole involving the macular area and nasal to the optic disc. It was associated with multiple areas of abnormal blood vessels temporal to the macula with attenuated vessels. Fundus fluorescein angiography(FFA) showed presence of telangiectatic vessels at the area of subretinal exudates and leakage of fluorescein from the telangiectatic vessels. The left eye was normal. Based on clinical and FFA findings, he was diagnosed to have adult Coats' disease. The right eye was treated with argon laser photocoagulation. Six months post laser, his visual acuity remained at 6/120 and there was minimal regression of the disease seen in the retina. ·CONCLUSION: The clinical and angiographic findings are important in diagnosing retinal telangiectasia. Treatment by laser photocoagulation in area of leakages may be beneficial in preventing visual loss.

A 42-year-old Malay lady presented with a 2-year history of painless and progressive right upper lid swelling. There was no history of trauma or similar lesion elsewhere. An excisional biopsy of the mass was performed and the histopathological findings of the excised lesion were consistent with those for a trichilemmal cyst. Trichilemmal cyst, although rare should be considered in any case of eye lid lesion.

A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.
Abscess ; Orbital cellulitis ; Carbon ion ; Ipsilateral ; Contralateral

The worldwide upsurge of Type 2 Diabetes Mellitus (T2DM) warrants the attention of public health, especially in complications. Diabetic Retinopathy (DR), the commonest ocular complication, contributes to the growing incidence of blindness. Recommendations that the visual acuity (VA) assessment guidelines should be used in DR screening was not routinely practiced. This study aims to model the predictive effect of VA - a simple economic clinical assessment - upon DR in patients with T2DM. A case-control study was conducted in Hospital Universiti Sains Malaysia with subjects recruited from the ophthalmology clinic. The primary variable during analysis was VA, and the outcome variable was DR. Models with eight control variables which included age, gender, and duration of DM were developed. The predictive effect measured by logistic regression showed that when unadjusted; four variables had a significant association with DR, at p-value<0.25; they were the duration of DM, systolic blood pressure, glycosylated haemoglobin and VA. From the eight different predictive models, the estimated adjusted odds ratio produced ranges from 6.09 to 11.64. Our study shows that VA has a predictive effect upon DR in T2DM patients. We suggest VA assessment, to be on par with the monitoring of blood pressure and blood glucose.
Predictive ; Visual acuity ; Diabetic Retinopathy ; Type 2 Diabetes Mellitus

AIM: To describe a case of diffuse conjunctival calcinosis in hyperpararthyroidism and end stage renal failure patient.METHODS: A case report.RESULTS: A 35-year-old gentleman, known case of hyperparathyroidism with subtotal parathyroidectomy done and end stage renal failure, presented with one month history of foreign body sensation of both eyes associated with redness and tearing. On examination, vision was 6/6 OU with diffuse conjunctival deposits and congestion. Conjunctival histopathological examination showed multiple foci of calcium deposits in the subepithelial stroma. Serum calcium was markedly raised and serum phosphorus was normal. His eye symptoms was reduced with topical steroid (betamethasone) and intramuscular calcitonin. CONCLUSION: Diffuse and symptomatic conjunctival calcinosis is uncommon condition of ocular calcium deposition. Hyperparathyroidism and renal failure are the contributing factors for the development of it.

A 32-year-old lady, diagnosed with anaplastic large cell non-Hodgkin's lymphoma of the mediastinum, presented with bilateral floaters and reduced right eye vision 3 years post chemotherapy. Ophthalmic examination revealed bilateral panuveitis with multiple deep seated choroidal lesions in the left eye. Computed tomography scanning of the orbit showed enhancing and bulky optic nerve sheath at the retrobulbar part of both optic nerves. The patient was treated with involved field radiation therapy of the orbit, with cumulative dose of 30Gy. Eight months post radiation therapy, she developed retinal pigment epithelial detachment at the macula and deep chorioretinal degeneration at superotemporal and inferonasal regions of the right fundus. There was evidence of vitreoretinal traction at the margin of chorioretinal degeneration areas, thus barricade lasers were performed in the affected eye. Her visual acuity remains 6/6 in both eyes. Retinal pigment epithelial detachment is a possible complication of radiation therapy in non-Hodgkin's lymphoma with intraocular metastasis. It is essential to alert the managing ophthalmologists about this rare complication.

·AIM: To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients. ·METHODS: Case series of three patients with syphilitic uveitis were managed in Hospital USM.·RESULTS: Three patients were diagnosed to have uveitis secondary to syphilis. All three patients were not known to have syphilis prior to presentation but had positive history of sexual promiscuity.Allpatients presented with progressive blurring of vision for average of one-month duration. Two of them had association with fever,ocularpainandfloaters.Visualacuityat presentation ranged from 6/12 to hand movement. Mild anterioruveitis( non-granulomatous),vitritisand papillitis were present in all the patients. First patient had multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinaldetachmentwhilethethirdpatienthad chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral.·CONCLUSION: Ocular syphilis presented here as non granulomatous inflammation associated with exudative retinal detachment, Final visual outcome is generally good despite slow improvement after treatment.

A 67-year-old man presented with right sided temporal headache and sudden onset of painless loss of vision in the right eye. It was associated with total ophthalmoplegia with swollen optic disc. ESR and C-reactive protein were elevated. Magnetic resonance imaging demonstrated features of optic perineuritis. The right temporal artery biopsy was normal. The extraocular movements improved with systemic steroids. Unfortunately the patient developed central retinal artery occlusion in the right eye. Total ophthalmoplegia is a rare presentation of giant cell arteritis and initiation of corticosteroids is required for a satisfactory outcome and to prevent blindness of the fellow eye.