Cause Of Unilateral Visual Loss Research Articles

Optic Neuritis: Hidden Manifestations and Mimickers

Optic neuritis is the most common cause of unilateral visual loss associated with orbital pain on ocular movements and impaired colour vision. It can present with anterior optic neuritis, papillitis, a swollen optic disc, retrobulbar neuritis with a normal optic disc, neuritis with oedema of the optic disc and the macular star or anterior ischemic neuropathy. It may be the only manifestation of a disease such as demyelination or associated with systemic diseases such as systemic lupus, giant cell arteritis, Sjogren’s syndrome, herpes simplex, herpes zoster, Lyme disease, CMV, EBV, HIV, toxoplasmosis, West Nile virus, Chikungunya, dengue fever, Rift Valley fever, mumps, rubella, measles, cat scratch disease, tuberculosis, syphilis, rickettsia illnesses, Q fever, Whipple disease, brucellosis, leptospirosis, leprosy, toxocariasis, malaria, Cryptococcus, candidiasis, histoplasmosis, Aspergillosis, mucormycosis, Bacillus Chalmette-Guerin (BCG) vaccination, ethanol and methanol toxicity, sarcoidosis, neuromyelitis optica and Liber’s hereditary optic neuropathy. A systemic approach to the diagnosis is of paramount importance in confirming, diagnosing and treating optic neuritis and underlying systemic diseases to provide definitive cures. Failure to diagnose optic neuritis and treat the cause may result in optic atrophy and permanent blindness. In this paper, we reviewed the diagnosis and differential diagnoses of optic neuritis, including arteritis, ischemic, neuroretina, and vasculitic causes.

Ocular Trauma in a Troubled Zone: Northeastern Nigeria

Ocular trauma is an important cause of preventable morbidity worldwide, and is a major cause of unilateral visual loss in developing countries. The eye is the third most common organ affected by injuries, after the hands and the feet Objective: We present the pattern of ocular injuries in Maiduguri: An armed conflict area. Material and methods A retrospective study of all the case records of patients with ocular trauma was done between January 2013 and December 2015.Results: Case note of 108 patients were available for this study. There were 86 (66.6%) males and 22(33.3%) females. The age range was between 3 years and 60 years of age. The age range 21 to 30 years was predominant 38 (35.2%). 45 (41.7%) of the patients presented within the first 24 hours. Blast injuries from improvised explosive devises were seen in 54(50.0%), gunshot injuries were seen in 25(23.1 %). 27(25.0%) of the patients had ruptured globe, corneal and corneo-scleral lacerations were seen in 19(17.6%) and 14(13.0%) respectively. Visual acuity on presentation and visual acuity on last visit of 6/18 or better was seen in 32 (31.5%) and 38(35.2%) patients respectively, while 62 (57.4%) and 50 (46.3%)had visual acuity of 3/60 or worst on first presentation and on last visit respectively.Conclusion: The findings from this study highlight a high incidence of severe ocular injury leading to blindness in countries or regions at warA.

Open globe injury in a 3-year-old child presenting 3 days later!!!

Open globe injuries are a very common cause of unilateral visual loss, with children accounting for up to 20% of all these injuries. The principles of management of ocular injuries are the same for children and adults. However, the management in the case of a child is made much more difficult due to variable cooperation with assessment and continuing therapy as well as the subsequent possibility of amblyopia further complicating the treatment. Here we report the successful management of a 3-year-old child who was brought to this center with a full thickness penetrating injury to her cornea, with a pencil, and the presence of hypopyon, 3 days after the occurrence of the injury.

Central retinal vein occlusion: a review

Central retinal vein occlusion remains a common cause of unilateral visual loss. Until recently, our treatment options for this condition were limited only to laser photocoagulation for the devastating end sequelae of anterior segment neovascularization. Over the last 2 years, a number of randomized controlled trials have given us significant new treatment options to address not only visual loss from macular oedema but also the ability to create a bypass around the obstruction in the central retinal vein and to address the raised venous hydrostatic pressure. In the future, it is likely that combination approaches to the management of central retinal vein occlusion will develop using specific agents and techniques to address the components of macular oedema, retinal ischaemia and raised venous hydrostatic pressure, all of which combine to produce the clinical picture and the reduction in vision seen in this condition.

