Manitoba Oculo-tricho-anal Syndrome (MOTA) is a rare autosomal recessive disorder characterized by eyelid coloboma, cryptophthalmos, anophthalmia or microphthalmia, abnormal hair growth from scalp to eyebrow, bifid or broad nasal tip, and gastrointestinal anomalies including omphalocele and anorectal malformations.1,2 We describe a multi-stage surgical approach to repair a right upper lid coloboma with an extensive congenital superomedial symblepharon obscuring the pupil in the context of MOTA. Surgical steps included reconstitution of the eyelid’s anatomical landmarks with dissection of the symblepharon invading the opacified cornea, freeing the pupillary axis, creation of a superior fornix, advancement of myocutaneous/periosteal flaps, and insertion of an implant to recreate the absent eyelid. This resulted in significant improvement of ocular surface protection, quality of life, and allowed for amblyopia treatment.

Purpose: To report the case of a patient with persistent vitreous hemorrhage in the right eye (RE) caused by occlusive retinal vasculitis secondary to tuberculosis. Methods: Male patient, 35 years old, with Indian ancestry, no history of previous systemic illness. First presented to our outpatient clinic with decreased visual acuity in the RE, lasting eight months. On exam, best-corrected visual acuity (BCVA) RE was <5/200 and BCVA in the left eye (LE) was 20/20. Keratic precipitates were visible and anterior chamber flare was described as 1+; extensive vitreous hemorrhage was present precluding fundus observation. Fundus fluorescein angiography (FFA) performed on his LE was normal. He was started on topical steroids and submitted to pars plana vitrectomy plus intraoperative retinal photocoagulation on his RE for peripheral retinal ischemia. Results: Post-surgery exam, BCVA in the RE was 20/100 and the LE was 20/20, no anterior chamber reaction bilaterally. Macular edema with exuberant vascular tortuosity and “phantom” vessels in RE. FA confirmed active occlusive vasculitis on the RE. Diagnostic workup was positive for a 28mm induration tuberculin test, supporting the diagnosis of ocular tuberculosis. The patient was started on anti-tuberculosis medication. Three months later, BCVA in the RE was 20/25 with no anterior chamber reaction in both eyes. Eighteen months later, the patient maintains good bilateral visual acuity without any evidence of disease reactivation. Conclusions: In the described clinical case, there was a good response after anti-tuberculosis treatment not associated with oral corticosteroid therapy, with improved visual acuity and remission of inflammatory angiographic signs, stressing the importance of searching tuberculosis etiology in cases of retinal vasculitis.

Haemolacria is a rare term that expresses the presence of blood cells in tears. It is commonly a benign process with diverse etiologies, from vascular diseases, trauma and neoplasms. We report the case of a 16 years old female patient who started with right hemicranial headache from moderate to severe pulsatile intensity, later bilateral epistaxis, bilateral otorrhea and hemolacria persisted for a month. Bilateral telangiectasias were found on the lower tarsal conjunctiva, tympani and on the back of the tongue, as we suspect in hereditary hemorrhagic telangiectasia. The diagnosis is clinical and based on Curaçao criteria, as definitive if the patient has 3 criteria. Management is to stop bleeding with tamponade or cauterization. Resumen La hemolacria es un término raro que expresa la presencia de células hemáticas en las lágrimas. Comúnmente es un proceso benigno que cursa con diversas etiologías, desde enfermedades vasculares, traumatismos y neoplasias. Presentamos el caso de una paciente de 16 años de edad que inició con cefalea hemicráneana derecha de moderada a severa intensidad de tipo pulsátil, posteriormente se le agregó, epistaxis bilateral, otorrea bilateral y hemolacria que persistió por un mes. En la exploración se encontraron telangiectasias bilaterales en la conjuntiva tarsal inferior, tímpanos y en el dorso de la lengua por lo que sospechamos en la Telangiectasia hemorrágica hereditaria. El diagnóstico es clínico y se basa según los criterios de Curaçao, como definitivo si la paciente presenta 3 criterios. El manejo consiste en detener la hemorragia con taponamiento o cauterización.

We present a case of a 71-year-old Caucasian male complaining of left lateral lower eyelid swelling after an insect sting sensation. Physical examination showed an oval shaped lesion (half a centimetre diameter), mobile, with well-defined edges, soft consistency, and erythema. Palpation was painless and without lymph node involvement. The patient had a history of metastatic prostate adenocarcinoma. One week later, the lesion showed rapid growth (two centimetres diameter) with central ulceration. Incisional biopsy was made. Immunohistochemistry findings were suggestive of a primary neuroendocrine carcinoma: Merkel Cell Carcinoma. The patient underwent surgery with wide local excision, regional lymphadenectomy, and eyelid reconstruction. Awareness of this type of tumor is crucial. A delay in diagnosis affects the prognosis of the disease significantly.

