The 2025 EastWest Eye Conference Poster Session
Chair: Dawn J. Goedde, O.D., F.A.A.O
OSU College of Optometry
Posters will be on display from 4:00 p.m. Thursday November 6, 2025, until 4:00 p.m. on Friday, November 7, 2025. The presenter must be available to discuss the poster Friday November 7, 2025, from 10:00 a.m. to 11:00 a.m. The authors of the top 10 posters will give a brief synopsis of their poster during a one hour lecture at 3p.m. on Friday November 7, 2025.
Posters:
#1 Title: Use of Irrigating Eyelid Retractor as a Novel Adjunct in the Treatment of Superior Limbic Keratoconjunctivitis: A Case Report
Authors: Cory Lappin, OD, MS, FAAO1; Srinivas Sai A. Kondapalli2, MD, FASRS; Shelby Brogdon, OD3
- The Dry Eye Center of Ohio, Cincinnati, Ohio
- Everett and Hurite Ophthalmic Association, Pittsburgh, Pennsylvania
- Noh Eyes, Little Rock, Arkansas
Category: Ocular Disease
Abstract
Background:
A 40-year-old female presented with a 5-month history of persistent ocular dryness, pain, and superior lid tenderness, predominantly in the left eye (OS). Symptoms were associated with photophobia and contact lens overuse. She had previously been treated with multiple topical agents, including corticosteroids, immunomodulators (lifitegrast and cyclosporine), and artificial tears, with minimal relief.
Case Discussion:
Vision was 20/30 OS. Slit lamp examination revealed 4+ superior conjunctival injection, papillary reaction, conjunctival staining, and superior corneal punctate keratopathy OS [Fig 1A]. Diagnosed with SLK, she was started on a prednisolone acetate taper, preservative-free artificial tears, nighttime ointment, and advised to stop contact lens wear. Blood work revealed a positive ANA; she was referred to a rheumatologist.
At a 3-week follow-up, the patient reported some improvement, but she continued to experience residual discomfort OS. Slit-lamp exam illustrated improved but persistent conjunctival injection [Fig 1B] Complete ocular surface lavage facilitated with an irrigating eyelid retractor was performed. This was followed by the initiation of Cequa (cyclosporine 0.09%) BID and continuation of supportive therapies.
Over the following two months, the patient experienced marked symptomatic and clinical improvement, with resolution of injection and corneal staining [Fig 1C] and return of visual acuity to 20/20 OU. She was able to resume contact lens wear using daily disposables.
Conclusion:
This case highlights the potential utility of an irrigating eyelid retractor as a novel adjunctive treatment in managing refractory SLK. In-office ocular surface lavage, in conjunction with topical anti-inflammatories and immunomodulators, may help accelerate recovery and reduce ocular surface inflammation. The friction between the superior bulbar and palpebral conjunctiva is thought to be a component of the pathogenesis of SLK. We hypothesize that targeting fluid at the palpebral conjunctiva reduces chronic inflammation and irritation between the superior bulbar and palpebral conjunctiva resulting in resolution of signs and symptoms of this difficult to manage disease.
Conflict of Interest:
CL is a consultant for Rinsada™. SK holds a patent for Rinsada™.
Contact Information:
Cory Lappin, OD, MS, FAAO
Email: corylappinod@gmail.com
#2 Title: Unilateral Acute Retinal Necrosis Secondary to Varicella Zoster Virus: Pathogenesis and Treatment
Authors: Makayla Hall, O.D.
Site: Cincinnati Eye Institute Resident
Category: Ocular Disease
Abstract
Background
Retinitis is inflammation of the retina with etiologies varying from autoimmune disease, infection, genetic predisposition, and drug induced. Acute retinal necrosis (ARN) is an infectious necrotizing peripheral retinitis likely caused by varicella-zoster virus (VZV) or herpes simplex virus (HSV). ARN typically presents unilateral in immunocompetent adults, however it can become bilateral and may affect all age groups. Clinical signs include panuveitis, retinal necrosis, occlusive vasculitis, optic disc edema, and high rates of retinal detachment (RD). Definitive diagnosis requires polymerase chain reaction (PCR) analysis of the aqueous humor. Successful treatment requires IV, intravitreal, and oral antivirals. Intraocular pressure (IOP) must be managed with topical ophthalmic drops, uveitis managed with a topical cycloplegic and steroid drop, and sequential RD managed by retinal specialist with PPV, RD repair, and likely silicone oil.
Case Discussion
An immunocompetent 64-year-old white male was referred by local OD for unilateral grade 3 iritis, IOP 35mmHg, pain, headache, blurred vision, and photophobia in the left eye for one week. Patient had no pertinent ocular or medical history. Initial presentation at the Cincinnati Eye Institute (CEI) revealed IOP 29 mmHg OS, +APD OS, 3+ diffuse bulbar injection OS, 2+ KPs OS, 2+ mixed cell in AC OS and visual acuity was 20/30-2 OS. All findings were WNL OD with VA of 20/20. Posterior segment findings OS were trace vitritis, mild diffuse optic disc edema, and peripheral subretinal infiltrates. OCT revealed vitreous debris and ONH edema OS. Fluoresceine angiography revealed occlusive vasculitis with leakage of the optic nerve OS.
Patient was admitted to UC hospital for ten days to receive 660 mg q8h IV acyclovir and MRI of the brain with and without contrast. PCR analysis of aqueous humor sample revealed a positive varicella-zoster virus. Blood testing and MRI ruled out other pathologies, thus confirming acute retinal necrosis (ARN) caused by VZV. Patient has been receiving intravitreal foscarnet and ganciclovir twice weekly for the past two months. Other treatment includes 2g oral Valtrex TID, Pred Forte QID, Cyclopentolate TID, Cosopt BID, and 40 mg prednisone QD. Retinitis is regressing, yet still active. Seven weeks after onset of symptoms, this patient developed a macula on inferior rhegmatogenous retinal detachment and underwent PPV with 5k silicone oil and RD repair.
Conclusion
Acute Retinal Necrosis is sight threatening and requires aggressive treatment. PCR testing of the aqueous identifies the pathogen. Treatment includes oral, IV, and intravitreal antivirals as VZV and HSV are common etiologies. If ARN is suspected, immediately begin oral antivirals and refer to the ER if severe. A retinal specialist will manage the patient for intravitreal antivirals and retinal detachments, which are the leading cause of vision loss. Prophylactic laser and/or PPV is yet to be thoroughly studied.
Conflicts of Interest: None to report
Contact information: Makaylahall@cvphealth.com
#3 Title: The Hidden Weakness: A Closer Look at Ocular Myasthenia
Authors: Brooke Radcliffe, OD
Site: Cincinnati Eye Institute Resident
Category: Binocular Vision
Abstract
Background:
This case highlights a classic presentation of ocular myasthenia gravis in an elderly patient. Myasthenia Gravis is an autoimmune condition that targets acetylcholine receptors at the neuromuscular junction. Approximately 85% of patients with generalized MG initially present with ocular symptoms characterized by fatigable ptosis, and diplopia. Positive confirmatory testing includes elevated AChR antibodies and a positive ice pack test. Although not needed in this case, MuSK antibody testing or single-fiber electromyography (SFEMG) are alternative diagnostic tools for seronegative presentations. Prompt recognition of these hallmark features allowed for early initiation of treatment and appropriate referral for systemic evaluation.
Case Discussion
A 77-year-old Caucasian female presented with vertical diplopia and right eyelid ptosis, both progressively worsening over the past year. The diplopia was constant, more prominent at the end of the day, and exacerbated by fatigue. She also reported intermittent dysphagia. One year prior, she had undergone bilateral blepharoplasty. There were no recent medication changes. Cover test in primary gaze revealed a 10 prism diopter LHT. EOMs revealed a subtle cogan’s lid twitch with reduced elevation of the right eye while in superior gaze. MRD1 of the right lid was 0-1mm and the left eye had an MRD1 of 4mm. All other clinical findings were within normal limits. The patient was started on Pyridostigmine (Mestinon) 60 mg TID and referred to neurology to evaluate for possible generalized MG. A chest CT was ordered to rule out a thymoma, commonly associated with MG. She will return in six weeks for follow-up and reassessment of her ocular symptoms.
