A carotid-cavernous fistula (CCF) is an arteriovenous fistula with an abnormal connection between the carotid artery and cavernous sinus that can be sight and life-threatening. The conjunctival injection is often the most prominent feature, and patients are commonly misdiagnosed for other ocular conditions leading to a delay in diagnosis and treatment. All three patients in this case series presented with persistent red eyes. They were all treated for conjunctivitis and only referred for further workup when other progressing ocular symptoms occurred. The diagnosis of CCF was confirmed with digital subtraction angiography and with successful endovascular embolization, their ocular symptoms resolved with preserved optic nerve function. A high index of suspicion in patients presenting with an atypical red eye is very crucial for timely diagnosis of CCF.

Triggered by the COVID-19 pandemic, medical education has moved online, tasking medical educators with developing virtual learning experiences. This is particularly challenging for less-represented disciplines, such as ophthalmology. We designed a red eye clinical reasoning case for preclinical medical students, which can be delivered virtually, using video conference software.
We developed a 90-minute red eye/clinical reasoning workshop for which prereading was assigned to students. We then delivered a virtual development session to nonophthalmologist copreceptors and provided a session faculty guide. The entire first-year medical student class (No. = 140) participated in one of four identical workshops, which included virtual small- and large-group discussions. Students completed a knowledge pre- and posttest, and an optional session postsurvey.
Knowledge gains from pretest (No. = 94) to posttest (No. = 73) were statistically significant (p < .05), with average scores improving from 57% to 70%. Overall, students were satisfied, rating the following items 4 or 5 out of 5: session (86%, No. = 31), virtual format (83%, No. = 30), and if they recommended future use (69%, No. = 35).
This novel, virtual clinical reasoning case simulated small- and large-group learning, achieved knowledge gains, and was well received by students. Minor technical challenges were encountered but successfully remedied, without apparent disruption to learning. This virtual medical education model can be used to enhance ophthalmology education in preclinical medical students and can be adapted for virtual design of other curricular content.

Carotid cavernous fistula (CCF) is an abnormal vascular shunt from the carotid artery to the cavernous sinus. They are commonly classified based on hemodynamics, etiology or anatomically. Hemodynamic classification refers to whether the fistula is high or low flow. Etiology is commonly secondary to trauma or can occur spontaneously in the setting of aneurysm or medical conditions predisposing to arterial wall defects. Bilateral carotid cavernous fistulas are rare. We present a case of bilateral CCF secondary to trauma. Ophthalmology was urgently consulted to assess the patient in the intensive care unit (ICU) for red eye. The patient was found to have decreased vision, increased intraocular pressure, an afferent pupillary defect, proptosis, chemosis, and ophthalmoplegia. Subsequent neuro-imaging confirmed a bilateral CCF. The patient underwent two endovascular embolization procedures. Trauma is the most common cause of CCF and accounts for up to 75% of cases. Most common signs of CCF depend on whether it is high or low flow. High-flow CCF may present with chemosis, proptosis, cranial nerve palsy, increased intraocular pressure, diplopia, and decreased vision. Cerebral angiography is the gold standard diagnostic modality. First-line treatment consists of endovascular embolization with either a metallic coil, endovascular balloon or embolic agent. It is unclear in the literature if bilateral cases are more difficult to treat or have a different prognosis. Our patient required two endovascular procedures suggesting that endovascular intervention may have reduced efficacy in bilateral cases.

We reported a case of unusual intraocular Loa loa in a 27-year-old patient who presented with painful red eye. Biomicroscopy revealed a living and active adult worm in the anterior chamber of the right eye. After surgical extraction under local anesthesia, parasitological identification confirmed L. loa filariasis.

Gonorrhoea is a sexually transmitted disease marked by urethritis in males; it may also be transmitted to other organs through contact with infected genital secretions or urine, although rare in this era of modern antibiotics and rapid diagnostic tools. It could pose a difficult situation when we encounter emerging resistant strains. This paper reports a male who presented initially with unilateral gonococcal conjunctivitis contracted via autoinoculation and was found out to be suffering from gonococcal urethritis.