Case Of Compressive Optic Neuropathy Research Articles

A Case of Compressive Optic Neuropathy Caused by Orbital Emphysema

Purpose: We report a patient with compressive optic neuropathy (CON) in whom visual acuity (VA) was restored after removing conjunctival emphysema through the conjunctiva.Case summary: A 55-year-old man was transferred to emergency department complaining of decreased VA in the right eye after trauma to the right temporal side of the head. The best-corrected visual acuity (BCVA) was 0.6 in the right eye. We confirmed a relative afferent pupillary defect and limited eye movement inferiorly in the right eye. The patient had blown his nose several times while being transferred to the hospital. On silt-lamp examination, there was conjunctival emphysema of the right eye. Orbital computed tomography showed a medial wall fracture of the right orbit and orbital emphysema above the optic canal. The P100 wave was delayed in the visual evoked potential (VEP) exam, and there was a decreased peripheral visual field on the Humphrey visual field test. Based on these findings, we diagnosed CON and treated him accordingly. To decompress the intra-orbital area, we injected mannitol intravenously, applied intraocular pressure-lowering and antibiotic eye drops in the right eye, and removed part of the conjunctival emphysema through the conjunctiva. At the 3-week follow-up, the BCVA had improved to 1.0 in the right eye with a normalized P100 wave on the VEP exam.Conclusions: In a case of CON caused by orbital emphysema after trauma, it is important to decrease the intra-orbital pressure as soon as possible to enable a good prognosis for the VA.

Restoration of vision by combined experimental antithymocyte therapy, and orbital radiation with high-dose steroids for severe, acute, steroid-refractory, congestive thyroid orbitopathy

PurposeWe report diagnostic and therapeutic dilemmas in the difficult case of compressive optic neuropathy with severe visual acuity and visual field loss with subsequent visual recovery in both eyes, in a patient with Graves’ orbitopathy (GO) by a combination of experimental antithymocyte therapy, orbital radiotherapy with high-dose steroids.MethodsA 72-year-old man presented with severe vision loss in both eyes. The visual symptoms had appeared over a year before the GO diagnosis. He was initially misdiagnosed with neuroborreliosis and optic neuritis based on brain and orbital magnetic resonance imaging. There was no exophthalmos. The ophthalmological examination included visual acuity, visual field, tonometry in primary and upgaze eye position, optical coherence tomography (OCT), pattern electroretinogram (PERG), pattern, and flash visual evoked potentials (PVEP and FVEP). The patient received experimental therapy with ATG, followed by high-dose of intravenous steroids and orbital radiotherapy.ResultsDelayed VEP peaks became shorter after treatment. After systemic and local therapy lowering of intraocular pressure was achieved. Abnormal PERG has been found three months before ganglion cells atrophy was detected in OCT. Visual acuity and visual field improvement occurred in both eyes after therapy, despite partial left optic nerve atrophy. The patient regained full decimal visual acuity (1.0 right from as poor as 0.3 to 1.0 in the right eye and from hand movements to 0.9 in the left. Severe visual field loss with advanced absolute scotomata has improved to slight relative scotomata. The duration of follow-up time after the treatment was 4 months.ConclusionsIntensive treatment of steroid-resistant Graves’ orbitopathy (GO) may prevent total optic nerve atrophy. Despite severely advanced optic neuropathy, this report emphasizes the necessity of therapy even with nearly complete visual function loss hence there is always a possibility to regain full visual acuity and visual field. Patients with tense orbital septum may not present with significant exophthalmos, thus delaying the correct diagnosis of orbitopathy. A supporting sign of GO was the difference in intraocular pressure in the primary and upgaze eye positions. Electrophysiological examinations are helpful in the diagnosis and monitoring of GO therapy. To our knowledge, this is the first report of this kind presenting visual function restoration and structural recovery in a patient with advanced optic neuropathy in GO.

Compressive Optic Neuropathy Caused by Internal Carotid Artery Aneurysm Presenting with Concurrent Neuromyelitis Optica

Purpose: To report a case of compressive optic neuropathy caused by an internal carotid artery aneurysm accompanied by concurrent neuromyelitis optica (NMO).Case summary: A 48-year-old female presented with sudden painless blurry vision in the inferior visual field of her right eye for 2 days. The corrected visual acuity was 0.7 in the right eye, and a relative afferent pupillary defect was observed. The visual field test demonstrated an inferior altitudinal defect in the right eye, while the color vision test was normal. However, after 5 days, she developed decreased color vision. Optic nerve enhancement in the right eye was observed on orbital magnetic resonance imaging, and anti-aquaporin-4 antibody was positive. She was diagnosed with NMO, and high-dose steroids were administered intravenously. In addition, brain magnetic resonance angiography showed a 5-mm aneurysm in the ophthalmic segment of the right internal carotid artery, which was compressing the optic nerve. Coil embolization of the aneurysm was performed. On the fourth day of steroid therapy and the first day after coiling, the corrected visual acuity in the right eye improved to 1.0. At 6-week follow-up, color vision and visual field defect also showed complete recovery.Conclusions: In this rare case of internal carotid artery aneurysm combined with NMO, early active treatment led to complete recovery of visual acuity and field defects.

