Digital Journal of Ophthalmology

A glittering anterior chamber with corneal bullae

2024-08-07T08:08:43+00:00

A 62-year-old man presented at Zhongshan Ophthalmic Center with pain and tearing in his right eye of more than 6 months’ duration. He had undergone vitrectomy and silicone oil tamponade for retinal detachment 6 years previously. Slit-lamp examination showed injection of the bulbar conjunctiva, corneal limbal neovascularization, two bullae under the corneal epithelium, and an anterior chamber filled with silicone oil emulsion particles, which had a glittering appearance. Axial T1-weighted magnetic resonance imaging (MRI) highlighted silicone oil in the vitreous cavity, and the anterior chamber showed middle signal intensity, with crescent-shaped low signal vitreous humor on the lower side of the vitreous cavity with the patient supine. Axial T2-weighted MRI showed silicone oil of middle signal intensity in the upper side vitreous cavity, and the emulsified silicone oil filled with anterior chamber was slightly higher signal intensity.

Honeycomb-like corneal edema following netarsudil eye drops in a 65-year-old previously treated for retinal detachment

2025-06-21T11:14:33+00:00

A 65-year-old man presented at Guru Nanak Eye Centre with progressively diminishing vision and ocular discomfort in the right eye. He had previously undergone complex vitreoretinal surgery with silicone oil tamponade for retinal detachment at another institution. Postoperatively, emulsified silicone oil droplets were observed in the anterior chamber, and high intraocular pressures were noted. To manage persistently elevated intraocular pressure, netarsudil 0.02% ophthalmic solution had been prescribed, among other antiglaucoma eye drops. Within days of starting netarsudil, the patient developed a distinctive honeycomb-like pattern of corneal edema, most prominent in the central and inferior paracentral cornea. This edema was associated with worsening vision and photophobia. On discontinuation of netarsudil, the corneal changes gradually resolved. Netarsudil, a rho kinase inhibitor, is known to cause unique corneal changes, including reticular or honeycomb epithelial edema, especially in eyes with compromised endothelium. The presence of emulsified silicone oil in the anterior chamber may have exacerbated endothelial dysfunction in this case and induced edema. Netarsudil must be prescribed with caution to patients with preexisting endothelial compromise, particularly in the presence of intraocular silicone oil. Early identification and withdrawal of the medication can lead to resolution of the edema and prevent further decompensation.

Anterior segment complications following silicone oil tamponade

2025-06-27T07:39:51+00:00

We present four images that illustrate anterior segment complications secondary to the use of silicone oil in vitreoretinal surgery. Silicone oil is a critical tool in managing complex retinal detachments; however, it carries the risk of anterior migration and emulsification. We encountered these complications in 4 nonconsecutive patients, who presented at Hassan II University Hospital for treatment of complex rhegmatogenous retinal detachment associated with proliferative vitreoretinopathy and underwent vitreoretinal surgery with silicone tamponade. Uncomplicated surgery was performed. On postoperative follow-up, ranging from 4 weeks to 10 months, the patients developed the following anterior segment complications. The first image shows a classic reverse hypopyon, where emulsified silicone oil droplets accumulated in the superior anterior chamber due to their buoyancy. This phenomenon can cause inflammation, disrupt aqueous outflow, and raise intraocular pressure (IOP). The second image shows subconjunctival silicone migration, a postoperative complication resulting from wound leakage or elevated IOP. It appears as dome-shaped, translucent elevations beneath the conjunctiva. The third image shows nonemulsified silicone oil bubbles occupying the anterior chamber. These bubbles may migrate through zonular defects, surgical incisions, or in aphakic eyes. Their presence can obstruct the trabecular meshwork, increasing the risk of secondary glaucoma. The fourth image shows band keratopathy developing under prolonged silicone oil tamponade. Calcium deposits form in Bowman’s layer and the superficial stroma, leading to corneal opacification and visual disturbance. This complication may result from chronic inflammation, disrupted tear film, or extended oil–cornea contact.

Phthiriasis palpebrarum misdiagnosed as blepharitis

2024-11-18T01:52:17+00:00

A 40-year-old woman presented at Sankara Eye Hospital Ludhiana with a complaint of itching in both eyes for the previous month. Before presenting at our outpatient clinic, she had been diagnosed and treated elsewhere, without improvement, for blepharitis. On examination, visual acuity was 20/20 in both eyes. Slit lamp examination revealed red, crusty eyelid margins and mild conjunctival hyperemia, with lice (Pthirus pubis) moving over the eyelashes, along with nits at the base. The patient was diagnosed as a case of bilateral phthiriasis palpebrarum. There was no history of similar complaints in other family members, overcrowding, or sexual contact with a louse infested individual. General examination did not reveal lice anywhere else on the body. The patient was treated with topical application of petrolatum jelly over the eyelashes with thorough soap-water rinsing, followed by the mechanical removal of all parasites. Local application of antibiotic eye ointment and 1% permethrin was advised. Systemic combination albendazole 400 mg with ivermectin 12 mg combination was prescribed for 5 days.

