Purpose: To describe a clinical case of unilateral and intermittent exophthalmos of subacute onset and persistent course. Methods: A 43‐year‐old woman who was referred to the orbit section due to a sensation of protrusion of the left eye (LE) that increases when bending down. Shee also reports that she hears an intermittent murmur. It is not accompanied by eye pain or blurred vision. She evidenced it a few months ago, not being related to any traumatic event. She has no personal or family history of interest. It was observed with the patient sitting that the LE seemed to protrude more than the RE. Exophthalmometer measurement revealed a 2 mm proptosis. When the patient was lying on her left side, the exophthalmos increased as the minutes passed. It was a reducible but not pulsatile exophthalmos. No murmur was observed during the examination. The rest of the ophthalmological examination showed no alterations. Given the suspicion of intermittent exophthalmos due to a left orbital tumour, it was decided to perform a contrast‐enhanced CT scan that revealed a varicose venous lesion with an intraconal component and slight extraconal prolongation in the Valsalva sequences. Results: Due to the difficult surgical access, the small size and the mild symptoms, having ruled out the presence of haemorrhage, varicose thrombosis or compression of the optic nerve, it was decided to carry out clinical follow‐up. Conclusions: Clinical suspicion of orbital varicocele in a case with typical symptoms is essential. Orbital CT with contrast in Valsalva sequences is one of the most used diagnostic test. Good clinical follow‐up is necessary in cases with mild symptoms. References Howells MS, Sharma R. Orbital varices. BMJ Case Rep. 2019;12(12):e232887. doi: 10.1136/bcr‐2019‐232 887. PMID: 31818898; PMCID: PMC6904158. Shchurova IN, Pronin IN, Melnikova‐Pitskhelauri TV, Serova NK, Batalov AI, Solozhentseva KD. Orbital'nyi venoznyi varikoz: sovremennye metody diagnostiki i differentsial'nyi diagnoz [Orbital venous varices: modern diagnostic methods and differential diagnosis]. Zh Vopr Neirokhir Im N N Burdenko. 2020;84(6):33–48. Russian. doi: 10.17116/neiro20208406133. PMID: 33306298.

Purpose: Corneal neovascularization (CNV) in the paediatric population has a variety of etiologies including bacterial ulcers, herpes keratitis, exposure keratopathy, blepharokeratoconjunctivitis and corneal anaesthesia. Monotherapy with antiangiogenic agents or corneal fine‐needle diathermy (FND) alone do not completely resolve CNV; however, the combined treatment of these two seems to offer better results. Methods: We present the results of FND with adjuvant injection of intrastromal and subconjunctival Bevacizumab in a child with CNV of herpetic origin. Results: A 3‐year‐old patient who has been treated in our hospital for corneal involvement in the left eye (LE) due to herpetic keratitis of weeks of evolution comes to our consultation. Examination under general anaesthesia reveals in LE an inferior paracentral corneal leukoma with partial involvement of the visual axis and CNV that enters through the limbus from 5 to 8 h and begins to involve corneal stroma; no epithelial lesions, no corneal oedema or inflammatory activity in the anterior segment. After not improvement, it was decided to perform FND of lower CNV in conjunction with an intrastromal injection and another subconjunctival injection of Bevacizumab. Subsequently, it remains stable with topical and oral antiherpetic treatment, and topical corticosteroid therapy. At 3 months, the CNV reactivated, for which FND + intrastromal and subconjunctival bevacizumab was performed again. Finally, at 2 months, the patient is asymptomatic with VA LE of 1.0, with 2 corneal leukomas without CNV or epithelial lesions, and continues to be treated with oral acyclovir at prophylactic doses. Conclusions: FND of CNV together with adjuvant treatment with intrastromal and subconjunctival Bevacizumab is a good choice in children to treat those active corneal neovascularizations that do not respond to corticosteroid. References 1. Yeung SN, Lichtinger A, Kim P, Amiran MD, Slomovic AR. Combined use of subconjunctival and intracorneal bevacizumab injection for corneal neovascularization. Cornea. 2011; 30(10): 1110–4. 2. Koenig Y, Bock F, Kruse FE, Stock K, Cursiefen C. Angioregressive pretreatment of mature corneal blood vessels before keratoplasty: Fine‐needle vessel coagulation combined with Anti‐VEGFs. Cornea. 2012; 31(8): 887–92.

