Retrobulbar neuritis following contralateral ocular trauma: A diagnostic conundrum

Ocular trauma is an important cause of visual loss and has varied manifestations. Here, we present the case of a 34-year-old male who presented with a history of trauma in the right eye (RE) 2 months when he was hit with a tennis ball while playing cricket. He had a visual acuity of counting fingers close to face in the RE. The slit-lamp evaluation revealed a hyphema of more than half of the anterior chamber volume. The left eye (LE) was normal. Intraocular pressure (IOP) was 48 mmHg (RE) and 17 mmHg (LE). The patient was started on anti-glaucoma medications (tablet Diamox, eye drop Timolol, and Brimonidine) and IOP reduced to 21 mmHg in the RE. After 1 month, the gonioscopic evaluation revealed an angle recession in 4 clock hours. Recorded IOP was 18 mmHg in the RE and 16 mm Hg in the LE. The optical coherence tomography retinal nerve fiber layer showed early glaucomatous changes. Based on these findings, the patient has been diagnosed as a case of angle recession glaucoma RE and kept on follow-up.

Paracentral acute middle maculopathy as a cause of unexplained visual loss in central retinal vein occlusion

Interocular differences in visual quality due to ocular aberrations and scattering in a patient with post-traumatic anisocoria: A case report

Purpose To describe a case of early-stage Extensive Macular Atrophy with Pseudodrusen-like appearance (EMAP) presenting with acute monocular loss and atypical retinal lesions suggestive of posterior uveitis. Methods Case report with longitudinal follow-up including visual field testing and multimodal imaging. Results A 53-year-old woman presented with sudden vision loss in her right eye (RE). Best corrected visual acuity (BCVA) was 20/400 in RE and unaffected in left eye (LE). Fundoscopy revealed bilateral pseudodrusen and peripheral paving-stone degeneration, consistent with stage 1 EMAP. Autofluorescence showed a hyper-autofluorescent reticular pattern in RE, colocalizing with pseudodrusen. Optical coherence tomography (OCT) demonstrated retinal pigment epithelium (RPE) thickening, RPE-Bruch’s membrane separation, and atypical feathery lesions in the RE, along with ellipsoid (EZ) loss. In the LE, only pseudodrusen and RPE-Bruch’s membrane separation were observed. Oral prednisone (30 mg, tapered) was initiated. At 24 weeks, the EZ had recovered, the feathery lesions resolved, and the RPE appeared normal, with a reduced hyper-autofluorescent pattern in the RE. At 30 weeks, the patient returned with recurrent vision loss in her RE. OCT revealed EZ loss without further lesions. After treatment with intravenous methylprednisolone and oral prednisone (tapered) plus methotrexate (15 mg/week), BCVA improved to 20/32, and EZ fully recovered. Discussion We describe a case of stage 1 EMAP presenting with symptoms and lesions suggestive of concomitant Multiple Evanescent White Dot Syndrome (MEWDS)-like reaction. After treatment, resolution of inflammatory features and a partial improvement of the RPE abnormalities were observed.

Introduction : Corneal rupture in new-born, especially during the first week of life is rare. Some of these cases occur because of ocular trauma during deliveries, systemic infection, and congenital anomalies. We aim to deliver a rare case of spontaneous lens and uveal prolapse in new-born and management in treating the case.
 Case Illustration : A-2-day-old full-term-baby was referred due to bleeding of the right eye 6 hours post-partum by spontaneous vaginal delivery with no trauma. The mother, a 23-year-old, having the second born with no history of medical illness or vaginal discharged during pregnancy. Measurements of birth weight and length were normal. Eye examination of the right eye (RE) was uveal and lens prolapse and left eye (LE) cloudy cornea with leukoma and prominent neovascularization. Orbital CT-Scan revealed bilateral vitreous bleeding of both eyes. Laboratory examination showed reactive IgM for herpes simplex virus, reactive IgG for both toxoplasma and rubella. Corneal swab culture was sterile. Systemic and topical antibiotics were administered then switched to systemic antivirus. The 12-day-old-patient showed partial epithelization of cornea, less uveal volume with it partially shrank. Close observation was conducted and evisceration was postponed.
 Discussion : Although etiologic work-up has been addressed, exact etiology remains unknown with the possibility of congenital cause. It has been postulated that structurally malformed eyes are more prone to corneal perforations. Management should be personalized based on the patient’s need.
 Conclusion : Thorough examination is vital a rare case with undisclosed aetiology especially new-born. Patient monitoring is sufficient if no infections and bleedings found.

Purpose: To present a rare case of optic nerve avulsion due to gun shot injury. Case Report: A 30-year-old man presented with sudden visual loss on the Right Eye (RE) after a gun shot on his left frontal bone. On examination of the RE, he had periorbital hematoma and edema, and also conjunctival chemosis. There was no light perception of the RE, and his pupil was dilated and nonreactive to light. There’s also an eye movement resistance. On the examination of the Left Eye, he had periorbital hematoma and edema, visual acuity was 1.0 and other examinations was within normal limit. B-scan USG of the RE showed a hyperechoic image on the retinal projection in front of the optic nerve. CT-scan showed multiple metal density fractions in the subcortical cortical left frontal lobe and right retrobulbar. On funduscopic examination, there was bleeding in the inferior vitreous originating from the optic nerve papilae. The patient underwent craniotomy, debridement, and corpus alienum extraction by neurosurgeon and plastic surgeon. The patient was treated with high dose steroid (methyl prednisolone 4 x 250 mg iv). After a week of therapy, there was no improvement of his RE visual acuity. Conclusion: Optic nerve avulsion is a rare case with devastating results because there’s still no definite therapy to improve the outcome.

