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Fulltext Epiphora as the primary initial presentation for a huge sino-nasal osteoma: a rare presentation

Nadia Yaacob, Adil Hussein

Journal of Biomedical and Clinical Sciences, 2018;3(2):26-28.
MyJurnal

Sino-nasal osteoma is a common benign tumour of paranasal
sinuses and usually asymptomatic. Here, we presented a case of a huge sinonasal osteoma. Despite the large size of the tumour, the only presentation
was epiphora. There were no headache, facial pain or diplopia. Nasal
obstruction only occurred after involvement of the nasal cavity. In diagnosing
aetiology of the epiphora, sino-nasal pathology needed to be ruled out after
excluding ocular causes. Multidisciplinary approach between otolaryngology
(ORL) team and ophthalmology team was essential in managing the case.
The tumour was successfully removed surgically via endoscopic approach;
and dacryocystorhinostomy (DCR) was performed to alleviate the epiphora.
Fulltext Herpes Zoster Ophthalmicus, persistent hyphema and orbital apex syndrome; a blinding combination

Shavani, Abirami, Adil Hussein, Wan-Hazabbah W.H.

Journal of Biomedical and Clinical Sciences, 2017;2(2):48-51.
MyJurnal

To report a rare case of an elderly gentleman who presented with herpes zoster ophthalmicus, complicated with persistent hyphema and orbital apex syndrome. A 75-year-old Malay gentleman presented with left herpes zoster ophthalmicus that was complicated with complete ophthalmoplegia and ptosis. He developed total hyphema in the affected eye with a secondary elevated intraocular pressure after a week. He was treated with oral acyclovir and topical corticosteroids. However, the total hyphema persisted that required an anterior chamber washout surgery. Herpes Zoster Ophthalmicus complicated with persistent hyphema and orbital apex syndrome is rare and very challenging to manage. Radiological imaging is important to exclude other causes of OAS. It is recommended to treat HZO with systemic acyclovir for a longer duration in view of ocular and neurological involvement.
Fulltext Silent occlusive retinal vasculitis in a patient with pulmonary tuberculosis

Nadia Yaacob, Adil Hussein, Maizan Yaakob, Zuraidah Mustari

Journal of Biomedical and Clinical Sciences, 2018;3(1):31-34.
MyJurnal

The presence of retinal vasculitis in patients with pulmonary tuberculosis is not uncommon. However, asymptomatic presentations are quite rare. Here, we present a case of 25-year-old Malay gentleman with pulmonary tuberculosis, who was referred for an eye assessment following initiation of anti-tuberculosis drugs. His vision was good; he had no other symptoms despite having retinal neovascularization, pre-retinal haemorrhages and healed choroiditis at the fundus of the left eye. Fundus fluorescein angiography showed multiple areas of capillary fallouts at the superotemporal quadrant of the left eye with leakage from the retinal neovascularization. He was treated with laser retinal photocoagulation and oral steroids for 6 weeks, while the anti-tuberculosis drugs were continued for 9 months. Subsequent follow-ups showed regression of the neovascularization. He has remained asymptomatic since his initial visit to the eye clinic.
Fulltext Traumatic globe displacement into anterior cranial fossa

Patricia Ann John, Sylves Patrick, Mohtar Ibrahim, Adil Hussein

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):325-327.
MyJurnal

A 64-year-old Malay gentleman alleged occupational injury when a malfunctioned metal hydraulic door hit on his face while unloading sand from his tipper-truck. Post-trauma, he complained of right eye (RE) pain and total loss of vision. On examination, noted RE visual acuity was unable to be assessed and left eye (LE) was 6/24 with pinhole 6/9. No eyeball could be seen in the right socket with superior orbital rim step deformity and left periorbital haema- toma. Computed tomography scan of the brain and orbit confirmed displaced right eye globe into the right anterior cranial fossa with right and left multiple orbital wall fractures. He then underwent successful right eye globe reposi- tioning. Traumatic orbital roof fracture is a rare condition. Repositioning of the eye globe was done to salvage the eye globe for a cosmetic reason and to avoid localised inflammatory reaction at the anterior cranial fossa.
Fulltext Case Series of Cornea Bee Sting: Different Approaches of Management

