Anisocoria, characterized by unequal pupil diameters typically ranging from 0.3 mm to over 2.0 mm, represents a clinically significant finding that requires thorough evaluation in the emergency department. This asymmetry may indicate dysfunction of the cranial nerves or iris musculature, thereby providing valuable insight into the integrity of the autonomic nervous system. Although anisocoria may be physiologic or benign, it can also serve as a warning sign of severe neurologic or ophthalmologic pathology, including intracranial hemorrhage, oculomotor nerve palsy, or Horner syndrome. In the absence of overt trauma, the diagnostic process may be complicated by a lack of clear clinical indicators, potentially delaying appropriate intervention. Timely recognition and accurate differentiation between benign and pathologic causes are critical, given the association of anisocoria with high-risk neurologic emergencies, pharmacologic influences, and considerable patient distress. This case report details the presentation of a previously healthy 40-year-old man who arrived at the emergency department with acute-onset anisocoria. It includes a comprehensive review of the underlying pathophysiology, clinical manifestations, diagnostic algorithms, and therapeutic considerations. Particular emphasis is placed on the role of a meticulous history and focused physical examination in guiding prompt and effective clinical decision making.

Sports-related ocular trauma is an important cause of preventable visual morbidity, particularly in contact sports such as football (soccer). Although many injuries initially present with mild anterior segment findings, significant posterior segment pathology may coexist and can be easily overlooked. We report the case of a 17-year-old male football player who presented with left eye pain, blurred vision, and periorbital bleeding following blunt ocular trauma during a football match. Examination revealed traumatic mydriasis with anterior uveitis, subconjunctival hemorrhage with conjunctival laceration and exposed Tenon's tissue, as well as commotio retinae with a peripheral horseshoe-shaped retinal tear. No retinal detachment was identified. The patient underwent prompt laser retinopexy and received topical anti-inflammatory and antibiotic therapy, resulting in favorable anatomical and visual outcomes. This case highlights the importance of maintaining a high index of suspicion in sports-related ocular trauma, as relatively subtle anterior segment findings may mask significant posterior segment injury. Careful and systematic anterior and posterior segment examination, including peripheral retinal evaluation, is essential to avoid missing sight-threatening complications and to ensure timely intervention.

Parrots (Psittaciformes) comprise a large group of approximately 400 species of birds. There are currently no comprehensive reviews of parrot ophthalmology in the peer-reviewed literature. This review describes the unique ocular variations of parrots, including visual ability and anatomic adaptations. A comprehensive summary of ophthalmic diagnostic tests, including aqueous tear measurements, tonometry, conjunctival cytology, conjunctival microbiology, and ocular ultrasonography, in clinically normal psittacine birds is presented. Common ocular disorders of parrots and their treatments are discussed. Aqueous tear production can be measured using Schirmer tear tests, phenol red thread tests, and endodontic absorbent paper point tear tests. Intraocular pressure is best measured with a rebound tonometer; however, applanation tonometry has also been described. Conjunctival cytology, conjunctival microbiology, and ocular ultrasonography are useful in determining disease etiopathology. Topical neuromuscular blocking agents may be effectively used with caution to induce pharmacologic mydriasis in psittacine birds. Ongoing research should be performed on all available psittacine bird species to increase sample size and available data from which normal reference intervals can be determined.

