Extraocular Movements Research Articles

Reply Re: "Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease".

Reply Re: "Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease".

Re: "Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease".

Re: "Reduction in Extraocular Muscle Cross-sectional Area and Correlation With Extraocular Motility and Diplopia Following Teprotumumab for Thyroid Eye Disease".

Orbital Mucormycosis: Understanding the Deadly Fungus Sweeping the Globe.

Introduction Mucormycosis (black fungus) is a rare opportunistic fungal infection commonly affecting immunocompromised individuals. There has been a surge in the number of these cases during the second wave of the coronavirus disease 2019 (COVID-19) in India. Mucormycosis has been reported to occur within a week or a few weeks post-recovery from COVID-19. The most common clinical manifestation of mucormycosis is rhino-orbital-cerebral mucormycosis (ROCM). At our tertiary care center, we initiated a prospective study to identify risk factors, study ocular manifestations, and explore medical and surgical management of orbital mucormycosis patients in the post-COVID-19 era. Material and methods This is a detailed description of a prospective observational hospital-based study. The study included 148 patients who presented with ROCM. A detailed history was taken regarding the complaint, duration, and associated risk factors. Systemic, local, and complete ophthalmic examinations were done that included assessment of extraocular movements, visual acuity, slit-lamp examination, and fundus examination. All data were recorded separately for each patient in a pre-decided proforma. Result The study group consisted of 148 patients. In our study, the highest association was with COVID-19-positive status (68.24%), out of which 57 (56.43%) were on oxygen support. Diabetes mellitus contributed next to COVID-19 with 86 (58.10%) patients with a positive history of diabetes. Seventy-one (47.97%) patients were on steroids, out of which 68 (67.32%) were COVID-19-positive and the rest (23%) were on steroids due to various systemic reasons. Rhinomaxillary involvement was present (51%). Out of 63 patients with orbital involvement, 16 (25.39%) presented bilaterally and 47 showed unilateral orbital involvement more on the right side (42.85%). The predominant location of orbital involvement was the orbital apex. The most common symptom seen in our study was nasal discharge (86.5%), and ophthalmoplegia was the most common sign. Conclusion Corticosteroids should be used with caution to prevent negative impact and potential ROCM. Good glycemic and metabolic control is crucial for treatment.Management of mucormycosis involves surgical debridement, antifungal agents, and retrobulbar amphotericin B injections. Early diagnosis and aggressive treatment are essential for success. Orbital exenteration may be necessary for advanced stages, while conservative approaches may work for earlier stages. Patient counseling is needed for cosmetic rehabilitation. A multidisciplinary approach involving various specialists is necessary.

Orbital tuberculosis presenting as proptosis: A case report

A 53-year-old male complained of gradual, painless dimness of vision with swelling of the right eye (R/E) for 15 days. Best-corrected visual acuity in R/E: Hand movement, left eye: 6/9, abaxial proptosis, restricted extraocular movements in all directions, conjunctival injection, and high intraocular pressure R/E were noted. Fundus showed pale optic disc R/E and macular exudates in both eyes. The patient was diabetic and on oral hypoglycemic agents with raised erythrocyte sedimentation rate and C-reactive protein; random blood sugar: 152 mg/dL. Magnetic resonance imaging (MRI) showed right-sided orbital abscess involving extraconal compartment extending into the right orbital apex with compression of the right optic nerve. Mantoux test was positive and computed tomography thorax was normal. Histopathology of biopsy from middle turbinate showed granulomatous inflammatory cellular lesion. The patient was started on anti-tubercular therapy. He got relieved of symptoms. Repeat MRI showed reduction in disease process.

Eight-and-a-half syndrome in a patient with hypertensive emergencies.

An 88-year-old white female was admitted with a hypertensive emergency and a sudden onset of abnormal extraocular movements and facial (cranial nerve VII) palsy. This article presents a case of the eight-and-a-half syndrome and discusses its underlying etiology. The patient's unique clinical presentation at the time of admission was correctly identified, leading to the correct diagnosis. Finally, the article provides a review of the neuroanatomy related to the lesion causing the eight-and-a-half syndrome in this patient.

