Jaya Agrawal

Conjunctival ulceration following triamcinolone injection

PURPOSE To report conjunctival ulceration as a complication of periocular triamcinolone acetonide injection. Interventional case series. METHODS Conjunctival ulceration was found in three patients who had anterior subtenons or subconjunctival deposition of triamcinolone. Cultures from the ulcer edges were negative. RESULTS Most of the triamcinolone extruded, and the conjunctival ulcers healed with minimal scarring. CONCLUSIONS Conjunctival ulceration was a potential complication of periocular triamcinolone injection in three patients who had anterior subtenons or subconjunctival deposition of the corticosteroid.

Iridoschisis associated with lens subluxation

The etiopathogenesis of iridoschisis is unclear, although age-related degeneration and angle-closure glaucoma are its most common associations. We report the case of a 50-year-old man with lens subluxation (familial) in 1 eye and ipsilateral iridoschisis. The inferotemporal edge of the lens was directed anteriorly, pushing the iris forward; this led to iridoschisis and shallowing of the anterior chamber. The patient had bilateral angle-closure glaucoma. A subluxated lens rubbing against the iris may be a mechanical precipitating factor in the development of iridoschisis.

Complete capsular bag distension syndrome

After conventional extracapsular cataract extraction and in-the-bag intr aocular lens (IOL) implantation 3 years previously, the partially cut su perior one-third of the anterior capsulotomy flap resealed in the eye of a 55-year-old woman. With the integrity of the capsular bag restored, it distended fully; the IOL was in the center and milky fluid accumulated inside. A neodymium:YAG laser was used to drain the milky fluid and di srupt the opacified anterior and posterior capsules, restoring vision.

Cilium as a foreign body in the meibomian gland opening

Case 1 A 15-year-old girl presented with pain, foreign-body sensation, photophobia, watering, and gradually increasing whiteness in the lower part of the cornea of the left eye of 1 month duration. The symptoms had not been relieved by multiple ophthalmic consultations. There was no history of lid disease. On examination, conjunctival injection and keratitis in the lower part of the cornea were seen and the adjoining middle of the lower lid was inflamed with redness and swelling. Hourly instillation of chloramphenicol 0.3% eyedrops were prescribed. The symptoms were not relieved, and repeated slitlamp examination revealed no other lid pathology. During examination 2 weeks later, as the lower lid was pulled, an eyelash popped out of the inflamed meibomian gland from the center of the lower lid (Figure 1). The eyelash was pulled out without resistance. It was inverted, with the tip, which had laid inside, and the root, which pointed out, intermittently causing keratitis. All symptoms and signs resolved. The follow-up examinations at 1 and 2 months were normal.

Double-ring corneal arcus

Corneal arcus comprises a single ring of peripheral corneal opacity occurring as a result of lipid deposition in the corneal stroma. It occurs most commonly in elderly people (arcus senilis). We report 2 cases with 2 complete rings of corneal arcus bilaterally, an unusual finding. The first patient was an 85-year-old woman seen at our clinic with advanced cataract in both eyes. The right eye also had an old central corneal opacity. The second patient, a 60-year-old man, had an immature cataract and an old superior trabeculectomy bleb in both eyes. In both eyes of these 2 patients, 2 complete rings of corneal arcus were present all around (Figures 1 and 2). The inner ring was well-defined with a sharp peripheral border, fading gradually toward the center. The outer ring had a sharp inner border, and the opacity gradually decreased as it reached the periphery, ie, the limbus. Hence, 2 clear zones of cornea (lucid interval of Vogt) were present, the first separating the 2 sharp borders of the 2 rings and the second between the outer ring and the limbus. The 2 corneal arcus rings were shifted centrally in the right eye of the first patient at 6 o’clock and in the left eye of the second patient at 7 o’clock; these 2 sites had old peripheral corneal opacities. The 2 rings of arcus involved the entire corneal stromal thickness, and no abnormal blood vessels on the cornea, the limbus, or the angle could be detected on slitlamp examination or gonioscopy. The rest of the ocular examination and systemic examination was within normal limits. The second patient’s systemic history was notable for the presence of psoriasis for 30 years; he had used topical glucocorticoids, salicylic acid, and crude coal tar off and on. Complete blood count, blood sugar, and serum lipid profile of the 2 patients were within normal limits. On examination of available siblings and children of the 2 patients, the younger individuals were found to have no arcus and the elder individuals had single-ring arcus senilis that was normal for their age. The mechanism of corneal arcus formation is not known. In normal individuals, the incidence of corneal arcus tends to increase with age, although an early arcus may be caused by dyslipidemia. The earliest sites of lipid deposition when the corneal arcus develops are the deeper layers of the corneal stroma and the sclera adjoining the deep scleral vascular plexus; later, the ciliary body and iris may also become involved. During normal arcus senilis formation, annular infiltration of the peripheral corneal stroma and a perilimbal zone of the sclera occurs constituting 2 concentric bands about 1.0 mm wide, leaving the limbal area between entirely free. Arcus formation is related to the increasing permeability of limbal vessels with age, allowing lipids to pass into the cornea. Its dependence on limbal blood vessels is also shown by the fact that when there is increased vascularity as from an old inflammation or a tumor, the deposition forms preferentially in the neighborhood and