Venous stasis retinopathy complicating a case of cavernous-carotid fistula with an initial normal computed tomography angiogram of the brain

Carotid-cavernous fistula (CCF) can be spontaneous or due to trauma. Due to its complication to the eye, diagnosis and intervention should not be delayed. We report a case of an elderly female who presented with left eye redness with gradual onset of protrusion over the same eye. She was suspected to have CCF with the clinical presentation. Nevertheless, she had a normal computed tomography diagnosis of CCF was confirmed. However, due to delay in diagnosis and treatment, the patient developed venous stasis retinopathy and neovascular glaucoma. Her vision remained poor despite aggressive systemic and ocular treatments. This case report is to emphasise the importance of clinical suspicion of a disease despite a normal imaging. This is to prevent irreversible blindness and other systemic complications. angiogram of the brain. Later, she was scheduled for cerebral angiography and th

Frontal mucocele masked as upper lid abcess-a case report

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

Recurrent chalazia secondary to bortezomib

Few cases of chalazia secondary to bortezomib are reported in literature. However, it is not a recognized ocular adverse effect. We hereby report a case of recurrent chalazia secondary to bortezomib. A 40-year-old male with light chain myeloma on ten weeks of chemotherapy with bortezomib was treated for left eye inflamed chalazion with bilateral meibominitis. Severe chalazia persisted despite treatment, which necessitated cessation of chemotherapy. The patient’s condition improved on oral doxycycline and chemotherapy was recommenced but his chalazia recurred, necessitating incision and curretage. His chalazia responded to oral azithromycin without further cessation of chemotherapy. Bortezomib’s association with chalazia has been characterized as a possible adverse drug reaction according to the World Health organization classification, and its recognization as an established adverse reaction to will allow earlier identification and appropriate co-management of the patient

Development of Contact Lens Suitability System (ClenSyst)

This paper proposes a system that can determine the suitability of contact lenses usage.The aim of this work is to provide a decision making system by using the application of fuzzy logic to analyze and decide the appropriate type of contact lenses based on the corneal condition, astigmatism, reason and environment of the patient.A corneal topography is used to give information on corneal power and astigmatism measurement.The expected output of the system is suitability of using contact lenses, corneal power and the type of contact lens

Chronic Follicular Conjunctivitis Secondary to Chlamydial Trachomatis

Chronic follicular conjunctivitis is commonly caused by Chlamydia trachomatis infection. Patients usually present with non-resolving conjunctivitis which is associated with tender lymphadenopathy. We report a case of a monogamous young female with chronic inclusion conjunctivitis. A 34-year-old healthy female presented with redness of the left eye (LE) for 3 days, associated with blurred vision and ocular discharge. Visual acuity (VA) of the right eye (RE) was 6/6 and 6/24 in LE with pinhole 6/6. There was mucopurulent discharge over the LE with injected conjunctiva and follicular reaction involving the upper eyelid. She was treated as LE bacterial conjunctivitis and started on topical eyedrops ciprofloxacin 0.3% and artificial tear eye drops every 2 hours. She denied any history of contact with patients with similar history or history of sexually transmitted infection. She discontinued treatment and presented again 3 weeks later with bilateral eyes injected with follicular reactions and the presence of a thin pseudomembrane over the upper eyelids associated with painful preauricular lymph nodes. Noted generalized punctate epithelial erosions (PEE) over bilateral eyes with mucous strands adhered to cornea epithelium. A corneal epithelial defect of 3.7 mm(V) x 4 mm(H) was noted in the RE. The VA in the RE was 6/18 with pinhole 6/12, and 6/9 in the LE, with pinhole the same. The diagnosis of bilateral follicular conjunctivitis with filamentous keratoconjunctivitis secondary to Chlamydia trachomatis was confirmed by a positive conjunctival smear. She was then treated with fucithalmic ointment twice daily and tetracycline 250 mg orally four times daily for three weeks. Signs and symptoms disappeared after completion of tetracycline treatment

Large leaking descemetocele presenting as a traumatic corneal laceration

A 47-year-old healthy Indonesian gentleman, presented with blurring of vision on the left eye associated with pain and redness after history of foreign body entering the eye. A general practitioner prescribed him some eye drops; however, his symptoms worsened. A corneal laceration wound measuring 0.5 x 3.5mm with a large stromal abscess measuring 9.0 x 5.0mm with flat anterior chamber was seen on the left eye. Emergency corneal T&S revealed a large descemetocele and cyanoacrylate corneal glue was applied on the area. C&S showed Pseudomonas aeruginosa. Patient was subsequently undergone penetrating keratoplasty as a definitive measure. This case highlights the rapid progression of pseudomonas keratitis, presented with a large descemetocele, which can be mistaken as an infected corneal laceration wound. Corneal cyanoacrylate glueing together with corneal suturing is a viable temporary method for large descemetoceles awaiting definitive surgery