Pseudonictitating Membrane

A 69-year-old man presented with a membrane over the bulbar conjunctiva in his right eye (OD), encroaching cornea from the temporal side, and freely movable over the conjunctival and corneal surface (A). Extraocular movements were free. The patient had no history of pain, foreign body sensation, lacrimation, chronic illness, prior hospitalization, trauma, adverse drug reaction, or chemical injury. The Schirmer’s test showed normal tear film production. The patient had cataracts in both eyes, otherwise, anterior segment and fundus findings were normal. Uncorrected visual acuity was 6/36 OD and 6/18 in the left eye (OS). Intraocular pressure was 16 mmHg OD and 15 mmHg OS, respectively. Image of OD with membrane in (B) primary gaze, (C) down and out position, and (D) up and inwards (Magnified version of Figure A-D is available online at www.aaojournal.org).

Predicting disease progression and the need for tumor-directed treatment in tectal plate gliomas.

Tectal plate gliomas are rare, slow-growing tumors of the midbrain that are discovered predominantly in the pediatric population. Because of their indolent nature, treatment mainly consists of observation and management of hydrocephalus. Unfortunately, a subset of tectal gliomas may exhibit tumor enlargement and disease progression. Currently, there are no established guidelines for predicting future progression of tectal gliomas or the need for tumor-directed treatment. In this paper, the authors present a large case series of tectal plate gliomas with the aim of determining early indicators of tumor progression and the need for tumor-directed treatment in a pediatric population, along with providing their experience in treating progressive tumors. A retrospective chart review of 170 patients diagnosed with tectal plate glioma from a single institution, of whom 67 were pediatric patients (≤ 18 years of age), was performed. Univariate analysis was used to determine statistically significant predictors of symptomatic disease progression requiring eventual tumor-directed therapy. The median patient age of the full cohort was 24 years (range 0-73 years). Compared with the pediatric population, the adult population had more instances of incidental lesions (p < 0.001) and lower rates of hydrocephalus (50% vs 84%, p < 0.001). Of the pediatric patients who had ≥ 5 years of follow-up (n = 51), 12 (24%) experienced radiological progression and 13 (25%) required treatment for their tumor. The 1-year, 5-year, and 10-year radiographic progression-free survival (PFS) rates were 98%, 90%, and 86%, respectively. In univariate analysis, lesion involvement of the pons, moderate T1 hypointensity, and moderate contrast enhancement on baseline radiology were significantly associated with worse radiographic PFS. Alternatively, significant predictors of requiring tumor-directed treatment included extraocular eye movement abnormalities at presentation, involvement of the lesion beyond the tectum on baseline radiology, moderate T1 hypointensity, moderate contrast enhancement, and an increase in total lesion size during progression. At the most recent follow-up, 94% of the patients had stable/nonprogressive disease, 2% had progressive disease, and 4% died of tumor progression. Patients who demonstrate radiographic progression may not necessarily experience clinical/symptomatic progression or require tumor-directed treatment. Certain patient presentation characteristics and baseline radiographic features may be predictive of worse radiographic PFS or the need for future tumor-directed treatment in the pediatric population. Typically, the natural history of these lesions lends to excellent long-term survival, even in patients who experience clinical progression, should appropriate treatment be initiated.

Patch Technique for Primary Treatment of Type A Carotid Cavernous Fistula: A Case Series and Technical Notes.

The utilization of flow diverters (FDs) in the treatment of high-flow Type A carotid cavernous fistulas (CCFs) has been described before mainly as an adjunct to the traditional endovascular techniques and rarely as a stand-alone treatment. In this study, we retrospectively evaluated our experience with FDs as the solo nonadjunctive treatment of Type A CCF with severe cortical venous reflux (CVR). A retrospective review was performed of patients with Type A CCFs who were treated using FDs' patch technique (PT). Patients' demographics, clinical data, and preoperative and postoperative ocular examination were recorded. The procedure technique, pipeline embolization device (PED) diameters, and immediate and late procedure outcomes were described. Three patients were included in this case series. All patients had history of trauma and presented with decreased visual acuity, cranial nerve II deficit, limited extraocular muscles' movement, and increased intraocular pressure (IOP). Diagnostic angiography was performed, which confirmed high-flow Type A CCF. Endovascular treatment was performed through distal radial access in 2 patients and femoral access in 1 patient by deploying 4 sequentially enlarging PEDs with immediate resolution of the ocular symptoms. Follow-up angiography confirmed complete resolution of CCF in 2 patients. One patient was lost to follow-up; however, angiogram at 4 months demonstrated residual small CCF with significant improvement from postprocedure angiogram. The patch technique using sequentially enlarging FDs is a reasonable alternative solo technique for the treatment of direct CCF symptoms and results in immediate resolution of CVR while preserving the cavernous sinus anatomy.