An atypical case of compressive optic neuropathy and cranial nerve 6th palsy caused by a cholesterol granuloma

An atypical case of compressive optic neuropathy and cranial nerve 6th palsy caused by a cholesterol granuloma

A Case of Compressive Optic Neuropathy Caused by Intraorbital Metastasis During Chemotherapy for Mantle Cell Lymphoma

A Case of Compressive Optic Neuropathy Caused by Intraorbital Metastasis During Chemotherapy for Mantle Cell Lymphoma

A Case of Compressive Optic Neuropathy due to Unruptured Cerebral Aneurysm Surrounding the Optic Nerve

A Case of Compressive Optic Neuropathy due to Unruptured Cerebral Aneurysm Surrounding the Optic Nerve

A case of compressive optic neuropathy putatively caused by IgG4-related idiopathic orbital inflammation.

We report the case of a 58-year-old male presenting with an impairment of the left-sided visual acuity caused by compressive optic neuropathy, and marked bilateral proptosis. Blood test showed markedly elevated IgG4 (1830 mg/dl) and positive TSH receptor-stimulating antibodies (200%), but the thyroid function test were normal. Orbital MRI revealed abnormal soft tissue proliferation around the optic nerve and fusiform enlargement of the extraocular muscles. Systemic CT analysis detected multiple lymph node swelling, pseudotumor in the lung, retroperitoneal fibrosis, and kidney lesions. We considered that the eye manifestation was most likely caused by IgG4-related idiopathic orbital inflammation. Systemic administration of a moderate dose of prednisolone dramatically improved the compression of the optic nerve, as shown by the improvement of the visual acuity and the MRI findings. The clinical course made thyroid-associated ophthalmopathy unlikely. In conclusion, an overall consideration of the clinical picture and extensive work-up of any possible differential diagnosis including measurement of the serum levels of IgG4 was highly useful in making the diagnosis of the patient. ACTA MEDICA NAGASAKIENSIA 57: 29－32, 2012

A Case of Compressive Optic Neuropathy due to Breast Cancer Metastasis

Purpose: To report a case of compressive optic neuropathy due to breast cancer metastasis to the periorbital lesion 26 years after the treatment of primary cancer. Case summary: A 64-year-old female presented with headache, facial pain and visual disturbance in her left eye for four months. The patient had received chemotherapy and radiotherapy after left breast modified radical mastectomy for invasive ductal carcinoma 26 years previously, and right breast wide resection with axillary dissection nine years earlier. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. MRI and PET-CT revealed an enhancing mass in the left periorbital area that was compressing the optic nerve. Partial resection of the tumor and left orbital wall was performed. Adjuvant chemotherapy and radiotherapy was performed after the operation. After two months later, the best corrected visual acuity was 20/20 in the left eye, and the color perception test showed normal findings, which have been maintained for one year. Conclusions: Prompt management can result in visual recovery in patients with compressive optic neuropathy caused by breast cancer metastasis.

A case of compressive optic neuropathy caused by sphenoid sinus cholesterol granuloma

A case of compressive optic neuropathy caused by sphenoid sinus cholesterol granuloma

Radiation therapy for thyroid-associated ophthalmopathy

To observe indication and effectiveness of radiation therapy (RT) in the treatment of the patients with thyroid-associated ophthalmopathy (TAO). 23 patients of TAO who received RT in Sichuan University were collected from 1992 to 2004. Among those patients, 9 cases of infiltrative exophthalmos and 14 cases of compressive optic neuropathy were ineffectively with glucocorticoid treatment or could not treated with glucocorticoid, or could not perform orbital decompression due to severe diabetic mellitus or hypertension, or feared to receive the operation, all of patients were active ophthalmopathy and with short duration. Outer orbital radiation was applied using linear accelerator with Donaldson's method, radiation treatment fields was 4 cm x 5 cm, exposure energy was 2 GY fractions with total of 20 GY. In 11 cases with severe inflammation prednisone was administered during radiotherapy. Photos and CT scan were taken for each patient before and after RT. Visual acuity (VA) of the patients was improved from before RT 0.04 - 0.2 to after RT 0.1 - 0.8 in 14 cases of compressive optic neuropathy. Extraocular muscle of patients decreased in size confirmed by CT scan. VA improvement was correlated with the degree of extraocular muscle decreased in size. Eyelid and conjunctive swelling, eyelid incompletely closure, exposure keratitis, limitation of motion and proptosis were improved after RT in 9 patients with infiltrative exophthalmos. Following up the patients for 1 - 3 years, it was found that VA decreased in 3 cases and inflammation recurred in 4 cases, eyelids could not closed in 2 cases after RT. RT could be used in severe, active cases of TAO. If there is severe inflammation, steroids could be combined with RT therapy.

