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Objective This study was designed to evaluate potential differences in circumpapillary retinal nerve fibre layer (cpRNFL) thickness and segmented macular retinal layers between dominant and nondominant eyes on spectral-domain optical coherence tomography in a pediatric population. Design Cross-sectional study. Participants 89 healthy children attending a general pediatric clinic. Methods Participants underwent sighting dominant testing and macular and cpRNFL spectral-domain optical coherence tomography. Segmented macular layer thicknesses and cpRNFL thickness were compared for individual patients based on their ocular dominance. Results Ocular dominance occurred particularly in the right eye (64.7%). Dominant and nondominant eyes did not differ significantly in axial length or spherical equivalent refraction; axial length: 22.99 ± 1.17 mm versus 22.98 ± 1.19 mm; p = 0.51 and spherical equivalent refraction: −0.09 ± 2.68 D versus 0.32 ± 2.93 D; p = 0.41. In the comparison of the macular ganglion layer the average thickness in the 1 mm central Early Treatment Diabetic Retinopathy Study area was significantly different between the dominant and nondominant eye (16.56 ± 6.02 μm vs 17.58 ± 8.32 μm; p = 0.02). However, when compensating with Bonferroni, this difference was no longer statistically significant. There were no differences in the analyses of average global and sectorial cpRNFL thickness in dominant and nondominant eyes. Conclusion Dominant eyes demonstrated no significantly thicker average macular retinal nerve fiber layer (mRNFL), Ganglion cell layer (GCL) thickness or cpRNFL thickness. No ocular characteristic was found to be associated with the relative dominance of an eye in eyes with low anisometropia.

Resumen Proposito Evaluar la percepcion de las barreras en la asistencia sanitaria y del impacto de las inyecciones intravitreas en los pacientes con degeneracion macular asociada a la edad neovascular (DMAEn). Metodos Estudio transversal de 108 pacientes con DMAEn en tratamiento con inyecciones intravitreas mediante un cuestionario de 26 preguntas (puntuacion del 1 al 5) divididas en 3 bloques: 1) enfermedad y su tratamiento con inyecciones; 2) barreras en la asistencia sanitaria, y 3) nuevas tecnologias. Resultados La edad media fue 80,4 ± 7,0 anos y la agudeza visual (AV) de 75,2 ± 12,4 letras. Las principales barreras en la asistencia sanitaria fueron los largos tiempos de espera en consulta (72%), seguida por otras comorbilidades (10%). El 63% de los pacientes dedican entre 3 y 5 h para acudir a la consulta. Se aprecio una ansiedad notable debida a las inyecciones (2,8 ± 1,3), estando presente en el 71% el dia antes. Se observo un gran miedo a la ceguera y a dejar de ser independientes (4,4 ± 0,9 y 4,3 ± 1,1), sin existir diferencias en relacion con la AV, la edad o el sexo (p ≥ 0,135). El 28% de los pacientes refieren que les cuesta bastante o mucho la asistencia a consulta, presentando el 69% del total un gran interes en tener un aparato diagnostico en el domicilio. Conclusiones La DMAEn y su tratamiento suponen una importante carga asistencial para los pacientes, existiendo un gran miedo a la ceguera y a perder su independencia, siendo la principal barrera el largo tiempo de espera en consulta.

To assess the vision-related quality of life and the depression and anxiety rates in patients with neovascular Age-Related Macular Degeneration (nAMD).A cross-sectional study of patients with nAMD treated with intravitreal injections was performed. The patients completed two validated questionnaires: the Visual Functioning Questionnaire (VFQ-25, score from 0 to 100), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, gender and visual acuity (VA) in the Early Treatment Diabetic Retinopathy Study (ETDRS) scale was registered.Fifty-five patients with nAMD participated with a mean age of 80.9 ± 6.6 years-old (range 67-93) and a mean VA in the best eye of 73.5 ± 12.7 letters (range 44-95). The global VFQ-25 mean score was 57.4 ± 21.9 being 38.9 ± 13.2 for the general vision and 42.0 ± 19.5 for the general health. VA in the best eye was associated with the global score of the VFQ-25 scale (R = 0.608; P .001), but no correlation was observed with general health (P = .936). In the HADS scale, 26.9% and 25.5% of patients had symptoms of depression and anxiety respectively. A negative correlation was found between the HADS and VFQ-25 scales for the general vision score (R = -0.438).This study elucidates the impact of vision impairment and the visual functioning in nAMD, describing an important rate of depression and anxiety symptoms.