To investigate associations between multiple factors-including gender, parental myopia, outdoor activities, near work, and school/family-based myopia education-and myopia prevalence among high school students in Hefei in the post-COVID-19 period. A cross-sectional survey was conducted among 6475 senior high school students (aged 17-19 years) from 15 schools in Hefei, China, between March and May 2023. Visual acuity was measured using a standard logarithmic eye chart, and refraction was assessed via non-cycloplegic autorefraction with tropicamide-induced mydriasis. Myopia was defined as spherical equivalent (SE) < - 0.5 D. Self-reported questionnaires captured data on parental myopia, outdoor time, near work, sleep, and myopia prevention strategies. Data were analyzed using chi-square tests, tQUER-tests, and multivariate logistic regression, with sensitivity analyses accounting for potential overestimation due to non-cycloplegic refraction. Of 6414 participants (after exclusions), myopia prevalence was 85.3% (adjusted to approximately 82.5% in sensitivity analysis assuming 0.5 D overestimation). Females showed higher prevalence than males (88.9% vs. 82.9%; χ[2] = 46.434, p < 0.01). Parental myopia was associated with higher risk (χ[2] = 84.69, p < 0.01; adjusted OR = 2.20, 95% CI 1.75-2.85). Outdoor activities > 1 h/day were associated with lower prevalence (χ[2] = 110.5, p < 0.01; adjusted OR = 0.40, 95% CI 0.28-0.58), while prolonged near work (> 6 h/day in 55% of students) correlated with higher rates. Parental and school education on myopia prevention (e.g., promoting outdoor time, regulating screen exposure) was linked to lower severity, though adoption was low (17.2% parental, 36.5% school). High myopia prevalence was observed, associated with female gender, parental myopia, reduced outdoor time, and increased near work-factors that were commonly observed in this post-pandemic cohort (with behaviors consistent with patterns reported during the pandemic period). School- and family-based education were associated with myopia severity, but the cross-sectional design precludes causal inference (reverse causality is possible). Non-cycloplegic measurements may inflate estimates. These findings may inform targeted prevention strategies.

Primary open-angle glaucoma (POAG) is rarely recognized in large felids, yet it may cause severe vision loss and chronic pain. This case report presents the ophthalmological evaluation of a four-year-old Siberian tiger (Panthera tigris altaica) maintained under human care that exhibited signs of visual impairment and altered sensorium. Under neuroleptic analgesia, clinical findings included bilateral convergent strabismus, persistent mydriasis, pathologically elevated intraocular pressure (48-52 mmHg), extensive map-like retinopathy, and focal retinal degeneration, supporting a diagnosis of advanced-stage bilateral POAG with irreversible vision loss. Pupillary light reflexes were absent, while fluctuations in pupil size were attributed to ketamine. Although medical and surgical options used in domestic cats may be applicable to non-domestic felids, frequent topical treatment was impracticable and unsafe, vision-preserving surgery was no longer indicated, and advanced diagnostics and specialist ophthalmic surgery were unavailable on site. The therapeutic goal was therefore shifted from vision preservation to long-term pain surveillance and welfare maintenance, including housing adaption and a defined threshold for humane euthanasia. Two types of neurological episodes were also documented as secondary findings; however, their causal relationship with the ocular disease could not be established without advanced neuroimaging. This case highlights the need for accessible on-site or referral-based ophthalmic diagnostics and surgical capacity in zoo settings.

Acute headache is a common clinical presentation with a broad differential diagnosis, ranging from benign to life-threatening conditions. Early recognition of atypical causes is essential, particularly when initial investigations are inconclusive. The etiology of acute headache can be broadly classified into primary and secondary causes. Primary headaches occur in the absence of identifiable structural pathology, whereas secondary headaches arise from an underlying organic cause. In this case presentation, a 65-year-old woman presented with a severe headache, which was triggered by an episode of sneezing. The pain was severe, rated 10 out of 10 in intensity, described as a constant dull ache that was felt all over the head but was more prominent in the occipital region, and it was accompanied by photophobia. The pain was not relieved by pain medications and was not associated with fever or trauma. No past history of migraine. On examination, she had no neck stiffness or abnormal neurology. Eye examination revealed bilateral redness and dilated and fixed pupils. Pain continued to be severe despite regular analgesia. A CT head revealed no space-occupying lesion or bleed. She was admitted for close observation and consideration of further investigations, including MRI, lumbar puncture, and inpatient neurology review. Unfortunately, before the MRI, the headache worsened, and the patient also complained of reduced vision in both eyes. An urgent ophthalmology review was requested, which revealed increased intraocular pressure (IOP) in both eyes (right eye 39 mmHg, left eye 40 mmHg, normal IOP: 10-21 mmHg). She was diagnosed with bilateral acute angle-closure glaucoma (AACG). She was given medical management as per the glaucoma protocol; however, as the headache worsened, medical management failed to reduce ocular pressure. She was taken for emergency anterior chamber (AC) paracentesis due to refractory IOP and peripheral iridotomy on the same day as definitive management. Over the next few days, her vision and headache started to improve. She was discharged with regular follow-up with the glaucoma clinic.

In dogs, intraocular pressure (IOP) responses to topical atropine administration vary, and the anatomical basis for this variability remains unclear.