sis syndrome, high myopia, angioid streaks and choroidalrupture (trauma). Less common conditions include optic nervehead drusen and recurrence from postoperative laser photoco-agulation. Although most patients with CNVM present withone of these common conditions, it is rare to find a case thatpresents with no possible cause of CNVM.Case Summary: A 35-year-old Hispanic female presented tothe clinic with complaints of blurred vision in her left eye inJune 2007. This had come on suddenly. In November 2006BVA was 20/20 O.D., 20/60 O.S. The macula of the left eyehad a subfoveal hemorrhage temporal to the fovea con-firmed by fluorescein angiography and OCT. An intraocularinjection was performed O.S. with bevacizumab. Visionslowly improved, and after 7 months post-treatment visionhas stabilized to 20/20 with a small macular scar. Recentrepeat fluorescein angiography and photos show completeresolution without new complications.Conclusion: Idiopathic or juvenile CNV is uncommon forall ages; however, it affects individuals primarily youngerthan 50 years of age. The diagnosis of idiopathic CNV isone of exclusion. Treatment includes argon laser photoco-agulation and more recently the use of anti-VEGF medica-tion. In this case, the patient was referred to a retina clinicfor evaluation and management of the CNV. With patientconsent, bevacizumab, which attaches to and inhibits theaction of VEGF, was injected O.S. The patient’s visioncurrently has stabilized to 20/20.

Poster 46

Interferon Retinopathy: A Side Effect From theTreatment of Hepatitis CDavid Meltzer, O.D., Brooke Army Medical Center, 3851Roger Brooke Drive, San Antonio, Texas 78234

Background: A 52-year-old white male presented to theclinic with blurry vision in the right eye and a spot in hisright inferonasal field. In the past 4 months he was diag-nosed with a relapse of hepatitis C virus and started treat-ment in July 2007.Case Summary: The patient scheduled a comprehensive eyeexam to find out why he had a spot in his vision. His ocularhistory was significant for bifocal glasses. His medical historyconsisted of hepatitis C, for which he was treated successfullyfrom 2003 to 2004. He had no history of hypertension ordiabetes mellitus. His current medications included ribavirin,Interferon Alfacon-1, venlafaxine hydrochloride, filgrastim,and modafinil. Aided visual acuity was 20/20 in each eye atdistance. The patient’s dose of Interferon Alfacon-1 at hisinitial exam was 15 MCG injected daily. The normal dose ofInterferon Alfacon-1 was 9 MCG 3 times per week. Allentrance tests were normal except he noticed a spot inferonasalO.D. on confrontation field testing. His anterior segment wasunremarkable. On dilated fundus exam multiple cotton woolspots were observed in both eyes, including 1 cotton wool spotsuperior to the macula. A visual field was performed andshowed an inferior defect OU. Ophthalmology and gastroen-

terology departments were consulted. The ophthalmologist didconfirm that this patient’s retinopathy was most likely causedby his interferon therapy. The gastroenterologist found that hisblood pressure was high normal and started him on Lisinoprilonce a day. The gastroenterologist also reduced the dose ofinterferon to 9 MCG per day. At his 2-month follow-up therewere no new lesions, and his previous lesions appeared to beregressing.Conclusion: Ocular side effects are well-recognized com-plications of interferon and ribavirin therapy for hepatitis C.Multiple studies have shown that retinopathy caused frominterferon therapy will most likely resolve on its own.Although patients on interferon therapy rarely report sub-jective problems with their vision, regular fundus examsshould still be performed.

Poster 47

Ocular Findings in Incontinentia PigmentiChristine L. Allison, O.D., and Melissa K. Sigler, O.D.,Illinois College of Optometry/Illinois Eye Institute, 3241South Michigan Avenue, Chicago, Illinois

Background: Incontinentia pigmenti (IP) is a rare skindisease that has been reported in 700 to 1,000 cases in theliterature. It is a dominant X-linked genetic disorder that canaffect the skin, hair, eyes, skeleton, and central nervoussystem. The skin pigmentation begins to develop in the first2 weeks after birth, usually on the trunk and extremities, andconsists of irregular patterns of discoloration. A female bornto an affected mother has a 50% chance of inheritance,while a male child would not be viable. Ocular findingsassociated with IP are abnormal retinal blood vessel growth,microphthalmos, cataract, optic atrophy, and strabismus.Severe visual loss can occur if retinal blood vessel growth isnot managed appropriately. It is recommended that a com-plete dilated fundus evaluation be performed every 3months during the first year of life, with continued careoccurring every 6 months thereafter.Case Report: A 3-month-old infant with a history of IPpresented for a comprehensive eye exam. His mother re-ported that one of the infant’s eyes would turn out. At theinitial exam no strabismus was found. An expected amountof hyperopia was found and dilated fundus exam wasunremarkable. Upon follow-up, an intermittent left exotro-pia was observed and temporal optic nerve pallor O.S. wasnoted; however, the peripheral retina was normal OU. Shewas then referred for consultation with a pediatric ophthal-mologist to assess optic nerve pallor.Conclusions: Due to the X-linked inheritance, women withthis condition should be strongly urged to undergo geneticcounseling. Although IP is a very rare condition, it isimportant that optometrists be aware of the need for con-tinued retinal examination throughout the early years whenmanaging a child with IP. If retinal neovascularizationoccurs, the patient may benefit from laser treatment orcryoplexy. Management of these patients may also include

320 Optometry, Vol 79, No 6, June 2008

treatment for strabismus, amblyopia, visual perceptual def-icits, and the use of low vision aids if severe vision lossoccurs. Early optometric management of children with IPcan improve their future potential.