Michael Dau Bing Ngu, Tengku Norina Tuan Jaffar, Adil Hussein

Journal of Biomedical and Clinical Sciences, 2019;4(1):1-4.
MyJurnal

Cornea bee sting is a rare condition with mild to severe complications. We report a case series of three patients with cornea bee sting presented to a tertiary center. All patients sustained embedded stingers in the cornea stroma and presented within a few hours of injuries. All patients received topical antibiotics, topical steroids and removal of stingers. However, techniques of stinger removal and administration of the medications are among factors that contributed to different outcomes in these patients
Fulltext Methicillin-resistant staphylococcus aureus (mrsa) orbital cellulitis- a case report and literature review

Siti Amirah Hassan, Rafidah MD Saleh, Norlaila Talib, Adil Hussein

Journal of Biomedical and Clinical Sciences, 2019;4(2):1-4.
MyJurnal

Orbital cellulitis is a clinical diagnosis. Once the diagnosis is made, an empirical antibiotic is started, and in most cases, the clinical improvement can be observed within 24-48 hours. We discuss treatment options in managing orbital cellulitis in a 34-year-old male in which no improvement was seen despite being started on empirical broad-spectrum antibiotic. Patient had a prior history of being bitten by an insect in the left upper eyelid while doing gardening about 5 days prior to admission. The patient developed left orbital cellulitis a few days following the insect bite. Patient was started empirical broad-spectrum antibiotic immediately, but no improvement observed. Culture and sensitivity taken from the upper eyelid grew methicillin-resistance Staphylococcus aureus (MRSA) which was sensitive to vancomycin. Patient was treated with intensive fourteen days of intravenous vancomycin. The infection resolved as evidenced by clinical improvement and reduction of white blood cells count.
Fulltext Case series of ocular tuberculosis; the great masquerader

Loh, Ui Lyn, Nadras, Indira, Yeong, Choo Mee, Nadarajah, Gaayathri, Fazilawati Qamarruddin, Shelina Oli Mohamed, et al.

Journal of Biomedical and Clinical Sciences, 2018;3(2):1-5.
MyJurnal

Tuberculosis, an ancient disease, still thrives today as the leading infection caused by Mycobacterium tuberculosis. Diagnosis of ocular tuberculosis poses a great challenge due to the varied clinical presentations. We report 3 cases of primary ocular tuberculosis with varied presentations: conjunctival abscess, sclera-uveitis and occlusive vasculitis. There were no symptoms suggestive of pulmonary tuberculosis in all cases. All patients presented with acute, unilateral painful red eye. The first case had good visual acuity (VA) OD (6/9) with a swollen upper lid, localized perilimbal-hemorrhagic conjunctival swelling superiorly, keratic precipitates and mild anterior chamber reaction. The posterior segment was normal. The second case had a VA of 6/60 OD. There was presence of conjunctival injection, keratic precipitates, posterior synechiae and anterior chamber reaction of 1+. A few days later, there was a progression to vitritis OU and hyperemic optic disc OD with choroidal folds, cystoid macula edema and a positive T sign on B scan ultrasonography. The third case had VA of 6/6 OU, AC reaction of 2+ OD. There was multiple peripheral choroiditis with peripheral vasculitis seen in the posterior segment OU. Fundus fluorescein angiography (FFA) showed peripheral periphlebitis in all 4 quadrants OU. All 3 cases had positive Tuberculin Skin Test (Mantoux test) results which were more than 20mm. Anti-tuberculous treatment was promptly started and all patients showed significant clinical improvement. This case series highlights the diverse clinical presentations of ocular tuberculosis. A high clinical index of suspicion led to prompt initiation of anti-tuberculous therapy which resulted in good clinical outcomes for all cases.
Fulltext Recurrent optic neuritis as early presentation of idiopathic hypertrophic cranial pachymeningitis

Norhayaty Samsudin, Tai, Evelyn Li Min, Chui, Yain Chen, Kumar, Lakana, Azhany Yaakub, Adil Hussein, et al.