Resumen Proposito Evaluar la calidad de vida relacionada con la vision, asi como la presencia de sintomas de depresion y ansiedad en los pacientes con degeneracion macular asociada a la edad neovascular (DMAEn). Metodos Se realizo un estudio transversal de pacientes con DMAEn en tratamiento con inyecciones intravitreas de antiangiogenicos. Los pacientes realizaron 2 cuestionarios validados: el cuestionario de funcion visual (VFQ-25, cuya puntuacion varia de 0 a 100) y la Escala hospitalaria de ansiedad y depresion (HADS). Se registraron la edad, el sexo y la agudeza visual (AV) en la escala Early Treatment Diabetic Retinopathy Study. Resultados Se incluyeron 55 pacientes con DMAEn con una edad de 80,9 ± 6,6 anos (rango 67 a 93) y una AV en el mejor ojo de 73,5 ± 12,7 letras (rango 44 a 95). La puntuacion global media en el VFQ-25 fue de 57,4 ± 21,9, siendo 38,9 ± 13,2 para la vision general y 42,0 ± 19,5 para la salud general. La AV se correlaciono con la puntuacion global de la escala VFQ-25 (R = 0,608; p Conclusiones Este estudio muestra el impacto en la calidad de vida y funcion visual en los pacientes con DMAE neovascular, presentando en un porcentaje considerable de los casos sintomas de depresion y ansiedad.

Epiretinal membrane (ERM) represents a common complication of uveitis that may contribute independently to vision loss in patients with uveitis. Although spontaneous idiopathic ERM separation has been previously reported, to the best of our knowledge there are only two case reports in the scientific literature that depicts spontaneous regression of an inflammation-associated ERM. Spontaneous ERM separation is a rare but possible event, which occurs most often subsequent to posterior vitreous detachment. We present a case series of three patients with uveitis that exhibit the formation and subsequent spontaneous resolution of an inflammatory ERM.

Purpose: To evaluate corneal hysteresis (CH), acquired with ocular response analyzer (ORA), as a risk factor for glaucoma progression in early-stage primary open-angle glaucoma (POAG). Methods: In a historical cohort study, patients diagnosed in 2011 with early-stage POAG according to the Hodapp, Parrish and Anderson classification modified for Octopus perimetry and followed up until glaucomatous progression development; otherwise, observations were censored in October 2018. Cox regression was used to obtain hazard ratios (HR) to evaluate baseline variables (CH, central corneal thickness, gender, age IOP and glaucoma family history) as risk factors for perimetric glaucoma progression. A likelihood ratio test for interaction was performed in order to assess the effect of the combination of CH and CCT on the risk of progression. Results: Of the cohort of 1573 patients, 11.38% developed early-stage POAG progression during the follow-up. The mean follow-up time was 3.28 ± 1.92 years. Patients without progression had a higher CH (11.35 ± 1.43 vs 9.07 ± 1.69 mmHg; p < 0.001) and CCT (570.75 ± 17.71 vs 554.51 ± 23.20; p < 0.001). In the multivariate analysis, each 1 mmHg of lower CH was associated with an increase of 2.13 times in the HR of progression (95% CI: 1.92–2.32; p < 0.001). CH hazard ratio was modified by CCT, with higher values of CCT and CH resulting in a higher HR of early glaucoma progression (p < 0.001). Conclusions: CH can be considered as a risk factor of progression in early-stage POAG. The risk associated with CH changed depending on CCT values, acting synergistically slowing the risk of glaucoma progression with higher values.

