Lik Thai Lim

Tamoxifen Keratopathy as Seen with In-vivo Confocal Microscopy

Tamoxifen is a triphenylethylene non-steroidal oestrogen antagonist widely used in oestrogen receptor-positive breast cancer, with well-documented ocular side-effects. Here we report a corneal confocal microscopy finding of a patient on low-dose tamoxifen. We believe that this is the first case report of a patient on low-dose tamoxifen with demonstrable corneal stromal crystalline deposits with confocal microscopy, but clinically asymptomatic with unremarkable corneal findings on cursory slit lamp examination. In summary, confocal microscopy is a useful adjunct in monitoring tamoxifen crystalline keratopathy, and helps detect subclinical deposits not visible/detected on slit lamp examination.

A review of drug-induced acute angle closure glaucoma for non-ophthalmologists

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Several types of drugs have the potential to precipitate acute angle closure glaucoma. These include adrenergic, cholinergic and anticholinergic, antidepressants, anticoagulants and sulfa-based agents. This article provides a basic overview of the risk factors and pathophysiologic mechanisms involved in angle closure glaucoma and focuses on drug-induced angle closure glaucoma for the non-ophthalmologist. A PubMed search limited to the English language was conducted to find relevant literature for the purpose of this article. Most attacks occur in subjects unaware that they are at risk due to innately narrow iridocorneal angles. Clinicians should always review medications in patients presenting with symptoms of acute angle closure glaucoma. The aim of this article is to bring this ophthalmic condition to the attention of clinicians, particularly those outside the field of ophthalmology who commonly prescribe these medications or see these patients prior to referring to ophthalmologists.

Secondary Intracranial Hypertension from Testosterone Therapy in a Transgender Patient

Abstract We report an occurrence of intracranial hypertension secondary to testosterone therapy in a transgender patient. This is the first reported case to our knowledge demonstrating a direct association with raised levels of free testosterone and intracranial hypertension.

Impact of Parental History of Myopia on the Development of Myopia in Mainland China School-Aged Children

Background Myopia is a very common condition and a significant public health problem in China. The objective of the study was to explore the genetic influence on myopia in Mainland China school-aged children in Beijing. Methods In 2008, the data from 15,316 Chinese school students aged 6–18 years from 19 randomized schools in Beijing were analyzed to evaluate genetic influence on myopia in children. Heritability was calculated by mid-parent–offspring regression and parent–offspring regression. Results The estimate of heritability was 0.30 (95% CI, 0.27–0.33) for refractive value (RV). The adjusted mean refractive error was –2.33D (95% CI, –2.45 to –2.21) in children with two myopic parents compared with –1.13D (95% CI, –1.78 to –1.08) in children with no parental myopia. The adjusted odds ratio (OR) was 2.83 (95% CI, 2.47–3.24) in children with two myopic parents compared with no parental myopia. Conclusion The study found a strong association between parental history of myopia and genesis of myopia in the offspring even after adjusting for environmental factors.

Acute pulmonary histoplasmosis in a patient with uveitis after infliximab therapy

The purpose of this study is to report a case of disseminated histoplasmosis in a patient with uveitis, after treatment with infliximab. The method employed in this study is single case report. Infliximab can be useful in controlling idiopathic uveitis, but can give rise to disseminated histoplamosis, especially in patients living in geographic areas where histoplasmosis is endemic. Clinicians should be aware of the possibility of rapid onset histoplasmosis in patients receiving anti-tumor necrosis factor agents. In such cases, these agents should be immediately stopped, investigations performed, and appropriate treatment started.

Bilateral anterior uveitis secondary to erlotinib

We would like to report the first case of bilateral severe anterior uveitis secondary to erlotinib. Erlotinib is an epidermal growth factor receptor (EGFR) inhibitor which can contain certain cancer cells [1]. It is licensed for use in patients with non-small-cell lung carcinoma (NSCLC) in the UK as a secondary treatment for those patients who fail to respond to standard chemotherapy.

Macular optical coherence tomography findings following blunt ocular trauma

This case report describes the optical coherence tomography (OCT) results of Berlin’s edema in a male subject following blunt ocular trauma from a soccer ball. A 27-year-old male presented with blurred vision in his left eye following blunt trauma. On admission, he underwent a complete eye examination and an OCT of the macula. Fundoscopy revealed commotio retinae, observed as an abnormal cream-colored discoloration of the fovea. The OCT showed outer photoreceptor segment disruption, retinal pigment epithelium inter-digitation, and intra-retinal edema of the outer nuclear layer. Following initial management, a repeat OCT after 3 months showed near complete resolution. OCT can be a useful adjunct for monitoring the progress of Berlin’s edema secondary to blunt ocular trauma because Berlin’s edema may present similarly clinically to other ocular trauma, but can affect different layers of the retina depending on the type of injury to the eye.

Lymphomatoid Papulosis of the Eyelid

Lymphomatoid papulosis (LyP) is a chronic papulonecrotic or papulonodular skin disease, with histological features suggestive of malignant lymphoma. It was originally described by Macauley (1968) as a “self-healing paradoxical eruption, histologically malignant but clinically benign.” Unless accompanied by systemic lymphoma, most patients have no constitutional symptoms, and physical findings are limited to the skin. The distribution of lesions is characteristically on the trunk or extremities, but the face, scalp, or oral mucosa may be involved. We report an unusual case of lymphomatoid papulosis of the eyelid. To the best of our knowledge, this is the first report of eyelid involvement by lymphomatous papulosis.

Topical Steroidal And Nonsteroidal Antiinflammatory Drugs For The Treatment Of Cystoid Macular Edema In Retinitis Pigmentosa

PURPOSE Oral carbonic anhydrase inhibitors have been the treatment of choice for managing cystoid macular edema (CMO) in retinitis pigmentosa. We report a case illustrating the effectiveness of topical steroidal and nonsteroidal antiinflammatory drugs (NSAIDs) in managing CMO in a patient with retinitis pigmentosa, who is unable to take oral carbonic anhydrase inhibitor because of chronic renal impairment. METHODS An 85-year-old woman with retinitis pigmentosa-related CMO in the left eye was prospectively followed up after treatment with a 4 times daily regimen consisting of a topical steroid (prednisolone acetate 1%) and an NSAID (ketorolac trometamol 0.5%). The right eye showed no evidence of CMO. Oral acetazolamide was avoided as the patient had chronic renal impairment. RESULTS Three months after treatment, best-corrected visual acuity in the left eye improved from 20/200 to 20/60, and spectral domain optical coherence tomography showed complete resolution of CMO. Topical steroid and NSAID were therefore stopped. However, 6 months later, left best-corrected visual acuity was reduced to 20/120 and spectral domain optical coherence tomography showed recurrence of CMO. This was managed with the same treatment regimen of topical steroid and NSAID, which resulted in complete resolution of CMO with best-corrected visual acuity in the left eye improving to 20/80 after 3 months. CONCLUSION To our knowledge, this is the first report that demonstrates the effectiveness of topical steroids or NSAIDs in managing CMO in a retinitis pigmentosa patient with chronic renal impairment who is unable to take a carbonic anhydrase inhibitor because of chronic renal impairment.

Minocycline induced conjunctival autofluorescence deposition.

Minocycline can cause palpebral conjunctival greyish deposits in which autofluorescence can be readily demonstrated. We believe that this is a first report of the demonstration of in-vivo conjunctival autofluorescence of palpebral conjunctival minocycline deposit. In conclusion, minocycline deposit can be shown clinically without the need of an invasive biopsy procedure in patients with a history of blepharitis on long-term tetracycline group of medication presenting with palpebral conjunctival deposits.