Macular hemorrhage after laser exposure and cannabinoid intake during a disco party

An unusual presentation of Devic’s neuromyelitis optica (NMO) disease associated with bilateral internuclear ophthalmoplegia (INO) is described. A 32-year-old pregnant patient was diagnosed with NMO. First symptoms were headache and sudden visual loss in her right eye (RE). Eighteen months ago, she reported other neurologic symptoms such as paresthesia. Based on her visual field, fundoscopy and Ishihara test, she was diagnosed with retrobulbar neuritis of the RE. After delivery, new neurologic symptoms resembling transverse myelitis appeared. She was treated with methylprednisolone and plasmapheresis, which improved her visual acuity; however, a sudden bilateral INO appeared, with adduction defect and nystagmus with abduction in both eyes. No improvement was obtained after treatment with azathioprine and rituximab. Paresis of the legs and the right arm persisted, but double vision and OIN gradually disappeared. At the end, the patient had a residual exophoria in the RE and nystagmus with abduction in the left eye. Prevalence of NMO is lower than one case per one million inhabitants, and it is not likely to affect the encephalic trunk; furthermore, bilateral INO in NMO is rare. Two major criteria and at least two of the three minor ones are required to confirm a NMO diagnosis, and our patient fulfilled these diagnosis criteria.

Oclusión de la arteria central de la retina como complicación postransfusional de glóbulos rojos

Purpose: Post typhoid autoimmune-mediated simultaneous retrobulbar optic neuritis (RBN) involving both eyes is a rare complication requiring early diagnosis and prompt treatment. Case presentation: We present a case of bilateral RBN in a six-year-old male who came to our department with a chief complaint of sudden onset painless profound loss of vision in both eyes, after an episode of high-grade fever 2 weeks earlier. Perception of light was doubtful in right eye (RE) and vision was hand movement in left eye (LE). On ocular examination, anterior segment and fundoscopy of both eye were normal. Blood investigation was normal except for raised ESR. CT of brain and orbit was normal. MRI of brain and orbit revealed bilateral thickening and restriction of optic nerve suggestive of ON. He was initiated with intravenous methyl-prednisolone for three consecutive days after which tapering doses of oral corticosteroid was given. Results: A rapid and marked improvement in Uncorrected Visual Acuity (UCVA) was observed with UCVA improving to 6/ 12 RE and 6/ 9 LE post 1 month. The pupillary reaction also became normal in both eyes. Moreover, there was a significant reduction in the Widal titre of the patient post 2 weeks of treatment. Discussion: Paediatric ON has rare and unique characteristics, which differentiates it from adult ON. No clinical trials have been performed for paediatric ON, so current clinical practice follows the evidence drawn from the Optic Neuritis Treatment Trial (ONTT). Conclusion: Paediatric ON is uncommon. Despite having clinically severe bilateral vision loss, retrobulbar optic neuritis in children post typhoid fever has excellent response to steroid therapy if early diagnosed and treated. Abbreviations: RBN = Retrobulbar Optic Neuritis, MRI = Magnetic Resonance Imaging, CT = Computerized Tomography, UCVA = Uncorrected Visual Acuity, RE = Right eye, LE = Left eye, ON = Optic neuritis, ONTT = Optic Neuritis Treatment Trial.

An unusual presentation of Devic’s neuromyelitis optica (NMO) disease associated with bilateral internuclear ophthalmoplegia (INO) is described. A 32-year-old pregnant patient was diagnosed with NMO. First symptoms were headache and sudden visual loss in her right eye (RE). Eighteen months ago, she reported other neurologic symptoms such as paresthesia. Based on her visual field, fundoscopy and Ishihara test, she was diagnosed with retrobulbar neuritis of the RE. After delivery, new neurologic symptoms resembling transverse myelitis appeared. She was treated with methylprednisolone and plasmapheresis, which improved her visual acuity; however, a sudden bilateral INO appeared, with adduction defect and nystagmus with abduction in both eyes. No improvement was obtained after treatment with azathioprine and rituximab. Paresis of the legs and the right arm persisted, but double vision and OIN gradually disappeared. At the end, the patient had a residual exophoria in the RE and nystagmus with abduction in the left eye. Prevalence of NMO is lower than one case per one million inhabitants, and it is not likely to affect the encephalic trunk; furthermore, bilateral INO in NMO is rare. Two major criteria and at least two of the three minor ones are required to confirm a NMO diagnosis, and our patient fulfilled these diagnosis criteria.

Pseudo-Foster Kennedy syndrome due to idiopathic intracranial hypertension

Oclusión de la arteria central de la retina tras inyección facial de ácido hialurónico

Central retinal artery occlusion following facial injection of hyaluronic acid

Sarcoidosis, a multisystem granulomatous disease, can occasionally involve the optic nerve, often presenting as optic neuritis. However, its association with Non-Arteritic Anterior Ischemic Optic Neuropathy (NAAION) is rare and can create diagnostic challenges. Here, we report a case of a 52-year-old male who initially presented with sudden visual loss in his left eye, diagnosed clinically as NAAION with a disc at risk in the right eye (RE). He was managed with antiplatelets and steroids. Three months later, he experienced vision loss in the RE with evidence of bilateral intraocular inflammation. Imaging, including Fundus Fluorescein Angiography and Indocyanine Green Angiography, revealed choroidal granulomas, raising differential diagnoses of Sarcoidosis, Vogt-KoyanagiHarada disease, and Tuberculosis. Intravenous methylprednisolone followed by oral steroids resulted in visual improvement in both eyes. This case underscores the importance of comprehensive assessment and imaging to identify atypical presentations of sarcoidosis masquerading as NAAION, ensuring timely intervention and improving visual outcomes.