Summary Purpose To evaluate optical coherence tomography (OCT), fundus autofluorescence (FAF) imaging and optical coherence tomography angiography (OCTA) as diagnostic tools in optic disc melanocytoma (ODM) and study the differences in peripapillary and macular vascular density in eyes with ODM using OCTA. Methods Patients with ODM were enrolled in this case series. Each patient underwent evaluation of best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, fundus photography, standard visual field testing, spectral domain OCT, ultrasound B-scan examination, FAF, fluorescein angiography and OCTA. Results Eight patients (three males and five females) with ODM (9 eyes) were enrolled. The largest ODM presented a nodular appearance with a hyper-reflective tumor surface and a posterior optical shadow on OCT. FAF images showed hypoautofluorescence of the tumor with well-defined outlines. Analysis of optic nerve vascular area showed decreased values in the radial peripapillary capillary plexus (3 of 5) and the outer retinal plexus (4 of 5) in the eyes with ODM. In contrast, the ODM eyes had a higher macular vascular area in the deep capillary plexus in 4 of 6 patients. Conclusions ODM may be associated with changes in peripapillary and macular perfusion, with an increase in peripapillary vascularization being a possible risk factor for growth. OCTA might be a helpful objective method in the analysis of changes in flow in patients with ODM.

Objective To evaluate the impact of subfoveal choroidal thickness (SFCT) and other clinical biomarkers in intravitreal anti-vascular endothelial growth factor response in treatment-naive Caucasian patients diagnosed with polypoidal choroidal vasculopathy (PCV/AT1). Design Cross-sectional study. Participants Treatment-naive patients diagnosed with PCV/AT1 recruited in a single centre from January 2013 to December 2020. Methods Eligibility was determined in treatment-naive PCV patients who received a loading dose of 3 injections of 0.5 mg ranibizumab. A diagnosis of PCV/AT1 was made based on the diagnostic criteria in the efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with sumptomatic macular polypoidal choroidal vasculopathy study. Choroidal thickness was manually measured by enhanced depth imaging technology in Spectralis spectral domain optical coherence tomography. Results Eighty-three eyes of 83 patients were included in this study, 47 patients diagnosed with PCV/AT1 with a good response to 3 intravitreal injections of ranibizumab and 36 with a poor response. The receiver operating characteristic curve of treatment effect against the SFCT revealed that the area under the curve was 0.85 (range, 0.74–0.96). Based on the Youden index, the optimal SFCT cut-off point for predicting a poor response to anti-vascular endothelial growth factor is 257 µm. In the multivariate analysis, the SFCT remained statistically significant (odds ratio 1.02 [range, 1.01–1.04]; P = 0.008). The combined effect of treatment effect against clinical biomarkers produced an area under the curve of 0.90 (range, 0.82–0.98). Conclusion SFCT is a risk factor for a poor response to the 3 loading injections of ranibizumab in treatment-naive PCV/AT1 Caucasian patients. A cut-off point of 257 µm could be a valuable parameter for defining the population at risk for an inadequate response to ranibizumab.

To evaluate the perception of barriers in healthcare and the impact of intravitreal injections in patients with neovascular age-related macular degeneration (nAMD).Cross-sectional study including 108 patients with nAMD in treatment with intravitreal injections. The patients answered a questionnaire with 26 questions (score from 1 to 5) divided in three sections: 1) the disease and its treatment with injections, 2) healthcare barriers and 3) new technologies.The mean age was 80.4 ± 7.0 years and visual acuity (VA) was 75.2 ± 12.4 letters. The main barriers in healthcare were long waiting times (72%), followed by other comorbidities (10%). Some 63% of patients have to wait between 3 and 5 h to attend their clinical visit. Significant anxiety due to the injections (2.8 ± 1.3) was observed, being present in 71% of the cases the day before. A great fear of blindness and losing independence was observed (4.4 ± 0.9 and 4.3 ± 1.1), with no differences in relation to VA, age or sex (p ≥ 0.135). Moreover, 28% of the patients reported that it was quite or very difficult for them to attend the clinical visit, with 69% of the total showing great interest in having a diagnostic device at home.The nAMD and its treatment represent a significant burden on patients, among whom there is a great fear of blindness and of losing their independence, the main barrier being the long waiting time for the clinical visit.