Purpose: We describe a case of Fish‐Eye Disease (FED) in which the clinical features and visual function were investigated using anterior‐segment optical coherence tomography (AS‐OCT). Methods: A 38‐year‐old Spanish man with a known history of dyslipidemia came to our Hospital referring mild blurred vision and whitening of both eyes. Visual acuity was 1.00 (decimal). Slit‐lamp examination showed bilateral, peripheral yellowish‐white corneal opacities, causing corneal clouding. An AS‐OCT was then performed, showing homogeneously hyper‐reflective corneal stroma. On systemic examination, the patient had low plasma high‐density lipoprotein cholesterol levels. Results: Both slit‐lamp examination and AS‐OCT imaging revealed a corneal opacification compatible with FED, a clinical feature secondary to a lecithin‐cholesterol acyltransferase (LCAT) deficiency. The patient was sent to genetic counselling to study the mutation, which was later found to be positive for LCAT gene. Conclusions: Although it is not a common genetic disorder, FED should be included in the differential diagnosis of corneal clouding. The findings from this case suggest that a complete eye examination, both with slit‐lamp and AS‐OCT, can be useful for an early FED diagnosis despite good visual acuity.

Purpose: Optic disc pit (ODP) is a rare congenital disorder that affects one in 10 000 people. Serous detachment of macula is the most common complication and the natural history of untreated ODP maculopathy is a gradual deterioration with significant visual loss. A multitude of interventions have been designed for the treatment but none has been established as the treatment of choice. Pars plana vitrectomy is one of the most commonly used procedure in recent years. We present a case report with surgical treatment and management of complications. Methods: An interventional case report of a 63‐year‐old man who attended the emergency room due to sudden visual loss and best corrected visual acuity (BCVA) of 20/200 in the right eye (RE). Upon his arrival, a visual field was performed in which complete abolition of the right field was observed, severely affecting the central area. A papillary pit was found in the eye fundus. Optical coherence tomography (OCT) revealed a serous retinal detachment (RD) with macular involvement and surgical management was decided. Results: A successful pars plana vitrectomy (PPV) with peeling of the internal limiting membrane and application of an endolaser was performed. Three months later, he came back with a higher serous RD and a worsening of BCVA. We performed a second PPV with sulfur hexafluoride (SF6) with good anatomical results. One year later, cataract and an inferior rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) was treated with intraocular lens implantation and PPV with silicone oil. Five months later, supero‐temporal retina was detached, so a new PPV was carried out with silicone oil again. One year later, the silicone oil was removed and a retinal detachment was noted 3 months later. Finally, the last surgery was performed practicing encircling band, PPV, application of endolaser and again using silicone oil. Conclusions: Surgical management of serous retinal detachment caused by papillary pit continues being a challenge for retinal specialists. Complications of surgery are no usually publish in literature and this case report make us take into account. Since it ranges from observation to surgical approach using different techniques and procedures without any showing clear superiority.

Purpose: To describe the presentation and management of gliomas of both optic nerves in a paediatric patient with neurofibromatosis type 1 (NF1). Methods: A 4‐year‐old female patient referred for ophthalmological evaluation due to a recent diagnosis of neurofibromatosis type 1. She presented better corrected visual acuity (BCVA) of 20/40 in both eyes (OU). Symmetrical and normoreactive pupils, normal extrinsic ocular motility, no proptosis or exophthalmos. In biomicroscopy Lisch nodules are observed in OU. Funduscopy of normal appearance except slight pallor of both optic papillae Refraction measurements with cycloplegia showed anisometropia: Right eye: +0.75–0.25 at 180°; Left eye: +1.75–2.75 at 170°. Stereopsis: 120 s of arc. Correction is prescribed and a follow‐up visit is scheduled. In subsequent visits we found a slight decrease in BCVA (20/50). In the Optical Coherence Tomography (OCT) we observed a clear decrease in the thickness of the retinal nerve fibre layer (RNFL) in the temporal sector. Visual campimetry and colour vision test cannot be performed Because of the patient's age. Due the clinical situation of decreased BCVA without justifiable cause in a patient with NF1, Magnetic Resonance Imaging of the brain and orbit is requested and a fusiform thickening of both optic nerves in their intraorbital portions with prolongation towards the optic chiasm is evidenced. Results: Due the clinical progression and deterioration on the RNFL OCT tests, an interconsultation with the Paediatric Oncology Department was made and it was decided to start systemic treatment with vinblastine. Conclusions: A complete ophthalmological examination adjusted to age is currently considered to be of choice in patients with NF1, being necessary annually until the age of 8 years and every 2 years until the age of 18. However, this examination in younger children, who are at greatest risk of developing gliomas, can be complex and requires experience.