Conclusion
This case highlights the importance of considering myasthenia gravis in patients presenting with fluctuating diplopia and ptosis, particularly when symptoms worsen with fatigue. With proper management, most patients with ocular myasthenia gravis can achieve significant improvement in quality of life and visual function. It is essential to rule out generalized myasthenia gravis to prevent potentially life-threatening complications and to screen for the presence of a thymoma.
Conflict of Interest: The author declares that there are no conflicts of interest relevant to the content of this poster.
Contact Information: Brookeradcliffe@cvphealth.com
#4 Title: Advanced Presentation of Ocular Cicatricial Pemphigoid
Authors: Sarah Muha, OD
Site: Columbus Ophthalmology Associates
Category: Ocular Disease
Abstract
Background
The purpose of this case is to describe possible manifestations of Ocular Cicatricial Pemphigoid (OCP), an ocular condition caused by a rare group of autoimmune diseases called Mucus Membranous Pemphigoid. These systemic diseases cause inflammation and scarring of mucous membranes, most commonly the ocular and oral membranes. OCP most often affects people between the ages of 60-75 and women twice as often as men. Early OCP may present as persistent redness, tearing, foreign body sensation, and photophobia and is often misdiagnosed as allergic conjunctivitis or dry eye disease. The classic signs of OCP include bilateral forniceal shortening, conjunctival cicatrization, symblepharon, and ultimately fusion of the upper and lower lids. While conjunctival biopsies may be used to aid in diagnosis, their frequent false negatives cause most providers to diagnose OCP by clinical signs alone. OCP generally requires systemic therapy such as oral immunomodulators, dapsone, sulfonamide antibiotics, or corticosteroids. The inflammation must be managed before any surgical correction of symblepharon is initiated to prevent any readhesion of the conjunctiva to the cornea. About 1/3 of patients will relapse and require further systemic treatment. Following immunomodulatory therapy, the compromised ocular surface requires aggressive dry eye therapies including preservative-free lubricants, punctal plugs, and serum tears.
Case Summary
A 70-year-old female presents with a mild decrease in vision in her right eye and notices that her right upper lid has been sitting lower for the past year. The patient reported no ocular or medical history and denied taking any medications. The patient presented with a severe symblepharon of the upper lid attached to the upper half of the cornea crossing the visual axis and causing a BCVA of 20/100 in the right eye. The right eye also exhibited significant ptosis due to conjunctival adhesion to the cornea. The left eye presented with a shortened fornix with a much milder symblepharon temporally and superiorly. The patient was started on topical prednisolone four times a day in both eyes with a slow taper and referred to an ocular inflammatory specialty ophthalmologist for systemic treatment prior to surgical removal of the symblepharon.
Conclusion
While OCP may be rare, its early diagnosis and treatment is critical in preventing devastating sequelae. Early OCP should be considered in patients with persistent redness, irritation, and forniceal shortening. Systemic care of these patients should include co-management with rheumatology, dermatology, and otolaryngology.
Conflict of Interest: None to report.
Contact Information: muha.33@osu.edu
#5 Title: When Nutrition Affects Vision: Xerophthalmia and the Role of Vitamin A
Authors: Sarah V. Monterusso, OD
Site: Cincinnati Eye Institute
Category: Ocular Disease
Abstract
Background:
Xerophthalmia refers to the range of ocular signs and symptoms resulting from severe vitamin A deficiency (VAD). It results from either poor dietary intake of vitamin A or impaired vitamin A metabolism due to liver disease, gastrointestinal surgery, or pancreatitis. Deficiency may result in a range of ocular complications affecting the conjunctiva, cornea, and retina. Treatment for VAD-related xerophthalmia involves high-dose vitamin A, given orally or intramuscularly. After supplementation, corneal lesions often improve within one week, Bitot’s spots improve around two weeks, and retinal changes may persist for four weeks.
Case Discussion:
A 39-year-old African American female patient presented to clinic due to extreme dryness, blur and nyctalopia. Anterior segment examination revealed conjunctival and corneal xerosis as well as Bitot’s spots, findings consistent with Xerophthalmia due to severe vitamin A deficiency.
Systemic health history included hidradenitis suppurativa, chronic diarrhea, and previous gastric bypass surgery. The patient had recently spent two weeks in the hospital due to malnutrition. Medications included methotrexate and a daily multivitamin.
Visual acuity uncorrected was 20/150 OD and 20/250 OS. Anterior segment evaluation showed severe conjunctival and corneal xerosis and Bitot’s spots consistent with Xeropthalmia due to severe vitamin A deficiency. The World Health Organization (WHO) classifies xerophthalmia based on anatomical involvement: early signs include night blindness (XN) and conjunctival changes (X1A, X1B), which can progress to corneal xerosis (X2), ulceration (X3A/B), scarring (XS), and retinal changes (XF).
A more thorough investigation into her recent hospital stays showed a vitamin A level of <2.5ug/dL (reference range: 18.9-57.3ug/dL). Given the state of the ocular surface and high risk for corneal ulceration, lubrication was advised. Bilateral upper and lower punctal plugs were placed and a prophylactic antibiotic was prescribed to prevent infection.
This patient was referred to her PCP for vitamin A IM injections. She was given 100,000iu IM on two separate occasions and was then prescribed 50,000iu IM for three days. Her PCP also prescribed 10,000iu of oral vitamin A.
Conclusion:
Vitamin A is an essential fat-soluble vitamin that is important for eye health and functioning. When patients present with xerophthalmia, it’s important to take a thorough medical and dietary history to identify potential underlying causes. Early recognition, prompt vitamin A supplementation, ocular surface support with lubrication and antibiotic prophylaxis, and appropriate follow-up significantly lower the risk for vision loss and irreversible damage.
Conflict of Interest: None to report.
Contact Information: sarahmonterusso@gmail.com
#6 Title: Seeing Beyond Limits: Scleral Lens Fitting in Post-Hydrops Severe Keratoconus with Down Syndrome
Authors: Amy Zheng O.D.; Katie Wulff O.D., FAAO, FSLS
Site: Ohio State University College of Optometry Contact Lens
Category: Contact Lens
Abstract
Background: Down syndrome, a genetic condition caused by trisomy 21, affects approximately 200,000 individuals in the United States. Ocular manifestations frequently observed include strabismus, nystagmus, cataracts, and keratoconus. Elevated risk of keratoconus in Down syndrome patients may be attributed to steeper and thinner corneas, vigorous eye rubbing, and possible linkage between overexpression of certain genes on chromosome 21. In keratoconic patients, approximately 2-3 % will develop acute corneal hydrops- a break in the descemet’s membrane that leads to corneal edema. Corneal hydrops can result in central corneal scarring and flattening; in severe cases, it may necessitate penetrating keratoplasty. In patients with compromised corneas, subtle signs of corneal edema should be evaluated using techniques such as retroillumination, sclerotic scatter, and fluorescein staining, and symptom assessment should include inquiries about halos and blurred vision.
Case History: A 45 year-old white male accompanied by caregivers presented for initial scleral lens fitting secondary to severe keratoconus post corneal cross-linking OD and post hydrops OS. The patient’s chief complaint was severe blurred vision in both eyes with limited improvement in spectacles. His spectacle BCVA’s were OD CF 1’ and OS CF 5’, PHNI OU. Slit lamp examination revealed apical thinning and dense central scarring OU, questionable trace corneal edema OD, inferior pannus OS. A pentacam scan showed severe central steepening OD and severe inferior steepening OS, severe corneal thinning OS>OD. A large diameter scleral lens (19 mm) was chosen with the greatest sag available, however the initial fit was poor due to the severely ectatic cornea. His scleral BCVA were OD 20/70 and OS 20/100, OU 20/60. At the follow-up, the patient developed corneal edema in the right eye, additional channels and fenestration as well as significant reduction in central clearance and usage of muro 128 were implemented. The corneal edema resolved after discontinuation of the right lens and the patient will be closely followed with the new scleral lens, results of final fit pending. If the corneal edema is not resolved with a well-fitted scleral lens, consider reduced wear time, long-term usage of hypertonic solution, and involve corneal specialist co-management.
