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We report an unusual intraoperative finding in the case of a 4-month-old infant with bilateral congenital cataracts removed within a 1-week period. Surgery in the right eye was uneventful. During removal of the cataract in the left eye, signs of the intraoperative floppy-iris syndrome (IFIS) were observed; ie, iris floppiness, iris prolapse to the incisions, and progressive miosis. The surgical technique was identical in both eyes except that epinephrine was added to the irrigating solution in the right eye but inadvertently omitted in the left-eye surgery. Use of intracameral epinephrine has been documented to prevent IFIS in adult eyes at risk for developing the syndrome. Our case highlights the importance of epinephrine in the irrigating solution in pediatric cataract surgery.

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In the absence of obvious pulmonary or disseminated tuberculosis, ocular and central nervous system (CNS) tuberculosis may represent a significant diagnostic challenge. Refinements in polymerase chain reaction techniques and neuroimaging have strengthened the battery of tests used to diagnose CNS and ocular tuberculosis, yet in many cases, the diagnosis remains one of exclusion; it may ultimately be determined through exacerbation by anti-inflammatory therapy with subsequent improvement by antitubercular medication treatment. Because of emerging drug resistance, at least a two-drug regimen is required for therapeutic testing and treatment of isolated ocular tuberculosis. If pulmonary or miliary disease coexists, a 6-month, four-drug regimen with isoniazid, rifampin, pyrazinamide, and ethambutol is required for treatment. Tubercular meningitis is treated with the same four-drug regimen for at least 9 to 12 months. Burden of therapeutic compliance rests on the treating physician and public health sector. Best compliance is realized with directly observed therapy.