We present a case of reactivation of herpes keratouveitis shortly after vaccination with Zostavax in a patient with previous herpes zoster ophthalmicus. We demonstrate, for the first time, ultrastructural evidence consistent with inactive virus capsids in diffusely degenerated keratocytes in the extracted corneal tissue.

neal section on station I02 at the Diamond Light Source. 2 The data were analyzed 1 to form vector plots-the radial extent of which, in any direction, is proportional to the number of fibrils preferentially aligned in that direction. These were assembled, and the larger plots scaled down, to show the predominant orientation of collagen throughout each tissue section. Results. Abnormalities in collagen organization were seen in both the anterior and posterior stroma of the keratoconus cornea (Figure 2), with the most drastic disruption occurring within the region of greatest corneal steepening (Figure 1). In the posterior stroma, the normal orthogonal predominant orientation of collagen was absent; in the anterior stroma, the usual isotropic arrangement of collagen was replaced with more highly aligned unidirectional collagen. Comment. The results indicate that a gross rearrangement of lamellae had occurred in both the anterior and posterior regions of the keratoconus corneal stroma (Figure 2). These findings support our belief that the specific arrangement of stromal collagen plays a significant role in the maintenance of normal corneal curvature.

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The most useful stains in ruling out SCC in a suspected case of MECC were shown to be mucicarmine and the glycosaminoglycan (GAG) stains. However, in cases where mucicarmine and the GAG stains are negative or difficult to interpret and there is suspicion of a diagnosis of MECC, CEA and mucin-1 may be helpful for this diagnosis. The findings of CK7+/CK20- also may be of assistance, but are not as sensitive when compared to analogous salivary gland lesions, when differentiating MECC from SCC.

A uniquely indolent case of necrobiotic xanthogranuloma with bilateral, periorbital involvement was presented. This patient presented with cutaneous eyelid lesions of 20 years' duration. Although symptomless, the patient underwent testing for hematologic malignancy, which led to a diagnosis of multiple myeloma. A review of the literature revealed that this is the longest interval between the onset of the skin manifestations and the diagnosis of the systemic malignancy in this rare disease.

ObjectiveTo develop Canadian recommendations for the screening, monitoring and treatment of uveitis associated with Juvenile Idiopathic Arthritis (JIA).MethodsRecommendations were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)-Adolopment approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including EtD tables, survey responses, and virtual meeting discussion.ResultsThe survey identified that 7 of the nineteen recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of non-biologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo.ConclusionRecommendations for JIA-associated uveitis were adapted to the Canadian context by a Working Group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis and parent/patient input utilizing lenses for cost, equity, and access.

A 13-year-old boy presented with asymptomatic, bilateral, nasal bulbar conjunctival lesions. Excisional biopsy of the larger lesion showed a mature, mixed lymphocytic infiltrate with germinal centers, consistent with a diagnosis of benign reactive lymphoid hyperplasia, a rare condition in children.