Conclusion: Detecting and managing keratoconus in Down syndrome is challenging due to significant communication barriers, limited reliable data, and behavioral difficulties. Proactive advocacy for corneal cross-linking, coupled with vigilant monitoring for lens-related complications, is imperative.
Conflict of Interest: None to report.
Contact Information: Zheng.2838@osu.edu; kwulff@compeyecare.com
#7 Title: Scleral Lenses in Ocular GVHD: Enhancing Vision, Comfort, and Quality of Life
Authors: Maddison Fortman, OD, MS; Chantelle Mundy, OD, FAAO, FSLS
Site: The Ohio State Wexner Medical Center, Department of Ophthalmology and Visual Sciences
Category: Cornea and Contact Lens
Abstract
Background:
Ocular graft vs. host disease (oGVHD) is a complication of allogeneic hematopoietic stem cell transplantation, a procedure commonly used for treatment of hematologic malignancies. Donor-derived T-cell–mediated immune response against host tissue results in inflammation, scarring, and fibrosis of conjunctival, corneal, and lacrimal gland tissue. The skin, gastrointestinal tract, and lungs are also commonly affected. The reported incidence of oGVHD in patients undergoing bone marrow transplantation varies across studies, with a large meta-analysis estimating it at 38%. Clinical signs may include punctate epithelial staining, conjunctival scarring, and meibomian gland dysfunction. In severe cases, complications such as symblepharon formation, corneal ulceration, and corneal perforation can occur. Primary treatment includes traditional dry eye therapies such as artificial tears, ointments, punctal plugs, and topical immunomodulators. Scleral lenses are an effective treatment option, as the fluid reservoir provides constant lubrication and protection from mechanical friction of the eyelids. This case report discusses the use of scleral lenses to improve vision and ocular comfort in a patient with oGVHD.
Case Presentation:
A 67-year-old white male with oGVHD following bone marrow transplant for cutaneous T-cell lymphoma was referred for scleral lens fitting. The patient reported worsening foreign body sensation, pain, photophobia, redness, and blurred vision OU, with insufficient relief with artificial tears prn and erythromycin ointment qhs OU. Entering acuities with glasses were 20/40 OD, 20/25-2 OS. Slit lamp examination revealed cicatricial ectropion of both upper and lower eyelids, lagophthalmos, and 1-2+ punctate epithelial erosions OU. The patient was fit with scleral lenses with a diameter of 18.0mm and achieved 20/20 vision with over-refraction. Scleral lenses were ordered and dispensed. The patient was seen for a follow-up visit after four weeks of scleral lens wear, at which he reported significant improvement in ocular comfort since initiating lens wear. BCVA was 20/20 OU and improvement in punctate epithelial staining OU was noted on slit lamp examination.
Conclusion:
Ocular GVHD leads to persistent ocular symptoms that can diminish a patient’s quality of life. Scleral lenses not only provide effective symptom relief but also enhance vision while promoting ocular surface rehabilitation.
Conflict of Interest: None to report.
Contact Information: Maddison.fortman@osumc.edu; Chantelle.mundyod@osumc.edu
#8 Title: Optometric Management of an Orbital Blowout Fracture
Authors: Logan J. Oostdyk, OD; Cari Nealon, OD
Site: Cleveland VA Medical Center
Category: Ocular Disease
Abstract
Background: The human orbit has the shape of sideways pyramid, bounded by a roof, floor, and medial and lateral walls. Trauma to the head and midface has the potential to fracture one or multiple of the seven bones which comprise the four walls of the orbit. Fracture of the orbital walls can occur in isolation (i.e. orbital floor fracture) or in combination with an orbital rim fracture, termed a complex orbital fracture. A “blowout fracture” is an isolated fracture of the orbital floor without compromise of the orbital rims. Anyone with a suspected or confirmed orbital fracture should receive an ophthalmic examination as soon as possible. Acute findings such as orbital compartment syndrome, retinal detachment, or traumatic optic neuropathy, may accompany orbital fractures. Long term complications of orbital fracture include: enophthalmos, extraocular muscle entrapment, infraorbital hypesthesia. Initial management of an orbital fracture includes oral antibiotics and avoidance of nose blowing or valsalva to prevent potential sinus infection, and herniation of ocular tissues, respectively. Orbital surgery may be required depending on the severity of the fracture and symptoms.
Case Discussion: A 77-year-old Asian female presented to the eye clinic at the Louis Stokes Cleveland VA Medical Center. Her chief complaint was concern for hearing “popping sounds” from her right eye while bending over earlier that morning. The patient explained that she had fallen and hit her head on the sidewalk three days prior and was seen at an ER and diagnosed with a right inferior and medial orbital wall fracture. The patient stated that the ER had performed a CT scan and started her on oral antibiotics and oral pain medications.
The patient reported experiencing oblique double vision the day after her fall, but this symptom had resolved by the time she presented to the VA eye clinic. Physical examination revealed 3+ periocular ecchymosis with edema laterally and inferiorly to the right eye. Entrance testing revealed a clear cornea, open angles OU, and 20/20-1 BCVA OD and OS. There was no APD. Extensive subconjunctival hemorrhage was noted OD. The anterior chamber was deep and quiet OU. EOM testing revealed a full range of motion OU without pain. Cover test found an exophoria and right hypophoria, however this finding was longstanding and previously documented. Cranial nerve testing was performed which found dramatically reduced sensation on the right lower eyelid, check and upper lip. This finding indicates impingement of the right infraorbital nerve. The remainder of the dilated retinal exam was normal.
Conclusion: Orbital floor fractures may be treated nonsurgically, especially if there is minimal to no enophthalmos or diplopia, and no apparent muscle restriction. In the case of this patient, the recommended treatment plan was to finish the course of oral antibiotics and oral pain medications as prescribed by the ER, as well as use cold compresses. The patient was also instructed to keep an upright head position as much as possible until seen at the follow up visit in 6 weeks.
Conflict of Interest: None to report.
Contact Information: programmed2serve@att.net; cari.nealon@va.gov
#9 Title: Usher Syndrome Type 1B and Cystic Macular Edema in a Pediatric Patient
Authors: Allie Noe, OD, MS, and Adam Peiffer, OD, MS, FAAO
Site: University Hospital’s Rainbow Babies and Children’s Hospital Division of Pediatric Ophthalmology
Category: Pediatrics
Abstract
Background: Usher Syndrome is the most common inherited condition that causes both hearing and vision loss. Nine genes have been identified as causative for Usher Syndrome so far: MYO7A, USH1C, CDH23, PCDH15, and USH1G (SANS) for Usher type 1; USH2A, ADGRV1, and WHRN for Usher type 2; CLRN1 for Usher type 3. Usher Syndrome is an autosomal recessive condition and is divided into three types and then subtypes based on its clinical presentations. Type 1 Usher Syndrome causes severe-profound hearing loss from birth, progressive vision loss beginning in childhood due to retinitis pigmentosa, and vestibular difficulties. Type 2 and 3 Usher Syndrome are less severe, often with later onset of hearing and vision loss and progressing later into adulthood. The MYO7A gene, associated with Type 1B Usher Syndrome, has been shown to have a correlation with cases of cystic macular edema. The RS1 gene is responsible for x-linked juvenile retinoschisis and can also lead to early vision loss and macular edema in pediatric patients. Oral acetazolamide has been determined to be the most effective treatment for cystic macular edema related to retinal dystrophies, but topical carbonic anhydrase inhibitors can be an effective substitute in pediatric or febrile patients.
Case Discussion: A six-year-old Caucasian male presented to clinic in November 2024 after evaluation with an optometrist in the private sector in Toledo, who noticed abnormal changes in the retinal periphery on a screening photo. The patient had sensorineural hearing loss since birth and utilized cochlear implants. After the evaluation in Toledo, he underwent genetic testing and was determined to have biallelic variants in the MYO7A gene and was then diagnosed with Usher Syndrome Type 1B.
On his initial visit, his vision was 20/50 OD and 20/40 OS in his current spectacles, which corrected for bilateral amblyogenic with the rule astigmatism. An abnormal foveal light reflex with a cystic appearance was noted, as was a salt/pepper pigmentary changes in the retinal periphery. The patient was observed to have cystic edema of both eyes on the Macula OCT, debated to be related to retinitis pigmentosa versus attributed to an X-linked retinoschisis. The patient was started on 2% dorzolamide BID OU and scheduled to follow up in 3 months for a repeat Macular OCT and HVF 30-2 if patient able to tolerate.