Journal of Biomedical and Clinical Sciences, 2017;2(1):23-26.
MyJurnal

44-year-old Malay lady presented with drooping of the right eyelid and worsening of left eye vision for one week duration. There was associated headache, periorbital discomfort and diplopia on left gaze. She previously had a history of recurrent optic neuritis affecting both eyes over a period of 12 years. On examination, there was right-sided partial ptosis and left exotropia. The adduction, abduction, elevation and depression of the right eye was limited. Left eye extraocular movements were full. The right eye visual acuity was 6/9, while the left eye visual acuity was perception to light, with a positive relative afferent papillary defect and a pale optic disc. The right optic disc was normal. There was reduced sensation in the trigeminal nerve distribution over the right side of the face. Neurological examination was otherwise normal. Magnetic resonance imaging of the brain and orbit revealed meningeal thickening with involvement of the right orbital apex and cavernous sinus. Blood investigations for infectious and autoimmune causes were unremarkable. She was diagnosed to have idiopathic hypertrophic cranial pachymeningitis and treated with systemic corticosteroids. The right eye extraocular motility improved, while the left eye visual acuity improved to counting finger. This case demonstrates that idiopathic hypertrophic cranial pachymeningitis may present as recurrent optic neuritis in the early phase, before radiological evidence of the disease is present. A high index of suspicion for the underlying cause is essential to prevent irreversible optic nerve damage due to recurrent optic neuritis.
Fulltext Candida glabrata endophthalmitis following penetrating keratoplasty in a patient with negative donor rim culture

Muzaliha MN, Adil H, Ibrahim M, Shatriah I

BMC Ophthalmol, 2010;10:18.
PMID: 20537193 DOI: 10.1186/1471-2415-10-18

Candida glabrata endophthalmitis following keratoplasty is rare and almost always associated with positive donor rim culture.
Fulltext Successful treatment of syphilitic uveitis in HIV-positive patients

Nurfahzura MJ, Hanizasurana H, Zunaina E, Adil H

Clin Ophthalmol, 2013;7:1651-4.
PMID: 23986629 DOI: 10.2147/OPTH.S46876

We report successful treatment of syphilitic uveitis in a case series of three Human immunodeficiency virus (HIV)-positive patients at Malaysia's Selayang Hospital eye clinic. All three patients with syphilitic uveitis were male, aged from 23 to 35 years old, with a history of high-risk behaviors. Of the patients, two presented with blurring of vision and only one patient presented with floaters in the affected eye. Ocular examination revealed intermediate uveitis (case 1 and case 3) and panuveitis (case 2). Each patient showed a high Venereal Disease Research Laboratory (VDRL) titer at presentation and they were also newly diagnosed as HIV positive with variable CD4 counts. All three patients responded well to a neurosyphilis regimen of intravenous penicillin G. At 3 months posttreatment, there was reduction in VDRL titer with improvement of vision in the affected eye. Diagnosis of syphilis needs to be ruled out in all cases of uveitis. All syphilitic uveitis cases should have HIV screening and vice versa, as syphilis is one of the most common infectious diseases associated with HIV-positive patients. Early detection and treatment are important for a good visual outcome.

Study site: opthamolagy clinic, Hospital Selayang
Fulltext Neuroretinitis in ocular bartonellosis: a case series

Raihan AR, Zunaina E, Wan-Hazabbah WH, Adil H, Lakana-Kumar T

Clin Ophthalmol, 2014;8:1459-66.
PMID: 25120352 DOI: 10.2147/OPTH.S63667

We report a case series of neuroretinitis in ocular bartonellosis and describe the serologic verification for Bartonella henselae. This is a retrospective interventional case series of four patients who presented in the ophthalmology clinic of Hospital Universiti Sains Malaysia from June 2012 to March 2013. All four patients had a history of contact with cats and had fever prior to ocular symptoms. Each patient presented with neuroretinitis characterized by optic disc swelling with macular star. Serology analysis showed strongly positive for B. henselae in all of the patients. All patients were treated with oral azithromycin (except case 4, who was treated with oral doxycycline), and two patients (case 1 and case 3) had poor vision at initial presentation that warranted the use of oral prednisolone. All patients showed a good visual outcome except case 3. Vision-threatening ocular manifestation of cat scratch disease can be improved with systemic antibiotics and steroids.
Study site: Ophthalmology clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Fulltext A Rare Ocular Manifestation of Idiopathic Hypertrophic Cranial Pachymeningitis

