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Inverse hypopyon (hyperoleon) at the posterior segment in pathological myopia
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  1. Koushik Tripathy1,2,
  2. Rohan Chawla2
  1. 1Department of Vitreoretina and Uvea, ICARE Eye Hospital and Post Graduate Institute, Noida, India
  2. 2Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  1. Correspondence to Dr Rohan Chawla, dr.rohanrpc{at}gmail.com

https://doi.org/10.1136/bcr-2017-223416

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    Description

    A 54-year-old woman presented a year after vitreoretinal surgery with silicone oil injection in the left eye. The left eye showed emulsified silicone oil in the anterior chamber and a posterior chamber intraocular lens. The fundus revealed a posterior staphyloma, attached retina and whitish emulsified silicone bubbles with a horizontal lower border giving rise to inverse hypopyon in the posterior pole (figure 1).

    Figure 1
    Figure 1

    The fundus photo shows chorioretinal atrophy temporal to the optic disc and emulsified silicone oil bubbles with a horizontal lower level suggestive of inverse hypopyon.

    Inverted hypopyon at the posterior pole1 is a rare finding which can be seen in patients with posterior staphyloma and long-term silicone oil tamponade.2 The emulsified silicone oil being lighter than fluid floats superiorly giving rise to this appearance mostly in the anterior segment (hyperoleon).3 In our case, the emulsified silicone oil bubbles (asterisks, figure 2) were limited within a pocket of residual hyaloid/membrane (arrows, figure 2) at the edge of the staphyloma leading to an appearance of an inverted hpopyon in the posterior segment.

    Figure 2
    Figure 2

    Horizontal optical coherence tomography image (A) and oblique vertical scan (B) revealed a membrane (arrows) with hyperreflective droplets of emulsified silicone oil bubbles (asterisks) trapped between the membrane and the retina.

    Learning points

    • Inverse hypopyon or hyperoleon is a feature of emulsified silicone oil.

    • The inverse hypopyon may be seen in the anterior chamber or rarely in the posterior segment.

    References

    1. ↵
      1. Filloy A,
      2. Rubio MJ,
      3. Comas C, et al
      . Inverted hypopyon in the posterior pole. Retina 2013;33:1088–9.doi:10.1097/IAE.0b013e31828312ab
      OpenUrl
    2. ↵
      1. Parlak M,
      2. Dönmez O,
      3. Reichel M, et al
      . Inverses Pseudohypopyon bei degenerativer Myopie. Der Ophthalmologe 2014;111:267–9.doi:10.1007/s00347-013-2940-9
      OpenUrl
    3. ↵
      1. Tripathy K,
      2. Sharma YR
      . Inverted hypopyon in the eye. BMJ Case Rep 2016;bcr2016214638.doi:10.1136/bcr-2016-214638
    View Abstract

    Footnotes

    • Contributors KT managed the patient. Both KT and RC wrote the manuscript, approved the current form and agreed to be accountable for the work.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.