The patient was seen again in March of 2025 and was found to have stable visual acuity to previous and an improvement in the appearance of the macula on both OCT and the fundoscopic exam. The patient’s father noted good compliance with the 2% dorzolamide TID OU. Genetic testing for the RS1 gene was ordered through University Hospitals, given the similar appearance to an X-linked retinoschisis. The patient was found to not have a mutation in the RS1 gene in April 2025, attributing the macular edema to the patient’s retinitis pigmentosa rather than an additional diagnosis of x-linked retinoschisis. The patient is scheduled to follow up in early October for a repeat macular OCT.
Conclusions: This case highlights the opportunity for interprofessional collaboration and efficient patient management within an academic medical center. Genetic testing can be an effective resource in pediatric patients to determine their diagnosis in those with inherited retinal conditions and provide insight into their visual prognosis.
Conflict of Interest: None to report.
Contact Information: noe.81@osu.edu; adam.peiffer@uhhospitals.org
#10 Title: Pseudophakic Angle Closure Associated with Chronic Vitreous Prolapse
Authors: Benjamin Lowis, OD
Site: Cincinnati VA Medical Center
Category: Ocular Disease
Abstract
Background
Vitreous Prolapse is a condition where the vitreous shifts forward into the anterior portion of the eye. The most frequent etiology is complications during intraocular surgery including cataract surgery. Vitreous prolapse after cataract surgery occurs in 1.7 to 7.7% of surgeries and is highly dependent on the surgeon’s experience (Ali-Reza). Potential complications associated with vitreous prolapse are retinal detachment, cystoid macular edema, glaucoma, and corneal decompensation (Chan). Treatment of vitreous prolapse is removal by anterior vitrectomy or posterior pars plana vitrectomy. There is not extensive literature that discusses the association of vitreous prolapse with early and late onset pseudophakic angle closure. The consensus of multiple articles with small sample sizes is to treat with iridectomy/iridotomy and IOP lowering medications (Shrader). While it is common to only observe this condition if stable, providers may want to consider prophylactic removal of vitreous prolapse to prevent complications from arising.
Case Presentation
An 84-year-old white male presented to the Cincinnati VA for a 6 month IOP check. Pertinent past ocular history includes Vitreous Prolapse OD after cataract surgery in 2017 and OHTN OD first documented in Aug 2024. The patient was not using any ocular medications. Presenting BCVA was stable at 20/25 OD, 20/20 OS. Goldmann tonometry was 44 OD, 18 OS. Slit Lamp Exam revealed anterior vitreous prolapse with embedded pigment that has been stable since 2022 with a new shallow AC. Gonio revealed iris bombe with no visible angle structures OD. Iris Bombe secondary to Vitreous Prolapse, OD was diagnosed.
Treatment began immediately with one drop of cosopt, latanoprost, and brimonidine. The glaucoma clinic was consulted and a same-day LPI was performed. After LPI and another round of IOP lowering medications, the patient’s IOP was 25 OD with a deep AC. Because of the good response to treatment, the patient was to RTC in three days for an IOP and AC check. The patient was instructed to continue Cos BID, Lat QHS, and Brim BID until returning to clinic. The patient was educated that surgical intervention may be needed if the current therapy is ineffective.
Conclusion
This report discusses a complication of vitreous prolapse that occurred eight years after the contributory cataract surgery. This case, along with a few other reports, points to considering surgical removal of vitreous prolapse prophylactically even if the condition is not currently associated with any secondary complications. When treated, patients have favorable long-term outcomes with an improvement in vision, symptoms, and IOP.
Conflict of Interest: None to report.
Contact Information: ben.lowis@yahoo.com; Matthew.Horton3@va.gov
#11 Title: Posterior Lens Luxation Secondary to Persistent Hyperplastic Primary Vitreous (PHPV): A Rare Presentation
Authors: Ian Binns, OD
Site: The Ohio State University College of Optometry – Pediatric Optometry/Vision Therapy and Rehabilitation
Category: Binocular Vision & Pediatrics
Abstract
Introduction:
Persistent Hyperplastic Primary Vitreous (PHPV), also known as persistent fetal vasculature (PFV), is a rare congenital ocular anomaly caused by failure of the fetal hyaloid vasculature to regress during development. This abnormality leads to remnants of the tunica vasculosa and hyaloid artery to persist after birth. PHPV typically presents unilaterally and has no strong racial or gender predilection.
Clinically, PHPV is classified as anterior, posterior, or combined. The combined form, seen in roughly 60% of cases, features both anterior segment findings (e.g. cataract, retrolental membranes, shallow anterior chamber, secondary glaucoma) and posterior findings (e.g. persistent hyaloid stalk, retinal folds or detachments, vitreous hemorrhage, optic nerve hypoplasia). Diagnosis is based upon clinical examination, fundoscopy, and imaging—particularly B-scan ultrasound. Management varies with severity; mild cases may be observed, while surgical intervention is reserve for more advanced presentation, though surgical efficacy is still debated in the literature.
Case Presentation:
A 13-year-old white female presented for a routine eye exam. Previous records noted BCVA of 20/250 OD and 20/20 OS, with a refractive error of -13.75 -4.00 x177 OD. Prior documentation mentioned unspecified lenticular and vitreous opacities in the right eye. At her most recent presentation, the patient reported no visual complaints. Entering visual acuity was 20/2400 OD and 20/25 OS. Refraction revealed a significant hyperopic shift OD to +10.00 -4.00 x175, with BCVA improving to 20/200.
Dilated fundus examination showed absence of the crystalline lens in the patellar fossa, suggestive of complete posterior lens luxation. The lens was not visible on fundoscopy or widefield imaging. B-scan ultrasound confirmed lens dislocation into the posterior chamber and revealed reflectivity patterns consistent with PHPV, including persistent hyaloid stalk. The patient and parent denied any history of ocular trauma or connective tissue disorders. She was referred to pediatric ophthalmology for further evaluation; follow-up is currently pending.
Conclusion:
Although PHPV is a well-recognized pathology, posterior lens dislocation secondary to PHPV is extremely rare and, to our knowledge, not previously reported in the literature. This case expands the clinical spectrum of PHPV and emphasizes the importance of imaging, especially B-scan ultrasound, in evaluation unexplained lenticular abnormalities in pediatric patients.
Conflict of Interest: None to report.
Contact Information: binns.32@osu.edu
#12 Title: Out of Sight and Under Pressure: Central Retinal Artery Occlusion after EVO
Implantable Collamer Lens Surgery
Authors: Jose Germain, OD; Bascom Palmer Eye Institute
Category: Ocular Disease
Abstract
Background: A central retinal artery occlusion (CRAO) is an ophthalmic emergency and
warrants immediate escalation of care with a comprehensive stroke evaluation. A CRAO is
commonly caused by an embolus originating from the carotid artery or heart, vasculitis,
trauma, and rarely, elevated intraocular pressure. In this case, elevated intraocular
pressure secondary to implantable collamer lens (ICL) dislocation and diffuse pigment
dispersion is observed in the affected eye, ultimately reducing ocular perfusion, resulting
in occlusion of the central retinal artery.
Case Discussion: A 42-year-old Caucasian female presented to the BPEI Emergency
Department with complaints of decreased vision, pain, and redness OS x 1 day and was
s/p EVO ICL surgery OU x 14 days. Entrance testing revealed visual acuity of 20/30-1 OD
and 20/HM OS, IOP 18 OD and 44 OS, and (+) APD OS. The anterior segment examination
of the left eye revealed a superiorly displaced PCICL with the inferior edge resting at the
pupil margin and 3+ loose pigment in the AC. The posterior segment evaluation of the left
eye revealed a CRAO with a pale posterior pole and central cherry red spot and a small
<0.25DD subretinal hemorrhage superotemoral to the fovea, dilated and tortuous veins.
Ancillary testing is as follows:
– Gonioscopy: open to TM OU with 4+ diffuse pigment OS and 2+ scattered pigment
OD.
