1/10. Bilateral posterior ischemic optic neuropathy after spinal surgery.PURPOSE: To report the association between bilateral posterior ischemic optic neuropathy and spinal surgery. METHOD: Case report. RESULTS: After prone-position spinal surgery of 8 hours' duration, a 68-year-old woman was completely blind in both eyes. Moderate periorbital edema and temporal conjunctival chemosis were present bilaterally. Ophthalmic examination disclosed normal-appearing optic nerve heads, except for bilateral nasal fullness related to bilateral optic nerve drusen, and no retinal edema. Immediate cerebral arteriography, magnetic resonance imaging, and electroretinography were normal. Visual-evoked response was not detectable, and 7 weeks later, severe bilateral optic nerve head pallor developed. CONCLUSIONS: Severe selective hypoperfusion of the retrobulbar optic nerves may occur after spinal surgery. Pressure to the periorbital region may be a contributing factor.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
2/10. Bilateral optic nerve infiltration in central nervous system leukemia.PURPOSE: To report the case of a 58-year-old man with sequential bilateral retrolaminar leukemic infiltration of the optic nerves who presented with normal-appearing optic nerves and no optic nerve enhancement. DESIGN: Interventional case report. methods: A 58-year-old man with chronic myelogenous leukemia (CML) developed progressive vision loss to no light perception in both eyes over four days. The patient received 14 doses of external beam irradiation and 10 cycles of intrathecal cytarabine. Despite treatment, he developed optic nerve pallor, and visual acuity remained no light perception in both eyes. CONCLUSIONS: In a patient with leukemia, leukemic optic nerve infiltration may occur even with normal-appearing optic nerves and a normal magnetic resonance image. It is important to maintain a high clinical suspicion for optic nerve infiltration so that prompt local irradiation may be initiated.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
3/10. Acute visual loss in a child with autosomal recessive polycystic kidney disease: case report and review of the literature.Acute visual loss secondary to ischemic optic neuropathy in children is extremely rare. The causes are usually hypotension or anemia. We describe the clinical course of a 9-year-old boy with a functional renal transplant who presented to the emergency room hemodynamically stable after waking up with complete bilateral loss of vision (no light perception). Examination showed that he had suffered massive nocturnal blood loss from esophageal varices secondary to portal hypertension. The patient's end-stage renal disease was secondary to autosomal recessive polycystic kidney disease (ARPKD), an entity comprised of renal cysts and hepatic fibrosis. Ophthalmologic findings in ARPKD are rarely cited in the literature. A literature search revealed 3 other cases of sudden visual loss reported in nonophthalmologic journals in patients with ARPKD. Funduscopic examination showed bilateral optic nerve head pallor and swelling with associated flame hemorrhages. The fact that this patient already had mildly pale nerves on presentation, along with hemodynamically compensated blood pressure and pulse, suggested chronic as well as acute ischemia. Based on our findings and other reported cases in the literature, ophthalmologic examinations may be indicated in all patients with ARPKD.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
4/10. Orbital apex syndrome after ethmoidal artery ligation for recurrent epistaxis.A 34-year-old man with severe, recurrent epistaxis underwent external anterior and posterior ethmoidal artery ligation on the right side. Visual loss from optic neuropathy and complete ophthalmoplegia developed after surgery. Computed tomography revealed surgical clips within the right orbital apex. Emergent removal of the surgical clips and medial wall decompression were performed. Four weeks later, his visual acuity and extraocular motility were unchanged, and diffuse pallor of the right optic disc was observed. Orbital apex syndrome can be a complication of ethmoidal artery ligation. Severe visual loss and ophthalmoplegia may persist despite prompt recognition and treatment.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
5/10. Bilateral optic neuritis in a child following Epstein-Barr virus infection.A rare case of bilateral optic neuritis is presented in a child with no light perception. Ophthalmic examination revealed dilated pupils without reaction to the light, swollen optic discs with small peripapillary hemorrhages in both eyes. serology revealed evidence of recent Epstein-Barr virus infection. After treatment with high dose of corticosteroid visual acuity gradually improved. After four months visual acuity was normal despite complete pallor of the optic disc. Ebstein-Barr virus infection should be considered in the differential diagnosis of bilateral optic neuritis in a child with severe bilateral visual loss.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
