Précis: Depression increases with severity of visual field defect in older adults with primary open-angle glaucoma (POAG).Purpose: This study aimed to determine the prevalence of depression among patients with POAG and examine the relationship between depression and the severity of POAG in older adults.Materials and Methods: Three hundred and sixty patients with POAG aged 60 years or above were recruited from 2 tertiary centers located in an urban and suburban area. The participants were stratified according to the severity of their glaucoma based on the scores from the modified Advanced Glaucoma Intervention Study (AGIS) to mild, moderate, severe, and end stage. Face-to-face interviews were performed using the Malay Version Geriatric Depression Scale 14 (mGDS-14) questionnaire. Depression is diagnosed when the score is ≥ 8. One-way analysis of variance was used to compare the subscores between the groups. Multifactorial analysis of variance was also applied with relevant confounding factors.Results: Depression was detected in 16% of older adults with POAG; a higher percentage of depression was seen in those with end stage disease. There was a significant increase in the mean score of mGDS-14 according to the severity of POAG. There was evidence of an association between depression and severity of visual field defect (P < 0.001). There was a significant difference in mGDS-14 score between the pairing of severity of POAG [mild-severe (P = 0.003), mild-end stage (P < 0.001), moderate-severe (P < 0.001), and moderate-end stage (P < 0.001)] after adjustment to living conditions, systemic disease, and visual acuity. Conclusion:Ophthalmologists should be aware that older adults with advanced visual field defects in POAG may have depression. The detection of depression is important to ensure adherence and persistence to the treatment of glaucoma.

A woman in her 70s presented with reduced vision in her left eye, progressive narrowing of right eye opening for 6 months and anosmia. On examination, she had right enophthalmos and pseudoptosis with inferior globe dystopia. Her visual acuity was 6/9 and nil light perception in the right and left eyes, respectively. Extraocular muscle examination showed limited right up gaze. Funduscopy showed a normal right optic disc and left optic disc atrophy. Systemic examination revealed left breast ulceration with skin tethering. CT revealed an infiltrative mass invading the ethmoidal sinuses, frontal sinuses and both orbits. A histological diagnosis of infiltrative ductal breast carcinoma was made after nasal endoscopic and left breast biopsy. She underwent palliative chemoradiotherapy and survived with good disease control after 1 year. Metastatic carcinoma is a differential diagnosis of a sino-orbital mass, and comprehensive clinical assessment is indicated for all patients presenting with non-acute eye injury.

Burkholderia pseudomallei is Gram-negative anaerobe causing melioidosis. We report a case series including three cases of rare ocular presentations in patients with positive melioidosis serology in the state of Pahang, Malaysia. The first case involved a 32-year-old male with a sudden onset of painless decrease in vision in the left eye, with a history of swimming in a river. Eye examination revealed a choroidal abscess with inferior retinal detachment. The second case was that of a 14 year-old-male patient with painless reduction of vision in the left eye and a history of parotid gland swelling. Eye fundus examination showed optic disc swelling with macular star. The third case, a 10-year-old male, presented with left eye optic disc granuloma and subtotal exudative retinal detachment with vasculitis. The three cases were successfully treated with the antibiotic ceftazidime. Ocular melioidosis should always be taken into consideration in any patient with suspected infectious uveitis. A high index of suspicion is required to initiate early and prompt treatment.