Lee JEH, Subramaniam S, Cheah CF, Chan KH, Adil H

Cureus, 2021 Dec;13(12):e20633.
PMID: 35106199 DOI: 10.7759/cureus.20633

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare form of thickening of the dura mater. There are limited reports on the ocular manifestation of IHCP and its treatment. Up to our knowledge, there is no report on bilateral superior ophthalmic veins (SOV) dilatation with IHCP and there are only a few reports on anterior scleritis with IHCP. We report a 62-year-old gentleman with underlying hypertension and chronic headache who presented with fever, headache, and unresolving both eyes redness as manifestations of bilateral anterior scleritis, anterior uveitis, secondary glaucoma, and multiple cranial nerve palsies. Magnetic resonance imaging of the brain showed global thickening and enhancement of the pachymeninges with bilateral SOV dilatations. The diagnosis of IHCP was made after ruling out infective and autoimmune causes. The patient was treated with oral prednisolone, oral azathioprine, topical timolol maleate, topical dexamethasone, and topical moxifloxacin. The patient was successfully treated and was stable throughout two years review. In conclusion, unresolved red eyes with headaches can be an early presentation of IHCP. Pathophysiology and treatment of the ocular manifestations and IHCP were discussed.
Fulltext Open globe injury in Hospital Universiti Sains Malaysia - A 10-year review

Madhusudhan AP, Evelyn-Tai LM, Zamri N, Adil H, Wan-Hazabbah WH

Int J Ophthalmol, 2014;7(3):486-90.
PMID: 24967196 DOI: 10.3980/j.issn.2222-3959.2014.03.18

To identify the aetiology of open globe injuries at Hospital Universiti Sains Malaysia over a period of 10y and the prognostic factors for visual outcome.
Fulltext Comparison of peripapillary retinal nerve fiber layer thickness between myopia severity groups and controls

Tai ELM, Ling JL, Gan EH, Adil H, Wan-Hazabbah WH

Int J Ophthalmol, 2018;11(2):274-278.
PMID: 29487819 DOI: 10.18240/ijo.2018.02.16

AIM: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness measuredviaoptical coherence tomography (OCT) between different groups of myopia severity and controls.
METHODS: This was a prospective cross-sectional study. All subjects underwent a full ophthalmic examination, refraction, visual field analysis and A-scan biometry. Myopic patients were classified as low myopia (LM) [spherical equivalent (SE) from greater than -0.5 D, up to -3.0 D], moderate myopia (MM; SE greater than -3.0 D, up to -6.0 D) and high myopia (HM; SE greater than -6.0 D). The control group consisted of emmetropic (EM) patients (SE from +0.5 D to -0.5 D). A Zeiss Cirrus HD-OCT machine was used to measure the peripapillary RNFL thickness of both eyes of each subject. The mean peripapillary RNFL thickness between groups was compared using both analysis of variance and analysis of covariance.
RESULTS: A total of 403 eyes of 403 subjects were included in this study. The mean age was 31.48±10.23y. There were 180 (44.7%) eyes with EM, 124 (30.8%) with LM, 73 (18.1%) with MM and 26 (6.5%) with HM. All groups of myopia severity had a thinner average RNFL than the EM group, but after controlling for gender, age, and axial eye length, only the HM group differed significantly from the EM group (P=0.017). Likewise, the superior, inferior and nasal RNFL was thinner in all myopia groups compared to controls, but after controlling for confounders, only the inferior quadrant RNFL was significantly thinner in the HM group, when compared to the EM group (P=0.017).
CONCLUSION: The average and inferior quadrant RNFL is thinner in highly myopic eyes compared to emmetropic eyes. Refractive status must be taken into consideration when interpreting the OCT of myopic patients, as RNFL thickness varies with the degree of myopia.

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