1/20. Lung cancer, proptosis, and decreased vision.A 48-year-old man presented to the emergency department with a 3-day history of decreased vision in a painful proptotic right eye. The patient was being treated with chemotherapy and radiation for non-small cell lung carcinoma. Examination showed visual acuity of hand motions, decreased motility, and an afferent pupillary defect on the right, consistent with an orbital apex syndrome. neuroimaging revealed "dirty" orbital fat and no paranasal sinus disease. Orbital biopsy initially showed only fibrosis; however, on subsequent biopsies, nonseptate hyphae later identified as mucormycosis was recovered. The patient survived with exenteration and systemic amphotericin b.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
2/20. Chronic, traumatic intraconal hematic cyst of the orbit removed through the fronto-orbital approach--case report.A 22-year-old male presented with a chronic encapsulated intraorbital hematoma 3 months after blunt trauma to his left eyeball. Ophthalmological examination found the best corrected visual acuity was 4/20 in the left eye, and 20/20 in the right eye. The orbit exhibited exophthalmus and inability of the eye to move above the horizontal level. Orbital magnetic resonance imaging showed a fairly well-demarcated area in the medial aspect of the orbit appearing as hyperintense on T1-weighted images and isoto hyperintense on T2-weighted images. This area was believed to be hemorrhage. No other abnormalities were found. The diagnosis was hematic cyst. The cyst was approached through a left fronto-orbital route and its location identified within the periorbita and orbital fat. The cyst was removed partially. Histological examination demonstrated cystic accumulation of blood and breakdown products in a non-epithelium-lined fibrous capsule, compatible with hematic cyst. The presence of hemosiderin in the cyst wall suggested that the cyst was a chronically enlarging lesion. Hematic cysts of the orbit usually present as subperiosteal mass months to years after trauma. Surgical removal of the cyst wall rather than needle aspiration is recommended to prevent recurrence.- - - - - - - - - - ranking = 4keywords = eye (Clic here for more details about this article) |
3/20. Enhanced responsiveness of human extravisual areas to photic stimulation in patients with severely reduced vision.Lesions in the primary visual cortex induce severe loss of visual perception. Depending on the size of the lesion, the visual field might be affected by small scotomas, hemianopia, or complete loss of vision (cortical blindness). In many cases, the whole visual field of the patient is affected by the lesion, but diffuse light-dark discrimination remains (residual rudimentary vision, RRV). In other cases, a sparing of a few degrees can be found (severely reduced vision, SRV).In a follow-up study, we mapped visually induced cerebral activation of three subjects with SRV using functional magnetic resonance imaging. We were especially interested in the visual areas that would be activated if subjects could perceive the stimulus consciously although information flow from V1 to higher visual areas was strongly reduced or virtually absent. Because subjects were only able to discriminate strong light from darkness, we used goggles flashing intense red light at a frequency of 3 Hz for full visual field stimulation. Besides reduced activation in V1, we found activation in the parietal cortex, the frontal eye fields (FEF), and the supplementary eye fields (SEF). In all patients, FEF activation was pronounced in the right hemisphere. These patterns were never seen in healthy volunteers. In a patient who recovered completely, we observed that extrastriate activation disappeared in parallel with the visual field restitution. This result suggests that damage to the primary visual cortex changes the responsiveness of parietal and extravisual frontal areas in patients with SRV. This unexpected result might be explained by increased stimulus-related activation of attention-related networks.- - - - - - - - - - ranking = 2keywords = eye (Clic here for more details about this article) |
4/20. Aggravation of proliferative diabetic retinopathy after laser in situ keratomileusis.We describe a patient with proliferative diabetic retinopathy who had laser in situ keratomileusis (LASIK). Rapid progression and pronounced aggravation of diabetic retinopathy occurred after LASIK, resulting in severe visual loss in both eyes.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
5/20. sphenoid sinus mucocele with recurrent visual disturbance.We present a case of sphenoid sinus mucocele with recurrent visual disturbance on the same side. A 22-year-old female showed two episodes of visual disturbance in the left eye for 3 months, and acute retrobulbar optic neuritis was diagnosed. With corticosteroid, visual disturbance improved in 1 week. MRI and CT scans showed mucocele in the left sphenoid sinus, and left optic nerve swelling with high intensity was observed in T2-weighted MRI. No destruction of the optic canal was found. The contiguous inflammation in the optic nerve rather than compression was considered as pathogenesis.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
6/20. Free autologous buccal mucosal graft transplantation to treat ocular complications after toxic epidermal necrolysis: case report.BACKGROUND: Toxic epidermal necrolysis (TEN) can lead to ocular surface scarring associated with pain, dry eye symptoms, and decreased visual acuity that often are difficult to treat. history AND SIGNS: A 34-year-old woman was referred to our department two-years after TEN induced by lamotrigin (lamictal(R)). She was complaining of severe visual acuity loss, pain, and dry eye symptoms. visual acuity was reduced to light perception in the right eye (RE) and to 0.2 in left eye (LE). Basal Schirmer test was 2 mm in RE and 3 mm in LE. With or without therapeutic contact lenses, the patient was experiencing severe discomfort requiring tear supplementation up to 50 - 80 times/day in both eyes. THERAPY AND OUTCOME: A free autologous mucosal graft (3.5 x 2.0 cm) was transplanted from the lower lip into the upper RE fornix. Six months after surgery, with therapeutic contact lenses, the need for tear supplementation was markedly reduced to 3 - 4 times/day in RE while it remained unchanged in LE. In RE, slit-lamp examination revealed decreases in the corneal stromal edema and in the diameter of neo-vessels associated with an improvement of visual acuity (counting fingers at 30 cm). Basal Schirmer test values were unchanged. It has to be mentioned that the improvement observed after surgery was markedly dependent on wearing a therapeutic contact lens. CONCLUSIONS: Free autologous buccal graft transplantation (with its presumably accessory salivary glands) in association with the use of a therapeutic contact lens can be an efficient approach to treat ocular complication following drug-induced TEN (Lyell's syndrome).- - - - - - - - - - ranking = 5keywords = eye (Clic here for more details about this article) |
