Bilateral Blurred Vision Research Articles

Anterior segment ischaemia with giant cell arteritis

Case report: A 69-year-old male presented with bilateral blurred vision, left periocular pain, and headache. Ocular examination revealed a right optic neuropathy and left anterior segment ischaemia. An elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) raised suspicion of giant cell arteritis (GCA), which was confirmed by temporal artery biopsy. Treatment with intravenous methylprednisolone followed by a gradually reducing dose of oral prednisolone improved vision in both eyes. Comments: GCA typically affects large- and medium-sized vessels. It is a recognised cause of anterior ischaemic optic neuropathy. Anterior segment ischaemia is usually caused by disease of the anterior ciliary arteries not typically affected by GCA. This case illustrates that GCA can rarely cause anterior segment ischaemia, without posterior segment involvement in the same eye.

Radiation Retinopathy Caused by Low Dose Irradiation and Antithyroid Drug-Induced Systemic Vasculitis

We report on a patient with Graves' disease with radiation retinopathy caused by low-dose irradiation and antithyroid drug-induced antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis. A 38-year-old woman with Graves' disease presented with bilateral blurred vision, microaneurysms, telangiectasia, and macular edema. The patient was examined by ophthalmoscopy and fluorescein angiography, and radiation retinopathy was diagnosed. The patient had been treated with low-dose irradiation for her Graves' ophthalmopathy a few years earlier. She also had ANCA-positive vasculitis induced by the antithyroid drug (propylthiouracil, PTU) that had been prescribed for her at that time. Because of multiple avascular areas on both retinas, she was treated by intensive retinal photocoagulation to control progressive retinopathy. The radiation doses used to treat Graves' disease ophthalmopathy are low. Nevertheless, there is still a risk of radiation retinopathy developing in patients with PTU-induced ANCA-positive vasculitis.

Optical Coherence Tomography Imaging of Surgical Resolution of Bilateral Vitreomacular Traction Syndrome Related to Incomplete Posterior Vitreoschisis: A Case Report

To report a case of surgical resolution of bilateral vitreomacular traction syndrome related to incomplete posterior vitreoschisis as documented by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Dublin, CA). In both eyes of a 72-year-old man with bilateral blurred vision, OCT examination disclosed a relevant increase in mean foveal thickness (right eye = 714 microm; left eye = 757 microm) due to a vitreomacular traction syndrome. At the edges of the most highly elevated area of vitreo-macular traction, OCT scans showed a characteristic splitting of the hyperreflective signal in both eyes, usually identified as posterior vitreous cortex. Both eyes underwent vitrectomy with epiretinal membrane peeling. Postoperative OCT examination showed vitreomacular traction resolution in both eyes with an evident decrease in mean foveal thickness (right eye = 364 microm; left eye = 335 microm). Right visual acuity improved from 20/200 to 20/50; left visual acuity changed from 20/150 to 20/40. OCT was a useful tool in identifying an unusual case of bilateral vitreomacular traction syndrome linked to incomplete posterior vitreoschisis and following a favorable course after surgical management.

Ethambutol‐Induced Optic Neuritis in Patients with End Stage Renal Disease on Hemodialysis: Two Case Reports and Literature Review

Ethambutol, a synthetic bacteriostatic agent, is a first line agent against Mycobacterium tuberculosis. Although optic neuritis is the most serious adverse effect of ethambutol, most cases in the literature are reversible. Renal failure prolongs the half‐life of ethambutol and increases the risk of ethambutol‐induced optic neuritis. We present two patients with end stage renal disease (ESRD), who were on maintenance dialysis and suffering ethambutol‐induced optic neuritis. The first woman had been suffering ESRD on hemodialysis for 2 years. After tuberculosis was diagnosed, she was prescribed three‐combined anti‐tuberculosis medications, including ethambutol 800 mg/day. Bilateral blurred vision suddenly occurred 4 months after the start of treatment, and she became totally blind despite discontinuing ethambutol. The second woman had been on hemodialysis for 5 months. Tuberculosis was diagnosed by lung biopsy. After 3 weeks of three‐combined anti‐tuberculosis medications including ethambutol (1200 mg/day), reduced visual acuity and color vision defects occurred. One year after the discontinuation of ethambutol, visual acuity remained little improved. Physicians should be aware of ethambutol‐induced optic neuritis and ethambutol should be used cautiously in patients with renal failure.

Narrow-angle glaucoma presenting as acute, painless visual impairment

A 42-year-old woman presented with the acute onset of bilateral blurred vision that occurred immediately after bending over. She denied pain or any other associated symptoms. Markedly increased intraocular pressure readings were found. Treatment for acute narrow-angle glaucoma was initiated, and normal vision returned. This case represents an atypical presentation of acute narrow-angle glaucoma, a true ophthalmological emergency. The pathophysiology and treatment options of this disease process are summarized.

Visual disturbance and carotid artery disease. 500 symptomatic patients studied by non-invasive carotid artery testing including B-mode ultrasonography.

Non-invasive carotid artery testing was performed on 500 consecutive patients with visual disturbances not related to local ophthalmic pathology to determine the extent of carotid artery disease, particularly in patients with symptoms not typical of amaurosis fugax. Three hundred eighty six patients (77.2%) had an abnormal study. However, the incidence of hemodynamically significant lesions was only 16%. The patients could be divided into three groups: Patients with symptoms that could be explained on an ocular basis, including amaurosis fugax, had a 79% incidence of ipsilateral carotid plaques. Patients with symptoms which could not be easily explained on an ocular basis, such as bilateral blurred vision, bilateral visual loss (both transient and permanent), and homonymous hemianopsia had an incidence of carotid artery plaques similar to patients with amaurosis fugax. Patients with unilateral blurred vision and bilateral scintillations had a lower incidence (57%) of carotid plaques than the other groups. Younger symptomatic patients had less carotid plaques than the overall series. Twenty-one percent of patients under age 50 had the Doppler finding of early systolic flutter turbulence, which is usually of mitral valve origin. Women predominated in the under 50 age group by about 2:1. In view of the prevalence of carotid plaques in the population of patients with visual symptoms other than amaurosis fugax, evaluation of these patients with non-invasive testing is indicated to determine which of these patients has hemodynamically significant obstruction to flow at the carotid artery bifurcation.