Blurred Vision In Right Eye Research Articles

Balint syndrome: an unusual triad

The paper investigates a case of sudden loss of vision in a patient with recent history of blurred vision of right eye diagnosed with Central retinal artery occlusion (CRAO). The point of interest of this case report is that the clinical features are something different from those of a CRAO and revealed cardinal triad of simultanagnosia, optic ataxia, and oculomotor apraxia which are conclusive of a rare clinical entity known as Balint syndrome.

Orbital Apex Syndrome With Encephalitis: A Rare and Serious Complication of Herpes Zoster Ophthalmicus

Introduction: Herpes zoster reactivation is more common in the elderly population. Although ocular complications are seen in 20-70% of patients with herpes zoster ophthalmicus, orbital apex syndrome is a rare case. Encephalitis is also a rare neurologic complication of HZO. Purpose: To report a Herpes Zoster Ophthalmicus (HZO)case with rare neurologic complication that ophthalmologist should be aware of. Case Presentation: A 68-year-old man had a chief complaint of a sudden blurred vision in right eye two days before admission, followed by rash and pain on the right upper eyelid and forehead. Visual acuity was hand movement on the right eye and 0.5 on the left eye. The patient had total ophthalmoplegia and total ptosis on his right eye, reverse relative afferent pupillary defect on his left eye and right peripheral facial nerve palsy. Optic discs were found to be normal on both eyes. The patient was diagnosed as orbital apex syndrome on his right eye associated HZO and right peripheral facial nerve palsy. The patient received oral acyclovir 800 mg five times/day and intravenous methylprednisolone 250 mg four times/day for three days. After four days of admission, the patient had a seizure and loss of his consciousness. The patient was consulted to neurology department and was given anticonvulsant therapy. The spinal tap revealed pleocytosis and increased protein. The patient was diagnosed as herpes zoster encephalitis. After one week, the patient regained full consciousness and his visual acuity was improved to 0.16 on the right eye. Color vision, visual field, and contrast sensitivity were also improved, ophthalmoplegia were partially resolved and peripheral facial nerve palsy was fully resolved. Conclusion: Herpes Zoster Ophthalmicus affect the central and peripheral nervous system at the same time and can be life-threatening with delayed diagnosis and treatment. It may be necessary to collaborate with the neurology department for every HZO case to minimize the life-threatening complications of HZO.

OPTIC DISC PIT MACULOPATHY IN A 13 YEARS OLD CHILD: A RARE CASE

ABSTRACT
 
 Introduction: Optic disc pit is a rare congenital abnormality of the optic disc. It is generally appears in the third or fourth decade of life; however, cases of serous detachment in children have been reported. Treatment includes argon laser to the peripapillary region, macular buckling surgery, vitrectomy combined with laser and/or gas injection.
 Objective: To report a case with optic disc pit maculopathy in a 13 years old child.
 Case Illustration: A 13 years old male presented to us with complaints of blurred vision in right eye started a month ago. No history of trauma. On examination, her visual acuities were 20/50 right and 20/20 left eye. Both anterior segments were normal, with normal intraocular pressures. OCT imaging showed optic disc pit located temporally, with associated serous macular detachment in the right eye.
 Result: After 12 weeks observation, there is no significant change in the examination of the visual acuity, fundus examination and OCT imaging.
 Conclusion: Currently there is no universally accepted treatment for optic disc pit maculopathy because the pathogenesis is not yet fully understood. In pediatric cases, 3-6 months of follow-up before any surgical and invasive procedures is appropriate.
 Keyword: Optic disc pit maculopathy, OCT imaging, observation.

Right Ethmoidal Sinus Schwannoma: Case Report of a Common Entity with an Unusual Presentation

Schwannomas are benign, encapsulated nerve sheath tumors arising from Schwann cells. Approximately, 25-40% of all Schwannomas occur in the head and neck region, acoustic nerve being the most frequent site. The tumors originating from nasal cavity or paranasal sinuses are rare and constitutes only four percent.
 A 40-year-old male presented with history of blurred vision of right eye and protrusion of right eye ball since 6 months. It was associated with history of watering and redness. Examination of right eye revealed mild proptosis and ptosis. Computed Tomography [CT] scan showed a large expansile cystic lesion measuring about 5.2x5.6x6.5cm involving entire right ethmoidal sinus. It showed expansion into anterior cranial fossa, roof and medial wall of right orbit. Radiological opinion suggested mucocele of right ethmoidal sinus. Intra-operatively, tissue specimen was sent for squash smear cytology. Cytology smears showed features suggestive of spindle cell tumor. Possibility of Schwannoma was considered. The specimen was subsequently subjected to histopathological examination. Microscopy showed tumor tissue composed of tumor cells arranged in alternate hypercellular and hypocellular pattern. Hypercellular areas showed occasional verocay bodies. Hypocellular areas showed loosely arranged spindle shaped tumor cells. Histopathological features were suggestive of Schwannoma. On Immunohistochemistry (IHC), neoplastic cells were positive for S-100 and negative for EMA.
 Ethmoidal sinus schwannoma extending into anterior cranial fossa is an unusual presentation. Clinically, it poses a diagnostic dilemma. Squash smear cytology is challenging, but helpful in establishing the correct diagnosis. Histopathology is confirmatory and immunohistochemistry is supportive.