Orbital abscess with white eye in patients treated with oral antibiotics for orbital cellulitis

ABSTRACT Purpose To report a case series of seven patients with late presentation of orbital/subperiosteal abscess following oral treatment of orbital cellulitis. Methods A retrospective case series of all patients presented with orbital abscess following oral treatment of orbital cellulitis from two tertiary-care eye centres in Riyadh, Saudi Arabia, was conducted. Demographic profiles, risk factors, initial clinical presentation, management regimens, and final outcome were analysed. Results Patients presented mainly with proptosis and limitation of extraocular motility without external ophthalmic inflammatory signs. Most patients needed surgical evacuation despite the appropriate initiation of intravenous antibiotics following presentation to our hospitals. Conclusion Treating orbital cellulitis with oral antibiotics may lead to delayed presentation of orbital abscess without external ophthalmic inflammatory signs.

Efficacy and Safety of 6-Weekly versus 12-Weekly Intravenous Methylprednisolone in Moderate-to-Severe Active Thyroid-Associated Ophthalmopathy.

To compare the efficacy and safety of 6-weekly and 12-weekly intravenous methylprednisolone (IVMP) regimens in moderate-to-severe, active thyroid-associated orbitopathy (TAO) patients. Retrospective comparative study of patients who received IVMP between January 2011 and July 2021 at the Thyroid Eye Clinic, the Chinese University of Hong Kong. Outcome measures included the 7-item clinical activity score (CAS), exophthalmos, extraocular muscle motility (EOMy), marginal reflex distance (MRD), best corrected visual acuity (BCVA), intraocular pressure (IOP), the requirement of additional treatment, and complications. A total of 65 (63% (41/65) females) moderate-to-severe, active TAO patients aged 50 ± 13 (25-74) years received 6-weekly (n = 22) or 12-weekly (n = 43) IVMP. Sex, age, smoking status, and Graves' disease status were comparable in the two groups (all p > 0.05). CAS at week 6 (p = 0.0279), 12 (p = 0.00228), and 52 (p = 0.0228) were lower at each time for the 12-weekly group. Exophthalmos improved more at week 6 (p = 0.0453) and 12 (p = 0.0347) in the 12-weekly group. The improvement of diplopia, MRD1, MRD2, and EOMy were comparable between the two groups. More patients in the 6-weekly group (p = 0.00169) required additional treatments including IVMP+/-ORT. Patients in the 6-weekly group who did not require additional treatment had a lower presenting CAS (p = 0.0193) than those who required additional treatment. The total numbers of adverse events were comparable between the two groups.

Strabismus and myopia: a challenge for the ophthalmologist

Myopia is a condition widely spread throughout the world, and it is expected to affect almost half of the population within 2050. Its correlation with many ocular pathologies, such as retinal detachment, retinal degeneration, maculopathy, glaucoma and cataract, is already well known. Strabismus associated with myopia is more likely to develop as exotropia; however it can also show different clinical features, and thus therapeutic needs, which often make it a challenge for the ophthalmologist to be detected and treated. Heavy eye syndrome is a pathology related to high degenerative myopia, and it is characterized by a wide range of deviation, which goes from a small angle esotropia to a large angle of eso-hypodeviation. Bielschowsky esotropia, ore AACE type III esotropia, is a condition spreading rapidly among population, mainly in association with the use of electronic devices. It is characterized by onset of diplopia for distance vision, followed by the involvement of near vision, and for the preservation of binocular vision. Treatment options include prisms and botulinum toxin therapy; however surgery remains the best curative alternative. Myopia is a predisposing factor for rhegmatogenous retinal detachment, which often can be treated with the positioning of scleral buckling. This surgery is related to the development of strabismus, due to the extraocular motility restriction and subsequent diplopia. Finally, refractive surgery for the treatment of myopia may result in different type of strabismus and diplopia, through many different mechanisms. This review aims to describe clinical features and therapeutic approaches for all these conditions.