– Ultrasound biomicroscopy (UBM): both angles were open, with a superiorly
displaced ICL OS.
– OCT Macula OS: engorged vessels, retinal thickening, hyperreflectivity of the inner
retinal layers.
– FA/ICG: delayed arterial filling, normal choroidal filling, and delayed AV transit time
OS.
IOP was unresponsive to topical aqueous suppressants and an AC tap was performed but
did not have a prolonged effect as IOP spiked to 50mmHg after the procedure. The patient
was started on topical dorzolamide/timolol BID OS, brimonidine TID OS, and oral
acetazolamide 500mg q4h, then admitted to a local hospital for systemic and stroke
evaluation which were unremarkable. Ultimately, the recommendation for ICL explanation
and an Ahmed Glaucoma Implant was made.
Conclusion: Corneal-based procedures have long dominated the refractive surgery field
but, with further advancements in technologies being made, there is an emerging shift
towards intraocular lens-based refractive surgeries. EVO ICLs are widely regarded as a
safe and effective procedure that requires critical IOP observation and management. A
CRAO is an extremely rare and visually devastating complication of EVO ICL implantation.
Conflict of Interest/Acknowledgement of Grant Support: I have no financial disclosures or conflicts of interest.
Contact Information: Jxg6029@miami.edu
#13 Title: Beyond Hearing Loss: Ocular Sequelae of Vestibular Schwannoma Resection
Authors:
Primary: Kevin Gress, OD
Secondary: Rachael LaBounty, OD; David Roncone, OD, FAAO
Site: Cleveland VA
Category: Ocular Disease
Abstract
Background: The purpose of this case report is to describe a unique presentation of a patient with a history of an acoustic neuroma resection. The patient underwent resection of a Schwannoma, which is an abnormal neoplastic growth of the glial cells within the peripheral nervous system. They are common in Neurofibromatosis-2 and Schwannomatosis, the latter of which our patient had previously been diagnosed and treated. Depending on the size of the tumor and skill of the surgeon, ocular manifestations may occur if other cranial nerves are affected. Due to the location of the vestibular nucleus in the brainstem, the next most common nerve affected is the facial nerve (CN VII) which can lead to exposure keratitis secondary to poor orbicularis oculi strength on the affected side. Less common, the trigeminal nerve (CN V) may be affected, leading to decreased sensation to the affected side of the face. Diplopia and strabismus may also be present if the abducens nerve (CN VI) is compressed/severed.
Case Presentation: A 44-year-old Black male presented to the Eye clinic as an inpatient add-on with decreased vision following vestibular schwannoma resection on the left side. He reported intermittent binocular horizontal diplopia, decreased vision and ocular irritation OS, hearing loss, and lack of facial sensation on the patient’s left side.The hearing loss was longstanding from the initial surgery (first resection). Ocular examination revealed weaker sensation on the left side of the face, mild abduction deficit OS with pronounced end-gaze nystagmus, and weak orbicularis strength OS with associated corneal staining. Treatment consisted of copious lubrication (daytime artificial tears QID OS and nighttime ointment qHS OS). Although the patient has a guarded prognosis, ENT and Neurosurgery are hopeful as reduced functionality of cranial nerves was likely secondary to stretch injuries from the resection itself and not severing the involved cranial nerves.
Conclusion: Understanding the neuroanatomy of the brainstem is crucial when working through a complex case s/p neuroma resection to determine the extent of the neurological deficits, the cause (compression vs iatrogenic), prognosis of recovery, and patient education.
Conflict of Interest: None to report.
Contact Information: gress@va.gov;Rachael.labounty@va.gov; David.roncone@va.gov
#14 Title: When Treatment Fuels Inflammation: Medication-Induced Uveitis
Authors: Sarah Baron, OD
Site: Cleveland VA Medical Center
Category: Ocular Disease
Abstract
Background: The purpose of this case report is to describe a presentation of anterior non-granulomatous uveitis in a patient after recently starting Anastrozole, which is a non-steroid aromatase inhibitor used to treat breast cancer.
Case Presentation: A 73-year-old patient presented to the Cleveland VA Medical Center in July 2025 for an acute onset of right eye pain. The patient reported redness, blurry vision, photophobia, and tearing. The patient reported that she recently started taking a new medication, Anastrozole 1 mg po daily, for her breast cancer. Upon review of systems, stiffness and hip pain s/p hip replacement were the only remarkable symptoms. The patient’s ocular history was significant for pigment dispersion syndrome, ERM, retinal tear s/p retinoplexy OD x 2014, RE c presbyopia, physiological anisocoria, DES, and cataracts. The patient’s medical history consisted of breast cancer, osteoarthritis, gout, COPD, chronic hepatitis C, HTN, lumbar spondylosis, T2DM, and tobacco and alcohol dependance. The patient was diagnosed with Stage II carcinoma of the right breast and is currently undergoing radiation, starting in May, and taking oral Anastrozole. BCVA was 20/40-2 OD and 20/40+2 OS. EOMs were full with reported pain more-so on ST gaze. Pupils were round and reactive to light. CVFs had mild constriction SN OD, FTFC OS. IOPs were 26 mmHg OD and 17 mmHg OS. SLE was remarkable for mild edema on RUL and RLL, 3+ diffuse injection OD, dense 3+ cells and flare OD, and one clock hour of post synechiae IT OD. 1 gtt of Cosopt and 1 gtt of Brimonidine were instilled OD in-office, effectively lowering the eye pressure to 9mmHg OD. DFE showed no vitritis and stable large cupping of the optic nerve head with pink and distinct rims. The patient was diagnosed with unilateral anterior non-granulomatous uveitis secondary to Anastrozole use and prescribed Cosopt BID OD, Durezol QID OD, and Cyclopentolate BID OD and told to RTC in 2-3 days or sooner if worsening.
Conclusion:
While anterior non-granulomatous uveitis is commonly idiopathic, if chronic and recurrent, systemic etiology is likely attributing. Anastrozole is a non-steroidal aromatase inhibitor (AI) drug used for treatment of breast cancer. Studies have well-described ocular side effects of tamoxifen use, but there are now studies documenting adverse effects of AIs as well. These studies correlate uveitis and CME during AI treatment. Although more research needs to be done to further investigate ocular side effects with AIs, providers should keep in mind possible correlations when assessing patients with ocular symptoms and taking AIs.
Conflict of Interest: None to report.
Contact Information: sb3563@mynsu.nova.edu
#15 Title: Diffuse Unilateral Subacute Neuroretinitis (DUSN) in a Pediatric Patient
Authors: Tyler D. Thomas O.D., M.S., MBA
Site: Cincinnati Children’s Hospital Medical Center
Category: Pediatrics
Abstract
Background: The purpose of this case report is to describe the presentation of diffuse unilateral subacute neuroretinitis (DUSN) in a pediatric patient. DUSN is a rare, vision-threatening inflammatory condition caused by motile nematodes residing in subretinal space. It primarily affects children and young adults presenting with progressive unilateral vision loss, retinal lesions, and optic nerve inflammation. Diagnosis is often clinical, supported by characteristic fundus findings which may include multifocal yellow-white lesions, vitritis, and optic disc edema. Definitive diagnosis is confirmed by direct visualization of the motile worm, though this occurs in only 25–39% of cases. Treatment involves laser ablation when the worm is visualized, which halts migration and inflammation.
Case Presentation: A 14-year-old White female presented to the pediatric retina clinic with peripheral chorioretinal changes concerning for posterior uveitis and papillitis in the left eye (OS). She was initially evaluated at Cincinnati Children’s Hospital in August 2024 for unilateral chorioretinal lesions, presumed to be inactive chorioretinitis; no laboratory workup was performed. At follow-up in August 2025, progression of peripheral retinal lesions was noted, along with mild papillitis and anterior uveitis OS. She was referred to the pediatric retina service and evaluated one week later. Fundus examination revealed numerous old peripheral chorioretinal scars and a new active lesion superior to the vascular arcade OS, with no lesions OD. Visual acuity was 20/20 OD and 20/25 OS. Anterior segment findings included 1+ anterior vitreous cells and rare anterior chamber cells OS. Extensive laboratory workup for infectious and inflammatory etiologies—including toxoplasmosis, tuberculosis, syphilis, Lyme disease, and sarcoidosis—was negative, except for an elevated erythrocyte sedimentation rate. No motile nematode was visualized. Based on clinical presentation and exclusion of other causes, a diagnosis of DUSN was made. The patient is being monitored weekly in hopes of visualizing the nematode for ablative laser treatment. Other therapeutic options include oral steroids and anthelmintics, but laser treatment is the preferred option if the nematode can be visualized at follow-up appointments.