PURPOSE: To compare the diagnostic performance of circumpapillary retinal nerve fiber layer (cpRNFL) analysis versus segmented ganglion cell complex analysis both by spectral-domain optical coherence tomography (SD-OCT) in children with primary congenital glaucoma (PCG). METHODS: Participants were 40 children diagnosed with PCG and 60 healthy children. Ophthalmological data collected (for one eye per child) were cup-disc ratio (C/D) and axial length (AL). SD-OCT with automated segmentation was used to measure the thicknesses and volumes of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). For the cpRNFL measurements conventional S-D OCT software was used and the capacity of each method to discriminate between normal and glaucomatous eyes was compared. RESULTS: Mean age was 11.20 ± 3.94 years for the glaucoma patients and 10.90 ± 2.46 years for controls (p = 0.64). All measurements were reduced (thinner) in the glaucoma group, significantly so for: cpRNFL, GCL, IPL and outer-superior and outer-inferior quadrant mRNFL. According to their areas under the receiver operating characteristics curve (AUC), temporal superior cpRNFL (0.869) and outer superior GCL (0.840), IPL (0.799), and mRNFL (0.767) showed the better diagnostic capacity. No differences were observed in AUCs for the most discriminatory cpRNFL and macular measurements. CONCLUSION: Segmented macular layer analysis shows a good capacity to discriminate between normal and glaucomatous eyes; which is comparable to that of cpRNFL analysis in children with PCG.

Resumen Caso clinico Mujer de 75 anos intervenida de catarata en ojo izquierdo, que presentaba a las 24 h una agudeza visual de 0,8. En la biomicroscopia destacaba un cuerpo extrano anclado al iris en sector nasal coincidente con la incision principal de la facoemulsificacion, que fue retirado en un segundo acto quirurgico. Fue analizado e informado como estructura inerte de naturaleza plastica. Discusion Planteamos el posible origen de la presencia del resto plastico en el postoperatorio de la cirugia de la catarata. En este caso su naturaleza inerte no desencadeno mayor inflamacion intraocular. Ademas, la estructura rigida favorecio su anclaje al iris evitando otras complicaciones. Deben extremarse las medidas preventivas en la cirugia de la catarata revisando incluso los instrumentos y accesorios al terminar la cirugia.

Case report A 75-year-old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analyzed and described as an inert structure made of plastic. Discussion The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favored its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure.

Purpose To report an unusual case of multifocal and bilateral perifoveal exudative vascular anomalous complex (PEVAC) lesions in an otherwise healthy patient. Observations A 62-year-old male with complaints of long-term progressive blurred vision in both eyes. There was no history of diabetes, arterial hypertension or inflammatory disease. Best-corrected visual acuity was 75 and 80 letters in his right eye (OD) and left eye (OS) respectively. Fundus examination showed three perifoveal isolated large aneurysmal lesions in his OD and an additional one in his OS, associated with smaller microaneurysms, haemorrhages and intraretinal exudation. On optical coherence tomography PEVAC appeared as a round lesions with a hyperreflective wall and lumen containing variably reflective material, typically surrounded by intraretinal fluid. Dye-based angiography demonstrated three and one well-defined large hyperfluorescent aneurysmal lesions in his OD and OS respectively, with no leakage. The optical coherence tomography angiography images showed flow signal within the intraretinal aneurysmal lesions. No anomalous flow signal in the outer retina and choriocapillaris was present. After one bilateral anti-vascular endothelial growth factor intravitreal injection no anatomical or functional improvement was observed, and no changes in the lesions or visual acuity were observed at 6 months follow-up. Conclusions and importance We describe an atypical case of PEVAC, an uncommon and poorly known macular disorder, with bilateral presentation and multifocal lesions in one eye. To our knowledge, this is the first reported case of bilateral PEVAC lesions. Hence, PEVAC should be included in the differential diagnosis of bilateral perifoveal aneurysmal lesions with macular edema.

Resumen Caso clinico Se presenta el caso de un varon de 71 anos con Artisan® y edema macular asociado con insuficiente respuesta a corticoides intravitreos. Se decidio tratamiento combinado con Trigon® y Avastin® intravitreos y desarrollo un glaucoma agudo, que resolvio tras lavado urgente de camara anterior. A pesar de la excelente respuesta macular, esta fue unicamente transitoria y el endotelio corneal, competente hasta ese momento, sufrio danos irreversibles. Discusion La combinacion de ambos tratamientos, junto con la anatomia especial en estos pacientes, pudieron ser factores precipitantes de este desafortunado resultado.

