An acute presentation of an optic disc hemorrhage can indicate true optic nerve head damage or can be a result of tractional forces on the vitreopapillary interface. An isolated optic disc hemorrhage secondary to vitreopapillary traction (VPT) can mimic the clinical presentation of a glaucomatous process or that of an underlying ocular or systemic condition. This article highlights the use of spectral domain optical coherence tomography (SD-OCT) 5 line raster (5LR) in differentiating true optic disc hemorrhages from those as a result of tractional forces. Two examples are given of patients presenting to our clinic with unilateral optic disc hemorrhages and various underlying disease processes as risk factors. With the use of SD-OCT 5LR imaging, VPT was implicated as the cause of the disc hemorrhages in both patients. Although this imaging tool alone is not enough to rule out a disease process such as glaucoma or prevent the need for additional diagnostic testing, SD-OCT 5LR is a noninvasive and valuable clinical tool in distinguishing VPT from other etiologies of an optic nerve hemorrhage.
Cutaneous leukocytoclastic vasculitis (LCV) is a systemic condition that can be associated with iritis. LCV is characterized as a small-vessel vasculitis of the cutaneous area. The disease demonstrates purple lesions on the skin due to the destruction of small cutaneous blood vessels. These lesions are palpable and most often coalesce forming larger patches on the surface of the skin. During early stages of LCV, the disease can be undetected due to the infrequency and small size of the skin lesions. As such, the patient might go undiagnosed for years while having symptoms of LCV or iritis of unknown etiology. This article discusses the correlation seen with LCV and iritis. We report a case on a patient that presented to our clinic with a history of bilateral chronic iritis. After extensive laboratory testing, we concluded that the chronicity of her iritis was due to her LCV. The correlation between LCV and iritis was not evident for several years in our patient. We also discuss the correlation with systemic Sjogren's syndrome and LVC and how these two separate diseases are linked in many patients. We will illustrate the importance of serological testing, imaging, and skin lesion biopsy for the diagnosis of LCV.
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