Automatic Rule Generator via FP-Growth for Eye Diseases Diagnosis

The conventional approach in developing a rule-based expert system usually applies a tedious, lengthy and costly knowledge acquisition process. The acquisition process is known as the bottleneck in developing an expert system. Furthermore, manual knowledge acquisition can eventually lead to erroneous in decision-making and function ineffective when designing any expert system. Another dilemma among knowledge engineers are handing conflict of interest or high variance of inter and intrapersonal decisions among domain experts during knowledge elicitation stage. The aim of this research is to improve the acquisition of knowledge level using a data mining technique. This paper investigates the effectiveness of an association rule mining technique in generating new rules for an expert system. In this paper, FP-Growth is the machine learning technique that was used in acquiring rules from the eye disease diagnosis records collected from Sumatera Eye Center (SMEC) Hospital in Pekanbaru, Riau, Indonesia. The developed systems are tested with 17 cases. The ophthalmologists inspected the results from automatic rule generator for eye diseases diagnosis.  We found that the introduction of FP-Growth association rules into the eye disease knowledge-based systems, able to produce acceptable and promising eye diagnosing results approximately 88% of average accuracy rate. Based on the test results, we can conclude that Conjunctivitis and Presbyopia disease are the most dominant suffering in Indonesia. In conclusion, FP-growth association rules are very potential and capable of becoming an adequate automatic rules generator, but still has plenty of room for improvement in the context of eye disease diagnosing

Mental health state of low vision patients using the hospital anxiety and depression scale and the depression, anxiety and stress scale

Mental health status of low vision (LV) patients is not a routine evaluation. This study was carried out to determine the mental health status among LV patient using Depression Anxiety Stress Scale (DASS-21) and Hospital Anxiety and Depression (HAD) Scale questionnaires. A total of 100 LV patients were recruited in this cross-sectional study. Standard LV assessment and mental health screening using DASS-21 and HAD Scale questionnaires were administered. The mean age of the subjects was 62.77+9.15 years old. There were 63% Malays, followed by 26% Chinese and 11% Indians. The mean visual acuity of the subjects was 0.45+0.24 LogMAR. Results showed the mean score for depression and anxiety for HAD scale questionnaire were 3.11+3.35 and 2.85+3.21, respectively. The mean score for depression, anxiety and stress for DASS questionnaire were 4.83+6.90, 3.58+3.79 and 6.18+6.92, respectively. The mean scores fell into the normal range classification of severity on both HAD scale and DASS. The HAD Scale showed that 12% of the subjects experienced depression and 8% experienced anxiety while the DASS showed that 7% had depression, 17% had anxiety and 24% experienced stress. These findings illustrate that the mental health of the LV patients can be affected due to visual impairment. In conclusion, the mental health status of LV patients can be screened objectively using DASS-21 and HAD Scale questionnaire. Understanding the mental health status of LV patients will enable us to provide better LV assessment and rehabilitation

Hemangioblastoma in the setting of Von Hippel Lindau disease: a case report

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

Binasal hemianopia due to bilateral internal carotid arteries dolichoectasia: A case report and literature review

Binasal hemianopia is rare. It is more commonly associated with ocular diseases than intracranial pathologies. Nevertheless, the proximity of internal carotid arteries (ICA) to the visual pathway may cause a variety of neurologic effects which may lead to visual loss. Although visual loss is uncommon, ICA aneurysm may compress the optic nerve causing visual field defect and reduced visual acuity. We report a 66-year-old male presented with asymptomatic binasal hemianopia detected during routine glaucoma screening. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain and orbit showed dolichoectasia in the cavernous segment of both ICA, which compressed the pre-chiasmatic optic nerve bilaterally. Humphrey’s visual field test confirmed the diagnostic of binasal hemianopia respecting the vertical midline. This was the first reported case of binasal hemianopia without visual disturbances. This case highlights the importance of using CT and MRI as additional diagnostic tools to identify the true cause of binasal hemianopia (ICA dolichoectasia) in patients with glaucoma. A thorough assessment of any visual field defect helps to detect life-threatening intracranial pathologies effectively and is managed accordingly