Thyroid Orbitopathy (TO) is characterized by exophthalmos, palpebral retraction and compressive optic neuropathy (CON) in the more severe cases. Orbital decompression surgery is carried out in these cases to preserve vision. The study presents a 56 year old masculine patient, who is a smoker with hypertension. In 2009, he was diagnosed with Graves' disease with a slight TO that progressed to severe TO with CON, after he was treated with radioactive Iodine to control hyperthyroidism. An orbital compression surgery by nasal endoscopy was carried out with excellent visual and aesthetic results. Objectives: To show the results of the orbital decompression by endonasal endoscopy, besides the analysis of the complications and factors associated with TO progression in this patient. Results: The results of the surgery were satisfactory, as regard to the exophthalmos and the intraocular pressure decrease plus the visual acuity, colour vision and visual field improvement. He suffers strabismus after surgery. Conclusion: We concluded that the surgery results were satisfactory in this patient and strabismus was a complication after surgery. Smoking and iatrogenic hypothyroidism were the factors worsening the thyroid orbitopathy.

In an effort to keep up with the ever rising cost in the current private practice setting, ophthalmology practices are becoming busier, implementing innovative and cost-effective procedures. This has led to a significant decrease in the amount of time that the physician spends with the patient, which eventually may jeopardize the quality of care. We recently encountered a case of poor doctorpatient communication in which all ethical principles and limits of patient care were trespassed leaving the patient as a blind victim. We present the case hoping to touch upon every doctor's conscience to remember the primary role of a physician in educating patients and treating without inflicting harm as a way to offer better and safer quality of health care. Resumen En un esfuerzo para soportar los incrementos de los precios en las prácticas médicas privadas, los oftalmólogos se han visto en la necesidad de incrementar el número de pacientes, al igual que implementar procedimientos innovadores de costo beneficio adecuado. Esto ha llevado irremediablemente a disminuir el tiempo que el médico le dedica a cada paciente, lo que puede eventualmente comprometer la calidad del tratamiento. Recientemente encontramos uno caso de pobre comunicación médico-paciente, en el que se traspasaron los principios éticos llevando al paciente a la ceguera irreversible. Presentamos este caso con la esperanza de crear conciencia recordando que el rol primordial del médico es la educación y el tratamiento sin infligir daño al paciente, ofreciendo un mejor y seguro servicio de salud.

Summary: It is necessary to heighten the level of knowledge about glaucoma because of the real danger of blindness that it represents, which could minimize serious consequences. Objective: To identify the level of knowledge of patients with glaucoma about their illness. Methods: A descriptive cross-sectional study was undertaken on the Glaucoma Service of the Ophthalmological Center of the Dr. Salvador Allende University Hospital, between January and March of 2010. The cohort included 947 patients with primary open-angle glaucoma who came to the Service during this period, and the sample consisted of the first 100 patients who fulfilled the inclusion criteria (willingness to participate in the study and an appropriate level of communication to respond the survey). A survey of the National Eye Health Education Program 2020 Vision was employed (Bethesda, USA). The results were evaluated a based on responses to true or false questions. The percentage method was used for the calculation of the frequencies in each case. Results: Women (62.0%) and patients between 50 and 69 years of age (43.0%) predominated. The risk factor most commonly recognized was family history of the illness (94.0%) and the least commonly recognized were racial characteristics (21.0%). The asymptomatic character of the disease was clearly understood (93.0%), but there were incorrect answers on the increase of the intraocular pressure. 87.0% of those interviewed were certain that the illness could only be controlled, but only 9.0% knew visual recovery was not possible. 100.0% erroneously identified intraocular pressure as the only diagnostic indicator of the disease. 69.0% demonstrated a mid-level of knowledge about their illness, and 19.0% an appropriate level. Conclusions: In the patients evaluated, the mid-level of knowledge prevailed. Resumen Es imprescindible elevar el nivel de conocimientos sobre glaucoma por el peligro real de ceguera que representa, lo que podría minimizar sus graves consecuencias. Objetivo: Identificar el nivel de conocimientos de enfermos glaucomatosos sobre su enfermedad. Métodos Se realizó un estudio descriptivo y transversal en el Servicio de Glaucoma del Centro Oftalmológico del Hospital Universitario Dr. Salvador Allende, entre enero y marzo de 2010. El universo estuvo constituido por los 947 pacientes con glaucoma primario de ángulo abierto que acudieron al Servicio en el periodo y la muestra por los primeros 100 que cumplieron los criterios de inclusión (disposición de participar en el estudio y adecuado nivel de comunicación para responder la encuesta). Se aplicó una encuesta del National Eye Health Education Program 2020 Vision (Bethesda, USA). Los resultados fueron evaluados según el conocimiento demostrado por los pacientes de acuerdo con el tipo de respuesta (cierto o falso). Se utilizó el método porcentual para el cálculo de las frecuencias en cada caso. Resultados Predominaron las mujeres (62,0%) y los pacientes entre 50 y 69 años de edad (43,0%). El factor de riesgo más reconocido fue el antecedente familiar de la enfermedad (94,0%) y las características raciales el menos (21,0%). Fue claramente identificado el carácter asintomático de la enfermedad (93,0%), pero no hubo respuestas correctas sobre el aumento de la presión intraocular. El 87,0% de los encuestados consideró cierto que la enfermedad sólo puede ser controlada y el 9,0% conocía lo referente a la no recuperación visual. El 100,0% valoró erróneamente la presión intraocular como único proceder diagnóstico y el 76,0% correctamente la dilatación pupilar. El 69,0% demostró un nivel medio de conocimientos sobre su enfermedad y el 19,0% un nivel adecuado. Conclusiones En los pacientes evaluados, predominó el nivel medio de conocimientos. Palabras clave: percepción, riesgo, glaucoma, conocimientos, enfermedad.

