Purpose: To report a detachment that apparently separated photoreceptor inner segment myoids from inner segment ellipsoids as a manifestation of toxoplasmosis chorioretinitis in a patient with pachychoroid spectrum disease.Methods: Multimodal imaging including fundus photography, spectral domain and enhanced-depth imaging optical coherence tomography (OCT), indocyanine green angiography, and OCT angiography.Results: A 33-year-old man with a history of toxoplasmosis chorioretinitis reported 1 week of decreased vision to 20/200 in his right eye. Examination of the right eye demonstrated mild vitritis with recurrent chorioretinitis inferior to the fovea and adjacent to a chorioretinal scar. A dome-shaped, foveal photoreceptor layersplitting detachment was noted on OCT. Because degenerating cone photoreceptors are capable of shedding their inner segments, we inferred the location of the detachment at the level of the inner segment myoid and provided a histological example of such from an unrelated donor case. In addition, multimodal imaging revealed dilated choroidal veins (pachyvessels) with attenuation of the inner choroid in both eyes and asymptomatic findings of central serous chorioretinopathy in the left eye. After 1 month of antibiotic and steroid therapy, the chorioretinitis resolved, as did the detachment. Hyperreflective foci on the vitreoretinal interface were appreciated with en face OCT that appeared to aggregate throughout the course of therapy, induce inner retinal striae, and resolve without inducing epiretinal membrane formation.Conclusion: Patients with preexisting pachychoroid spectrum disease may manifest a more significant retinal fluid accumulation in the setting of superimposed chorioretinal inflammation. In this case of macular toxoplasmosis chorioretinitis, inflammation manifested as a retinal detachment at the level of photoreceptor inner segment myoids that we named as a bacillary layer detachment. In this case, inflammatory sequelae of toxoplasmosis reactivation responded well to oral and intravitreal therapy.

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Congenital respiratory-type ciliated cyst of the lacrimal sac Bonafide cysts of the lacrimal sac are rare, with only a few reports in the literature. 1À3 Most are probably congenital in origin while others may be acquired. The epithelial lining of these cysts can be squamous or ciliated-respiratory in type, depending on the region of the sac lining that spawns the lesion. Conjunctival cysts arising from the medial regions of the forniceal conjunctiva must be distinguished from cysts deriving from the lacrimal sac. Other cyst-like conditions may be formed by closure of a dacryocystocele as a result of trauma or inflammation. 1,3 (A dacryocystocele is a diverticulum, a saccular outpouching of an epithelial-lined cavity, often resulting from an obstruction and attendant increased intraluminal pressure.) A lacrimal sac cyst presents as a Correspondence e30