A five-year-old female, child of a medical assistant working in a tertiary care teaching hospital in the Sultanate of Oman, underwent bilateral routine uneventful cataract extraction and posterior chamber intraocular lens implantation for congenital cataracts. She presented with painful red eyes two weeks post-surgery. The parents had discontinued the postoperative topical steroid (Prednisolone acetate 1%; Predforte® Allergan Inc, Irvine CA) administered four times daily and antibiotic drops (Ofloxacin 0.3% w/v; Exocin® Allergan, Irvine CA) administered four times daily and was instead treated with ‘Wasam’ treatment. At the time of presentation, the vision in the right eye was hand motions and the left eye was 1/50. Both eyes showed conjunctival congestion, corneal edema, retrocorneal membrane formation, posterior synechiae and secondary glaucoma (left eye 25 mmHg, right eye 40 mmHg). B scan ultrasound showed normal posterior segments in both the eyes.\nThere were two circular ulcerated areas on her occiput of about 4 cm diameter.\nThe child was hospitalized for over one month to control the intraocular inflammation, secondary glaucoma and to ensure that the ulcers on the occipital region healed (). Six months later, the secondary glaucoma had resolved, but vision remained unchanged (right eye hand motions and left eye, 1/50). The child had scars of ‘wasam’ in the occipital region.
A 60-year-old Pakistani male with a history of acute exacerbation of open angled glaucoma of the right eye underwent branding of the right temple and vertex by a faith healer. Four days later, he presented to the hospital with blurry vision in the right eye and cellulitis over the right temporal region. Further examination revealed chemosis, corneal haziness, severe restriction of ocular movements and multiple well circumscribed round full-thickness burns ranging from 2 to 5 cm with no evidence of active drainage. Fundoscopy showed papilledema and hemorrhages with engorgement of veins. On day five, similar signs appeared in the contralateral eye. His past medical history was insignificant except for glaucoma. He had no prior history of sinus headaches or ear infections. Since local infection is the major reason for cavernous sinus thrombosis (CST), the diagnosis was suspected in our patient as the typical sequelae had started after branding. Acute glaucoma can sometimes present with CST; however, he was already on treatment for open angled glaucoma and had no previous infection. The fact that he had acute exudative wounds after branding and had no prior history of ear or sinus infections points towards branding as a cause of CST. Our diagnosis was confirmed by magnetic resonance imaging (MRI). We believe this local inflammation and infection may have spread and reached one of the cavernous sinuses which may turned into an infected clot. The patient partially responded to intravenous broad-spectrum antibiotics (Amoxicillin with clavulanic acid and Ceftriaxone) and local wound management, but suffered permanent blindness.