Eyeworld

EW RESIDENTS 160 March 2015 Secondly, the appearance of asymmetric flattening on corneal topography is particularly interest- ing. While this patient's corneal topography clearly accounted for her decreased visual acuity, primary corneal pathology should not be at the top of a differential diagnosis in the absence of slit lamp findings and of such rapid onset. Although correlation is not causation, the synchrony of the chalazion and her vision loss should raise questions of whether a unifying diagnosis may exist. Lid masses such as these can produce corneal molding. In Figure 1A, a wire frame 3D map of her cor- nea overlain with refractive color- coding demonstrates the substantial area of flattening superonasally in her cornea, directly beneath her chalazion. The patient's dramatic im- provement with hard contact lens over-refraction and especially with treatment of her chalazion demon- strates the important refractive implications of even subtle corneal warpage. Furthermore, this case highlights the importance of all portions of the eye exam, including the lids, adnexa, and cornea, when working up acute vision loss. Outcome In subsequent follow-up visits with complete resolution of her chala- zion, her visual acuity returned to baseline and her corneal topography became normal again (Figure 2).This demonstrates the potential for im- provement of corneal warpage after resolution of an extrinsic compres- sion. Although corneal warpage has been described with contact lens use, similar phenomena are possible with any extrinsic impression on the cornea. As an epilogue, the patient eventually developed high-risk ocular hypertension as a result of her pigment dispersion, a patholo- gy most assuredly unrelated to her chalazion. EW Editors' note: Dr. Zahid is a resi- dent physician in the Department of Ophthalmology, New York University Langone Medical Center. Contact information Zahid: sarwar.zahid@nyumc.org demonstrating residual hyperopia but with much less irregular astig- matism. Her corneal topography was markedly improved as well. Discussion This case illustrates 2 important les- sons for both experienced clinicians and ophthalmologists-in-training: 1) the importance of considering all possible etiologies of acute vision loss, including those that may not be acutely vision threatening and 2) the differential diagnosis of abnor- mal corneal topography in elderly patients. In this case, all clinicians in- volved focused on potentially vision -threatening etiologies of vision loss. While it is critical to rule out a vitreoretinal, optic nerve or CNS etiology, the work-up may distract from more benign causes. The "bump" on this patient's right upper eyelid was not initially considered relevant to her visual symptoms, and work-up focused on lab testing for autoimmune, inflammatory, and infectious etiologies. Had this been considered earlier in this patient's work-up, much time and cost would have been saved. An unexpected etiology continued from page 159 The best-in-class Red Reflex from Leica Microsystems combined with the cutting-edge Digital Microscope Platform from TrueVision ® 3D Surgical create the most powerful heads-up surgery and guidance technology in the industry. · Enhanced Ergonomics: Heads-up capability provides relaxed working position; less stress to neck, back muscles · Improve Workflow: Surgical field displayed for entire OR suite on 3D screen, engaging the whole team visually · Increase Accuracy: TrueGuide ® , a patented computer-guidance application, is designed to help leading surgeons achieve targeted refractive outcomes with toric IOLs · Revolutionize Education: 3D enhances learning environment and facilitates teaching Contact us today for a demo of the heads up system and learn what IOL navigation can do for your practice. Learn more at www.leica-microsystems.com/3D-HeadsUp. 3 D H e a d s - U p S u r g e r y T M + I O L G u i d a n c e www.leica-microsystems.com/3D-HeadsUp www.HeadsUpSurgery.com V i s i t u s a t A S C R S i n A p r i l : T r u e V i s i o n b o o t h # 4 3 1 | L e i c a M i c r o s y s t e m s b o o t h # 9 3 9 The Leica M822 and M844 seamlessly integrate with TrueVision's 3D Heads-Up technology and IOL guidance

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