Augmented loop myopexy with concurrent intraocular lens implantation for myopic strabismus fixus.

To evaluate safety profile and surgical outcomes of loop myopexy with concurrent intra-ocular lens implantation in cases of myopic strabismus fixus (MSF). A retrospective chart review of patients who underwent loop myopexy with concurrent small incision cataract surgery with intra-ocular lens implantation between January 2017 and July 2021 for MSF at a tertiary eye care centre was undertaken. A minimum of 6 months of follow-up after surgery was required for inclusion. The main outcome measures were improvement in alignment postoperatively, improvement in extra-ocular motility postoperatively, intraoperative and postoperative complications and post-operative visual acuity. 12 eyes of 7 patients (male (6): female (1)) underwent modified loop myopexy at a mean age of 46.86 years (range 32-65 years). 5 patients underwent bilateral loop myopexy with intra-ocular lens implantation whereas 2 patients underwent unilateral loop with intra-ocular lens implantation. All eyes underwent additional medial rectus (MR) recession with lateral rectus (LR) plication. At the last follow-up, mean esotropia improved to 16 prism dioptres (PD) (Range: 10-20 PD) from 80 PD (Range:60-90PD), P = 0.016; and success (deviation ≤20PD) was achieved in 73% (95% CI 48 to 89%). Mean hypotropia at presentation was 10 PD (range 6-14 PD), which improved to 0 PD (range 0-9 PD), P = 0.063. Mean BCVA improved from 1.08 LogMar to 0.3 LogMar units. Loop myopexy combined with intra-ocular lens implantation is a safe and effective procedure in the management of patients who have Myopic Strabismus Fixus with visually significant cataract and improves both visual acuity and ocular alignment significantly.

Assessing the Impact of a Multi-Modal Neuro-Ophthalmology Educational Workshop on Resident Confidence in the Neuro-Ophthalmology Examination (P1-2.005)

<h3>Objective:</h3> To identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Background:</h3> The Neuro-Ophthalmology examination is essential for neurological localization. However, increased workloads and limited exposure make it challenging for residents to become proficient. This study aims to identify gaps in Neuro-Ophthalmology training and assess resident responsiveness to a multi-modal Neuro-Ophthalmology workshop. <h3>Design/Methods:</h3> This is a single-center, mixed methods, quantitative-qualitative (convergent parallel design) survey-based study evaluating resident confidence in neuro-ophthalmological examination. The utility of a didactic-based and hands-on Neuro-Ophthalmology workshop covering evaluation of visual fields, extraocular movements (EOM), and fundoscopic exam was assessed. A survey composed of Likert scales (1=strongly agree, 5=strongly disagree) and open-ended questions for qualitative feedback was administered before and after the workshop. Descriptive data and paired comparisons (Wilcoxon signed-rank test) are reported. <h3>Results:</h3> 16 adult and pediatric neurology residents (81% adult, median post-graduate training-year 3, [range 1–4]) participated in the 2-hour workshop. Pre-workshop surveys revealed that residents were least confident in disc edema assessment (median rating 4 [range 2–5]) and reported an unmet need for teaching and feedback about examination techniques (median rating 4 [range 2–5]). Post-workshop surveys demonstrated a significant improvement (p&lt;0.05) in overall confidence in exam skills, specifically when identifying relative-afferent pupillary defects and pathognomonic characteristics of ophthalmological disorders. Fundoscopic exam confidence did not improve significantly, but results were limited given early termination of breakout sessions. Videos of EOM abnormalities and immediate feedback from instructors were reported as most helpful. Residents suggested increasing workshop length for future sessions. <h3>Conclusions:</h3> A combined didactic-based and hands-on Neuro-Ophthalmology workshop is helpful in identifying gaps in Neuro-Ophthalmology training and increasing resident confidence. Additional instruction in visual acuity and fundoscopic assessments may be beneficial in future workshops. We aim to utilize our findings to create an optimized Neuro-Ophthalmology curriculum with future application to other aspects of resident training. <b>Disclosure:</b> Dr. Kang has nothing to disclose. Dr. Flowers has received intellectual property interests from a discovery or technology relating to health care. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Lavin has nothing to disclose. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Shah has received publishing royalties from a publication relating to health care.