®a b s t r a c t Case report: We present a 71-year-old patient with an Artisan ® implant and macular edema associated with unsatisfactory response to repeated intravitreal corticosteroids. An intravitreal Trigon ® and Avastin ® combined injection was given, and acute glaucoma developed.

a 75-year old woman who had had cataract surgery in her left eye and showed a visual acuity of 0.8 twenty-four hours post-surgery. Biomicroscopy revealed a foreign body attached to the iris in the nasal sector that coincided with the main incision of the phacoemulsification, which was then removed in a second surgical procedure. It was analysed and described as an inert structure made of plastic.The possible origin of the presence of a fragment of plastic in the postoperative period following cataract surgery is established. In this case, its inert nature did not cause any further intraocular inflammation. Its rigid structure also favoured its attachment to the iris, thus avoiding any other complications. There must be greater preventative measures during cataract surgery, including checking the instruments and accessories before and after the surgical procedure.

We present the unusual case of a 35 year-old woman with stage IV melanoma and widespread metastases, who was undergoing treatment with interferon alpha-2b and who presented with interferon-associated retinopathy. The patient, who had been taking interferon treatment for three months, complained of a sudden loss of visual acuity in the left eye. An ocular examination revealed multiple cotton wool spots along the retina and macular involvement. Interferon treatment was suspended. Although rare, retinopathy represents a potentially serious adverse effect of interferon treatment. Although normally patients are asymptomatic, complications derived of its use may arise, which can lead to significant visual impairment. We therefore suggest that before initiating treatment with this drug, patients should be informed of its potential ocular risks, and that regular eye examinations are conducted along with the treatment.

We present a 71-year-old patient with an Artisan(®) implant and macular oedema associated with unsatisfactory response to repeated intravitreal corticosteroids. An intravitreal Trigon(®) and Avastin(®) combined injection was given, and acute glaucoma developed. Anterior chamber washout was performed to resolve the rise in intraocular pressure. In spite of an excellent macular response, this was only temporary, and the corneal endothelium, which had remained competent so far, suffered irreversible damage.The combination of both treatments, along with the particular anatomic features in these patients, may have been precipitating factors in this unfortunate outcome.

Purpose: To compare rebound tonometry (RBT) and noncontact tonometry (NCT) using Goldmann applanation tonometry (GAT) as reference. Methods: The study sample was comprised of 108 eyes of 108 subjects consecutively examined at a general ophthalmology clinic. The order of use of the three tonometers was randomized at the study outset. The difference between the methods was plotted against the mean to compare the tonometers. The hypothesis of zero bias was examined by a paired t-test and 95% limits of agreement (LoA) were also calculated. Differences with respect to GAT were assessed according to the international standard for ocular tonometers (ISO 8612). Results: Mean intraocular pressures (IOPs ± SD) obtained using the three instruments were GAT 17.5 ± 3.8 mmHg; RBT 18.5 ± 5.5 mmHg and NCT 17.4 ± 5.6 mmHg. The 95% LoA were from −7.9 to +7.7 mmHg for NCT–GAT and from −6.8 mmHg to +8.7 mmHg for RBT–GAT. A difference with respect to GAT under ±1 mmHg was observed in 11.1% of the eyes measured by NCT and 18.5% of eyes measured by RBT. According to the IOP ranges established by the ISO 8612, differences from GAT measurements greater than ±5 mmHg were always above the accepted level of 5%. Correlations between IOP and central corneal thickness (CCT) were significant for all three tonometers. Conclusions: The rebound and noncontact tonometer behaved similarly when used to measure IOP taking GAT measurements as the reference standard. Neither tonometer fulfilled ISO 8612 requirements. Both were similarly influenced by CCT.