Conclusion: This case highlights the importance of clinical suspicion in diagnosing DUSN, especially when the nematode is not directly visualized. Prompt recognition and treatment can lead to significant visual recovery and prevent long-term sequelae. Pediatric patients presenting with unilateral retinal inflammation and progressive vision loss with a negative laboratory workup should be evaluated for DUSN, even in the absence of a confirmed parasite.
Conflict of Interest:
None to report.
Contact Information: Tyler.Thomas@cchmc.org; rsisk@cyphealth.com; Melissa.rice@cchmc.org
#16 Title: Behind the Blood: An Atypical Eyelid Lesion
Authors: Kaylin Maxwell, OD, MS
Site: Columbus Ophthalmology Associates
Category: Ocular Disease/Cornea and Contact Lens
Abstract
Background: The purpose of this case report is to describe a presentation of an abnormal lid lesion that led to recurrent episodes of haemolacria. Haemolacria, or bloody tears, is a rare ocular finding with a long list of potential causes. The most common causes include trauma, vascular lesions, inflammatory conditions, and vicarious menstruation. In the case our patient, the episodes of haemolacria were caused by an abnormal vessel anastomosis located on the superior palpebral conjunctiva that was discovered upon lid eversion.
Case Presentation: A 59-year-old white female presented to the clinic with complaints of an episode of spontaneous bleeding from her left eye three days prior that lasted about five minutes. Similar episodes have been occurring 1-2 times a year since 2021. She was previously seen by several outside ODs and MDs with no explanation as to the cause. A CT scan was performed and was clear. During examination a 0.75mm round area of superficial telangiectasia with an adjacent conjunctival hemorrhage and a 2mm smooth, lobular lesion of the superior palpebral conjunctiva was noted on lid eversion. The patient was referred to an oculoplastic specialist for further evaluation and possible biopsy. The lesion was deemed to be benign as was determined to be an abnormal blood vessel anastomosis. A follow up appointment was scheduled to cauterize the lesion to prevent further episodes of bleeding.
Conclusion: Haemolacria is a rare ocular finding with a long list of potential causes. Determining the cause of the bleeding can be a challenge, but it is vital for proper diagnosis and management of the condition. As always, if there is any suspicion for malignancy, a referral for further evaluation and potential biopsy is necessary.
Conflict of Interest: None to report.
Contact Information: maxwell.539@osu.edu
#17 Title: Multimodal Imaging in Early Onset Drusen and Associated Vitelliform Maculopathy
Authors: Brian Slattery Hart, OD
Site: Cincinnati VA Medical Center
Category: Ocular Disease
Abstract
Background:
The purpose of this case presentation is to describe the utility of multimodal imaging in evaluating a patient with early onset drusen maculopathy and associated vitelliform maculopathy. Early onset drusen maculopathy (EODM) is a group of conditions in which patients develop characteristic AMD findings at a young age (typically defined as less than 50 years). Multimodal imaging is often necessary to aid in categorization and differential diagnosis and to help identify patients with risk factors for progression to vision threatening complications. Evolution of vitelliform maculopathy is commonly mistaken for active exudative disease and OCT angiography is particularly useful in identifying neovascular membranes in these cases.
Case Presentation:
A 42 year old male new patient presented to the Cincinnati VA Retina clinic, referred to the clinic by the optometrist who reviewed the findings from his tele-eye screening performed by his primary care provider. Dilated fundus exam revealed extensive grouped peripapillary drusen extending nasally and throughout the posterior pole (coalescing in the macula) of both eyes. The left eye had pigmentary changes overlying a focal orangish colored lesion. The patient had no known family history of macular degeneration with some history of social tobacco use 10 years prior. The patient’s medical history was relatively unremarkable aside from exposure to numerous toxic substances during military duty. OCT imaging revealed these drusen to be cuticular drusen with a hypo reflective core and peaked appearance. The OCT showed pigmentary migration and a cystic space on the left eye overlying a regressing vitelliform type sub retinal lesion. The OCT showed pigmentary migration and a cystic space on the left eye overlying a regressing vitelliform type sub retinal lesion. OCT angiography showed a lack of flow through area of subretinal hyper reflective material and no neovascular membrane was identified in the choroid. The patient was educated extensively on the nature of their condition, started on AREDs, and sent home with a home amsler grid to self monitor vision. Return to clinic order was placed for 4 months to repeat OCTmac and monitor for changes with strict return precautions in the setting of any vision loss or changes on the HAG.
Conclusion:
Early onset drusen maculopathy is a heterogenous group of conditions, with many sharing clinical features of age-related macular degeneration. Given the association with both inherited retinal dystrophies and many rare AMD associated gene variants, these patients are often at high risk for vision threatening complications. Proper differential and early therapeutic intervention are increasingly important with developments in gene therapy and pharmacologic treatment for both exudative and non-exudative retinal disease. Keen clinical evaluation and multimodal imaging evaluation is foundational in these cases.
Conflict of Interest: None to report.
Contact Information: Brian.slatteryhart@va.gov
#18 Title: What’s all The Inflammation About?
Authors: Emily C. Naylor, O.D.
Site: Cincinnati Eye Institute
Category: Ocular Disease
Abstract
Background
The purpose of this abstract is to talk about the many causes of bilateral panuveitis & the important testing to get done to rule out some of the rarer causes.
Discussion
A patient presents with new onset tiny black floaters and a lacy veil causing blurry vision in both eyes. Examination reveals cell in the anterior chamber and vitreous, scattered choroidal granulomas, and vasculitis. The patient came in with an inflammatory condition, however RA is not known to cause a bilateral panuveitis. The patient stated his rheumatologist had switched him 4-5 months prior from Remicade to Methotrexate. The change in medication is noteworthy as it may have unmasked another underlying autoimmune condition. The cause of this bilateral panuveitis is highly suspicious for sarcoid, TINU, or VRL. The patient’s chronic cough, bilateral panuveitis, choroidal granulomas & vasculitis makes sarcoid a likely cause1. TINU is a rare, but important differential when trying to decide cause of an unknown uveitis. The traits that fit are a sudden onset panuveitis, but TINU typically affects young females2,3. VRL is often misdiagnosed as a uveitis as it presents with cells & will respond to steroids. The parts of this case that make it a likely diagnosis are the clumps of vitreous cells and small peripheral lesions4. Also, there has been a link to usage of anti-TNF therapies causing lymphoma5. The patient did disclose he had a lung CT the previous year for pneumonia, but this scan was clear & did not show any sarcoid findings. This patient was put on Durezol Q2h & sent for blood work: ACE, Lysozyme, FTA-ABS, Quantiferon-TB Gold, Beta-2 microglobulin, urine. All lab work has come back negative. The patient has had 2 follow-up examinations since initial presentation where the Durezol has been tapered after clearing AC cell, but not resolving vitreous cell. The patient was started on oral prednisolone 60 mg and is currently tapering over 6 weeks6. The patients next visit is set for 4 weeks to check that vitreous cell is resolving. If vitritis recurs after steroids are stopped, then a vitreous biopsy will be performed to assess for VRL.
Conclusion
In the cases of posterior segment involved uveitis it is important to get all lab work done prior to starting systemic steroids. Getting a proper history on any patient but especially those with uveitis including all of the review of systems questions and medications (especially changes) can help to point you in the direction of correct diagnosis.
Conflict of Interest: None to report.
Contact Information: emnaylor@iu.edu
#19 Title: Saving Sight Under Pressure: Orbital Compartment Syndrome Essentials
Authors: Kelsey Miller, O.D.; David Bejot, O.D.
Site: Specialty Eye Institute
Category: Ocular Disease
Abstract
Case Summary
Patient referred from the Emergency Room with double vision and redness, following an orbital floor fracture and lateral canthotomy after trauma to the left eye in a boating accident.
