Is There a Genetic Component in the Development of Pinguecula?

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

Poster Presentations is so sufficiently accepted, that a study used the presence of pinguecula as evidence of long-term sun exposure. Because genetic links are being established in an ever-increasing number of disorders, we investigated the possibility of a genetic component in pinguecula development by looking at the incidence of pinguecula in blood relatives of patients with this condition. Methods: We utilized an illustrated, 9-question survey sent to patients with pinguecula at the Optometric Center of Fullerton. We asked if the patients had noticed the condition as described and illustrated in the questionnaire on their eyes; and if a blood-related family member had the same condition. We also asked if the patients had observed pinguecula in a blood-related family member. Questions about occupation and sun exposure/sun protection were also included. Results: Ninety-one surveys were analyzed with binary logistic regression. After adjustment for age and race, the only factor that had a significant impact on the presence of pinguecula was the diagnosis of a blood-related family member with the condition (P 5 0.003). Having a blood relative with a pinguecula diagnosis increased a respondent’s odds of also having a pinguecula by 5.48 times. Use of sun protection by the survey respondents was not a significant factor (P 5 0.563). Sun exposure, age, and racial background were also not significant. Discussion: Although we asked patients to recognize pinguecula, we found fairly equal P values for all races and ages with regard to their ability to identify themselves as having pinguecula or not having pinguecula. Thus, they had an equal ability to identify pinguecula on themselves and blood relatives. We found preliminary evidence of a hereditary component associated with the presence of pinguecula and feel further investigations should be done to isolate the genetic component.

Poster 53 Idiopathic Orbital Inflammatory Disease: A Case Report Patricia Estes Walker, O.D., and Stephen Wetick, O.D., Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Idiopathic orbital inflammatory disease is a benign, noninfective, space-occupying lesion of the orbit of unknown etiology. The presentation is typically unilateral in nature in the third to sixth decade. Lid edema and erythema, pain, chemosis, restricted muscle motility, optic neuropathy, and uveitis are common. Additional testing include CT/MRI scan and blood work. Treatment includes observation, nonsteroidal anti-inflammatory drugs, corticosteroids, immunomodulatory therapy, or surgery. Case Report: A 48-year-old white woman presented with progressive swelling and pain O.S. for 4 days. Her systemic health is unremarkable. Ocular health was significant for myopia. Examination revealed restricted motilities O.S. and pain O.S. Corrected visual acuities measured 20/25

309 O.D., 20/25 O.S. Pupils were round, reactive to light with a negative APD. IOP was unremarkable. Slit lamp evaluation revealed 31 lid edema and erythema, 31 conjunctiva chemosis/injection O.S. Anterior chambers were void of cell and flare OU. Dilated fundus examination found normal structures OU. A stat MRI confirmed the diagnosis of idiopathic orbital inflammatory disease. She was treated with oral prednisolone 40 mg twice a day, 1,000 mg calcium and 500 mg vitamin D for 3 weeks. The steroids were tapered over the next 6 weeks. Her symptoms resolved after 2 weeks of treatment. Conclusion: The diagnosis is of exclusion. Ancillary testing and the use of oral corticosteroids are important in diagnosis and treatment of this disease.

Poster 54 An Explosive Onset: Leber’s Hereditary Optic Neuropathy Melinda Gruszka, B.S., Abby Vanderah, B.S., 2LT, USA, and Joni Scott-Weideman, O.D., CPT, USAFR, Illinois College of Optometry/Illinois Eye Institute, 3241 South Michigan Avenue, Chicago, Illinois 60616 Background: Leber’s hereditary optic neuropathy (LHON) is a rare condition resulting from a mutation of mitochondrial DNA transmitted by mothers to offspring. It commonly affects young men age 15 to 35 years old. Patients usually present with unilateral, acute or subacute, severe painless loss of central vision. Several weeks to months later, the fellow eye will become similarly affected. Early fundus evaluation can display mild swelling of the optic disc progressing to optic atrophy within weeks. To confirm diagnosis of LHON, genetic testing is required. There is currently no effective treatment available; however, once proper diagnosis is made, low vision aids as well as genetic and emotional counseling can be very helpful. LHON should be considered in any patient presenting with unexplained bilateral optic neuritis and visual loss. Case Report: A 52-year-old white man reported to clinic wearing darkly tinted glasses, complaining of photophobia. The patient was a veteran of the United States Marine Corps and at age 19 an ammo truck exploded near his face. This traumatic event is thought to have triggered the onset of the cause of this veteran’s legal blindness. Within the year after the veteran’s encounter, he became legally blind in both eyes and was diagnosed with Leber’s optic neuropathy. The patient had no history of family eye disease. Best-corrected Feinbloom distance visual acuities were 1/700 O.D. and 2/700 O.S. Slit lamp findings and intraocular pressures were within normal limits. Optic discs were symmetric and pale bilaterally. Systemically, the patient was diagnosed with depression, psychosis, and borderline personality disorder. The patient was fit with various low vision devices to optimize visual function. Conclusion: In addition to mitochondrial DNA mutations, environmental factors are thought to trigger the expression