Sarah Adelson, MD

A 50-year-old woman presented to an outside ophthalmologist with a 2-month history of irritation and discharge after injury to the left eye with a mascara brush. Her exam was notable for conjunctival injection and a nasal conjunctival scar. She was treated with erythromycin ointment and a topical steroid with improvement of her symptoms; however, her conjunctival scar remained unchanged, so she was referred to Tufts Medical Center for evaluation. Before this, the patient had no ocular issues. She was otherwise healthy with no medical history or prescribed medications. Her social history was notable for a 30 pack-year smoking history, but she had recently quit smoking.

A 56-year-old male property manager with no ocular history was referred to the New England Eye Center by an outside ophthalmologist for evaluation of eyelid asymmetry. For 5 months, the patient had noticed that his left upper eyelid appeared lower than his right upper eyelid. He felt the position of his eyelids changed through the day and seemed more equal after rest. He had no diplopia or difficulty moving his eyes. He did not report any palpitations, heat/cold intolerance or weight fluctuations, although he did endorse lower energy over the last few years. A few years before presentation, he was involved in a motor vehicle accident and sustained head injuries but reportedly had no eye trauma.

A 31-year-old woman, postop day 1 from cesarean section for dichorionic-diamniotic twins at 35 weeks’ gestational age, was transferred from an outside hospital for evaluation of blurred vision in the right eye that started postoperatively. The patient reported diffuse “fuzzy” vision in the right eye that was stable at distance and near. She denied double vision and eye pain. Systemically, she was feeling well before the visual changes, with no neurologic symptoms, headaches or transient visual obscurations. Neurology was consulted at the outside hospital to rule out neurologic causes of blurry vision. MRI, MRA and MRV were obtained, and all were within normal limits.

A 37-year-old woman with a history of ocular migraines presented urgently to the New England Eye Center with a 3-week history of seeing a blurred “circle” in the central vision of her right eye. She described the symptom as “looking through water” and felt it had been stable since onset. She noted that when she blinked, the circle seemed to pulse and colors appeared to change. She denied any flashing lights or floaters in her vision.

A 50-year-old woman presented to the New England Eye Center with 2 weeks of pain, blurry vision and photophobia in the right eye after sleeping in contact lenses. She initially saw an outside optometrist who diagnosed a corneal ulcer and prescribed hourly ofloxacin as well as tobramycin and dexamethasone drops four times daily. Several days later, she subsequently saw an outside ophthalmologist who switched her therapy to hourly moxifloxacin and trimethoprim/polymyxin B every 2 hours, in addition to tobramycin and dexamethasone four times daily. Initially, she noted improvement in her symptoms, but subsequently, her pain worsened and vision deteriorated, and she was referred to NEEC.