A 31-year-old woman developed bilateral painless enlargement of the lacrimal glands over a 2-month period (Figs 1 and 2, arrows). She underwent a right orbitotomy with lacrimal gland biopsy, which showed marked non-caseating granulomatous inflammation (Fig 3, star) displacing the normal gland architecture. Multinucleated giant cells were also present (Fig 4, arrow).

I have read with great interest this brief report claiming the universal recommendation for Age-Related Eye Disease Study (AREDS) supplements.1 Because this recommendation is of substantial importance to public health, affects tens of millions of patients, and is mandated by a Physician Quality Reporting System (PQRS) measure, the issue deserves further scrutiny.

An asymptomatic 14-year-old boy was incidentally found to have a “bunch-of-grapes”−like retinal lesion, consistent with a retinal cavernous hemangioma. Although typically sporadic and unilateral, these lesions can be familial and associated with cutaneous, hepatic, or intracranial hemangiomas. Vitreous hemorrhage may result from epiretinal membrane contraction and vitreous traction. Fundus photograph showing the retinal cavernous haemangioma (Fig A). Near-infrared spectroscopy (Fig B) and spectral-domain optical coherence tomography (Fig C) demonstrating the epiretinal membrane and vitreous traction.