large peripheral hemorrhages OU. The peripheral hemor-rhages were felt to be associated with his lymphoma. Adetailed history with differential diagnoses, optical coher-ence tomography, color fundus photos, and visual fields ofWaldenstrom macroglobulinemia will be illustrated.Conclusion: Waldenstrom macroglobulinemia has a mediansurvival rate between 5 and 10 years. The most importantprognostic factors include age, anemia, leukopenia, andthrombocytopenia. Initiation of treatment is reserved forpatients who develop disease-related signs and symptoms.Mild forms of hyperviscosity syndrome can present withperipheral retinal hemorrhages. With progressive severitythere is increased dilation of the retinal arteries and veins.Fluorescein angiography demonstrates increased arterio-venous passage time due to reduced retinal circulation.Hemorrhages in the posterior pole are usually only presentin severe forms. Ocular changes secondary to hypervis-cosity syndrome only become symptomatic when the cen-tral retina is involved. Waldenstrom macroglobulinemia–associated retinopathy is a slowly progressive conditiondirectly associated with increasing serum IgM levels andserum viscosity.

Poster 34

Asymptomatic Subconjunctival EmphysemaNadia Zalatimo, O.D., VAMC Manchester, 718 SmythRoad, Manchester, New Hampshire 03104

Background: Subconjunctival emphysema is an uncommoncondition that typically results from ocular trauma, duringwhich air is trapped beneath the conjunctiva. Other causesinclude ethmoid osteoma, vigorous coughing, nose blowing,and mechanical ventilation. The condition typically resolvesspontaneously. Rarely, serious vision-threatening complica-tions from orbital compression may occur. In the casereported, asymptomatic, unilateral subconjunctival emphy-sema was found in a 53-year-old woman who presented forroutine examination. This is believed to be the first knowncase report of mild, unilateral subconjunctival emphysemathat was discovered on routine examination.Case Summary: A 53-year-old woman presented for routineexamination with the complaint of slight blur at distanceand near OU. Ocular history was unremarkable. Biomicros-copy revealed clear, round air bubbles in the inferior bulbarconjunctiva, which extended into the inferior corneal mid-stroma OD. The conjunctiva was otherwise clear withoutinjection or laceration OD. The left eye was uninvolved.She denied vigorous nose blowing, coughing, sneezing,ocular trauma, or sinus problems. Orbital CT with contrastshowed no abnormality in the orbits or paranasal sinuses.The patient was diagnosed with subconjunctival emphy-sema with corneal involvement OD. Follow-up showedcomplete resolution within 2 weeks.Conclusion: Subconjunctival emphysema is a transient con-dition that often presents in conjunction with acute ocularsigns of trauma. Prognosis is typically excellent. Compre-

hensive ocular examination and orbital CT scanning arenecessary to properly manage patients with subconjunctivalemphysema and prevent vision loss from orbital compression.

Poster 35

Fun and Games—Until Somebody Gets Shot in the Eye:Blunt Trauma From a Paintball Causing an AngleRecession and Retinal TearElizabeth Sanders, O.D., and Sherrol Reynolds, O.D.,Nova Southeastern University, College of Optometry,3200 South University Drive, Ft. Lauderdale, Florida33328

Background: Reported cases of blunt force ocular injuriescaused by projectile paintball pellets often have a highvisual morbidity. Commonly reported paintball ocular inju-ries include corneal abrasions, cataracts, retinal detach-ments, hyphemas, and vitreous hemorrhage. Each injury hasthe potential to markedly decrease vision or cause signifi-cant pain, imploring the injured to seek treatment. However,blunt force injuries can also cause damage to structures ofthe eye with few acute symptoms but significant long-termeffects when left untreated.Case Summary: A 13-year-old Hispanic male presented toan urgent care clinic reporting a paintball injury to the lefteye 4 days earlier. Acute swelling and discomfort hadsubsided during the interim, but a moderate photophobiapersisted, causing the patient to seek treatment. Upon ex-amination, the left eye was found to have 20/20 acuity, asmall, but dense stromal impact scar to the cornea, acorectopic pupil, and an anterior chamber flare. Gonio-scopic evaluation followed and revealed a temporal anteriorchamber angle recession and a microhyphema. The patientwas treated with Lotemax, bedrest, and cool compresses.The retina was examined at the initial visit and at 1- and2-day follow-ups. During the 2-day follow-up, a peripheralflap tear with a possible choroidal rupture was identifiedtemporally in the left eye. The patient was followed up untilthe uveitis and hyphema had resolved and was referred forretinal tear repair.Conclusion: This case demonstrates an angle recession andretinal flap tear secondary to a traumatic paintball eye injurythat presented with minimal symptomatology. It highlightsthe importance of a careful evaluation of anterior andposterior ocular structures when a traumatic history ispresent.

Epidemiologic information, paintball eye safety informa-tion, gonioscopic photographs, and anterior and posteriorsegment photographs will be included.

Poster 36

Bilateral Papilledema: Case Presentation and ReviewLuciana Coscione, O.D., and Arlene Gold, O.D.,John D. Dingell VAMC, 4646 John Road, Detroit,Michigan 48201

284 Optometry, Vol 78, No 6, June 2007