Diplopia ; Headache ; Sinusitis ; Abducens Nerve Diseases

Dengue fever is a common pyrexial-viral infection in the Asian region and the incidence is increasing yearly. There are various ocular manifestations of dengue fever such as maculopathy, retinal hemorrhages, retinal lesions and vasculitis. Reduction in visual acuity and other visual disturbances such as metamorphopsia is the most common presentation of dengue-associated maculopathy. We report an interesting case of a young lady with bilateral maculopathy secondary to dengue fever who was managed conservatively with dramatic visual improvements. This case highlights the possibility of bilateral and simultaneous ocular involvements in patients infected with dengue fever. Both ophthalmologists and physicians need to be aware of ocular complications following dengue fever and advice patients regarding the symptoms.

We report a case of a 37-year-old smoker who presented with painless and sudden onset of loss of upper field vision of the right eye, associated with one month history of dry cough which was unresponsive to antibiotic and subsequent antituberculosis therapy. Visual acuity at presentation was counting finger. There was bullous retinal detachment on examination. Radiological imaging revealed multiple lung opacities, involving the brain and the right orbit. Bronchoscopy and biopsy confirmed the diagnosis of adenocarcinoma of the lung. This case illustrates masquerade syndrome of which a lung carcinoma harbours behind a seemingly innocent retinal detachment. It also highlights the importance of entertaining lung carcinoma as a differential diagnosis in suspected tuberculosis among heavy smokers.

Traumatic injury to the eye can occur due to various causes, most of which are avoidable. Here we report three cases of intrastromal corneal foreign bodies (FB) which required surgical removal. Most corneal FBs are removed easily at the slit lamp, however, these cases required surgical intervention due to the mechanism of which the FB penetrated into the stroma. Although the mechanism of injury was similar, with all three cases occurring at high velocity, we observed that the entry and level of penetration differed in each case. In the first case, the corneal FB penetrated the cornea and was embedded in the anterior stroma, whereas in the second case, the FB was embedded in the posterior stroma, but with an intact endothelium. In the third case, the FB caused a full thickness, self-sealed laceration wound but remained embedded in the stroma. Through further evaluation, we noted that several factors contribute towards the severity of the injury, namely, anatomy of the cornea, area affected, shape, size, mass and velocity of the object. We speak in depth about the mechanism of injury and physics associated with these injuries and why the penetration differed in each case.
corneal stroma ; foreign bodies ; injury ; mechanics ; physics

A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.

A 42-year-old Malay gentleman presented with progressive painless blurring of vision on his left eye associated with ocular ache, redness and increasing proptosis. Examination revealed presence of relative afferent papillary defect with visual acuity of counting finger, and 6/6 on the right eye. Extraocular muscle movement of the left eye was restricted to ten percent in all directions. Computed tomography (CT) and magnetic resonance imaging (MRI) showed enhancing mass occupying the left orbital apex. Diagnosis of optic nerve sheath meningioma was made, and patient subsequently went for radiotherapy. His symptoms subsided completely, until he presented with similar visual complains, and fullness of the upper lid two years later. A repeated MRI showed enlargement of superior and lateral recti muscles with extension to lacrimal gland region. Biopsy of the lacrimal gland revealed inflammatory cells consistent of inflammatory pseudotumor. High dose systemic steroid was instituted, followed by slow tapering of oral steroid. His symptoms completely resolved, and latest visual acuity was 6/9, with no recurrence, to date.

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.