6/10. Bilateral visual loss in craniodiaphysial dysplasia.PURPOSE: To report a rare case of craniodiaphysial dysplasia (CDD) that resulted in a profound loss of vision in both eyes. DESIGN: Observational case report. methods: A 2-year-old girl presented with midfacial anomaly. Marked thickening and sclerosis in the calvaria and facial bones were detected on the plain x-rays, which were compatible with CDD. Two years later, she visited our clinic because of visual loss in both eyes. RESULTS: The visual acuity was light perception in both eyes. The optic disk swelling with temporal pallor was observed in her both eyes. Orbital computed tomography scan revealed near-total obliteration of the optic canal in both eyes. CONCLUSIONS: CDD is a severe bone disorder characterized by massive generalized hyperostosis and sclerosis, especially involving the facial bones. Bony encroachment on the cranial foramina causes optic nerve compression, and this may lead to progressive visual impairment and ultimately to blindness.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
7/10. optic nerve trauma with prolonged blindness followed by visual-evoked potential.An accidental deep intraorbital penetration of a radio antenna tip damaged the optic nerve and caused immediate amaurosis in a 19-year-old female with normal funduscopic, electroretinographic and computerized tomographic orbital findings. A small visual-evoked potential (VEP) recorded within 2 h of injury and in the following days revealed persistent electrical nerve conduction despite loss of vision and afferent pupillary reaction. The VEP constituted the only anticipating sign for the visual recovery which occurred after 3 days. Further increase of the VEP amplitudes preceded the visual improvement, resulting, finally, in 6/24 visual acuity with only lower nasal quadrant scotoma and slight optic disk pallor.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
8/10. Bilateral retinal artery and choriocapillaris occlusion following the injection of long-acting corticosteroid suspensions in combination with other drugs: I. Clinical studies.Two well-documented cases of bilateral retinal artery and choriocapillaris occlusions with blindness following head and neck soft-tissue injection with methylprednisolone acetate in combination with lidocaine, epinephrine, or penicillin are reported. One case had only a unilateral injection. The acute observations included hazy sensorium, superior gaze palsy, pupillary abnormalities, and conjunctival hemorrhages with edema. Follow-up changes showed marked visual loss, constricted visual fields, optic nerve pallor, vascular attenuation, and chorioretinal atrophy. The literature is reviewed, and possible causes are discussed.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
9/10. Ocular quinine toxicity.A 25-year-old woman had no light perception in either eye 14.5 hours after ingesting 3.7 to 4.7 g of quinine. Fundus photographs showed mild venous distention and retinal haziness, but normal arteries. The electroretinogram, electrooculogram, and visual-evoked potential were all mildly abnormal. Two days after the patient ingested quinine, her visual acuity returned to 6/6 (20/20) with a markedly constricted visual field. The classic late fundus appearance of quinine toxicity, marked vascular narrowing, and disk pallor developed within six months. visual fields remained constricted to 12 degrees with small temporal islands.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
10/10. optic nerve enlargement and chronic visual loss.We present four patients with sarcoidosis of the anterior visual pathways. The first patient presented with unilateral visual loss, a mass lesion at the optic nerve head, and an enlarged orbital optic nerve. The second patient presented with bilateral progressive painless visual loss, associated with optic nerve pallor and visual field loss. In these two patients, optic nerve biopsy was diagnostic of sarcoidosis. The third patient developed optic nerve and chiasmal involvement after sarcoidosis was established by lacrimal gland biopsy. The fourth patient had optic nerve, pulmonary, and lymph node involvement with sarcoidosis. A conjunctival and lung biopsy were diagnostic. Computed tomography and magnetic resonance imaging have greatly facilitated diagnosis of sarcoidosis of the anterior visual pathways. sarcoidosis of the anterior visual pathways may occur alone or in association with other ocular or systemic manifestations. A conjunctival or lacrimal gland biopsy may be preferable as the initial diagnostic approach. Treatment of patients with this condition may require systemic immunosuppression, in addition to corticosteroids, to prevent permanent visual loss.- - - - - - - - - - ranking = 1keywords = pallor (Clic here for more details about this article) |
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