A 6-year-old boy with severe autism spectrum disorder (ASD) was brought to the hospital by his mother for whitening in the right eye. The patient was nonverbal at baseline and exhibited restrictive and repetitive behaviors. His diet consisted exclusively of cookies, apples, potato chips, and Gatorade. His mother noticed him frequently rubbing his eyes for several weeks, which she initially attributed to new-onset allergies. She did not describe any reduction in visual function or ability to perform low-luminance tasks.The patient was admitted and ophthalmology was consulted. He required an examination under sedation. His visual acuity could not be determined. There was no relative afferent pupillary defect in either eye. The eyelids were mildly erythematous with bilateral eyelash hypertrichosis. The conjunctiva and cornea appeared dry and leathery bilaterally. The right cornea was diffusely hazy with a 3-mm paracentral epithelial defect with 60% stromal thinning and a 1-mm infiltrate. There was a small crescentic fibrin deposit nasally in the right anterior chamber. The left cornea was diffusely hazy with a 1-mm epithelial defect without stromal thinning (Figure). Dilated examination showed bilateral grade 3 optic nerve head edema and otherwise normal retinal findings. Fortified vancomycin eye drops, 25 mg/mL, and tobramycin eye drops, 15 mg/mL, were initiated. Results of magnetic resonance imaging of the brain were normal.

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Extraocular muscles that are entrapped in orbital fracture sites require emergent surgical treatment. Muscle entrapment can present with subtle findings or mimic other conditions, contributing to delays in diagnosis.Here, we present two cases of extraocular muscle entrapment that were not immediately identified. By discussing the diagnostic challenge in these cases, we aim to increase the comfort of all physicians in identifying muscle entrapment in the emergency department.

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Purpose The aim of this study is to evaluate resident surgical performance based on complications after ocular evisceration. Methods A retrospective chart review of eviscerations performed between October 2011 and May 2017 by ophthalmology residents as the primary or assistant surgeon under the guidance of a single oculofacial plastic surgeon (M.O.G.) was completed. Data collected included reason for evisceration, resident participation in the case and resident's month of oculoplastic training, surgical technique, subsequent complications, and duration of follow-up. Results There were no significant differences in complication rates or surgical sequelae in resident-led versus attending-led surgeries. The complication rate for all cases in total was 5.77%. A slight negative correlation existed between the resident's month of training and the presence of postoperative complications. The number of adverse events was found to be significantly correlated with the duration of patient follow-up. Discussion Ocular eviscerations performed by ophthalmology residents as primary surgeons achieve outcomes equivalent to published reports, suggesting ocular eviscerations are a safe, effective procedure wherein residents can refine surgical skills. Some surgical sequelae may be linked to particular surgeons, implying evisceration outcomes can be used to assess resident surgical performance. Fewer adverse events arose as the resident's length of oculoplastic training increased, but this finding did not reach significance. Larger studies are needed to explore these trends.