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Korean J Ophthalmol Vol.30, No.4, 2016
et al. [3] introduced the term ‘tarsoconjunctival crypts.’
They postulated that the tarsal conjunctiva sequestration of bacteria was initiated by trauma caused either by in- flammation from Stevens-Johnson syndrome or by me- chanical abrasion from nocturnal lid eversion. Partial sloughing of the tarsal conjunctiva and subsequent re-epi- thelization over a lamellar layer of epithelium formed an epithelized tunnel to trap the bacteria. Generally, chronic concretions do not need to be removed unless they are ex- posed, because their removal can aggravate other conjunc- tival and corneal surfaces. Unlike the cases in Tse et al. [3], our subject had no specific ophthalmologic conditions. Al- though patients reporting discomfort due to continuous discharge or conjunctival injection refractory to antibiotic eye drops might not have any other ocular disease, upper or lower eyelid eversion is necessary to treat relapsing mu- copurulent conjunctivitis that does not respond to topical antibiotic eye drop treatment.
Yun Hyup Na
Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
Se Jung Seo
YB Eye Clinic, Suwon, Korea
Joo Youn Shin, Jong Hyun Lee, Jin Hyoung Kim, Do Hyung Lee
Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
E-mail (Do Hyung Lee): [email protected]
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
References
1. Rose GE. The giant fornix syndrome: an unrecognized cause of chronic, relapsing, grossly purulent conjunctivitis.
Ophthalmology 2004;111:1539-45.
2. Sotozono C, Ueta M, Nakatani E, et al. Predictive factors associated with acute ocular involvement in Stevens-John- son syndrome and toxic epidermal necrolysis. Am J Oph- thalmol 2015;160:228-37.e2.
3. Tse BC, Shriver EM, Tse DT. Tarsoconjunctival crypts: un- recognized cause of chronic mucopurulent conjunctivitis.
Am J Ophthalmol 2012;154:527-33.
A Case of Ocular Decompression Retinopathy Mimicking Central Ret- inal Vein Occlusion
Dear Editor,
Ocular decompression retinopathy (ODR) presents as retinal hemorrhages following acute reduction of intraocu- lar pressure (IOP) [1]. A sudden increase in retinal intra- vascular flow due to hypotony and defective autoregulation of blood vessels due to longstanding glaucoma consequent- ly lead to retinal hemorrhages [2,3]. Retinal hemorrhages in ODR should be distinguished from differential diagno- ses including central retinal vein occlusion (CRVO), valsal-
va retinopathy, and ocular ischemic syndrome, since thera- pies for these diseases are different. We report a case of multiple retinal hemorrhages in ODR mimicking CRVO.
A 74-year-old female patient was referred to Daegu Fati- ma Hospital due to sudden ocular pain and sudden de- crease in visual acuity in the right eye. Her best-corrected visual acuity was 20 / 200 in the right eye and 20 / 25 in the left eye and IOP was 68 mmHg in the right eye and 14 mmHg in the left eye. There were signs of acute angle clo- sure including corneal edema, mildly dilated pupil, and shallow anterior chamber in the right eye. The optic discs had slight disc hyperemia in the right eye under a high IOP state (Fig. 1A). The patient was treated with intravenous mannitol 15% 250 mg, acetazolamide two tablets, and topi- cal dorzolamide-timolol and pilocarpine 2% eye drops. Af- ter 2 hours, IOP in the right eye decreased to 24 mmHg, and visual acuity increased to 20 / 100; however, fundus
Korean J Ophthalmol 2016;30(4):312-313 http://dx.doi.org/10.3341/kjo.2016.30.4.312
313 exam revealed slight tortuous veins and multiple retinal
hemorrhages scattered throughout the fovea, posterior pole, and peripheral retina in the right eye, similar to CRVO (Fig. 1B). Fluorescein angiography showed no de- layed filling of the retinal artery or vein (Fig. 1C). After a 1-week follow-up period, her visual acuity was further de- creased, and fundus exam revealed massive vitreous hem- orrhage involving the fovea in the right eye. We misdiag- nosed a vitreous hemorrhage and retinal hemorrhages as a presenting sign of CRVO. Two weeks later, a 23-gauge pars plana vitrectomy was performed in the right eye. One month after the surgery, the visual acuity in the right eye
improved to 20 / 50, and the IOP in the right eye was 13 mmHg. Fundus exam showed reduced retinal hemorrhages and vitreous hemorrhage (Fig. 1D).
In conclusion, multiple retinal hemorrhages due to abrupt hypotony occur in ODR and can mimic CRVO.
However, there are differences between ODR and CRVO [2]. Compared with CRVO, 80% of patients with ODR are asymptomatic. In clinical findings, oval-shaped hemor- rhages occur in all retinal layers, and there is no severe ve- nous dilatation or delayed venous filling on fluorescein an- giography as is expected in acute CRVO. Therefore, in case of multiple retinal hemorrhages after resolution of high IOP, careful observation is required during diagnosis, and various evaluations should be carried out for differen- tial diagnosis.
Min Gu Huh, Ji Hye Jang
Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
E-mail (Ji Hye Jang): [email protected]
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
References
1. Mukkamala SK, Patel A, Dorairaj S, et al. Ocular decom- pression retinopathy: a review. Surv Ophthalmol 2013;58:
505-12.
2. Saricaoglu MS, Kalayci D, Guven D, et al. Decompression retinopathy and possible risk factors. Acta Ophthalmol 2009;87:94-5.
3. Jea SY, Jung JH. Decompression retinopathy after trabe- culectomy. Korean J Ophthalmol 2005;19:128-31.
Fig. 1. Fundus photographs showing the clinical course of the patient. (A) Fundus photograph of the right eye showed slight disc hyperemia. (B) Fundus photograph of the right eye showed multiple retinal hemorrhages scattered throughout the fovea and posterior pole, mimicking central retinal vein occlusion after in- traocular pressure decrease. (C) Fluorescein angiography showed multiple areas of blocked fluorescence due to retinal hemorrhage and vitreous hemorrhage but no delayed venous filling. (D) One month after pars plana vitrectomy, disc hyperemia and hemor- rhages were resolved.
D B
C A
