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Five family members and three unrelated patients (four women, four men, 23 to 71 years old) had a dystrophy of the corneal epithelium. Direct slit-lamp examination showed bilateral or unilateral, gray, band-shaped, and feathery opacities that sometimes appeared in whorled patterns. Retroillumination showed intraepithelial, densely crowded, clear microcysts. Light and electron microscopy disclosed diffuse vacuolization of the cytoplasm of epithelial cells in the affected area. Visual acuity was so reduced in three patients that abrasion of the corneal epithelium was performed. The corneal abnormalities recurred within months, with the same reduction in visual acuity as before. The corneal opacities were progressive in two patients but diminished noticeably in another after he began using a hard contact lens. We found no other ophthalmic irregularities or associated systemic abnormalities and no indication of drug-induced keratopathy.

Wound disparity, mismatch between the size and shape of the donor corneal button and its wound, probably determines the direction and amount of postkeratoplasty astigmatism. Tilting a hand-held trephine is thought to contribute to an oval wound and to wound disparity. We examined the contribution of trephine tilt to wound size and shape. Eyebank eyes were hand trephined at 0, 5, 10, 15, 20, and 25 degrees of tilt. The button endothelial edges were analyzed by the photogrammetric index method. All index values were significantly different from those for a theoretically circular or symmetric button. Although the most oval buttons were at 20 and 25 degrees, buttons were similarly oval and asymmetric for trephine tilt from 0 to 15 degrees. Neither ovality nor asymmetry correlated with angle of tilt. Even when no attempt is made to tilt a hand-held trephine, oval and irregularly shaped wounds may result.

A 62-year-old woman developed a recurrent mucinous sweat gland adenocarcinoma of the eyelid. The clinical characteristics of this rare, primary adnexal neoplasm of skin in our patient were, to our knowledge, unique. The tumor mimicked a lacrimal sac tumor and had orbital extension demonstrated preoperatively by computed axial tomography. Orbital extension of the tumor mass was confirmed during a wide, en bloc, excisional biopsy.

Aeromonas hydrophilaand Plesiomonas shigelloidesare gram-negative, facultatively anaerobic rod-like bacteria. Both organisms have a reputation for low virulence in humans. Only recently have two corneal ulcers, one case of posttraumatic endophthalmitis, and two possible conjunctival infections caused by A. hydrophilabeen reported.1-3To our knowledge, there have been no reports of P. shigelloidesocular infections. We treated a case of posttraumatic endophthalmitis caused by A. hydrophilaand P. shigelloides.