Parnaparin versus aspirin in the treatment of retinal vein occlusion. A randomized, double blind, controlled study

Introduction Retinal vein occlusion (RVO) is a common cause of unilateral visual loss. Evidence based treatment recommendations for patients with RVO cannot be made because of the lack of adequate clinical trials. To compare the efficacy and safety of aspirin and of a low molecular weight heparin, parnaparin, in the treatment of RVO. Materials and Methods In a multicenter, randomized, double blind, controlled trial eligible patients with a delay between symptoms onset and objective diagnosis of less than 15 days were randomized to aspirin 100 mg/day for 3 months or to a fixed daily dose of parnaparin, 12.800 IU for 7 days followed by 6.400 IU for a total of 3 months. Primary end-point of the study was the incidence of functional worsening of the eye with RVO at 6 months, as assessed by fluorescein angiography, visual acuity, and visual field. Study end-points were adjudicated by an independent committee. Results Sixty-seven patients were enrolled in the study and 58 of them (28 treated with parnaparin, 30 with aspirin) were evaluable for the analysis. Baseline characteristics were well balanced between groups. Functional worsening was adjudicated in 20.7% of patients treated with parnaparin and in 59.4% of patients treated with ASA (p = 0.002). Recurrent RVO was diagnosed in 3 patients, all treated with ASA (p = n.s.). Bleeding rates were similar between the two groups. Conclusions Parnaparin appears to be more effective than aspirin in preventing functional worsening in patients with RVO. The results of this study need to be confirmed in a larger clinical trial. Trial registration number: Clinical trials.gov NCT00732927.

Ophthalmic artery occlusion: A cause of unilateral visual loss following spine surgery

Ophthalmic artery occlusion: A cause of unilateral visual loss following spine surgery

Amblyopia Therapy in Imam Khomeini Hospital of Kermanshah

Introduction: Amblyopia is reduced vision in an eye that has not received adequate use during early childhood. The most common cause of unilateral visual loss in children is amblyopia with prevalence rate of 1-4 percent in pre-school children . However, effective treatments may prevent intensive complication. This study was done to assess the treatment effects of amplyopia patients who have referred to Imam Khomeini Hospital of Kermanshah during 1998 to 2000. Materials & Methods: This study was a descriptive interventional before and after assessment. 56 amblyopia-diagnosed patients (86 eyes) with visual acuity less than 9 out of 10 referred to clinic of optometry were selected. In this research tools such as: ophthalmoscope, filter visioscope, dial astigmatic, prism bar, madoxwing, Snellen chart, titmus test and ischihara chart were used for diagnosis. Ophthalmologist performed amblyopia diagnosis and optometrist carried out treatment. Treatments included visual training, bleaching, part time patching, and full time patching and in some cases penalization carried out and descriptive & inferential statistics were used to analyze the data. Results: There were 58.5 percent refractive amblyopia, 10.9 percent strabismic, 7.3 percent deprivative and the rest were involved by mixed problems. The difference rate of steriopsis between after cure and before cure was 329.09 ±253.90 seconds figured by titmus stereo test. The average of visual acuity before and after treatment was 20/60 and 20/30 respectively. Conclusion: The results of this study showed that the considerable improvement was observed in amblyopia eyes with increased vision acuity about 3 lines in Snellen chart after curing the patients. We can conclude that treatment and curing of amblyopia may have good results. The earlier the treatment, the better the opportunity to reverse the vision loss. If not treated early enough, an amblyopic eye may never develop good vision and may even become functionally blind.

Traumatismes oculaires perforants de l'enfant: Étude rétrospective de 57 cas

The purpose of this study was to investigate the current causes and outcomes of open eye injuries in children. We reviewed the hospital records of 57 patients under 14 years of age who were treated for open globe injuries at Edouard Herriot Hospital, Lyon, France, between January 1999 and December 2003. This review includes 57 patients: 41 males and 16 females. The mean age at admission was 6.8 +/- 3.5 years. The injury involved the right eye in 27 cases and the left eye in 30 cases. Sharp or pointed objects accounted for the majority of injuries. The most common location for a perforating ocular injury to occur was at home. Wounds involved the cornea in 41 cases. There was iris hernia in 21 cases, hyphema in 15 cases, vitreous prolapse in 14 cases, lens damage in 12 cases, and shallow anterior chamber in 11 cases. The most frequent complication was traumatic cataract. Secondary lens removal was performed in 15 cases. Visual acuity was 0.5 or better in 27 of the 57 eyes, with a mean follow-up period of 12 months. Perforating ocular injuries are a frequent cause of unilateral visual loss. The highest proportion of injuries occurred at home and sharp objects were the most frequent causative agents. More adequate adult supervision and educational measures are necessary in order to reduce the prevalence of these accidents.