I. Case History
47yo White male
CC: redness, swelling, and double vision when reading
POH: no pertinent past ocular history
PMH: no pertinent past medical history
Meds: amoxicillin 875-125mg po q12hrs for 10 doses, ciprofloxacin 0.3% ophthalmic solution 2gtt OS every 8 hrs, Naproxen 500mg po
II. Pertinent Findings
BCVA OD 20/40, OS 20/40
Exophthalmometry: 22.5mm OD, 24mm OS, base 105mm
Cover test: 2-3 left hypertropia in down gaze
Pupils: round and brisk OD, traumatic mydriasis OS
Motility: Diplopia in extreme gazes with mild restriction on abduction OS
Adnexa: lid edema and ecchymosis OS, superior and nasal stitches OS, ptosis OS
Nerve: normal OU, CD 0.45 OD, CD 0.40 OS with no pallor
HVF 24-2: no significant defect OU
CT/ER notes:
Fractures of the left orbital floor and lamina papyracea. Intraconal and extraconal blood products in the left orbit with proptosis.
Fractures of anterior and medial wall of the left maxilla. Fractures of the left nasal bone and nasal septum. Blood products in the left maxillary sinus and left ethmoid air cells.
Lateral canthotomy performed at ER.
III. Differential Diagnosis for Orbital Compartment Syndrome
Orbital cellulitis, Orbital fracture, Pseudotumor cerebri, Graves orbitopathy, Space occupying lesion, Orbital foreign body
IV. Diagnosis Discussion
Although orbital compartment syndrome due to a retrobulbar hemorrhage is rare, it must be acted upon emergently. The patient’s history can be an early clue for a diagnosis. Orbital compartment syndrome is most commonly caused by trauma, but it may also be caused by sinus or neurosurgery, inflammatory conditions, or tumors. Due to the anatomy of the orbit, any swelling or hemorrhaging in the orbit causes significant stress and damage to the optic nerve and surrounding tissues. This condition can rapidly cause permanent vision loss. The constant intraorbital pressure on the optic nerve can lead to ischemic optic neuropathy, the most common cause of vision loss in affected individuals. Studies have shown that decompression of the orbit should be performed within 2 hours of the injury so the patient has better potential for visual recovery. Hemorrhaging can occur even hours after the initial trauma, so it is important to monitor the patient consistently and perform regular assessments.
V. Treatment/Management Discussion
If orbital compartment syndrome due to a retrobulbar hemorrhage is suspected, a lateral canthotomy should be performed before any other imaging, due to it being an ocular emergency. The assessment of how tight the eyelids are and resistance to retropulsion can indicate hemorrhaging behind the globe. A lateral canthotomy may be performed if proptosis appears to be worsening, or if blurry vision progressively worsen as well. It is important to note that globe rupture should be ruled out before proceeding with LC/C.
If an orbital fracture is present following trauma, the patient likely will have hypesthesia on their cheek, and palpation of the orbital rim may also show a step-off fracture. Palpation of the eyelids should be performed to check for crepitus, which indicates that air has entered the orbit through a fracture. The patient should emergently be sent for a CT of the orbit and midface, along with imaging of the brain if the patient had lost consciousness with the injury.
Conflict of Interest: None to report.
Contact Information: millerkelsey11@gmail.com; dlbtecot@yahoo.com
#20 Title: Elevated Understanding of Papilledema – An Unusual Case of Idiopathic Intracranial Hypertension
Authors: Joyce Kuo, OD
Site: Columbus VA/Chillicothe VA
Category: Ocular Disease
Abstract
Background: The purpose of this case report is to describe the presentation of papilledema, specifically from idiopathic intracranial hypertension (IIH), in an unusual demographic. Most commonly this is a condition that presents in females of child-bearing age and are obese. IIH is a diagnosis of exclusion as other conditions can cause increase in intracranial hypertension such as infection or space occupying lesions therefore using MRI and lumbar puncture is imperative. Severe headaches, pulsatile tinnitus, and transient vision loss or field defects are symptoms of IIH. Management of acute IIH includes oral acetazolamide which reduces cerebrospinal fluid production. Other further management includes weight loss and venous sinus stenting.
Case Presentation: A 37-year old white male presented at the Columbus VA in July 2025 for a new comprehensive eye exam. He complained of blurry vision in his left eye for two months, longstanding light sensitivity, occasional flashes, and a gray line would not completely go away in the left eye. He reported having a history of headaches, high blood pressure, and asthma. His BCVA was 20/20 in the right eye and 20/25 in the left. On examination both disc margins were very obscured and elevation was confirmed by OCT imaging. Humphrey visual fields were obtained reflecting an enlarged blind spot of the right eye and mild inferior arcuate scotoma of the left eye. Neuroophthalmology reviewed imaging that was obtained two days after the initial visit revealing areas of transverse sigmoid sinus stenosis. Cerebrospinal fluid cytology did not reveal any pleocytosis (increase in white blood cell count) and therefore infectious etiology was unlikely. Opening pressure on lumbar puncture was 32 cm of water which is significantly higher than the normative range. Oral acetazolamide was initiated in addition to chronic headache medication. Intracranial venous stenting is still being considered as a treatment option.
Conclusion: While IIH is most common in women of childbearing age, it is important to not discount a potential diagnosis based on demographics alone as atypical presentations or demographics are possible. When faced with bilateral disc edema, the importance of “diagnosis of exclusion” should be impressed upon the clinician and patient alike to avoid deleterious effects of misdiagnosis.
Conflict of Interest: None to report.
Contact Information: joy.k.chen@gmail.com
#21 Title: Non-arteritic Ischemic Optic Neuropathy
Authors: Becca O’Brien, OD
Site: Columbus VA/Chillicothe VA
Category: Ocular Disease
Abstract
Background:
Non-arteritic ischemic optic neuropathy is a relatively common optic nerve pathology whose pathogenesis is largely unproven. Vascular risk factors, such as hypertension and diabetes, are strongly associated with this ischemic optic neuropathy, especially when poorly controlled. Distinguishing NAION with other life- and sight-threatening conditions is crucial. Additionally, with the recent boom in prescription of GLP-1 inhibitors and emerging research on its association with NAION, interprofessional monitoring between primary care/endocrinology and optometry is vital.
Case Presentation:
A 59 year-old white male presented to the Chillicothe VA for a diabetic eye exam. He had no visual complaints other than occasional dryness for which he was using over-the-counter artificial tears. The patient was being followed for type 2 diabetes mellitus without retinopathy, hypertension with mild angiopathy, and mild nuclear sclerotic cataracts. The patient was also a high-risk glaucoma suspect being treated with latanoprost nightly in both eyes, with poor drop compliance. He had poor diabetic control with a hemoglobin A1C of 15.5% and had been begun titrating semaglutide two months prior to his optometry appointment.
Best corrected visual acuity was 20/20 in both eyes. Extraocular motility was smooth and full without pain or diplopia, confrontation visual fields were full to finger counting in both eyes, and pupils were equal, round, and reactive to light without a relative afferent pupillary defect in either eye. The patient was refracted with moderate myopia and presbyopia.
Anterior segment evaluation was relatively unremarkable with the exception of trace diffuse bulbar conjunctival injection and reduced tear break-up time in both eyes. Intraocular pressures were 15 mmHg in both eyes, with target pressures set for less than 13 mmHg in both eyes.
Internal evaluation demonstrated grade one nuclear sclerotic cataracts with trace cortical cataracts in both eyes and the vitreous demonstrated syneresis bilaterally. In the right eye, the optic nerve had a cup-to-disc ratio of 0.50 round with inferior, temporal, and nasal hyperemia with indistinct margins and hemorrhaging. The left eye cup-to-disc ratio was 0.50 horizontally and 0.55 vertically with normal color, distinct margins, and stable inferior thinning. The macula was flat and intact in both eyes without macular edema and the retinal vasculature demonstrated significant vessel tortuosity with scattered dot hemorrhaging in the arcades. Both eyes had pigmented lattice throughout the temporal periphery without holes, and the left eye had a chorioretinal scar in the inferior temporal periphery.
