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Rationale: To report a case of 44-year-old man with delayed suprachoroidal hemorrhage (DSCH) 2 days after cataract surgery., Patient Concerns: The patient developed sudden onset of ocular pain and reduction of visual acuity on his left eye 2 days after receiving conventional cataract operation., Diagnoses: The ocular conditions were accessed by best-corrected visual acuity, intraocular pressure, slit lamp examination, fundus photography, and B-scan ultrasound. Fundus color photograph revealed a raised choroidal mass and extensive subretinal hemorrhage. B-scan ultrasound also confirmed features of choroidal hemorrhage. Thus, he was diagnosed as DSCH., Interventions: He received conservative treatments for 1 month., Outcomes: The involved eye recovered well., Lessons: DSCH is a rare but dreaded complication occurring in intraocular operations. Conservative managements or surgeries may be beneficial for the recovery of visual acuity., (Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

The decision to administer intravenous tissue plasminogen activator (IV tPA) is based on standard exclusion and inclusion criteria, which include laboratories, imaging, and time of last known well. When patients present with a clinical scenario that is not addressed in these standards, the decision to administer IV tPA is more complex. We present a case of a patient with an acute stroke syndrome that also included acute subconjunctival hemorrhage (i.e., hyposphagma). We provide the medical decision making that occurred prior to the administration. Ultimately, the finding of hyposphagma should not disqualify eligible patients from receiving IV tPA., (Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: To assess the accuracy of ocular B-mode sonography and of standard head computed tomography (CT) as screening tools for intraocular hemorrhages related to subarachnoid hemorrhage (SAH)., Methods: 46 patients with spontaneous SAH were examined using ocular B-mode sonography and underwent funduscopy as gold standard for detection of ocular hemorrhages (OH). Additionally, all head CT scans done during the hospital stay of the study population were rated by a neuroradiologist for the presence of OH., Results: Funduscopy revealed vitreous and/or preretinal hemorrhages in ten eyes and retinal hemorrhages in nine eyes. In comparison with funduscopy, ocular sonography showed a sensitivity and specificity for the detection of vitreous and/or preretinal hemorrhages of 100%, while identification of retinal hemorrhages was less reliable with a sensitivity/specificity of 44%/100%. Standard head CT showed a lower sensitivity/specificity of 60%/96% for vitreous and/or preretinal hemorrhages, and 32%/95% for the diagnosis of any ocular bleeding., Conclusion: Ocular sonography identifies SAH-related preretinal and vitreous hemorrhages with high accuracy and is superior to standard head CT. It may be considered as new and useful bedside diagnostic tool for routine clinical care of patients with SAH., (Copyright © 2015 by the American Society of Neuroimaging.)

This is a report of a 57-year-old female patient who sought treatment for multiple episodes of bloody epiphora. A CT of her orbits revealed enhancement and enlargement of her left lacrimal sac and duct. A biopsy was then performed, which showed a varix involving the wall of the lacrimal sac. To the authors' knowledge, this is the first reported case of a lacrimal sac varix causing bloody epiphora.

Purpose: To report a case of non-traumatic subperiosteal hemorrhage (NTSOH) secondary to barotrauma., Material and Methods: Observational case report., Results: A 42-year-old female presented with right proptosis with bilateral petechial lid hemorrhages, chemosis and diplopia following scuba diving. This occurred in the context of a tight facemask resulting in 'mask squeeze', and performance of Valsalva maneuver to equalize ear pressure. Clinically, there were no signs of optic nerve involvement. Computed tomography (CT) demonstrated signs consistent with right subperiosteal hematoma adjacent to the orbital roof with inferolateral displacement of the superior rectus. Patient recovered well after being admitted for intravenous dexamethasone without surgical intervention., Conclusion: NTSOH from barotrauma can result from 'mask squeeze' under a tight-fitting mask and exacerbated by use of Valsalva maneuvers. This may be prevented with frequent pressure equalization during diving.

