case_images: PMC11182180_01
case_images: Clinical exam and optical coherence tomography (OCT) analysis. (A) Photograph of the left eye showing peri-orbital swelling, conjunctival injection, and chemosis (day 2 after receiving zoledronate). (B) On the left panel is a color fundus photo (Optos camera) of the left eye showing normal-appearing optic disc, vessels, and retina. The right panel shows the corresponding normal fundus autofluorescence photo. (C) The left image panel shows the en-face fundus photo of the retina (the green box highlights the area within the macula where the OCT scan was captured). The right panel shows the OCT image corresponding to the area indicated by the green arrow on the en-face image. The OCT macula shows normal retina structures, normal foveal contour, and the absence of cystic edema, intraretinal fluid, and subretinal fluid. The average central subfield thickness was measured as 297 microm, which is within the normal range (250-300 microm). (D) The OCT retinal nerve fiber layer (RNFL) analysis shows no optic nerve head swelling. The left panel is the en-face fundus photo showing the optic disc (the green circle indicates where the OCT analysis was captured). The right image panel shows the RNFL thickness along the different regions around the optic disc. TMP, temporal; SUP, superior; NAS, nasal; INF, inferior. The black line is within the green region, indicating that the patient's RNFL thickness is within the normal range. The abnormal yellow and red regions represent thin RNFL. Anything above the green region would indicate a thickened RNFL, i.e., optic disc swelling.
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case_images: PMC11182180_01_fopht-04-1372429-g001.jpg
case_images: f1
case_images: Her ocular symptoms started approximately 48 h after receiving her first intravenous infusion of 4 mg zoledronate (Zometa; medication revived on December 12, 2022) ( Figure 1A ). The fundus view was hazy, but the posterior segment appeared normal ( Figure 1B ). Optical coherence tomography (OCT) showed no macular edema or ischemia ( Figure 1C ); the average central subfield thickness was measured as 297 microm, which is within the normal range (250-300 microm). OCT also did not show optic disc swelling ( Figure 1D ).
case_images: B-scan ocular ultrasound. The B-scan shows diffuse thickening of the ocular coats (white arrowhead). The measurement of the ocular coats taken at the macula (posterior sclera) was 2.0 mm, which is twofold thicker than the normal value (1.0 mm in an average eye axial length of 23-25 mm; the patient's axial length was 24.5 mm). The asterisk shows hypoechoic regions on either side of the optic nerve which represents sub-Tenon's fluid. This is seen in cases of posterior scleritis (also called the T-sign).
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case_images: There was no evidence of vitritis on B-scan ultrasound, but there was diffuse thickening of the ocular coats (measuring 2 mm at the posterior sclera which is twofold thicker than normal;  Figure 2 ).
case_images: CT orbit. The left and right panels show the transverse and coronal plan, respectively. The asterisk shows left periorbital soft tissue swelling. The orange arrowhead shows lacrimal gland enlargement. The green arrow shows a blurry margin, thickening and enhancement of the sclera. The red arrow shows an increased density of orbital adipose tissue (fat stranding) adjacent to the sclera which is absent in the other eye. The blue arrow shows a mild thickening of the lateral rectus muscle belly.
case_images: fopht-04-1372429-g003.jpg
case_images: PMC11182180_01_fopht-04-1372429-g003.jpg
case_images: f3
case_images: The CT result demonstrated left periorbital soft tissue swelling, lacrimal gland enlargement, fluid collection along the inferior lateral aspect of the globe with diffuse thickening and enhancement of the sclera, and mild thickening of the left lateral rectus muscle belly ( Figure 3 ).