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PURPOSE: To demonstrate a case of massive vitreous haemorrhage obscuring the underlying diagnosis of a large mixed-cell choroidal melanoma which had undergone spontaneous necrosis. CASE REPORT: A 49-year-old man in good general health suddenly lost vision in his right eye due to an extensive vitreous haemorrhage 1 day after a workout at the gym. He reported good vision prior to that without any symptoms of flashes, floaters, or shadows. He was referred to the vitreoretinal department of a tertiary eye hospital, where he presented with a drop in vision to light perception only in the right phakic eye. Pars plana vitrectomy was performed in the right eye, which revealed intraoperatively massive retinal ischemia and choroidal haemorrhage, but no obvious tumour mass that could have been biopsied. The vitrectomy cassette specimen was sent for histopathology, where "ghost-like" melanoma cells were identified. The eye was subsequently enucleated, revealing an extensively necrotic and haemorrhagic choroidal melanoma of mixed cell type with only small viable tumour foci at the base and almost complete lysis of the detached retina. CONCLUSION: Some uveal melanomas (UMs) undergo spontaneous necrosis due to rapid growth, with the centre of the tumour outstripping its established blood supply in the "watershed area" of the eye, and becoming hypoxic with associated necrosis of intraocular structures. Such UMs are often associated with haemorrhage and/or inflammation and usually cause significant destruction of ocular tissues, resulting in enucleation as the only treatment option.

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Hypotension is a commonly encountered complication in haemodialysis patients and is a significant cause of morbidity and mortality. Bilateral visual loss in dialysis induced hypotension remains poorly recognized as a complication by both renal physicians and ophthalmologists. We report 2 cases of patients on renal dialysis who suffered severe longstanding hypotension with bilateral non-arteritic anterior ischaemic optic neuropathy. Both patients experienced bilateral loss of vision over a short time period. We feel that physicians must be aware of patients complaining of painless visual loss in this high risk group, as control of blood pressure may be the most important factor in prevention of this visually devastating condition.

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Neurosarcoidosis is seen in 5-15% of patients with systemic sarcoidosis. The most common cranial nerve presentations are optic neuropathy and facial nerve palsy. The authors present a case of sarcoidosis presenting with a pupil-involving third nerve palsy. The patient responded to corticosteroid therapy with resolution of investigations her cranial nerve palsy but progressed to develop cerebellar signs. This is the first documented case of a pupil-involving third nerve palsy occurring as the first presentation of neurosarcoidosis. Although typically a pupil-involving third nerve palsy necessitates urgent neuroimaging to rule out a posterior communicating artery aneurysm, it is important to recognise inflammatory causes in the differential diagnosis.

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A healthy 44-year-old slim female presented with a constant, non-specific dull headache of subacute onset. The examination showed papilloedema but no other problem. On further questioning she revealed transient visual obscurations and pulsatile tinnitus. The CT scan of the brain was normal, the lumbar puncture showed increased pressure but normal cerebrospinal fluid, and the MR scan and MR venogram was reported showing a small area of developmental venous anomaly in the left parietal region but no venous thrombosis. Benign intracranial hypertension (BIH) was diagnosed but later in the course further tests were done as the patient was atypical for BIH, which revealed essential thrombocythaemia. A CT venogram was arranged which showed partly recanalised chronic sigmoid sinus thrombosis with dilation of collaterals. The patient was treated with acetazolamide, wafarin and hydroxycarbamide. The headache resolved quickly and the papilloedema reduced significantly over 6 months.

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This is a retrospective study of the outcome of all consecutive exotropia surgery performed between the years 1999 and 2007. Excluded were cases of slipped muscles, muscle transpositions, and concurrent cyclovertical procedures. A total of 135 patients of mean age 40 years (range 6-72) were operated with a mean preoperative angle of deviation -40Delta (range -12 to -90). Five were treated with fixed sutures and the rest with adjustables. The surgery included preplanned lateral rectus recessions of mean 6 mm (range 2-9) and maximal possible medial rectus advancements with or without resections of mean 5.6 mm (range 2-11), intraoperatively adjusted to give a resistance of +1 to +2 for abduction on forced duction test (FDT). Adjustable suture patients were seen 4 to 6 hours after surgery and underwent further adjustment, if needed, to achieve the target angle. A further review took place at 2 weeks and 2 months. Children remained under follow-up till 8 years of age. Forty percent needed postoperative adjustment. The mean postoperative angle at final measurement was -2Delta (range +25 to -45). Eighty percent achieved an angle within 10Delta of orthotropia. No gross restrictions of ductions were present postoperatively.

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Patients with chronic headache associated with ocular symptoms regularly seek ophthalmologists' opinions. We report an unusual case of chronic paroxysmal hemicrania (CPH), a rare but well-described variant of cluster headache in a female presenting to an eye department with recurrent episodes of severe unilateral periorbital swelling with a chronic history of headaches. Clinical features, review of literature, and therapeutic response to indomethacin helped to establish the diagnosis as CPH. This is the first report of severe orbital inflammation with CPH to our knowledge.

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This is an interventional case report of a pseudo-cataract formation by the adherence of triamcinolone particles to the posterior surface of the lens following a 2-mg intravitreal injection for treatment of macular edema associated with non-ischemic central retinal vein occlusion. These deposits unusually persisted beyond 6 months.

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