Purpose: The goal of this study is to evaluate parameters on orbital CT as predictors of visual outcome in orbital compartment syndrome from retrobulbar hematoma or orbital cellulitis. The study will assess the assertion that certain patients are anatomically predisposed to vision loss in these conditions., Methods: A retrospective chart review of consecutive patients with the diagnosis of either orbital cellulitis or orbital hematoma from the clinic of a single provider in an academic practice from 2006 to 2009 was performed. Exclusion criteria included preexisting vision loss, lack of CT scan for analysis, or lack of 1-month follow up for final visual acuity. Measurements of final visual acuity, medial wall length, lateral wall length, distance from the globe to the apex, and a novel measurement of posterior globe tenting (stretch angle) were obtained. Patients were divided into 2 groups: normal visual acuity and vision loss. Statistical analysis was performed to identify significant differences between the 2 groups., Results: The normal vision group consisted of 11 patients, all with vision of 20/30 or better. The average length of the medial and lateral wall was 43.9 and 41.6 mm, respectively. The average distance from the globe to the apex was 26.3 mm in the uninvolved eye and 30.3 mm in the involved eye, resulting in an average difference of 4.18 mm. The average stretch angle measurement was 28.9° in the uninvolved eye and 28.5° in the involved eye, resulting in an average difference of 0.41°. The vision loss group consisted of 4 patients, all with vision of count fingers or worse. The average length of the medial and lateral wall was 46.9 and 45.7 mm, respectively. The average distance from the globe to the apex was 32.2 mm in the uninvolved eye and 36.7 mm in the involved eye, resulting in an average difference of 4.50 mm. The average stretch angle measurement was 32.3° in the uninvolved eye and 21.1° in the involved eye, resulting in an average difference of 11.2°. The difference in stretch angle between eyes in the vision loss and normal vision groups were found to be highly significant with a p value of less than 0.001. The difference between the 2 orbits for globe to apex is a rough measurement of proptosis and was not statistically different in the 2 groups (p = 0.71), whereas the length from the globe to the apex in the uninvolved eye was statistically different between the vision loss group and normal vision group (p = < 0.001)., Conclusions: Orbital compartment syndrome is a potentially vision-threatening condition. Minimal objective data are currently available in the literature to guide physicians in making clinical judgments regarding these patients. The results of this study indicate that comparing the novel stretch angle between the patient's 2 eyes and measuring the length from the globe to the orbital apex can help identify patients at risk for poor visual outcome. This study provides objective measurements that can aid ophthalmologists and radiologists in determining the relative threat to vision in patients presenting with orbital compartment syndrome from orbital cellulitis or retrobulbar hematoma. Hopefully, the data can help select patients that may benefit from more aggressive intervention and will ultimately result in superior visual outcomes.

Purpose: To evaluate the significance of multislice CT for the diagnosis of uncertain penetrating globe injuries., Materials and Methods: Based on a retrospective chart review between 2002 and 2007, we identified 59 patients presenting with severe ocular trauma with uncertain rupture of the globe due to massive subconjunctival and/or anterior chamber hemorrhage. The IOP (intraocular pressure) was within normal range in all patients. High resolution multidetector CT (MD-CT) scans (16 slice scans) with axial and coronar reconstructions were performed in all patients. The affected eye was examined for signs of penetrating injury such as abnormal eye shape, scleral irregularities, lens dislocation or intravitreal hemorrhages. Four experienced radiologists read the CT scans independently. Beside the diagnosis, the relevant morphological criteria and the optimal plane orientation (axial or coronar) were specified. The sensitivity, specificity, and negative and positive predictive value were calculated. Additionally the interobserver variability was determined by applying the Cohen's kappa test. Surgical sclera inspections were performed in all cases as a standard of reference. The evaluations of the CT examination were compared with the surgery reports., Results: 59 patients were evaluated (42 men, 17 women). The mean age was 29 years (range 7 - 91). In 17 patients a rupture of the globe was diagnosed during surgery. 12 of these 17 penetrating injuries (70.6 %) were classified correctly by MDCT, 5 of the 17 (29.4 %) were not detectable. 42 patients did not have an open globe injury. 41 of these patients were diagnosed correctly negative by MDCT, and one patient was classified false positive. This results in a sensitivity of 70 % with a specificity of 98 %. There was high inter-rater agreement with kappa values between 0.89 - 0.96. Most discrepancies were caused by wrong negative findings. The most frequent morphologic criteria for open globe injury were the deformation (n = 10) and the volume reduction (n = 7) of the globe. These changes were most certain and visible in the axial orientation., Conclusion: In about one third of all unclear cases with rupture of the globe due to severe trauma, CT evaluation failed to correctly diagnose the open globe injury, which might lead to a delay in necessary surgical intervention. Thus, surgical sclera inspection is always mandatory in such unclear trauma cases regardless of the MD-CT results.

Ultrasound study involving three-dimensional echography was made in 250 patients aged 25 to 70 years who had vitreous body hemorrhage of varying etiology. Three degrees of acoustic hemophthalmia density: 1) low (from 5 to 25 MG); 2) moderate (from 25.1 to 40 MG); 3) high (from 40.1 to 55 MG or higher). According to the extent of a pathological focus, the authors identified total hemophthalmia (from 50 to 100% of the volume of the vitreous body) that is equal to a volume of 2.61 cm3 or more; disseminated hemophthalmia (from 25 to 50% of the volume of the vitreous body) that corresponds to a volume of 1.31 to 2.6 cm3; partial hemophthalmia (up to 25% of the volume of the vitreous body) to a volume of 0.1 to 1.3 cm3. Three-dimensional echography makes it possible to measure the extent of intraocular hemorrhage, its acoustic density, to define criteria for evaluating the severity of intraocular hemorrhage, and to assess the risk of retinal detachment.