Anterior dislocated Morgagnian cataract

2024-06-15T05:46:20+00:00

A 62-year-old man presented at the Sankara Nethralaya outpatient department with gradual, painless loss of vision in his left eye. On examination, best-corrected visual acuity in the left eye was hand movements. Right eye visual acuity was normal. He had no history of trauma or ocular surgery. Slit-lamp examination revealed anterior dislocation of a hypermature Morgagnian cataract. Anterior segment optical coherence tomography revealed a diaphanous wavy capsular bag, along with liquified cortical matter and sunken nucleus touching the corneal endothelium. A narrow slit-beam examination angled at 60° showed the “triangle sign” indicative of Morgagnian cataract—a triangular area formed by the anterior and posterior lens capsule at the apex and the lens nucleus at the base. Posterior segment ultrasonography was unremarkable. Morgagnian cataract is prone to anterior dislocation or displacement because of the degeneration of the lens suspensory ligament. Untreated Morgagnian cataract can cause capsular bag rupture, potentially resulting in phacoanaphylactic uveitis or phacolytic glaucoma. Our patient underwent successful cataractous lens removal with anterior vitrectomy and scleral fixation intraocular lens implantation with good visual recovery.

Subconjunctival cysticercosis

2024-08-25T07:22:26+00:00

An 11-year-old boy presented at Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India, with a 1-month history of periocular swelling and pain in his right eye. Visual acuity was 6/6 in each eye. Examination revealed a 2 × 2 cm soft, cystic subconjunctival swelling in the right lower lid with injected overlying conjunctiva (A, arrows). Extraocular movements were full and unrestricted bilaterally. The remainder of the ocular examination was normal. T2-weighted magnetic resonance imaging (MRI) of the orbits showed a hyperintense lesion with a hypointense center, suggestive of cysticercosis. An MRI of the brain showed no evidence of neurocysticercosis. Excisional biopsy confirmed the presence of a cysticercosis cyst, and the periocular swelling resolved entirely after excision. Histopathological examination revealed the larval form of cysticercosis, with a fibrous wall and a double-layered eosinophilic membrane containing duct-like invaginations filled with neutrophil-rich inflammatory infiltrates. Cysticercosis is caused by the larval form of the tapeworm Taenia solium, typically contracted through the ingestion of eggs from contaminated food or water. The larvae migrate to various tissues, including the brain, eyes, and muscles. In tropical regions, orbital and subconjunctival spaces are common sites for these cysts. Treatment involves antihelminthic drugs such as albendazole with steroids, but surgical excision is preferred for subconjunctival cysts. Early intervention generally results in a favorable prognosis.

Central cloudy dystrophy of François: a case series and literature review of a rare corneal disease

2026-02-02T15:59:32+00:00

Central cloudy dystrophy of François (CCDF) is a rare corneal dystrophy characterized by bilateral, symmetric, gray, cloudlike lesions in the central posterior stroma. Diagnosis relies on detailed family history and careful slit-lamp examination to differentiate it from Vogt posterior crocodile shagreen. We describe 5 female siblings from two families (mean age, 58.5 years) with typical bilateral lesions consistent with CCDF. Very few cases of CCDF have been reported, and its pathophysiology and relationship to other corneal stromal dystrophies or degenerations remain poorly understood. These 5 cases constitute the second-largest series and the first documented reports of CCDF in the Mexican population, supported by representative illustrations and accompanied by a comprehensive literature review.

Benefits of mental health support after open-globe injury

2026-09-26T21:53:02+00:00

Emotional distress, including anxiety and depression, is common after severe eye trauma; however, there are no clear methods for treating these issues in the context of the injuries. We report the ophthalmic and psychological outcomes of 3 patients (ages 32-79) with open-globe injuries who participated in a novel mental health program embedded in our ophthalmology department post-surgery. Clinical outcomes were examined by extensive chart review and use of PHQ-9 and GAD-7 surveys. All patients showed improved mental health outcomes. Qualitative improvements in functioning and emotional regulation were also noted. This novel and expedited mental health support appeared beneficial in reducing anxiety and depression, offering a potential model for addressing emotional distress after severe ocular trauma.

Bilateral Boston Keratoprosthesis implantation in a case of keratitis-ichthyosis-deafness syndrome after 31 years of follow-up [letter]

2026-10-01T21:55:52+00:00

The authors comment on Cremona and Jerabek (Bilateral Boston Keratoprosthesis implantation in a case of keratitis-ichthyosis-deafness syndrome after 31 years of follow-up. Digit J Ophthalmol 2026;32:40-3) and discuss, in light of the available literature, the rationale for bilateral sequential KPro implantation and the timing of surgery in the fellow eye.

Bilateral Boston Keratoprosthesis implantation in a case of keratitis-ichthyosis-deafness syndrome after 31 years of follow-up [author reply]

2026-10-01T21:55:43+00:00

Author reply to Tolba and Harissi-Dagher's letter to the editor on Cremona and Jerabek, "Bilateral Boston Keratoprosthesis implantation in a case of keratitis-ichthyosis-deafness syndrome after 31 years of follow-up" (Digit J Ophthalmol 2026;32:40-3).