Bilateral Retinal Hemorrhage
Submitted by: Andrea Sandifer, OD
CASE SUMMARY:
A 42-year-old female presented for floaters and loss of vision in both eyes. The patient had been on a recent trip to Japan. On the flight, she noted seeing “bugs” on the plane walls, and when the flight landed, she passed out and was admitted to the hospital. She received 4 pints of blood, 3 B12 shots, and a platelet transfusion while in the hospital. While in Japan, she was told it was her gall bladder and anemia. On arrival back to the states, she was admitted again to the hospital for more blood and B12.
THE PROCESS:
Her entering visual acuities were Hand Motion in her right eye and Light Perception in the left eye. Her pupils were sluggish to respond. Intraocular pressures were 16 for the right eye and 19 for the left. The anterior segment of the eye was normal. On dilated eye exam, she showed diffuse retinal hemorrhages, Roth spots, and pre-retinal hemorrhages at the macula in both eyes.
TREATMENT:
The patient was referred to a retina specialist for evaluation. Patient is scheduled with Oncology and Hematology for examination and treated by Hematology.
CONCLUSION:
At her second follow-up with the retina specialist, her vision had improved to 20/40 OD and 20/30 OS. Patient was able to be monitored as needed with a retina specialist. Patient will continue regular care with hematology and the primary care provider.
Watch out for stink bugs!
Submitted by: Sarah Bricker, OD
CASE SUMMARY:
An 11-year-old boy developed a red, irritated right eyelid after being sprayed by a stink bug. He had no discharge, rash, or itching. Despite repeated saline eye washes over several days, irritation persisted. His right eye vision was 20/25.
PRESENTATION:
Slit lamp exam showed mild redness and crusting on the right upper eyelid, with no eyelash loss. The cornea and conjunctiva were unaffected, and the anterior chamber was quiet.
DIAGNOSIS & TREATMENT:
The patient was treated with topical Tobrex ointment and preservative-free artificial tears, with resolution of symptoms within 24 hours. Contact dermatitis was considered but was unlikely given the absence of itching, rash, chemosis, or discharge.
CONCLUSION:
The patient experienced mild eyelid irritation from stink bug fluids, which are acidic and can cause various ocular injuries, including keratitis, conjunctival pseudomembrane formation, dermatitis, and chemical burns.
