1/19. Acute onset of a bilateral areflexical mydriasis in Miller-Fisher syndrome: a rare neuro-ophthalmologic disease.Miller-Fisher syndrome (MFS) is characterized by variable ophthalmoplegia, ataxia, and tendon areflexia. It seems to be a variant of guillain-barre syndrome (GBS), but unlike in GBS, there is a primitive involvement of the ocular motor nerves, and in some cases there is brainstem or cerebellum direct damage. The unusual case of MFS in the current study started with a bilateral areflexical mydriasis and a slight failure of accommodative-convergence. Ocular-movement abnormalities developed progressively with a palsy of the upward gaze and a bilateral internuclear ophthalmoplegia to a complete ophthalmoplegia. In the serum of this patient, high titers of an IgG anti-GQ1b ganglioside and IgG anti-cerebellum. anti-purkinje cells in particular, were found. The former autoantibody has been connected to cases of MFS, of GBS with associated ophthalmoplegia, and with other acute ocular nerve palsies. The anti-cerebellum autoantibody could explain central nervous system involvement in MFS. The role of these findings and clinical implications in MFS and in other neuro-ophthalmologic diseases are discussed.- - - - - - - - - - ranking = 1keywords = ophthalmoplegia, ocular (Clic here for more details about this article) |
2/19. Temporary uniocular blindness and ophthalmoplegia associated with a mandibular block injection. A case report.A mandibular block injection produced temporary uniocular blindness, total ophthalmoplegia, mydriasis, and ptosis of the eyelid, with diplopia developing as the sight returned. These effects lasted 25-30 minutes. The explanation offered as to the cause of the anaesthetic phenomenon is an intra-arterial injection into the maxillary artery with backflow of anaesthetic solution into the middle meningeal artery. The instantaneous blindness results from the anaesthetic agent being carried into the central artery of the retina through an anastomosis of the ophthalmic and middle meningeal arteries via the recurrent meningeal branch of the lacrimal artery. Although of short duration, the symptoms mimic a more serious carotid artery embolus occluding the ophthalmic artery. Complications of mandibular blocks have been reported in the literature, however total blindness and ophthalmoplegia are extremely rare. This case report highlights an event where individual anatomical variation of the maxillary and middle meningeal arteries has allowed anaesthetic solution to be delivered to an ectopic site.- - - - - - - - - - ranking = 1.5052419547187keywords = ophthalmoplegia, ocular (Clic here for more details about this article) |
3/19. Dilated pupil during endoscopic sinus surgery: what does it mean?Endoscopic sinus surgery has become the standard of care for the surgical management of chronic sinus disease. Sinus disease and its surgical treatment carry the risk of orbital complications, irrespective of the approach. Orbital complications associated with sinus surgery include nasolacrimal duct damage, extraocular muscle injury, intraorbital hemorrhage/emphysema, and direct optic nerve damage, resulting in blindness. The finding of an unequal pupil at the end of a procedure would be a cause of considerable concern, but it is most likely due to the topical contamination of the eye with a mydriatic pharmacological agent commonly used in endoscopic sinus surgery.- - - - - - - - - - ranking = 0.0026209773593322keywords = ocular (Clic here for more details about this article) |
4/19. Accidental mydriasis from exposure to Angel's trumpet (datura suaveolens).PURPOSE: To report clinical findings after accidental instillation into the eye of sap from Angel's trumpet (datura suaveolens). methods: We report findings on seven patients who developed sudden onset of unilateral mydriasis. At least three of them also had ipsilateral cycloplegia and one developed transient tachycardia. RESULTS: The symptoms evolved after ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. Six patients were initially unaware of the cause of their symptoms. In these cases, patient history revealed recent contact with Angel's trumpet. CONCLUSION: Accidental ocular instillation of sap from Angel's trumpet should be noted as a cause of sudden onset of mydriasis in otherwise unaffected patients and also of general symptoms like tachycardia.- - - - - - - - - - ranking = 0.0052419547186643keywords = ocular (Clic here for more details about this article) |
5/19. hyperthyroidism, ophthalmoplegia and unilateral mydriasis.Clinical description of a 33 years-old woman, with hyperthyroidism, admitted to the emergency unit with external bilateral ophthalmoplegia and left mydriasis, unreactive to light. The external ophthalmoplegia is proven to be due to myasthenia. The left mydriatic pupil demonstrates features typical for Adie's tonic pupil. The association of a tonic pupil with an auto-immune disease is infrequent. The axiom that internal ophthalmoplegia in a patient with external ophthalmoplegia excludes myasthenia gravis should be reevaluated.- - - - - - - - - - ranking = 1.9895160905627keywords = ophthalmoplegia (Clic here for more details about this article) |