The paper deals with noninvasive YAG-laser surgery that is used in the treatment of hemophthalmia, particularly hemophthalmia of posttraumatic genesis. A Visulas YAG laser unit ("Karl Zeiss") was used for YAG laser radiation. Its energy parameters were 0.8 to 9.2 mJ; 2-10 impulses; 1-30 laser treatment sessions. YAG-laser radiation affected the altered part of vitreous body: from fresh blood to the emergence of hemophthalmia as adhesions and conglomerates. YAG-laser applied to pathological vitreous body changes in hemophthalmia is effective and causes their elimination with subsequent lysis. YAG-laser vitreolysis is the operation of choice in traumatic hemophthalmia and may be used not only as an independent surgical technique, but also an additional one in the surgical and medical treatment of hemophthalmia. YAG-laser application to the vitreous body reduces the time of treatment for traumatic hemophthalmia.

A hundred patients with hemophthalmia were examined by ultrasound B-scanning to estimate the volume of the blood that had bled into the vitreous body and to check up the efficiency of conservative treatment. The latter used the enzyme collalysine as parabulbar injections in combination with resolving therapy. There is evidence that complex resolving therapy is an effective treatment of hemophthalmia.

The efficiency of the enzyme therapy was studied in patients with hemophthalmos concurrent with diabetes mellitus of different types. Sixty-eight patients received parabulbar injections of the hemase and collelizin enzymes and another 25 patients underwent the routine therapy comprising injections of dicynone, emoxipin and heparinum. The method of ultrasound B-scanning was used to determine the area of hemorrhage spread into the vitreous body. A high efficiency of the enzyme therapy, as used within the complex treatment of hemophthalmos in patients with diabetes mellitus, was demonstrated. Ultrasound B-scanning is a highly informative technique in evaluating the enzyme-therapy efficiency. The enzyme therapy can be recommended as the most effective method for the treatment of hemophthalmos in patients with diabetes mellitus.

Purpose: This report aims to increase awareness of an unusual mechanism of orbital injury sustained by bicycle riders., Methods: In this retrospective small case series, we describe two cases of orbital injury caused by upper eyelid penetration. A 5-year-old boy (patient 1) and a 6-year-old boy (patient 2) presented to our service within a 2-week period. Both had been injured by similarly styled, handlebar-mounted bicycle hand brake levers. Patient 1 had an orbital roof fracture and penetrating brain injury and underwent repair of a left upper eyelid laceration, craniotomy for pseudoencephalocele, and ptosis repair. Patient 2 had orbital hemorrhage and underwent repair of left upper eyelid laceration., Results: In both cases, a handlebar-mounted bicycle hand brake lever perforated the left eyelid when the rider fell onto it. Neither patient was wearing protective headwear or eyewear. Two months after surgery, patient 1 had 20/25 visual acuity OU and excellent cosmetic appearance. Patient 2 had baseline amblyopic vision 2 days after surgery but moved from town and was lost to follow-up., Conclusions: Orbit injuries from bicycle brake levers are rare, and helmets or protective eyewear probably would not have prevented these injuries. However, a change in the design and/or mounting location of handlebar-mounted brake levers might help prevent further injuries of this type.

We report a case of a 27-year-old man who developed major exophthalmos associated with ophthalmoplegia occurring 48 hours after head trauma. CT scan showed an orbital roof fracture and a subperiosteal hematoma. Surgical evacuation of the hematoma and reconstruction of the orbital roof was performed via a frontal craniotomy. Two months later, the ophthalmologic examination was normal. We stress the importance of early diagnosis and prompt surgical treatment in such an unusual complication of head trauma.

Assessment of the orbit for orbital trauma is best achieved expeditiously with CT in the determination of extent of injury and the presence of foreign body. MR imaging has a limited role but is valuable in examining the optic nerve and globe for injury and has proven to be an adjunct modality in the assessment of orbital injury.

With improved imaging methods, the possibility of demonstrating pathological changes in the visual pathways has increased substantially. However, optimal evaluation of visual disorders requires familiarity with the anatomy and pathology of the visual pathways, and with the many advances in neuroimaging. The purpose of this article is to provide clinicians with a practical approach for selecting the most appropriate imaging modalities. Choice of technique is discussed with reference to anatomical regions rather than a complete list of diseases. Ophthalmoscopy reveals many intraocular abnormalities. Imaging studies help in cases where opaque media preclude a view of the fundus. In addition, imaging studies assist in confirming the extraocular extent of the lesion. The advantages and disadvantages of x-ray, computed tomography and magnetic resonance imaging are discussed and illustrated by examples.

