Here we report a case of optic neuritis in the setting of herpes zoster ophthalmicus (HZO) in a child. A six-year-old girl presented with HZO in the right eye. During the hospitalization, her visual acuity decreased. Fluorescein angiography (FAG) and optical coherence tomography revealed optic neuritis in the affected eye. Visual acuity improved with one month of treatment with acyclovir and steroids. FAG analysis showed no evidence of leakage at the optic disc. At one year post treatment, the patient's fundus exam and vision were normal. Therapy with antivirals and steroids may be effective in patients with childhood HZO optic neuritis.

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Background Alopecia areata (AA) is common non-scarring hair loss disease. Sleep distrubance has been regarded as a triggering or aggravating factor for AA. However, objective evaluation of sleep disturbance and its clinical effect on AA has not been clearly demonstrated. Objective This study investigated objective sleep evaluation tool for AA patients and their clinical correlation. Methods Patients presenting with new-onset AA or recurrences of pre-existing AA were included, and those who reported sleep disturbance in the preliminary survey were designated as the sleep disturbance group (SD group). Sleep quality was investigated for them using three self-administered questionnaires: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Epworth Sleep Scale (ESS). Demographic information and clinical features of AA were analyzed according to sleep quality. Results A total of 400 participants were enrolled, and 53 were categorized into the SD group. The incidence of stressful events was significantly higher in the SD group (54.7%) than in the non-SD group (25.1%) ( p <0.001). Based on the PSQI, 77.3% of participants were objective poor sleepers (score of 5 or more), and they showed a significantly higher incidence of stressful events compared to good sleepers ( p =0.019). The proportion of poor sleepers was significantly lower in patients with mild AA (S1) than in those with moderate to severe AA (S2~S5) ( p =0.045). Conclusion This study demonstrated a positive correlation among stress, SD, and AA. The degree of SD was objectively represented by the PSQI score, showing different scores according to AA severity.

Purpose: To report a rare case of primary mucinous adenocarcinoma arising from a sweat gland in the eyelid. Case summary: A 68-year-old male presented to our hospital with a painless, superficial nodular lesion over the skin of the right lateral canthus that had slowly grown over the past two years. The patient had a history of surgical excision for three nodular lesions at the same site 5 years ago, and an excisional biopsy was mucinous adenocarcinoma with a positive margin. A systemic evaluation, including whole-body Positron Emission Tomography scan (PET), chest computerized tomography, gastrointestinal endoscopy, and colonoscopy, revealed no other abnormal lesions. Therefore, the eyelid lesion was considered a primary mucinous adenocarcinoma of the skin. Conclusions: Primary mucinous adenocarcinoma of the eyelid can rarely metastasize. Therefore, a systemic examination is warranted to discriminate primary and metastatic adenocarcinoma and also to monitor the long-term follow-up for the evaluation of local recurrence.

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