Bilateral Chronic Central Serous Chorioretinopathy (CSCR) Induced by Long-Term Testosterone Treatment

Purpose: We reported a rare case of bilateral chronic central serous chorioretinopathy (CSCR) induced by long-term exogenous testosterone treatment. Method: A case report. Result: A 52-year-old man with medical history of diabetes mellitus, hypertension, diabetes insipidus and hypogonadism presented to our ophthalmologic clinic with unstable blurred vision of right eye for more than 5 years and vision loss of left eye since childhood injury. Optical coherence tomography (OCT) showed subfoveal fluid in both of his eyes. Fluorescein angiography (FA) revealed fluorescein in multiple leaking points around the arcade area, which appeared hyperfluorescence not only in early phase but sustained fluorescein pooling till late phase in both eyes. According to his medical records, he received intramuscular testosterone injection every two weeks as treatment of hypogonadism for more than 10 years. His serum level of testosterone was higher than normal range. After focal photocoagulation in his right eye combined with decreasing frequency of testosterone intramuscular injection, the subfoveal fluid in both of his eyes totally resolved with vision improvement. Conclusion: Testosterone related bilateral CSCR was rarely reported previously. It’s very important to review patients’ medical conditions and medications if there were unresolved or repeated episodes of bilateral CSCR.

RETRACTED: Choroidal osteoma with CNVM – Successful treatment with intravitreal Bevacizumab

Twenty-seven years old healthy woman presented with complaints of sudden painless blurred vision in right eye for 1week. On examination, visual acuity was 20/30 in the right eye and 20/20 in left eye. Fundus examination OS was normal; OD demonstrated a flat, opaque, yellowish parapapillary choroidal lesion with grayish membrane associated with minimal subretinal fluid suggestive of a CNVM in the center. B-scan ultrasonography revealed findings consistent with a choroidal osteoma. Fundus fluorescein angiography of the right eye revealed a relatively well-defined area of hyperfluorescence that increased in size and intensity in the later phases suggestive of active extrafoveal CNVM. Optical coherence tomography confirmed the extrafoveal CNVM with subfoveal fluid. She was treated with intravitreal Bevacizumab OD. At the 2weeks visit, vision OD improved to 20/20. The FFA and OCT revealed a resolved CNVM. Intravitreal Bevacizumab may be an effective alternative in the management of CNVM secondary to choroidal osteoma.

518 Choriorétinopathie séreuse centrale récidivante chez deux patients sous inhibiteurs de phosphodiestérase pour dysfonctionnement érectile

Central serous chorioretinopathy typically affects young and middle aged men with type-A personality under stressful events. It has been occasionally related with exposure to increased levels of endogenous or exogenous glucocorticoids, but other associations are possible. We present two cases of recurrent central serous chorioretinopathy in two men taking phosphodiesterase inhibitors. In both cases, chorioretinopathy appeared after intake of the inhibitor, resolved once the latter discontinued, and re-appeared when the inhibitor was restarted. First case: A 56-year-old white male presented for blurred vision and micropsia in left eye. He had been using vardenafil over the last 6 weeks. Visual acuity of left eye was 20/25. Left fundus examination revealed a bullous central serous chorioretinopathy. Three months after vardenafil cessation, fundus alterations completely resolved and visual acuity returned to 20/20. Fifteen months later, after restarting vardenafil, he consulted with a 2-month history of progressive left eye vision reduction, and micropsia. Visual acuity was 20/32. Left fundus examination showed a new central serous macular detachment, confirmed by OCT. Once vardenafil re-stopped, chorioretinopathy regressed within 3 months. Second case: A 67- year-old white male presented for blurred vision in right eye progressively deteriorating over a 1-month period. He was taking tadalafil for the last 2 months. Visual acuity of right eye was 20/32 and right fundus examination and fluorescein angiography evidenced a central serous chorioretinopathy. Four months after stopping tadalafil, complete resolution of chorioretinopathy with normal fundus and OCT image and 20/20 visual acuity was observed. Six months later, the patient restarted tadalafil and chorioretinopathy recurred in his right eye within one month, with visual acuity returning to 20/32. Subsequent controls after stopping tadalafil showed improvement in OCT and visual acuity. Central serous chorioretinopathy was previously described in a patient taking sildenafil citrate, but no association was known with either vardenafil or tadalafil. The presented two cases of central serous chorioretinopathy after intake of vardenafil or tadalafil suggest that this condition should be added to the side effects of phosphodiesterase inhibitors.