The authors report a case of a 68-year-old woman who developed hypotony and a narrow anterior chamber after an Ex-Press shunt implant. After resolution, tube was obstructed by iris hanging to the end of the shunt, which was liberated using Nd:YAG laser. We discuss our results compared with others shown in the literature. Resumen Los autores reportan el caso de un paciente femenino de 68 años que cursó con hipotonía y cámara plana en el postoperatorio de un implante Ex-Press. Tras resolverse el cuadro se observó obstrucción de la luz de entrada del implante por iris, el cuál fue liberado por medio de YAG laser. Reportamos nuestros resultados y discutimos los casos que se abordaron de manera similar en la literatura.

Orbital metastases are a rare manifestation of systemic malignancies, most commonly originating from the breast or lung in adults. Not infrequently there is not any diagnosis of cancer at the time of presentation with orbital metastatic disease. This is a case of a 62-year-old man whose initial presentation of metastatic small cell lung cancer was left upper lid ptosis and hypoglobus.

Introduction Combined hamartoma of the retina and of the retinal pigment epithelium are extremely rare benign tumors distinguished by retinal pigment epithelium (RPE) and glial tissue proliferation, provoking severe peripapillary and retinal distortion. There is no established management for combined hamartoma of the retina and of the retinal pigment epithelium. Case Reports A 46-year-old male and a 35-year-old female, diagnosed as having a combined hamartoma of the retina and retinal pigment epithelium were observed for four years. One of them was treated with pars plana vitrectomy due to large associated epiretinal membrane (ERM), and the other patient declined surgery. Initially, the evolution was satisfactory in the patient who underwent vitreoretinal surgery, with anatomic improvement and visual acuity stabilization. However, four years later, he complained of visual loss, presenting severe macular distortion, and, consequently, decrease in visual acuity. The patient who preferred a conservative management, showed no funduscopic changes during the follow-up. Conclusion Vitreoretinal surgery for combined hamartoma of the retina and retinal pigment epithelium may improve retinal architecture and visual acuity, but in the long-term functional recovery is frequently not possible, leading to a decrease in VA. We can conclude that the evolution of this pathology can be similar in both cases treated with vitreoretinal surgery and in cases without surgery. Therefore, conservative management may be adopted. A larger number of cases are required to be studied to confirm our clinical observations.

Purpose: Strabismus (heterotropia) is one of several possible complications of ocular traumatic injury. This condition is associated with a decreased quality of life. The purpose of this study is to report the functional outcomes of a series of 35 patients presenting with strabismus secondary to eye trauma. Methodology: Retrospective study. Treatments for each type of post-traumatic ocular lesion were categorized, which included conservative management by clinical observation; use of a lens with prismatic addition; intramuscular injection of botulinum toxin; or surgery. Strabismus conditions were evaluated prior to the treatment and six months after the last treatment had been received. The rate of therapeutic success, defined as ±10 PD (prism diopters) was assessed. Results: The orbital injuries that most commonly caused strabismus were found to be orbital fracture, penetrating eye injury and direct muscle trauma. All cases of direct muscle trauma received surgical treatment; 54% of orbital fractures resolved spontaneously during clinical observation, whereas 38% required surgery. Three cases of penetrating eye injury were observed and three were treated surgically. The rate of therapeutic success was 88.57%. A single treatment was sufficient for 88.6% of all cases. Conclusions: Non-surgical therapeutic clinical observation is sufficient in a significant percentage of cases because a large number of patients tend to spontaneous recovery. Additional techniques, such as treatment with botulinum toxin, can have a useful complementary role. Surgical intervention, assessed on a case by case basis, also turned out to be highly effective in the minority of cases where it was required.

While tearing patients have similar complaints, the etiology of their symptoms may vary widely and thus require a meticulous evaluation. A thorough history followed by systematic examination of the lids, ocular surface, anterior segment, and lacrimal system will lead the clinician to the proper diagnosis. Treatment options for lacrimal obstruction are varied and as surgical techniques continue to evolve, new studies are indicated to determine the approaches that provide the most successful outcomes while ensuring patient safety.