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Successful irido-zonulo-hyaloidotomy in combination with complete pars plana vitrectomy in malignant glaucoma may lead to better intraocular pressure (IOP) control and a promising visual outcome. We report a case of an 81-year-old woman who presented with a ten-day history of right eye redness and blurring of vision associated with throbbing pain. An ocular examination revealed right-eye visual acuity (VA) of 6/60. The cornea was oedematous with a shallow anterior chamber (AC) and a grade 0 (Shaffer's grading) by gonioscopy. The intraocular pressure at presentation was 52 mmHg. The optic disc was pink, with a cupdisc ratio of 0.3. Complete pars plana vitrectomy with irido-zonulo-hyaloidotomy was performed in view of poorly controlled intraocular pressure despite aggressive medical therapies, laser treatment, and the Chandler procedure. Postoperatively, the IOP was maintained at mid-teens without intraocular pressurelowering agents. The visual acuity improved to 6/9. The early decision for irido-zonulo-hyaloidotomy with complete pars plana vitrectomy leads to resolution of malignant glaucoma with a lower relapse risk.

Primary non-Hodgkin's lymphoma of the lacrimal sac is extremely rare, usually representing secondary involvement of systemic malignancy. We report a case of bilateral primary non-Hodgkin's lymphoma of the lacrimal sac presenting with bilateral medial canthal swelling for one month which was preceded by a history of chronic bilateral epiphora and a recurrent history of dacryocystitis. The symptoms partially responded to systemic antibiotics for the past three years. Clinical examination revealed bilateral diffuse erythematous medial canthal swelling extending to the upper cheeks. CT of the orbits and paranasal sinuses demonstrated soft tissue masses involving bilateral lacrimal sacs and ducts. Endoscopic dacryocystorhinostomy (DCR) with excision biopsy of both lacrimal sac was performed and histopathologically confirmed the diagnosis of extranodal marginal zone B-cell lymphoma. She completed six cycles of chemotherapy. The symptoms subsided and radiologically showed a significant reduction of soft tissue mass at bilateral nasolacrimal sacs and ducts after completion of chemotherapy. Recurrent atypical presentation of dacryocystitis with suboptimal response to standard treatment should raise a suspicion of secondary cause. Histopathological examination is therefore crucial to avoid delays in diagnosis and treatment.

Herpes zoster ophthalmicus (HZO) is a neurocutaneous disease caused by reactivation of herpes zoster infection from latent phase after varicella infection in elderly population. It affects ophthalmic division of trigeminal nerve. Common ocular presentation includes conjunctivitis, anterior uveitis, and keratitis. Orbital apex syndrome rarely occurs as a complication of herpes zoster ophthalmicus in young human immunodeficiency virus (HIV)-positive men.A 20-year-old, recently diagnosed HIV-positive man, presented with vesicular skin rashes over right periorbital and forehead area, associated with right eye redness. He was treated as herpetic zoster ophthalmicus with oral antiviral (acyclovir). Three days later, he developed right eye ptosis, reduced visual acuity, anisocoria, and total ophthalmoplegia. An orbit magnetic resonance imaging showed swelling of all rectus muscles of right eye with right optic nerve perineural enhancement. Diagnosis of right eye herpes zoster ophthalmicus with orbital apex syndrome was established, and intravenous acyclovir was initiated. Systemic antiviral acyclovir continued for up to 10 days. Upon discharge, his ocular features improved; however, his visual impairment persisted.Orbital apex syndrome is a rare complication of herpes zoster ophthalmicus. This irreversible sightthreatening complication can be prevented by early diagnosis of HZO and immediate starting of antiviral treatment.