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Monocular diplopia: contact lens related warpage?

1. Always do a corneal topography on difficult-to-fit corneas. Use the Tangential map for a true picture of the overall cornea and the corneal cap. Use the Absolute Scale maps to rule out abnormally steep or flat regions in the cornea and for accurate comparisons of both eyes. 2. Understand that fitting a myopic presbyope with contact lenses will have a subset of problems related to accommodation, opposed to fitting a hyperope. 3. If a contact lens is required to make the corneal surface more regular, consider soft lenses, especially if a monocular is needed. The comfort difference in the contact lens eye versus the normal eye will minimal, compared to a gas-permeable lens fit.

Accommodation, Ocular↗

Optic neuropathy, headache, and diplopia with MRI suggestive of cerebral arteritis in relapsing polychondritis.

The pathogenesis of central nervous system disease in relapsing polychondritis (RPC) is unknown but may be related to cerebral arteritis. Previous reports have described clinical and histopathologic evidence of cerebral vasculitis in RPC; however, a neuroimaging correlate has not been reported. We present a 36-year-old man with neuro-ophthalmic features of RPC whose magnetic resonance imaging revealed multifocal gray- and white-matter high intensities. This pattern is consistent with cerebral arteritis as described in other systemic vasculitides.

Adult↗