Prevalence and Associations of Retinal Vein Occlusion in Australia

To determine the prevalence and associations of retinal vein occlusion (RVO) in a defined older Australian population. Participants (N = 3654; age, > or = 49 years), representing 88% of the permanent residents from an area west of Sydney, Australia, underwent a detailed eye examination, including stereophotography (Zeiss). The diagnosis of RVO was made clinically and from photographic grading. Signs of RVO were found in 59 participants (1.6%; 95% confidence interval, 1.3-1.9). The prevalence for each age-specific participant was as follows: 0.7%, younger than 60 years; 1.2%, 60 to 69 years; 2.1%, 70 to 79 years; and 4.6%, 80 years or older. There was no significant sex difference in prevalence. Branch RVO was observed in 41 subjects (69.5%); of this number, 10 subjects had branch RVO outside the vascular arcade or in the nasal fundus and 3 subjects developed new vessels. Hemispheric RVO was found in 3 subjects (5.1%), and central RVO was observed in 15 (25%); RVO was bilateral in 3 subjects (5.1%). Visual acuity was affected most in the people with central RVO, with a visual acuity of 20/200 or less in 60% compared with 14% among the people with branch RVO. Retinal vein occlusion was the fifth most frequent cause of unilateral blindness in this population. Significant associations with RVO were found with glaucoma, hypertension, stroke, and angina. This study emphasizes RVO as an important cause of unilateral visual loss in an older population. The proportion of the 3 vein occlusion sites shows some differences from those of clinic-based reports and suggests a likely selection bias in previous clinic studies.

Causes and frequency of blindness in patients with intraocular inflammatory disease.

Uveitis, an intraocular inflammatory disease, is a significant cause of visual impairment. It is not known how many patients with uveitis will retain visual acuity and how many develop visual impairment or even blindness. The aim of this study was to assess the frequency of blindness in patients with uveitis and, more specifically, to identify the clinical profile of patients at risk for visual loss. A cross sectional and retrospective study of 582 patients with uveitis who visited the ophthalmology departments of two university hospitals in the Netherlands was performed. Within the group of 582 patients, 203 (35%) exhibited blindness or visual impairment; bilateral legal blindness developed in 22 (4%) patients, 26 (4.5%) had one blind eye with visual impairment of the other, and nine (1.5%) had bilateral visual impairment. Unilateral blindness developed in 82 (14%) patients, whereas 64 (11%) exhibited unilateral visual impairment. The most important cause of both blindness and visual impairment was cystoid macular oedema (29% and 41%, respectively). Complications of uveitis were encountered in more than half of the patients and 23% underwent one or more surgical procedures. When the patients were subdivided according to anatomical site, those with panuveitis had the worst visual prognosis. The systemic diseases associated with a poor visual prognosis were juvenile chronic arthritis and sarcoidosis. Ocular toxoplasmosis was the most frequent cause of unilateral visual loss. Cystoid macular oedema is the most frequent complication of uveitis and its occurrence plays a decisive role in the visual outcome of this disease.

Penetrating ocular injuries in young patients. Initial injuries and visual results.

Penetrating injuries are a leading cause of unilateral visual loss in young patients. We reviewed the records of 197 patients aged 18 years or younger who underwent primary repair of a penetrating ocular injury at the Wilmer Ophthalmological Institute from January 1970 through December 1981. The injury was caused by sharp objects in 49% of cases, missiles in 35%, and blunt trauma in 14%. Of 159 patients with at least 6 months follow-up, 110 (69%) achieved final vision of 5/200 or better, and 77 patients (48%) achieved final visual acuity of 20/50 or better. The prognosis after a penetrating injury is strongly influenced by the nature of the injury and the extent of initial damage. Several factors were found to correlate with an unfavorable visual outcome, including: initial preoperative visual acuity of worse than 5/200, injuries due to blunt trauma, wounds involving the sclera, double penetrating injuries, dense vitreous hemorrhage, and wounds associated with an intraocular "BB" pellet.