6/19. Ocular jellyfish stings.BACKGROUND: Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours. methods: Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years. RESULTS: Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. visual acuity returned to normal in all cases. CONCLUSIONS: The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.- - - - - - - - - - ranking = 0.0078629320779965keywords = ocular (Clic here for more details about this article) |
7/19. adult-onset acquired oculomotor nerve paresis with cyclic spasms: relationship to ocular neuromyotonia.PURPOSE: To describe the characteristics and significance of acquired oculomotor nerve paresis with cyclic spasm. METHOD: Retrospective case series of two patients with a history of previous skull base irradiation for intracranial tumor who developed double vision and were found to have oculomotor nerve paresis with cyclic spasm. Both patients underwent a complete neuroophthalmologic assessment, including testing of eyelid position, pupillary size and reactivity, and ocular motility and alignment during both the paretic and spastic phases of the condition. RESULTS: Both patients developed unilateral lid retraction and ipsilateral esotropia with limitation of abduction during the spastic phase of the cycle, with ipsilateral ptosis, exotropia, and variable limitation of adduction during the paretic phase. The cycles were continuous and were not induced or altered by eccentric gaze. CONCLUSIONS: Cyclic oculomotor nerve paresis with spasms may occur years after irradiation of the skull base. This condition is different from the more common ocular motor disturbance that occurs in this setting-ocular neuromyotonia. However, in view of the similarity between these two disorders, it seems likely that they are caused by a similar peripheral mechanism.- - - - - - - - - - ranking = 0.018346841515325keywords = ocular (Clic here for more details about this article) |
8/19. mydriasis due to datura inoxia.Unilateral, dilated unresponsive pupil may be secondary to a wide range of ocular and neurological disorders. "Gardener's pupil" is a pharmacological mydriasis caused by exposure to plants containing alkaloids. We report a case of mydriasis related to datura inoxia, and detail a number of plants that have toxic effects. This report emphasises the importance of accurate history taking when evaluating fixed dilated pupil. We recommend that labelling of such poisonous plants should detail the local and systemic effects of accidental exposure, rather than merely the fact that they are poisonous.- - - - - - - - - - ranking = 0.0026209773593322keywords = ocular (Clic here for more details about this article) |
9/19. Fixed, dilated pupil after phakic intraocular lens implantation.A 26-year-old man with degenerative high myopia had bilateral anterior chamber phakic intraocular lens (IOL) implantation under general anesthesia. The preoperative slitlamp examination was normal. No mydriatic drops were used before, during, or after the procedure. Postoperatively, the intraocular pressure (IOP) in the right globe increased to 60 mm Hg. After the IOP was controlled, the pupil became fixed and dilated. iris fluorescein angiography was obtained and delayed filling of the iris capillary plexus with large areas of no perfusion was observed in the right eye. Based on these findings, a diagnosis of Urrets-Zavalia syndrome was made. To our knowledge, this is the first report of Urrets-Zavalia syndrome after phakic IOL implantation.- - - - - - - - - - ranking = 0.015725864155993keywords = ocular (Clic here for more details about this article) |
10/19. Unilateral mydriasis without ophthalmoplegia--a sign of neurovascular compression? Case report.OBJECTIVE: We aimed to demonstrate the use of neuroimaging studies in vascular compression of the oculomotor nerve. CLINICAL PRESENTATION: A 24-year-old woman was noted by her dentist to have anisocoria, with the left pupil being larger than the right. After detailed ophthalmologic and neurological examination, we proceeded to perform neuroimaging. T2-weighted images (2 mm) and constructive interference in steady-state (0.3 mm) images were utilized. INTERVENTION: magnetic resonance imaging showed that duplicated left superior cerebellar artery, a prominent posterior communicating artery, and a posterior cerebral artery combined to compress the superomedial portion of the left oculomotor nerve. CONCLUSION: With continued improvements in neuroimaging, we think that more cases of isolated cranial neuropathies previously labeled as "idiopathic" will be shown to result from vascular compression.- - - - - - - - - - ranking = 0.99475804528134keywords = ophthalmoplegia (Clic here for more details about this article) |
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