A Case of Bilateral Fungal Endophthalmitis

308 including the optic nerve and superior and inferior peripapillary nerve bundles. Mid-periphery was defined as the retinal area from the optic nerve and peripapillary nerve bundles anterior to the equator. The far periphery was defined as the retinal area from the equator to the ora seratta. Results: A total of 165 images (eyes) were reviewed to determine the percentage of pathology in each region. Pathology was found in the posterior pole in 32% (53/165) of the images, 12% (19/165) in the mid-periphery, and 5% (9/165) in the far periphery. It is important to note that the far periphery was only visible enough for thorough review 52% (86/165) of the time; within those images pathology was noted in 10% (9/86) of the images. Glaucoma suspects accounted for 43% (23/53) of the pathology found in the central retina, with diabetic retinopathy accounting for 11% (6/ 53); drusen, hypertensive retinopathy, BRVO, peripapillary atrophy, medullated nerve fiber, choroidal nevi, melanocytoma and histoplasmosis scars were also noted. Mid-peripheral pathology included 11% retinoschisis (2/ 19), as well as PDR, histoplasmosis scars, choroidal nevi, retinal detachment, RPE hypertrophy, RPE degeneration, and RPE hypopigmentation. Of the pathology noted in the far periphery, white without pressure accounted for 67% (6/ 9), 22% (2/9) was recorded as retinal degeneration and 11% as retinoschisis (1/9). Vitreous pathology and media opacities were also noted in a small percentage of images. Conclusion: The mid-to-far periphery is the most challenging area of the retina to visualize during routine ophthalmoscopy, especially with restrictive pupil sizes. This study indicates the value and importance of Optomap images in identifying pathology in the peripheral retina. Results indicate that a total of 17% of the retinal findings in the patient population were found outside of the central retina.

Poster 50 A Case of Bilateral Fungal Endophthalmitis William Trent Tadlock, O.D., Seidenberg Protzko Eye Associates, 601 Thames Way, Bel Air, Maryland 21014 Background: Endogenous endophthalmitis is a rare disease typically seen in hospitalized patients. Fungal endophthalmitis is the most common form of endogenous endophthalmitis, with Candida albicans being the most common organism. Case Report: A 65-year-old white man presented with complaints of decreased vision and redness in his left eye that started while he was hospitalized the week before. This subsequently spread to his right eye. The patient had bilateral fungal endogenous endophthalmitis diagnosed and was hospitalized. He was treated successfully with intravitreal injections of amphotericin B, vancomycin, and ceftazidime. Conclusion: Endogenous fungal endophthalmitis is a potentially devastating ocular condition that, although rare, is an ophthalmic emergency. Prompt diagnosis and treatment is essential in the management of this disease.

Optometry, Vol 80, No 6, June 2009 Poster 51 Floppy Eyelid Syndrome in an Infant With Down’s Syndrome Jessica Schara, O.D., Cheryl Adams, and Christine Allison, Illinois College of Optometry/Illinois Eye Institute, 3241 South Michigan Avenue, Chicago, Illinois 60616 Background: Floppy eyelid syndrome (FES) has been described as easy eyelid eversion, generally occurring during sleep, and is frequently associated with middle-age obese men and those with sleep apnea. FES is rarer in infants and Down’s syndrome patients. Case Summary: A 16-month-old Hispanic male infant with Down’s syndrome presented to the examination sleeping with his eyelids everted. His mother had complaints of his eyelids flipping inside out while sleeping or crying. Artificial tears and ointment had been used. Visual acuity with Teller revealed 20/260 OU, and the patient could fixate and follow a moving object. Pupils, eye movements, and eye alignment were all unremarkable. Cycloplegic retinoscopy found mixed astigmatism OU. Upon anterior-segment evaluation, the patient had severe lagophthalmos and ectropion in both upper and lower eyelids OU. The upper eyelids were easily everted by gently pulling the skin of the lid toward the forehead. The palpebral conjunctiva showed mild injection, while the sclera was white and quiet. Corneal staining was present while rare superficial punctate keratitis was visible. Tactile pressures were soft and equal, and ophthalmoscopy was attempted but unable to test secondary to patient cooperation. The patient was told to continue lubricating ointment every night and artificial tears 4 times daily. Signs and symptoms of infectious conjunctivitis were discussed, and the patient was told to return to the clinic promptly if this occurred. Surgical consultation was performed, and the patient will have surgery in the near future. Conclusion: Although rare in infants, any child with ectropion, lagophthalmos, and chronic conjunctivitis should be considered for FES. Although a vast amount of chronic health conditions are exhibited in Down’s syndrome patients, FES should not be overlooked.

Poster 52 Is There a Genetic Component in the Development of Pinguecula? James LaMotte, O.D., Ph.D., Lauren Evans, B.S., and Javier Villalobos, B.S., Southern California College of Optometry, 3550 La Jolla Village Drive, San Diego, California 92161 Purpose: An estimated 30% to 40% of the general population has one or more pinguecula (small, yellowish, raised thickenings of the bulbar conjunctiva). If these thickenings become large enough, they are visible to patients and can cause concern. It has long been acknowledged that pinguecula occur as a result of long-term sun damage. This etiology