Compressive Optic Neuropathy after Use of Oxidized Regenerated Cellulose in Orbital Surgery: Review of Complications, Prophylaxis, and Treatment

We report 2 cases of compressive optic neuropathy after use of oxidized regenerated cellulose (ORC) in orbital surgery. To our knowledge, no complications have been reported previously after use of this material in orbital surgery. We also review the complications related to its retention at operative sites outside the orbit and recommend precautions to avoid them. Retrospective interventional case reports. Two patients with compressive optic neuropathy after use of ORC in orbital surgery. Case reports from 2 different clinics and review of the English scientific literature. Best-corrected visual acuity, extraocular motility, proptosis, and chemosis. One patient underwent orbital exploration and biopsy of an orbital tumor, and the second had repair of an orbital floor fracture. Postoperatively, both presented with chemosis, ophthalmoplegia, and progressive loss of vision. Orbital imaging revealed a retrobulbar soft-tissue density compatible with hematoma. Repeat orbital exploration revealed the soft-tissue mass to be swollen ORC. Retained intraorbital ORC may cause a compartment syndrome and should be suspected in postoperative patients with orbital symptoms. When ORC is used around the optic nerve, it should be removed after hemostasis is achieved.

Disease-Specific Assessment of Quality of Life after Decompression Surgery for Graves' Ophthalmopathy

Graves' ophthalmopathy (GO) is an organ-specific autoimmune disease. Hydrophily of accumulated acidic mucopolysaccharides into bulbar adipose tissue leads to swelling of the eye muscles. Orbital surgical decompression is performed in severe cases of compressive optic neuropathy and severe corneal exposure or failure of steroid therapy. The study was designed to evaluate decompression surgery with respect to the clinical benefit and the patient's satisfaction by means of a disease-specific questionnaire. The 90-item study questionnaire was distributed to 105 patients with GO who underwent orbital decompression surgery at the authors' institution. A total of 88% of patients stated that decompression had helped them, 80% of the interviewees would undergo decompression again, 78% were content with their eye symptoms, and 71% were satisfied with the cosmetic result of decompression. Furthermore, analysis showed a clinically relevant increase in quality of life after surgery. The correlation between the clinical endpoint proptosis at last examination and the quality of life score proved to be significant (p=0.05). The large majority of interviewees were satisfied with the result of the orbital decompression. These results confirmed that disfiguring proptosis is an important indication for decompression surgery.

Ophthalmic segment aneurysm simulating normal tension glaucoma

A diagnosis of glaucoma is made in the presence of a characteristic form of optic neuropathy and visual field defect, with some regard to intraocular pressure. We encountered a case of compressive optic neuropathy caused by an aneurysm of the ophthalmic segment, which presented with signs suggestive of normal tension glaucoma. To our knowledge, this mode of presentation of an ophthalmic aneurysm has not been previously described.

Computed perimetry study of optic nerve compression caused by orbital tumors

Seventeen cases of compressive optic neuropathy caused by orbital masses were examined with a 30-degree threshold program of automated perimetry. The orbital pathologies were represented by five cases of Graves' orbitopathy, three optic nerve sheath meningiomas, two hemangiopericytomas, two diffuse pseudotumors, one perineuritis, one case of orbital varices with hemorrhage, one lymphoma, one ethmoidal carcinoma and one suspected angioma. Visual field alterations varied from arcuate, inferior altitudinal and cecocentral scotomas, to temporal hemianopsy, nasal step and diffuse losses. In three cases (one Graves', one acute diffuse pseu-dotumor and one perineuritis), steroid administration was followed by partial or full perimetric recovery; in one case (orbital varices with hemorrhage) the full recovery was spontaneous, while in one case of benign hemangiopericytoma, the surgical removal of the tumor caused a significant improvement of the visual field.In the authors' series, perimetric pattern reflects the...

Transantral Orbital Decompression for Compressive Optic Neuropathy due to Sphenoid Ridge Meningioma

We present a case of unilateral exophthalmos and compressive optic neuropathy due to sphenoid ridge meningioma. The patient underwent transantral orbital decompression with removal of the orbital floor and medial wall that resulted in rapid, dramatic normalization of both visual acuity and visual field in the involved eye. Due to the slow-growing, noninfiltrative nature of meningiomas, we propose this procedure as an alternative, initial, palliative treatment for selected cases of compressive optic neuropathy due to meningioma compressing the posterior orbit. This procedure can provide restoration of visual function with less risk to the patient than neurosurgical resection.

Quantitative perimetry in compressive optic neuropathy and optic neuritis.

The Goldmann perimetric defects in 20 cases of compressive optic neuropathy and 54 cases of optic neuritis were analyzed. While defects involving the papillomacular bundle were the rule in both compressive and neuritis cases, sparing of the fixational area occurred in 24% of neuritis eyes but in none of the eyes with compressive neuropathy. The most reliable differential perimetric sign was the presence of a hemianopic defect; at least one eye of 15 (75%) cases of compression showed such a defect, which was not found in any neuritis cases. The I2e was the largest kinetic isopter to demonstrate the hemianopic defect in a substantial proportion of cases. These defects were corroborated with sequential static presentation of the I2e to I4e stimuli to either side of the vertical meridan, and with similar techniques using 18/1,000 red test objects at the tangent screen.