POLG-Related Ataxia and Ophthalmoplegia: A Case Report (P9-11.008)

<h3>Objective:</h3> Not applicable <h3>Background:</h3> Genetic variants of the POLG gene result in mitochondrial DNA defects and account for a large proportion of mitochondrial diseases. These disorders encompass a spectrum of phenotypes, with onset ranging from infancy to late adulthood. In addition to hepatic dysfunction and myopathy in younger populations, and hormone derangements with cataracts in older patients, patients may also present with prominent neurologic symptoms, including ataxia, parkinsonism, epilepsy, and ophthalmoplegia. More than 300 pathogenic mutations of POLG have been reported and there are no clear genotype-phenotype correlations. Given the rarity of these syndromes and wide range of clinical phenotypes, there is often delay in diagnosis. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> We present a 47-year old woman with symptoms of difficulty speaking and development of tremor, vision loss, dizziness, and gait difficulty progressing over several months. Initial exam was significant for ataxia and choreiform movements. Extraocular movement (EOM) testing revealed delayed initiation of saccades and slow, saccadic pursuits with nystagmus. Bloodwork, which included extensive workup for causes of chorea and ataxia, electromyography/nerve conduction studies, and imaging (MRI brain and malignancy work-up) were unremarkable. She continued to decline with development of ophthalmoplegia, ptosis, numbness, weakness, and pain, severely limiting her functional capacity. Whole exome sequencing was performed and showed a heterozygous variant of uncertain significance (VUS) in the POLG gene, which may explain her presentation. <h3>Conclusions:</h3> This case adds to a growing collection of case reports describing the various phenotypes of POLG-related disorders. Early detection of POLG variants and phenotype/genotype characterization may help guide development of future treatments for patients with similar conditions. <b>Disclosure:</b> Dr. Peabody has nothing to disclose. An immediate family member of Dr. Shpiner has received personal compensation for serving as an employee of University of Miami.

Transient Cortical Blindness Following Cerebral Angiography: A Case Report (P2-5.015)

<h3>Objective:</h3> We would like to report a case of Transient cortical blindness following cerebral angiography <h3>Background:</h3> Transient cortical blindness (TCB) is a rare complication following cerebral angiography. Its pathophysiology remains uncertain. We would like to report a case of TCB in a patient during follow up cerebral angiogram for post coil embolization of left internal carotid aneurysm. <h3>Design/Methods:</h3> 50-year-old woman with history of hypertension presents with bilateral vision loss during follow up cerebral angiography for ruptured left internal carotid artery aneurysm status post coiling. This was associated with headache, nausea, and emesis. No associated neurologic deficits. Review of symptoms was otherwise negative. CT Head and CTA showed no acute abnormalities. MRI done on admission showed no evidence of abnormalities. Ophthalmology saw the patient and exam was unrevealing. After 24 hours her vision gradually improved and was back to baseline after 48 hours with no intervention. <h3>Results:</h3> Transient Cortical Blindness is a rare but dramatic complication of cerebral angiogram. It is characterized by loss of perceived vision, normal fundi, normal papillary reflexes, and intact extraocular movements. Symptoms can occur at the start of the cerebral angiography procedure or until serval hours after. The recovery of normal vision may start within the first few hours, but may take as long as 5 days. Two hypothesis exist: could be due to a neurotoxic effect of contrast agent causing osmotic disruption of blood-brain barrier or could be the result of posterior reversible leukoencephalopathy syndrome leading to perivascular edema. There is no known treatment known to improve the condition. <h3>Conclusions:</h3> In summary, we reported a case of TCB following vertebral angiography, a rare but dramatic complication of cerebral angiography. Radiologists and clinicians should be aware of this complication. When it occurs, one should reassure the patient about the excellent prognosis of this condition. <b>Disclosure:</b> Dr. Gomez has nothing to disclose. Dr. Harris has nothing to disclose.