7/20. arachnoid cyst of the optic nerve: a case report.BACKGROUND: To report a case of an arachnoid cyst of the optic nerve with homonymous optic atrophy. history AND SIGNS: A 17-year-old female patient presented with severe visual loss, limited to light perception, of the left eye. She underwent complete ophthalmologic examination, color fundus photography and electrophysiological study. magnetic resonance imaging (MRI) revealed the presence of a fusiform structure involving the left optic nerve from the orbital apex to the posterior surface of the globe. The clinical and radiographic features are consistent with an arachnoid cyst of the optic nerve. THERAPY AND OUTCOME: The patient refused to be treated. Two years later, the VA remained unchanged. CONCLUSIONS: The arachnoid cyst of the optic nerve is a rare entity. Its differential diagnosis from the primary optic nerve glioma is difficult and important to be made in order to be treated properly.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
8/20. An instrument capable of grading visual function: results from patients with retinitis pigmentosa.There was no device to grade visual function in patients with retinitis pigmentosa (RP). We have therefore developed an instrument capable of measuring and quantifying the visual capabilities, and here present the results from patients with RP. In total, 118 eyes of 59 patients, 26 men and 33 women, with RP were studied. Seven eyes had hand movement (HM) and eight had light perception (LP) vision, and the others had better visual acuity. The Low Vision Evaluator (love) consists of a pair of goggles with white, light-emitting diodes as the stimulus, a control box, an on-off button to signal the detection of the stimulus, and a printer for permanent records. There are 15 luminance levels of stimuli (combination of 5 intensities and 3 durations). The stimuli are delivered in a random sequence with an audio signal presented 0.3 seconds prior to the light stimulus. Each eye was tested separately, and each stimulus magnitude (intensity x duration) was presented 3 times for a total of 27 stimuli per eye. With 6 catch trials (audio signal without a light stimulus), a total of 60 trials were examined in a full examination. The conventional visual acuity and kinetic visual fields were determined. 59 patients had different visual acuities that ranged from no light perception (NLP) to 1.5 vision, and visual field sizes that ranged from 0.0001 to 3.96 steradians. The visual acuity and visual field size were significantly correlated with the love score (r=0.58 and 0.64, respectively; p<0.01). These results indicate that the love is capable of grading the visual function of RP patients with various visual acuities and visual fields. The testing procedures are simple for the patient and examiner, and this instrument can be used to assess the effectiveness of medical and surgical therapy.- - - - - - - - - - ranking = 4keywords = eye (Clic here for more details about this article) |
9/20. Bilateral severe visual loss in brucellosis.PURPOSE: To report a case of brucellosis with bilateral permanent loss of vision. methods: Case report. RESULTS: Bilateral loss of vision developed within two weeks in a young adult with positive brucella antibodies. There was optic disc swelling with optic neuropathy and serous retinal detachment in both eyes. The patient had chronic active brucellosis confirmed by serum antibody titers (1/640). CONCLUSION: This case shows that optic neuropathy may result in severe visual loss in patients with brucellosis.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
10/20. Corticosteroid treatment for melanoma-associated retinopathy: effect on visual acuity and electrophysiologic findings.BACKGROUND: Visual disturbance in the course of melanoma is rare. Specific localized metastases and drug toxic effects are frequently the cause. Recognition of a retinopathy raises several questions when the diagnosis of melanoma-associated retinopathy (MAR) can be confirmed. Descriptions of such patients in dermatologic literature are rare and deserve attention because therapeutic decisions are mandatory. OBSERVATIONS: A 70-year-old woman had a first melanoma in 1985 and a second primary melanoma in 1994. Axillary lymph node involvement occurred in November 2000, leading to surgery and chemotherapy. In December 2001, she had sudden bilateral visual loss, with shimmering blobs of color and flickering photopsias. Computed tomography and cerebral magnetic resonance imaging ruled out localized tumor on the eyes or optic nerves or evolution of disease. Ophthalmologic examination revealed a bilateral posterior uveitis, with hyalitis and progressive destruction of retinal pigment. The electrophysiologic data confirmed the diagnosis of MAR. Symptoms improved after systemic corticosteroid therapy, with no relapse after tapering doses despite worsening of melanoma. CONCLUSIONS: As a rare paraneoplastic visual syndrome possibly leading to blindness, MAR is characterized by bipolar cell involvement without photoreceptor cell impairment. Also, MAR is linked to the presence of autoantibodies directed against melanoma antigens that cross-react with the rod bipolar cells of the retina. Corticosteroid therapy is rarely beneficial. Our case of MAR is noteworthy because it involved a woman, was associated with an uveitis, and improved with corticosteroid therapy.- - - - - - - - - - ranking = 1keywords = eye (Clic here for more details about this article) |
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