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Ophthalmic emergencies are invariably challenging for the non-specialist to identify and evaluate, and may be complicated by occult but vision threatening raised intraocular pressure. We present a case of hypertensive uveitis accompanied by the finding of retinal arterial pulsation, which when visualised by direct ophthalmoscopy allows the non-specialist to identify significantly raised intraocular pressure requiring urgent evaluation by an ophthalmologist.

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PURPOSE: To report an uncommon case of intraoperative ocular decompression retinopathy (ODR). CASE REPORT: A 48-year-old man presented with decreased vision and pain in the left eye (LE) for 10 days following trauma with a bamboo stick. He had visual acuity of counting finger close to face in the same eye, along with corneal edema, dilated pupil and posteriorly dislocated lens. Intraocular pressure (IOP) was 42 mm of mercury (Hg). He underwent 23-gauge pars plana vitrectomy with removal of the dislocated lens. Towards the end of otherwise uneventful surgery, blot hemorrhages appeared over the posterior pole and equator. The following day, his vision was counting finger close to face and IOP was 16 mm of Hg. Fundus examination revealed large blotches of hemorrhages at different levels of the retina, later confirmed by optical coherence tomography. Disc hyperfluorescence and blocked fluorescence corresponding to blot hemorrhages were seen on fundus fluorescein angiography. Blood investigations to rule out blood dyscrasias were within normal limits. CONCLUSION: Ocular decompression retinopathy, though not common, has been reported to occur following various types of surgeries, especially if associated with preoperatively raised IOP. The event can also occur intraoperatively and the preoperative control of IOP is of paramount importance in the prevention of ODR.

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PURPOSE: Obstructive sleep apnea syndrome (OSAS) patients are at risk of glaucoma but the risk increases if they have higher intraocular pressure (IOP) while sleeping. We aim to evaluate the postural effect of upright and prolong supine positions on IOP in these patients. METHODS: This is a cross-sectional study involving 27 patients with symptoms of OSAS seen at a tertiary institutional center and 25 normal controls performed between June 2015 and June 2016. All patients and controls underwent a polysomnography (PSG) test and were diagnosed with OSAS based on the apnea-hypopnea index (AHI). Patients are those with OSAS symptoms and had AHI > 5, whereas controls are staffs from the ophthalmology clinic without clinical criteria for OSAS and had PSG result of AHI < 5. IOP was measured 10 min after sitting, immediately and at 30 min on supine position and immediately after resuming sitting position. The main outcome measures were the changes in mean IOP in different positions. RESULTS: The increase in mean IOP when changing from sitting to supine position was significantly higher in OSAS patients in both the right eye (RE) (1.01 ± 1.14 vs 0.44 ± 0.41 mmHg, p = 0.033) and left eye (LE) (1.20 ± 1.26 vs 0.48 ± 0.62 mmHg, p = 0.044). After 30 min supine, the IOP in OSAS patients showed a further increase in IOP than controls (RE 1.20 ± 1.79 vs 0.12 ± 0.66 mmHg, p = 0.001 and LE 0.59 ± 2.00 vs 0.15 ± 0.78 mmHg, p = 0.246). Higher IOP when sitting post supine is associated with higher IOP on supine position. CONCLUSION: IOP increase is significantly more in OSAS patients on prolong supine position.

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PURPOSE: To illustrate the potential role for Heidelberg edge perimetry (HEP) in the assessment of early functional loss in glaucoma. CASE REPORT: A 46-year-old male presented with raised intraocular pressure but healthy optic discs and normal standard automated perimetry (SAP). He was diagnosed with ocular hypertension, but after 16 years, he developed glaucomatous changes to the right optic disc and inferior retinal nerve fiber layer thinning. Despite the evidence of progressive structural damage, functional testing using SAP was repeatedly normal, based on conventional criteria. HEP, on the other hand, revealed an extensive superior visual field damage in agreement with the structural changes. Additionally, and in contrast to SAP, the HEP indices of Glaucoma Hemifield Test, mean deviation and pattern standard deviation were all outside normal limits. CONCLUSION: This case illustrates that HEP may have an important role in the early detection of functional damage in glaucoma, with potential advantages over SAP.