RESUMEN Objetivo: Reportar el caso de un paciente con queratocono unilateral verdadero en el ojo derecho asociado a fibrosis localizada en la órbita ipsilateral. Métodos: Hombre de 25 años de edad con agudeza visual progresiva en el ojo derecho con diagnóstico de queratocono unilateral y fibrosis orbitaria unilateral. El ojo derecho con una agudeza visual de 20/800 que mejoraba a 20/40 con una refracción de -7.50 -6.00 x 175°, presentando signos clínicos de queratocono. Los movimientos oculares muestran limitaciones en la mirada hacia arriba en todas las posiciones. El ojo y órbita del lado izquierdo sin ninguna alteración con una agudeza visual de 20/20. Resultados: Se realizó tomografía computada, confirmando el diagnóstico de fibrosis orbitaria en la órbita derecha, las topografías corneales a través del tiempo mostraron progresión evidente del queratocono en el ojo derecho y estabilidad en el ojo izquierdo. Conclusiones: El queratocono unilateral verdadero es una condición rara. La asociación de queratocono unilateral con alteraciones unilaterales de párpados y órbita se ha descrito previamente. Sin embargo, según nuestro conocimiento, este es el primer reporte de fibrosis orbitaria asociado con queratocono. ABSTRACT Purpose: To report a case of a patient who presented with true unilateral keratoconus in his right eye associated to a localized fibrosis in his ipsilateral orbit. Methods: A 25-year old male with progressive visual acuity loss in the right eye was diagnosed with unilateral keratoconus and unilateral orbital fibrosis. Right eye visual acuity was 20/800 improving to 20/40 with a refraction of -7.50 -6.00 x 175° and he presented with clinical signs of keratoconus. Eye movements showed limitations in the upper gaze of the right eye in all positions. The fellow eye and orbit were under normal limits and visual acuity was 20/20. Results: Computed Tomography scan confirmed the diagnosis of orbital fibrosis in the right orbit and corneal topographies during a time span showed evident keratoconus progression of the right eye and stability in the left eye. Conclusions: True unilateral keratoconus is a rare condition. Association of unilateral keratoconus with unilateral eyelid and orbital conditions has been previously reported. Nevertheless, to our knowledge, this is the first report of orbital fibrosis associated with keratoconus.

Purpose: Report technique utilizing multilayered folded dehydrated amniotic membrane for refractory scleral delle management. Methods: A 3 x 2 centimeter dehydrated amniotic membrane was folded four times onto itself, with the basement membrane side on the exterior, to yield a 7.5 x 10 millimeter graft. This was sutured into the delle using four 9-0 vicryl sutures. Once adequate fixation of the multilayered folded graft was obtained, a primary conjunctival closure was performed using five 9-0 vicryl sutures. Total surgical time was fifteen minutes. Results: This technique was utilized on one patient with a refractory scleral delle after undergoing pterygium excision outside of my institution with bare sclera technique and intra-operative mitomycin C application. No post-operative complications or recurrence of the delle occurred after 9 months of followup. Conclusion: This technique provides an alternative efficient management of refractory scleral dellen while avoiding use of donor corneal or scleral tissue.

Acanthamoeba Keratitis. A Case Report Case report: A 33 year-old male, with hyperemic painful eye and no improvement after antibiotic and corticoid topic therapy. By biomicroscopy: annular infiltrate with inferior de-epithelialization, and limbal inflammation. Due to the suspicion of Acanthamoeba keratitis, we started treatment with clorhexidine 0.02%, polimyxin B+neomicin+ gramicidin (Oftalmowell^®) and propamidine isethionate (Brolene^®). A microbiological diagnosis confirmed the presence of Acanthamoebae, and diagnosis of Acanthamoeba keratitits was established. We observed a satisfactory evolution, with formation of a central corneal leukoma, followed by penetrating keratoplasty, with good results. Discussion: Clinical and microbiological early diagnoses are fundamental, since inappropirate treatment will lead to the development of cysts, and treatment resistance. Acanthamoeba keratitis, early diagnosis, microbiological diagnosis. Caso clínico: Varón de 33 años con ojo hiperémico, doloroso, sin mejoría tras tratamiento con antibióticos y corticoides tópicos. A la exploración biomicroscópica: infiltrado anular desepitelizado por la parte inferior, con limbitis. Ante la sospecha de queratitis por Acanthamoebae, se inició tratamiento con clorhexidina 0.02%, polimixina B+neomicina+gramicidina (Oftalmowell^®) e isetionato de propamidina (Brolene^®). El estudio microbiológico confirmó el crecimiento de Acanthamoebae, por lo que se estableció el diagnóstico de queratitis por Acanthamoeba. La evolución fue satisfactoria, con formación de leucoma corneal central, que llevó a queratoplastia penetrante, con buenos resultados. Discusión: Un diagnóstico precoz, clínico y microbiológico es fundamental, pues un tratamiento inicial poco acorde dará lugar al enquistamiento y resistencia al tratamiento. Palabras clave: Queratitis por Acanthamoeba, diagnóstico precoz, diagnóstico microbiológico.