Teaching Video NeuroImages: Convergence retraction nystagmus due to compressive lesion of the dorsal midbrain

A 28-year-old man had experienced binocular diplopia for the last 2 months. Around the same time, he noticed mostly nocturnal polyuria and polydipsia and eventually was diagnosed with diabetes insipidus. Extraocular motility testing demonstrated jerky convergence movements on an attempted upgaze and mild lid retraction (video 1). Urgent MRI of the brain revealed a large mass in the dorsal midbrain region, which was also compressing the hypothalamus (figure). The lesion was biopsied and a diagnosis of primary intracranial germinoma arising from pineal tissue was made. Treatment with low-dose radiotherapy commenced. Characteristic clinical features of convergence retraction nystagmus in this case allowed rapid localization of the lesion, its diagnosis, and eventually treatment.1

Methicillin-resistant Staphylococcus aureus-associated orbital cellulitis: a case series

PurposeIn recent years, methicillin-resistant Staphylococcus aureus (MRSA) orbital cellulitis (OC) has drawn increasing clinical and public health concern. We present a case series of MRSA OC encountered at four Australian tertiary institutions.MethodsA multi-centre retrospective case series investigating MRSA OC in Australia from 2013 to 2022. Patients of all ages were included.ResultsNine cases of culture-positive non-multi-resistant MRSA(nmMRSA) OC were identified at four tertiary institutions across Australia (7 male, 2 female). Mean age was 17.1 ± 16.7 years (range 13-days to 53-years), of which one was 13 days old, and all were immunocompetent. Eight (88.9%) patients had paranasal sinus disease, and seven (77.8%) had a subperiosteal abscess. Four (44.4%) had intracranial extension, including one (11.1%) case which was also complicated by superior sagittal sinus thrombosis. Empirical antibiotics, such as intravenous (IV) cefotaxime alone or IV ceftriaxone and flucloxacillin, were commenced. Following identification of nmMRSA, targeted therapy consisting of vancomycin and/or clindamycin was added. Nine (100%) patients underwent surgical intervention. Average hospital admission was 13.7 ± 6.9 days (range 3–25 days), with two patients requiring intensive care unit (ICU) admission due to complications related to their orbital infection. All patients had favourable prognosis, with preserved visual acuity and extraocular movements, following an average follow-up period of 4.6 months (range 2–9 months).ConclusionNMMRSA OC can follow an aggressive clinical course causing severe orbital and intracranial complications across a wide demographic. However, early recognition, initiation of targeted antibiotics and surgical intervention when required can effectively manage these complications and achieve favourable visual outcomes.

Incidence of ophthalmologic pathology and associated risk factors in orbital fractures at a level I trauma centre

ObjectifEstimer l'incidence des affections ophtalmologiques détectées lors de l'examen initial de patients en proie à une fracture orbitaire qui se sont présentés dans un centre de traumatologie de niveau I, d'une part, et les facteurs de risque connexes les plus significatifs, d'autre part. MéthodesOn a recensé, pendant une période de 2 ans, 278 fractures orbitaires chez 244 patients examinés dans un centre de traumatologie de niveau I. Le paramètre principal était l'incidence d'affections ophtalmologiques urgentes devant être traitées sans délai. Ont été enregistrés les caractéristiques démographiques des patients, leurs antécédents ainsi que les résultats de l'imagerie radiographique et de l'examen physique lors de l'examen initial et des visites de suivi. Les rapports de cotes (RC) ont été calculés avec un intervalle de confiance à 95 %. RésultatsLors de l'examen initial et des visites de suivi, 9,7 % des orbites présentaient une affection ophtalmologique. Celle-ci était urgente (syndrome orbitaire aigu et rupture du globe oculaire, notamment) chez seulement 3 patients (1,1 %); 22 patients (7,9 %) présentaient une affection semi-urgente et 4 patients (1,4 %), une affection sans caractère d'urgence. Les RC de la baisse subjective de la vision (RC = 3,5; p = 0,021), des blessures résultant de voies de fait (RC = 2,4; p = 0,036), d'un accident de travail (RC= 7,7; p = 0,004), du déficit pupillaire afférent (RC = 19,2; p = 0,017), de l'anisocorie (RC = 7,8; p = 0,001), de la limitation des mouvements extraoculaires symétriques (RC = 5,2; p = 0,003) et de la fixité pupillaire (RC = 16,9; p < 0,001) témoignent d'un lien statistiquement significatif avec la présence d'une affection ophtalmologique. En revanche, le sexe du patient, l’œil touché, l'intoxication, la prise d'anticoagulants et d'antiplaquettaires ainsi que les antécédents de chirurgie oculaire n’étaient pas associés à la présence d'une maladie ophtalmologique. ConclusionsLa plupart des fractures orbitaires ne s'accompagnent pas d'une affection ophtalmologique. La baisse subjective de la vision, les antécédents de voies de fait ou d'accident de travail et les anomalies pupillaires notées lors de l'examen étaient les principaux facteurs de risque d'affection ophtalmologique. Nos résultats mettent en lumière les éléments clés qui, relevés lors de l'examen initial, doivent inciter les premiers intervenants à consulter d'urgence un ophtalmologiste.

