Purpose In this report, we describe a case of episcleritis that appeared to be the first sign of the novel coronavirus disease (COVID-19). Observations A 29-year-old man with no prior medical condition presented with a complaint of redness and foreign body sensation in his left eye, which started two days before his consultation. He had no history of decreased vision, pain, photophobia, discharge, ocular surgery, or trauma. He had no symptoms in his fellow eye nor did he have any systemic symptoms. External examination of his left eye revealed a sectoral nasal conjunctival and episcleral injection and a clear cornea. There was no scleral edema. A diagnosis of episcleritis was made based on clinical grounds and topical fluorometholone 0.1%. was started. Three days later, the patient presented with headache, shortness of breath, cough, and fever (39.2 °C). Real-time fluorescence polymerase chain reaction test of his nasopharyngeal swab returned a positive result for COVID-19. The patient was then admitted for observation and supportive therapy. After five days, fever, respiratory and ocular symptoms were markedly improved and the patient was discharged and advised to isolate at home for 14 days. Conclusions and importance This is the first report that describes episcleritis as a possible presenting sign of COVID-19. Understanding the association between ocular signs/symptoms and COVID-19 can aid in the diagnosis of the viral infection and can help in limiting its transmission.

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PURPOSE: To investigate the efficacy and safety of illuminated microcatheter-assisted trabeculotomy as a secondary procedure in patients with primary congenital glaucoma (PCG). METHODS: This retrospective case series included patients with PCG who underwent trabeculotomy using an illuminated microcatheter with the intent of catheterizing the full circumference of Schlemm's canal in a single procedure. Success was defined as intraocular pressure (IOP) ≤21 mmHg, with or without the use of glaucoma medications. Clinical examination data were collected for up to 36 months postoperatively. RESULTS: Surgery was performed on 16 eyes of 16 patients. The mean patient age was 75.1 ± 69.4 months (range: 4.0–216.0 months). Complete catheterization was achieved in 11 of the 16 eyes (69%), whereas partial catheterization was achieved in five of the 16 eyes (31%). All eyes had previously undergone surgery for PCG. The mean follow-up duration was 20.3 ± 9.0 months (range, 12.0–36.0 months). IOP was reduced from a mean of 31.8 ± 6.6 mmHg preoperatively to 15.6 ± 3.7 mmHg at the final follow-up ( P < 0.001). The mean preoperative number of glaucoma medications was 3.9 ± 0.5, which was reduced to 1.1 ± 1.6 at the final follow-up ( P = 0.001). Ten (62.5%) of the 16 eyes did not require glaucoma medication by the final follow-up. Early transient postoperative hyphema occurred in six eyes (37.5%). No other complications were noted. All corneas were clear at the final follow-up. CONCLUSION: Ab externo circumferential trabeculotomy using an illuminated microcatheter may be safe and effective as a secondary surgical option for children with PCG after unsuccessful glaucoma surgery.

Patient: Male, 69-year-old Final Diagnosis: Corneal perforation Symptoms: Decrease of vision Clinical Procedure: — Specialty: Ophthalmology Objective: Rare disease Background: Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1), or its ligand PD-L1, are the mainstay treatment for several metastatic malignant conditions. ICIs are associated with multiple toxic adverse events affecting various organs, known collectively as immune-related adverse events (irAEs). Dry eye, uveitis, ocular myasthenia, and cicatrizing conjunctivitis are well-recognized ocular irAEs associated with ICIs. Case Report: We present a case of 69-year-old man who presented with paracentral, punch-out corneal perforation in the left eye, associated with bilateral severe ocular surface disease 3 weeks after receiving the second dose of atezolizumab-bevacizumab combination therapy for the treatment of unresectable hepatocellular carcinoma. Corneal gluing using cyanoacrylate glue was performed along with bandage contact lens application and temporary tarsorrhaphy to seal the corneal perforation and improve the ocular surface. On the subsequent follow-ups, the corneal glue was unstable and dislodged. Thus, penetrating keratoplasty was performed to salvage the globe along with holding the combination therapy. At the 8-month follow-up, the graft remained clear, and the ocular surface improved substantially in both eyes. Conclusions: Ocular irAEs associated with immune-modulating agents can lead to vision-threatening complications. Therefore, communications between oncologists and ophthalmologists in a multidisciplinary team would be of utmost importance for early detection and timely management of any ocular-related adverse events associated with the use of immunotherapy agents.