Background: A massive intraocular hemorrhage in the course of age-related macular degeneration (AMD) is a devastating event. We set out to determine the role of anticoagulant therapy prescribed for vascular or cardiac indications in the development of a massive hemorrhage., Methods: A retrospective case-controlled study was conducted of 50 cases of age-related macular degeneration complicated by massive subretinal and vitreous hemorrhage. The control group consisted of 50 cases of AMD with small subretinal hemorrhage., Results: There was a significant difference in the use of anticoagulant medication (warfarin sodium) between the groups. The difference in the use of antiplatelet medication (aspirin) between the groups was not significant. A patient with a massive intraocular hemorrhage and AMD is 11.6 times more likely to use anticoagulant medication. It appeared that more than 50% of the patients in the massive hemorrhage group were allowed to stop the anticoagulant medication., Conclusion: Anticoagulant medication poses a significant risk in the development of a massive intraocular hemorrhage in patients with exudative AMD. Antiplatelet medication poses a less significant risk. Physicians prescribing anticoagulant medication should be informed about the macular status of the patient. the In case of neovascular AMD, anticoagulant medication should be prescribed only for absolute systemic indications.

A four-year-old Labrador retriever developed sudden-onset blindness, associated with bilateral uveitis, intraocular haemorrhage and retinal detachment. It had been imported into the UK from Sardinia 36 months before presentation. Haematological abnormalities included non-regenerative anaemia, thrombocytopenia and neutropenia. Serum and urine protein electrophoresis demonstrated a monoclonal gammopathy. An immunofluorescent antibody test for Ehrlichia canis was positive, with a titre of 1:320, confirming a diagnosis of chronic monocytic ehrlichiosis. This case highlights how the prolonged subclinical phase of monocytic ehrlichiosis could enable infected dogs to enter the UK without signs of disease. Chronic monocytic ehrlichiosis should be considered in dogs which have been imported from E canis-endemic countries and present with bleeding disorders and gammopathy, even if signs develop many years after importation.

A method for evaluating ultrasonic gray-scale images by plotting amplitude histograms is proposed. From amplitude histogram analysis, echogenicity and homogeneity indexes of the examined tissues were estimated. A total of 213 images of bulky intraocular formations in 58 patients were analyzed by this method. Confidence intervals of the image echogenecity and homogeneity of choroidal melanomas did not overlap the confidence intervals of the above indexes of images of pseudotumorous intraocular formations. This permits using the homogeneity and echogenicity indexes as a test for differential diagnosis of bulky intraocular formations.

A total of 260 patients with uncomplicated hemophthalmia of different origin (eye contusions, essential hypertension, diabetes mellitus) are examined. A method for quantitative assessment of ultrasonic scanograms of the eye by microdensitometry and computer analysis of total intensity (acoustic density) and area (volume) of hemophthalmia is proposed.

Aim: To describe the CT and MR features of intraocular silicone oil which is used to treat complex retinal detachments in patients with acquired immune deficiency syndrome (AIDS)., Patients and Methods: Seven male patients with AIDS were treated by pars plana vitrectomy and intraocular silicone oil injection for complex retinal detachments due to biopsy proven cytomegalovirus retinitis. Two patients had bilateral therapy., Results: Silicone oil was hyperdense to muscle on CT with attenuation values of 106-139 HU (mean 115, SD 4.5). On MR, when compared with normal vitreous, intraocular silicone oil appeared hyperintense on T1-, proton density, and T2-weighted spin-echo sequences. A chemical shift artifact was seen on all MR images, being most marked on the T2-weighted images., Conclusion: The high attenuation value of silicone oil on CT and its hyperintensity on T1 weighted MR images my cause diagnostic confusion with haemorrhage. These entities can be distinguished at CT by directly measuring the attenuation number (silicone oil > 100 HU; blood < 90 HU), and at MR by the presence of a chemical shift artifact.

15 patients with ocular disease, in whom views of posterior segment of the eyes could not be obtained underwent ultrasonography of the eyes to aid in the diagnosis and further management of the patients. In some cases the ultrasound was then compared with the histological diagnosis when the eye was removed and in other cases to the ophthalmoscopic examination when a better view of the posterior segment could be obtained. This was done as a pilot study to ascertain the level of accuracy of our ultrasonic diagnosis and how much it could be depended upon for the very important decision of removal of the eye when indicated.