Purpose: To determine the relation between manifest refractive error and cycloplegic refractive error in children and adolescents in Campinas - SP, Brazil, and to compare the results with previous published studies. Methods: Dynamic and static retinoscopy was performed in children and adolescents. To obtain cycloplegia, three drops of 1% cyclopentolate was instilled in each eye every 5 minutes. Maximum cycloplegic effect was achieved after 45 minutes. The working distance for retinoscopy was 67 cm. During retinoscopy, the room was dimly illuminated, and patients were instructed to look at a spot of light at a distance of 6 m. Retinoscopic findings were measured before and after cycloplegia. Results: Two hundred and twenty-two (222) eyes of one hundred and eleven (111) children and adolescents were included. The average age of the participants was 10 years (range 4 to 15 years); 57 (51%) were girls, and the other 54 (49%) were boys. The most common refractive error in younger children was hyperopia, whereas myopia was the most common error in older children. The value of the latent error (the difference between cycloplegic and non-cycloplegic error) increased with hyperopia, especially in younger patients. The value decreased gradually in patients with moderate hyperopia and myopia. Conclusion: The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclo-refraction technique is highly recommended to precisely measure the refractive error in momentous conditions such as refractive surgery, epidemiological research, and amblyopia.

Purpose: To determine the relationship between pseudostrabismus and predictors of increased frequency of this presentation in our environment: epicanthus and hypertelorism. Study design: Binary logistic regression to relate Pseudostrabismus and predictors, and odds ratio for risk assessment. Statistical analysis: Binary logistic regression to relate pseudostrabismus and predictors, and odds ratio for risk assessment. Results: The association of Pseudostrabismus with hypertelorism (62 children - 50%) and hypotelorism (20 children -16.1%) determined through the DI in our study population showed statistical significance (p <0.05). The multivariate analysis OR), who evaluated the risk of having the diagnosis of Pseudostrabismus in the presence of these predictors showed values of 3,276 for hypertelorism and 2,087 for hypotelorism. The results of the association of Pbismus with the epicanthus (50 children without-40.3% and 74 with -59.7%) did not show statistical significance (p> 0.05); however, multivariate analysis or logistic regression gave us a value of 1.949. Conclusions: In our study population, hypotelorism and hypertelorism are predictors of the diagnosis of Pseudostrabismus. The statistical analysis for this association is significant (p <0.5), and the risk (O.R) of having Pseudostrabismus in the presence of hypertelorism is three times more, and two times more in the presence of hypotelorism. The risk of having Pseudostrabismus per epicanthus is 2-fold (O.R.1.949), the statistical analysis for this association was not significant (p> 0.05). RESUMEN Objetivo: Determinar la relación entre pseudoestrabismo y los predictores de mayor frecuencia de presentación en nuestro medio: epicanto e hipertelorismo. Tipo de estudio: Observacional, con nivel relacional y transversal. Análisis estadístico: Regresión logística binaría para relacionar Pseudoestrabismo con predictores, y Odds Ratio (O.R) para la determinación del riesgo. Resultados: La asociación de pseudoestrabismo con hipertelorismo (62 niños, 50%) e hipotelorismo (20 niños, 16.1%) determinados a través de la DI en nuestra población de estudio, mostró significación estadística (p<0.05) e igualmente el análisis multivariado (O.R) que estudió el riesgo de tener el diagnóstico de Pseudoestrabismo en presencia de éstos predictores muestran valores de 3.276 para el hipertelorismo y de 2.087 para el hipotelorismo. Los resultados de la asociación de Pseudoestrabismo con el epicanto (50 niños sin 40.3% y 74 con 59.7%) no mostró significación estadística.(p>0.05), sin embargo el análisis multivariado o regresión logística nos dio un valor de 1.949. Conclusiones: Hipotelorismo e hipertelorismo, en nuestra población de estudio, son predictores para el diagnóstico de Pseudoestrabismo. El análisis estadístico para ésta asociación es significativo (p<0.5), y el riesgo (O.R) de tener Pseudoestrabismo en presencia de Hipertelorismo es tres veces más y dos veces más en presencia de Hipotelorismo. El riesgo de tener pseudoestrabismo por epicanto es de 2 veces más (O.R.1.949), el análisis estadístico para esta asociación no fue significativa (p>0.05).

Purpose: Determine the benefits and challenges of combined femtosecond laser assisted cataract surgery with the Catalys® system (Abbott, Abbott Park, IL) and vitrectomy. Design: Retrospective study Methods: We retrospectively reviewed eight consecutive cases of combined femtosecond laser assisted cataract surgery with the Catalys® system and vitrectomy by a single surgeon. The University of Minnesota Institutional Review Board provided Expedited Review Approval for this project. Results: The study population was 25% male with mean age of 69.1 years, mean pre-operative intraocular pressure of 14.9 mmHg, and mean best corrected visual acuity of 0.44. All patients completed both portions of the combined procedure. There were no complications from the femtosecond laser portion with the mean vacuum time 163s (range 125-320s). Post-operative findings included intraocular pressure rise (25%), and persistent macular edema (38%). The mean intraocular pressure at month one was 16 mmHg with an improvement in mean best corrected visual acuity to 0.27 (range 0-0.52, p<0.05). Intraocular lens was centered in all cases, and mean manifest refraction spherical equivalent was -0.77 (range -2.75-0), which was not statistically significantly different than the target spherical equivalent of -0.59 (p=0.24). Conclusions: Combined femtosecond laser assisted cataract surgery with the Catalys® system and vitrectomy was not associated with significant complications, with an overall improvement in visual acuity.