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The tuberous sclerosis complex is a rare disease, with autosomal dominant transmission, with multisystemic involvement including ophthalmologic. Retinal hamartomas and retinal achromic patch are the most frequent ocular findings. Other ophthalmic signs and symptoms are relatively rare in this disease.We describe the case of a young woman with tuberous sclerosis who presented with horizontal binocular diplopia and decreased visual acuity without complaints of nausea, vomiting or headache. She had right abducens nerve palsy, pale oedema of both optic discs and retinal hamartomas. An obstructive hydrocephalus caused by an intraventricular expansive lesion was identified in brain CT.Observation by the ophthalmologist is indicated in all confirmed or suspected cases of tuberous sclerosis to aid in clinical diagnosis, monitoring of retinal hamartomas or identification of poorly symptomatic papilloedema.

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A 61-year old male was referred to the Ophthalmology department because of decreased bilateral visual acuity. The patient had metastatic pancreatic adenocarcinoma and was being treated with gemcitabine+nab-paclitaxel. On examination, the patient presented best corrected visual acuities of 4/20 and 2/20 in the right and left eye, respectively. The optical coherence tomography revealed bilateral severe macular edema. Macular edema was considered secondary to nab-paclitaxel and the drug was discontinued. Three months after drug discontinuation, the patient presented best corrected visual acuities of 20/20 and 16/20 in the right and left eye, respectively, and normal fundoscopy. Macular edema is a very rare side effect of taxanes, and the etiopathology is still unknown. Edema is usually reversible upon discontinuation of the offending agent. Clinicians should be aware of this adverse effect of taxanes, and a high index of clinical suspicion is essential for diagnosis.

Neurotrophic keratopathy is a condition associated with corneal damage and impaired corneal healing. There are no specific treatments available for this disease and current treatments are not associated with improved visual function. Matrix regenerating agents (RGTA) are recent topical agents showing positive results in the treatment of several corneal conditions, including neurotrophic keratopathy. We report the case of a 73-year-old patient with a neurotrophic ulcer treated with RGTA. Treatment with RGTA allowed complete corneal healing and a dramatic recovery in visual function in our patient. RGTA solutions are an important and safe therapeutic option for the treatment of selected corneal pathology.

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RESUMONo âmbito da prática clínica oftalmológica, as parasitoses por carraças são incomuns. Os autores descrevem o caso clínico de uma doente de 73 anos observada por edema e eritema da pálpebra superior direita. O exame oftalmológico revelou uma carraça aderente à margem palpebral. A carraça foi removida usando uma pinça fina, e poucos dias após, houve regressão total dos sinais inflamatórios, sem registo de complicações. O parasitismo por carraças representa uma ameaça para a Saúde Pública, pois as carraças são vetores de inúmeros agentes infeciosos responsáveis por patologias potencialmente graves, como a doença de Lyme. As carraças podem também induzir reações cutâneas locais e, mais raramente, paralisia neuromuscular. A morbilidade associada à picada da carraça aumenta com a duração da parasitação, pelo que a carraça deve ser removida o mais rápido possível, e os doentes devem ser alertados para os sinais de possíveis complicações locais e sistémicas. ABSTRACTTick infestation is rarely seen in ophthalmological practice. We report the case of a 73-year-old woman who presented with edema and erythema of her right upper eyelid. Biomicroscopic examination revealed a tick firmly attached to the eyelid margin. The tick was successfully removed using fine tweezers, and within a few days, the patient had fully recovered without sequelae. Ticks are a threat to public health as they are known vectors of numerous infectious agents responsible for serious pathologies such as Lyme disease. Ticks may also induce cutaneous local reactions, and more rarely, tick paralysis. Since morbidity increases substantially with the duration of the infestation, the tick should be completely removed as soon as possible, and patients should be aware about possible signs of tick related diseases.

Hypotension is the most frequent complication of haemodialysis. We report a case of acute visual impairment after one session of haemodialysis in a context of an acute optic neuropathy. The immunological and serological studies were negative. The records of hypotension greater than usual after the dialysis session that coincided with the visual complaints strongly suggest the dialysis-induced hypotension is the underlying mechanism of this non-arteritic anterior ischemic optic neuropathy.