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A carotid-cavernous fistula (CCF) is an arteriovenous fistula with an abnormal connection between the carotid artery and cavernous sinus that can be sight and life-threatening. The conjunctival injection is often the most prominent feature, and patients are commonly misdiagnosed for other ocular conditions leading to a delay in diagnosis and treatment. All three patients in this case series presented with persistent red eyes. They were all treated for conjunctivitis and only referred for further workup when other progressing ocular symptoms occurred. The diagnosis of CCF was confirmed with digital subtraction angiography and with successful endovascular embolization, their ocular symptoms resolved with preserved optic nerve function. A high index of suspicion in patients presenting with an atypical red eye is very crucial for timely diagnosis of CCF.

Endogenous Klebsiella pneumoniae panophthalmitis commonly affects those with compromised immunity. The occurrence of this infection in healthy individuals is rare. We describe the case of a healthy adult who presented with endogenous Klebsiella pneumoniae panophthalmitis from an asymptomatic liver abscess. A 64-year-old, previously healthy gentleman presented with rapidly progressive left eye periorbital swelling and blurring of vision. He had a low-grade fever three days prior to the development of ocular symptoms, but otherwise no other systemic complaints. Visual acuity was light perception in the left eye, and ocular motility was restricted in all directions of gaze. Ocular examination revealed proptosis, severe conjunctival chemosis, hazy cornea, and fibrin deposition in the anterior chamber. The posterior segment could not be visualized. Ultrasound of the hepatobiliary system revealed an abscess in the right lobe of his liver. His blood cultures grew Klebsiella pneumoniae. Despite being treated with high-dose intravenous antibiotics, his eye condition deteriorated. Evisceration was performed when he developed scleral melting and globe perforation. We highlight the importance of a high index of suspicion of endogenous Klebsiella panophthalmitis as it can be easily missed in healthy adults. Early diagnosis and prompt management are needed to prevent morbidity and mortality from this devastating infection.

Purpose To describe the epidemiology of open globe injuries and its prognostic factors from the perspectives of a tertiary care centre in northern Malaysia. Methods A retrospective study of open globe injuries in a period of three years between June 2017 and May 2020. Patients presenting with open globe injuries were identified and recruited from hospital census. Case records were retrieved and analysed after recruitment. Results A total of 114 patients with 118 open globe injuries were included in the study. Four patients had bilateral eye involvement. Men were found to have seven and a half times higher rate of ocular injuries than women. The predominant age group of ocular trauma presentation was in younger adults between the age of 21 and 30 years old. Work-related injuries account for almost half of the globe injuries (48.7%) followed by motor vehicle accident-related, domestic accident-related, and others. The significant factors related to the visual outcome are presenting visual acuity (VA), presence of relative afferent pupillary defect (RAPD) and vitreous loss. Conclusion The factors related to visual outcomes in this study may aid the clinician in determining the visual prognosis of ocular injuries. Young working males were the most susceptible group to sustain penetrating ocular injuries due to their job nature. Health education and safety at workplace are essential to reduce the occurrence of ocular injuries.

Headache can be a primary or secondary disorder. The characteristics of headache and its associated features, especially the presence of red flag signs, are important in distinguishing secondary from primary causes. Hemicrania continua is a type of primary headache disorder characterized by a continuous unilateral headache with episodes of exacerbations and association with cranial autonomic symptoms, which include several ocular symptoms. The absolute response to indomethacin remains the hallmark of this disease. We would like to report a rare case of hemicrania continua with scintillating scotoma during exacerbations apart from the typical autonomic features of conjunctival injection, ptosis, eyelid edema, and lacrimation.

Yoga has recently been touted as a means to improve physical and mental well-being. However, no form of exercise is without its risks. A 32-year-old Chinese female with moderate myopia complained of right eye sudden onset of floaters and mild blurring of vision after the head-down posture. The visual acuity was 6/12 in the right eye and 6/9 in the left eye. A right eye fundus examination showed posterior vitreous detachment, with a small blood clot located at the inferior margin of the optic disc. The patient was diagnosed with right eye vitreous hemorrhage secondary to acute posterior vitreous detachment and was managed conservatively. Acute changes in posture, especially between an upright and a head-down position, may cause acute posterior vitreous detachment. As yoga practitioners may be required to assume this head-down position, myopic patients should be warned of the possible ocular complications of this exercise.