Poster 48

Not Your Typical Eyelid Bump: Eversion of the SuperiorTarsus Reveals a Large Pyogenic GranulomaNektaria Mandadakis, O.D., Benjamin Casella, O.D.,Harriette Canellos, O.D., andRichard J. Madonna, O.D., M.S., SUNY State College ofOptometry, 33 West 42nd Street, New York, New York10036

Background: A pyogenic granuloma is a benign, inflamma-tory, and vasoproliferative response most often seen at a siteof poor wound healing. The underlying etiology is not trulyunderstood. They typically occur secondary to an underly-ing chalazion, ocular surgery, punctal plugs, or rarely,idiopathically. Treatment is warranted to aid with irritation,the tendency for ulceration and to rule out more serious,malignant lesions.Case Summary: A 42-year-old Hispanic female presentedwith complaints of a bump on her upper left eyelid withlocalized irritation and general irritation OU for 1 week. Shereported a sudden onset and minimal localized tenderness.There was no significant medical history. Ocular historywas remarkable for Travatan-controlled POAG OU. Best-corrected acuities were 20/20 O.D./O.S. Motilities were fullO.D./O.S. Slit lamp examination revealed inspissated mei-bomian glands, collarettes and severe crusting of the eye-lashes OU. The left upper eyelid demonstrated a moderatelysized, focal nodule that was hard and painless upon palpa-tion. Lid eversion revealed a bright red, smooth-surfaced,tongue-like appendage protruding from the superior tarsus.Although firmly attached, the appendage was soft and easilymoveable. Warm compresses BID OU, Tobradex ung QHSOU and Tobradex gtts QID O.S. were initiated. One weeklater the patient reported vast improvement in comfort butfelt as if the eyelid bump had increased in size. Upon lideversion, the appendage appeared wider in width and was ofa duller red color with a whitish-colored tip, thought to behealing tissue. Due to the size and minimal improvementwith topical steroids, an oculoplastics consult was re-quested. Two weeks after surgical removal, with the excep-tion of a barely visible depression where the appendageonce was attached, the eyelid appeared nonremarkable. Webelieve the patient’s underlying eyelid conditions were thelikely contributing factor for her ocular presentation.Conclusions: A pyogenic granuloma should be added to thelist of differentials of eyelid bumps. It can often present asa suspicious-looking lesion, often mistaken for squamouscell carcinoma. Topical corticosteroids are an excellentfirst-line treatment that often leads to complete resolution of

the lesions. For larger-sized lesions, surgical intervention isindicated.

Poster 49

Bitemporal Hemianopia Arising From a SuprasellarCraniopharyngiomaCynthia Overly, O.D., Paye Eye Care Center, 1515 SixthStreet, Green Bay, Wisconsin 54304

Background: Craniopharyngiomas are slow-growing, be-nign epithelial tumors that arise from remnants of theembryonic craniopharyngeal duct. Despite their benign na-ture, craniopharyngiomas can be clinically aggressive withfingerlike infiltration of surrounding structures. The tumorscan adhere strongly to major arteries and cranial nerves,making total removal difficult and sometimes impossible.When located near critical structures such as the pituitary,hypothalamus, and optic chiasm, craniopharyngiomas havethe potential to cause severe visual, neurologic, and endo-crine deficits. The most common presenting symptomsinclude decreased visual acuity, visual field defects (espe-cially bitemporal hemianopia), and headache.Case Summary: A 61-year-old white male presented foran eye exam, complaining of acute peripheral visual fieldloss in his left eye. Best-corrected visual acuity was20/25 O.D. and 20/40 O.S. Cover test showed a smallamount of exophoria. Extraocular motilities were unre-stricted in both eyes. Dilated fundus exam revealed flatoptic nerves with no signs of atrophy. Automated thresh-hold visual field testing revealed a bitemporal hemi-anopia with spared fixation in his right eye and splitfixation in his left eye. Subsequent neuroimaging showeda space-occupying suprasellar lesion that was producingsubstantial chiasm compression. Trans-sphenoidal resec-tion through the left nasal passage was used to excise themass. Comprehensive laboratory investigation facilitatedthe diagnosis of a craniopharyngioma. Shortly upon re-lease from the hospital, the patient developed cerebrospi-nal rhinorrhea. The patient noted binocular, vertical dip-lopia immediately upon regaining consciousness afterendoscopic repair of the cerebrospinal fluid leak. Covertest revealed a left hypertropia and left exotropia. Park’s3-step isolated a left superior oblique palsy. Eight monthspostoperatively the patient was scheduled for a follow-upMRI, which revealed recurrence of the craniopharyngi-oma almost to its original size.Conclusion: Eye care professionals should be aware thatcraniopharyngiomas can produce visual field defects such asbitemporal hemianopia. Early diagnosis is crucial becauselarger tumors have higher recurrence and morbidity rates.Treatment of craniopharyngiomas remains controversial.Even with apparent total removal, recurrence is likely in asignificant number of patients. Visual deficits can arise fromboth the aggressive nature of craniopharyngiomas as well asthe therapeutic intervention.

321Poster Presentations