Break the Fall: Orbital Blowout Fracture

Background: Head trauma can lead to multiple ocular complications, among the most concerning is an orbital blowout fracture. Common associations with an orbital fracture would include periorbital ecchymosis, subconjunctival hemorrhage, eyelid edema, and crepitus, among others. Concerning complications, such as retinal detachment, need to be ruled out at the time of presentation. Surgical intervention may be warranted in certain cases. An emergent head computed tomography scan must be performed to evaluate and determine management. Case Report: This case features a 66-year-old Caucasian male with an orbital blowout fracture following a fall. In addition to discussing the details regarding this patient’s case, this report highlights fracture types, pertinent imaging, determination of muscle entrapment, and other underlying complications. Conclusion: Careful evaluation is critical in proper management of potential orbital fracture cases. Entrance testing such as visual acuity measurement, pupil assessment, and extraocular muscle motility evaluation provide useful information regarding suspected severity of an orbital fracture. A dilated fundus examination is necessary for assessing concerning posterior complications. Computed tomography imaging must be obtained in all instances of questionable orbital fracture. Surgical intervention may be needed in some instances. Regardless of the necessity for surgical intervention, careful monitoring of these cases for resolution is advisable.

Book Review: Foundations of Artificial Intelligence in Healthcare and Bioscience

Book Review: Catania LJ. Foundations of Artificial Intelligence in Healthcare and Bioscience. Cambridge: Academic Press; 2020, $150.00, 524 pages, Paperback ISBN:9780128244777, e-book ISBN: 9780323860055.

Alternative Therapies for Treatment of Keratoconjunctivitis Sicca Associated with Sjorgren's Syndrome

Background: Sjogren’s syndrome is a chronic, systemic autoimmune disorder, which often results in significant ocular surface disease. Dry eye associated with Sjogren’s syndrome is a multifactorial disease which leads to decreased function of the lacrimal glands and altered tear composition. There currently are numerous anti-inflammatory methods used for treatment of this disease. Case Report: This case report will focus on the use of amniotic membrane placement and autologous serum tears to facilitate a successful scleral contact lens fit allowing for reduced ocular inflammation and discomfort associated with Keratoconjunctivitis sicca due to Sjogren’s syndrome. Conclusion: Clinical management of keratoconjunctivitis sicca due to Sjogren’s syndrome can be challenging. Diagnosis often requires numerous in office testing including Schirmer I/II, TBUT, sodium fluorescein stain, and osmolarity. Such testing can be repeated over time to monitor for improvement with addition of each new therapy. Various treatment modalities such as topical lubricants, cyclosporine, autologous serum tears, or amniotic membranes have been proven to provide short-term benefits and excellent maintenance of symptoms. Utilizing such treatments to promote an ideal scleral contact lens fit provides lasting benefits of corneal clarity and stable vision.

Case Report: The Dilemma of Imaging an Isolated Sixth Nerve Palsy

Background: Traditionally, eyecare providers employ a wait-and-see approach with respect to older patients presenting with a presumed vasculopathic isolated sixth nerve palsy. However, given review of recent literature and the potential of morbidity in these patients, acute neuroimaging should be strongly considered. Eyecare providers are often faced with challenging decisions when patients present with acute isolated oculomotor nerve palsies. This case highlights the diagnostic dilemma of an older patient with significant vasculopathic risk factors who presents with an isolated sixth nerve palsy. For patients older than 50, a vasculopathic etiology is the most likely cause, however, a small but significant percentage of these patients may suffer from a more ominous condition such as, giant cell arteritis, intracranial mass, or aneurysm. As evidenced by our case, acute neuro imaging should be considered in all isolated sixth nerve palsies. Case Report: A 69- year old Caucasian male presented to the VA Connecticut Healthcare System with new onset diplopia. The patient reported a recent history of mild orbital pain and headaches. Evaluation revealed an isolated left sixth nerve palsy. A microvascular etiology was presumed given his strong vasculopathic history. One week later the patient returned to clinic with a new left pupil-sparing third nerve palsy in addition to his original left sixth nerve palsy. Magnetic resonance imaging of the brain and orbits with and without contrast revealed a left cavernous sinus mass. The patient was transferred to the Smilow Cancer Hospital at Yale-New Haven and received gamma knife radiosurgery for the presumed neoplastic lesion. Conclusion: Although support can be made for both a “wait-and-see” approach and acute diagnostic imaging, our case highlights the benefits of early imaging. Appropriate acute neuro imaging in patients with presenting isolated sixth nerve palsies can be lifesaving.

Metachronous Eyelid Basal Cell Carcinoma on Opposite Eye and Lid: A Case Report

Background: Basal cell carcinoma (BCC) is the most common eyelid malignancy, accounting for approximately 90% of malignant eyelid lesions.1 Despite its high occurrence rates, it is frequently misdiagnosed as one of the benign “lumps and bumps” that can be present on the eyelid. In the present case, a patient with a past BCC on the right upper eyelid presented with a left lower eyelid lesion which persisted for months before the patient sought evaluation by an eyecare provider. This benign-looking lash-line lesion was the only external sign of the malignancy found on the deep surface of the eyelid and later diagnosed as BCC. Case Report: A 74-year-old patient presented with a persistent eyelid lesion that was resistant to treatment for greater than 6 months. The small lesion was slightly suspicious in appearance. Further evaluation revealed a larger, more irregular lesion on the conjunctival surface of the eyelid. The patient was referred to an oculoplastic specialist for biopsy. Pathology confirmed the diagnosis of basal cell carcinoma. Conclusion: Once the lesion was properly diagnosed, the patient underwent Mohs micrographic surgery and eyelid reconstruction. This case will highlight the importance of prompt and thorough evaluation of suspicious eyelid lesions which are persistent and resistant to treatment in patients with a history of eyelid malignancy.

Optic Disc Pits: A Case Report and Review

Background: Congenital optic disc pits (ODP) are a rare clinical finding affecting approximately 1 in 11,000 people. Affected individuals are generally asymptomatic unless fluid accumulates in the macula resulting in severe vision loss. The management of ODPs depends mostly on clinical findings and can range from observation to surgery. Optometrists need to be aware of clinical presentations and possible complications of ODPs. Case Report: This report will review a case of an asymptomatic optic disc pit and discuss the potential treatment options if complications arise. Conclusion: Although rare, congenital optic disc pits need to be accurately assessed and diagnosed. Symptoms can range from none to severe vision loss. Proper observation and management may lead to improved visual outcomes.