In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving systemic chemotherapy for embryonal ovarian carcinoma.

A middle-aged gentleman with history of left penetrating keratoplatsy presented with left eye perforated corneal graft secondary to infective keratitis. The affected eye was blind from absolute steroid-induced glaucoma. In view of expected poor graft survival in a blind eye, globe removal was offered. However, the patient refused the treatment and request for another corneal graft. This case highlights both the possibility of good outcome of cornea graft in such a case, and also illustrates that patient’s autonomy to refuse treatment option outweighs beneficence.
Blindness

Frontal mucocele is not commonly masked as upper lid abscess.A 72-year-old Chinese man with underlying hyperthyroidism complained of left upper eyelid swelling of 6 months duration. The swelling had persisted and worsen when intravenous antibiotic was changed oral type. Visual acuity on presentation was hand motion and reverse relative afferent pupillary defect was present. Because the swelling was large and resulted in mechanical ptosis and ophthalmoplegia, a CT imaging was performed, which showed huge left frontal mucocele eroding the supereromedial orbital rim. The left globe was displaced inferolaterally but there was no extension into brain parenchyma. Fundus examination showed pale optic disc with dull macula. Old laser marks were seen at peripheral fundus. Referral to ortholaryngologist was made and endoscopic sinus surgery and evacuation of mucopyocoele was done. Culture and sensitivity of the fluid showed no organism. He recovered well postoperatively with additional two weeks of antibiotics. We highlight the necessity of surgical drainage of mucocele, following a course of antibiotic.
Mucocele

A 17-year-old male student of Indonesian parentage presented with two weeks history of progressive painless bilateral visual deterioration. There was no contact with tuberculosis (TB)-infected patients and parents claimed that all immunization including BCG was completed. However, BCG scar was not apparent. Visual acuity was 6/36 and 6/60 in the right and left eyes respectively. The anterior and vitreous chambers were quiet. Funduscopic examination revealed retinal vasculitis with perivascular exudates, branch vein occlusion, neovascularization and macular oedema. Fluorescein angiography confirmed large areas of capillary non-perfusion and leaking new vessels. Mantoux test was positive and full regime anti-TB therapy was instituted. HIV screening was negative. Three days later, an immunosuppressive dose of oral steroid was started. Both eyes received intensive laser photocoagulation. Interestingly, there was no development of vitritis throughout.

A 21-year-old Chinese gentleman with no known medical illness, presented with a history of right painless blurring of vision with central scotoma of two weeks duration. He also had a history of multiple episodes of seizures prior to presentation. Visual acuity was 1/60 with unremarkable anterior segment findings and no relative afferent pupillary defect. Fundus examination of the right eye revealed dilated and tortuous retinal veins with multiple retinal capillary hemangiomas and sub retinal hard exudates at the macula with edema. A diagnosis of Von Hippel Lindau disease was made when a posterior fossa mass suggestive of hemangioblastoma with obstructive hydrocephalus was seen on computed tomography of the brain. Craniotomy with nodule excision was performed. The retinal capillary hemangiomas were treated with the combination of laser photocoagulation and intravitreal Ranibizumab injections. Visual acuity subsequently improved to 6/36.
Hemangioblastoma ; von Hippel-Lindau Disease

Non-compliance to hygienic practices in contact lens wear is regarded as a significant risk factor for contact lens-related complications. Non-compliant behaviour continues to prevent efforts to improve contact lens safety despite advancements in lens materials and care solutions. The objective of this study was to identify the association between knowledge, compliance and complications of contact lens wear. A cross-sectional design was used and contact lens users among medical faculty students were identified and recruited via convenience sampling throughout October 2013 to March 2014. A total of 36 close-ended questions that focused on knowledge level, compliance to standard contact lens practice, and experience of complications were administered. A total of 188 respondents, majority of females (89.4%; n=168) participated in this study. Although majority had good knowledge level (68.1%; n=128) on care and usage of contact lens while only a small number having moderate knowledge (26.6%; n=50) and poor knowledge (5.3%; n=10), most of them were partially compliant (74.5%; n=140) to the recommended contact lens practices. However, a small group was found to be fully compliant (24.4%; n=46) and the rest being non-compliant (1.1%; n=2). There was a significant association between knowledge on contact lens usage and compliance level to standard practices (p=0.0003). In addition, a significant association also existed between compliance level to recommended practices and risk of complications from contact lens usage (p=0.023). Findings of this study showed the positive association between knowledge of contact lens usage and compliance to recommended practices and negative association between knowledge of contact lens usage and complications experienced by contact lens users. By providing basic knowledge on contact lens care and usage via education, improvement on compliance and enhancement of safety of contact lens wear could invariably be achieved.

A 55-year-old healthy lady withhistory of regular contact lens (CL) use presented with 10 days history of progressive left eye blurring of vision, redness and pain. There was good CL hygiene practiced with no history of swimming, trauma or contact with domestic pets. Left eye vision was hand movement and right eye was 1/60, pinhole 6/18. On the left eye, there was a central, oval-shaped corneal infiltrate with an overlying large epithelial defect and stromal oedema, with significant anterior chamber cells and fibrin. B-mode ultrasound showed no vitritis. Intensive topical benzylpenicillin 10000iu/ml and topical gentamycin 1.4% hourly, homatropine 2% three times daily, oral doxycycline and oral ascorbic acid were started. The gram stain results showed gram positive cocci growth. Her ulcerimproved with the treatment and preservative-free dexamethasone 0.1% once daily was commenced to reduce inflammation and scarring. Interestingly, culture was reported as Pasteurella maltocida, a gram negative bacilli sensitive to penicillin, and so treatment was continued until the ulcer completely healed. She had central corneal scarring with best corrected vision of 6/24 in the left eye but was not keen on further surgery to improve her vision. Although it has not been previously reported, Pasteurella multocidacan cause CL related corneal ulcer with severe anterior chamber inflammation. This diagnosis should be considered even if there is trivial contact or no history of exposure to domestic animals.