Additional testing included retinal nerve fiber layer and macular OCT, as well as fundus photography. The macular OCT was unremarkable. Retinal nerve fiber layer OCT demonstrated an average thickness of 168 um in the right eye with inferior and nasal elevation. The left eye had an average RNFL thickness of 71 um with inferior thinning and a large wedge defect, likely due to a previous ischemic/vascular event. The patient’s blood pressure was taken in-office and was elevated at 157/94. A complete blood count with differential, erythrocyte sedimentation rate (ESR), and C-reative protein (CRP) were ordered. The results of the ESR and CRP were within normal limits and the CBC with differential uncovered slightly elevated red blood cell counts and hematocrit in combination with low MCH and MCHC. The patient denied scalp tenderness, jaw claudication, or other systemic symptoms associated with giant cell arteritis. Based on the bloodwork and presentation, the patient was diagnosed with non-arteritic ischemic optic neuropathy in the right eye.
Conclusion:
Vascular control is the most important risk factor for the onset of ischemic optic neuropathies. Patients should be carefully monitored between primary care and optometry, especially those at high risk of complications. Additionally, it is imperative to distinguish NAION from life and sight-threatening conditions such as giant cell arteritis.
Conflict of Interest: None to report.
Contact Information: beccanro@gmail.com
#22 Title: Chronic Uveitis in a Pediatric Patient
Authors: Holly Carlson, OD; Casandra Solis, OD
Site: Akron Children’s Hospital
Category: Pediatrics
Abstract
Background: The purpose of this report is to describe a presentation of a chronic anterior uveitis in a pediatric Juvenile Idiopathic Arthritis (JIA) patient. This condition presents either unilaterally, or bilaterally, and has a vast array of systemic associations. Slit lamp examination often reveals circumlimbal injection, cells and flare of the anterior chamber, keratic precipitates (KP’s), and posterior synechiae. Diagnosis is commonly made through slit lamp examination alone, but further workup is generally indicated to determine a systemic cause. Successful management and treatment include frequent monitoring for complications, and steroid and cycloplegic drug therapy.
Case Presentation: A 23-month-old child initially presented to Akron Children’s Hospital in July 2018 after a recent diagnosis of Antinuclear Antibody (ANA) positive, oligoarticular JIA. She was followed on a regular basis, as described by the American Academy of Pediatrics, with no occurrences of any ocular complications. In November of 2022, the patient presented with an asymptomatic, severe bilateral anterior uveitis with keratic precipitates, indicating a chronicity to the inflammation. The patient was started on topical steroid and cycloplegic drops at this time. Follow-up examinations revealed elevated intraocular pressure (IOP), and the patient was deemed to be a steroid responder, requiring pressure lowering topical medications. A full steroid taper was never able to occur without recurring uveitis, and the patient had to be placed on oral steroids and monoclonal antibody therapy in collaboration with rheumatology. The patient has had several recurrences of anterior uveitis, and is now showing signs of band keratopathy, a side effect of chronic uveitis.
Conclusion: While anterior uveitis is a well-known finding in many systemic diseases, the presentation in a pediatric patient is very different than adults, and it is important to be following pediatric bases on a much more rigorous schedule.
Conflict of Interest: None to report.
Contact Information: hollycarlson23@gmail.com, csolis@akronchildrens.org
#23 Title: Identification of Non-Exudative and Exudative Macular Neovascularization in a Case of Chronic Central Serous Chorioretinopathy
Authors: Mona Hammoud, OD (resident); Matthew Horton, OD. FAAO
Site: Cincinnati VA Medical Center
Category: Ocular Disease
Abstract
Background information:
Central serous chorioretinopathy (CSCR) is an eye condition characterized by the accumulation of subretinal fluid due to a breakdown in the outer blood-retinal barrier, primarily affecting the RPE. This dysfunction is often linked to choroidal vascular hyperpermeability and thickening, which can cause fluid to leak into the subretinal space, resulting in localized detachment of the neurosensory retina. In chronic or recurrent cases, the ongoing RPE disruption and choroidal abnormalities may lead to neovascularization of the macula, a rare but serious complication. The persistent leakage and inflammation can trigger angiogenic signals such as VEGF, resulting in the growth of abnormal vessels under the macula. Early detection of CNVM involves ancillary testing such as OCT, OCT-A or FA which can reveal subtle neovascular changes before overt symptoms arise. Recognition of SIRE (shallow irregular rpe elevation), also called SIPED is very important as this finding has been reported in 86-89% of patients with MVN in CSCR and does not require OCT A which is really a gold standard for identifying MVN in CSCR patients (NIH). Management often requires anti-VEGF injections to halt vessel growth and reduce leakage, aiming to preserve central vision and minimize long-term retinal damage. It is crucial to monitor chronic episodes more carefully due to persistent subretinal fluid and choroidal hyperpermeability which weakens the RPE barrier and transport functions, creating an environment that favors the development of neovascularization; properly utilizing multimodal imaging allows for timely intervention with anti-VEGF treatment for these cases.
Summary of the case:
A 77 year old male presented on July 2025 with a history of chronic CSCR OS and fluctuating presence of associated SRF; newly noted CNVM OS was confirmed via OCT-A OS. He reported mild macular distortion OS that began a few weeks ago and has been experiencing fluctuations in vision since the onset of CSCR in 2019; his BCVA today was 20/50 OS. He has no visual or ocular complaints OD. Pt reports long-term use of Symbicort, a corticosteroid used to treat COPD. He denies any diagnosis of HTN, any use of stimulant or sympathomimetic drugs, autoimmune or inflammatory conditions. He has a history of poor sleep and is a long-term smoker who quit in 2011. OCT-A revealed Pt was scheduled for initiation of Eylea OS, to address CNVM occurrence.
Conclusion:
It is important to monitor patients with recurring episodes of CSCR closely to assess for early signs of neovascularization; promptly identifying risks factors as well as obtaining the right imaging will result in better outcome for the patient in terms of preservation of vision.
Conflict of Interest: None to report.
Contact Information: Mona.hammoud@va.gov; matthew.horton3@va.gov
#24 Title: Approach to Glaucoma Diagnostic Evaluation in Patients with Inherited Retinal Dystrophies
Authors: Shreya Parekh, OD; Matthew Horton, OD, FAAO
Site: Cincinnati VA Medical Center
Category: Ocular Disease
Abstract
Background
The purpose of this case report is to review the diagnostic approach for a patient with ocular hypertension and a pre-existing inherited retinal dystrophy. Glaucoma management in patients with retinal dystrophies is often complicated by confounding abnormalities on diagnostic imaging. Structural and functional changes from retinal disease can obscure glaucomatous findings. As such, clinicians must tailor the approach to testing protocol and interpretation in these patients
Case Presentation
A 55-year-old African American female presented on August 2025 with a history of cone dystrophy and ocular hypertension, in both eyes. This patient is being monitored for glaucoma suspicion due to several episodes of ocular hypertension. The patient is currently taking latanoprost 0.005% once at night and dorzolamide twice a day, in both eyes. She is currently returning to the clinic every 3 months for intraocular pressure checks and visual fields. This patient has been diagnosed with cone dystrophy since 2018 and the onset of increased IOP was also in 2018. The patient has had stable IOPs since starting latanoprost in 2018, but had a significant increase in IOP this year, in 2025. Since this episode, the patient has been on latanoprost and dorzolamide. On dilated fundus exam, the optic nerves had distinct margins, good color, and cup to disc ratios were 0.25 and 0.30 respectively. The patient has had stable and robust RNFL OCT scans for years, however her visual fields show significant defects where it difficult to tell if the defects are glaucomatous or not. Ganglion cell analysis shows diffuse loss, likely due to pathology from cone dystrophy. HVF 24-2 has historically shown central and inferior paracentral defects OU and HVF 10-2 shows consistent dense superior temporal defects. These defects do not correlate to the robust RNFL that has stayed stable over the years.
Conclusion
Retinal dystrophies present a diagnostic challenge for patients with co-existing glaucoma or ocular hypertension. Focusing on specific features of glaucomatous optic neuropathy through careful analysis of the funduscopic and OCT tomographic disc features can improve accuracy in diagnosis.
Conflict of Interest:
None to report.
Contact Information: Sp2010@mynsu.nova.edu; matthew.horton3@va.gov