A 78-year-old woman, with an acute exacerbation of chronic obstructive airways disease, was treated with nebulised ipratropium bromide and salbutamol. Twenty hours after beginning this treatment, she developed acute angle-closure glaucoma (AACG) in her left eye which resolved rapidly with appropriate treatment.Nebulised ipratropium bromide and salbutamol increases the intraocular pressure and may cause an AACG in susceptible patients (those with a shallow anterior chamber, hypermetropia, or chronic angle-closure glaucoma). Increased vigilance in such patients treated with these bronchodilators may avoid this adverse effect. Ensuring the mask is correctly fitted, using a T-piece or unvented nebuliser and protective eye wear, are some of the many recommendations made to minimize the development of AACG in these patients.

Background The prevalence of myocardial perfusion alterations in autoimmune diseases has been estimated by previous studies at 40%. There is no consensus on the scrutiny of cardiovascular alterations in patients with Antiphospholipid Syndrome. Objectives To evaluate the existence and seriousness of ischemic cardiomyopathy or asymptomatic ventricular dysfunction in a group of patients with primary or secondary Antiphospholipid Syndrome using 99 Tc MIBI Gated-SPECT and equilibrium radioisotope ventriculography. Methods This is a transversal study performed in collaboration with the Rheumatology Departments of the following hospitals: General Naval de Alta Especialidad (SEMAR), Centro Medico Nacional 20 de Noviembre (ISSSTE), and the Department of Nuclear Medicine of the Instituto Nacional de Cardiologia “Ignacio Chavez”. The study started on January 1, 2010 and ended on November 15, 2010. Twelve patients participated in the study and all of them underwent a myocardial perfusion study with 99 Tc MIBI Gated-SPECT and a planar equilibrium radioisotope ventriculography and SPECT. Results A total of 12 patients participated. There was no evidence of ischemic cardiomyopathy in any of the patients. The systolic and diastolic functions of the left ventricle were normal on all cases. Right ventricle alterations were observed: a third had dilation; one had systolic dysfunction (8%); and 4 had diastolic dysfunction (33%). The association of right ventricle dysfunction and the presence of seropositivity of anticardiolipin andtibodies isotype IgG and lupus anticoagulant (p=0.041) stands out. Conclusions Even though the Antiphospholipid Syndrome is associated with accelerated atherosclerosis, this group of patients didn’t present any evidence of coronary disease or left ventricle dysfunction. However, right ventricle anomalies were found. These anomalies might be related to alterations of pulmonary circulation. Further studies are needed to establish the origin of these alterations. References Ian N. Bruce, Dafna D. Gladman. Single Photon Emission Computed Tomography Dual Isotope Myocardial Perfusion Imaging in women with Systemic Lupus Erythematosus. II. Predictive Factors For Perfusion Abnormalities. J Rheumatol 2003; 30: 288-91. Alexanderson E, Cruz P. Endothelial dysfunction in patients with antiphospholipid syndrome assessed with positron emission tomography. J Nucl Cardiol (2007);14:566-72. Nilda Espinola Zavaleta, Erick Alexanderson. Analisis de la utilidad de ecocardiografia de contratte y medicina nuclear en afecciόn cardiovascular de origen autoinmune. Archivos de Cardiologia de Mexico Vol. 75 2005:42-48. E. Alexanderson, A. Gόmez-Leόn. Myocardial ischemia in patients with primary antiphospholipid syndrome: a 13 N-ammonia PET assessment. Rheumatology 2008;47:894-896. Disclosure of Interest None Declared

Purpose To report a case of herpetic optic neuritis associated with herpetic keratitis. Methods A 65 year old woman presented with oedema in the nasal sector of his right papilla. Blood biochemistry, a haemogram, erythrocyte sedimentation rate and C-reactive protein were all normal. The patient was diagnosed as having a non-arteritic anterior ischaemic optic neuropathy. One week later slit lamp examination showed diffuse stromal corneal oedema and a dendritic lesion in the nasal zone of the corneal epithelium. Results Serology for varicela-zoster virus was positive. Treatment was started with valacyclovir given orally and topical acyclovir ointment. A week later, the optic disc swelling and corneal lesions had resolved. Conclusions The precise mechanism through which the papilla and cornea were successively affected in our patient is unclear but the sensitive innervation of both these structures is provided by the nasal branch of the nasociliary nerve and the spread of herpes via this nerve could affect both sites.