Likelihood of spontaneous closure of cavernous sinus dural arteriovenous fistulas based on clinical and radiological findings.

Cavernous sinus dural arteriovenous fistula (CSDAVF) is a rare condition that radiologists would encounter in their careers. We aim to describe the clinical and radiological characteristics of this condition, and to provide a management workflow. In our retrospective study, we studied 27 patients with CSDAVF from January 2007 to August 2020. Patients with direct cavernous sinus AVFs and patients with incomplete date were excluded. Clinical and radiological data were collected and analyzed. Fourteen patients were conservatively treated with spontaneous resolution while 13 patients had endovascular intervention performed. In the intervention group, seven patients had intra-cranial reflux seen on radiological imaging and six patients had clinical deterioration, hence requiring intervention. Clinically, among our patients, 21 had proptosis, 20 had conjunctiva hyperaemia, 18 had extraocular movement limitation, 13 had raised intraocular pressure, 11 had chemosis, ten had ocular pain, nine had ocular bruit, eight had headache and six had worsening visual acuity. Radiologically, a concurrence was seen between superior ophthalmic vein thrombosis and spontaneous resolution of the CSDAVF, as compared to those who underwent intervention. A paradoxical increase of ocular symptoms was seen despite a decrease of flow or stagnation of contrast in radiological imaging of CSDAVF. In our study, 52% of CSDAVF closed spontaneously. As deterioration of ocular symptoms in patients with CSDAVF might also reflect spontaneous progressive occlusion, it warrants dynamic vascular imaging to check the status of venous outflow. Patients with CSDAVF with corticovenous reflux or deterioration of visual acuity need more urgent (endovascular) treatment.

Analysis of the Ophthalmological Manifestations of Diagnosed Cases of Idiopathic Intracranial Hypertension

Purpose: The purpose of this study was to explore the ophthalmological involvement in diagnosed cases of Idiopathic Intracranial Hypertension (IIH). Methods: Case series of all patients diagnosed with IIH from October 2012-2014 at the Neurology Department of Amrita Institute of Medical Sciences were prospectively analysed. Analysis was done for 35 patients who fulfilled the updated diagnostic criteria. Results: 80% of the patients were women with a mean age of 34.5. The chief complaint was a throbbing headache in 85.7%.The least common complaints were tinnitus, phonophobia, and photophobia, and one patient had right facial paresis. All patients had well-preserved visual acuity. 30 patients had normal extraocular movements, bilateral abduction restriction was found in 4 patients, and one was reported to be with third and sixth nerve paresis. 22 patients were in Obese class I. CSF opening pressure was elevated in all patients. 80% had Grade 1 papilledema. Enlargement of blindspot and peripheral constriction of fields were commonly seen. 41.4% of patients showed inferior RNFL thickness to be the most affected. A statistically significant association was found between the grade of papilloedema and the visual field. Conclusion: All our patients had papilledema clinically, with well-preserved central vision. Visual field defects were found, which showed a positive correlation with the severity of papilledema, showing the visual field to be a sensitive indicator. Contrary to expectation, an increase in RNFL on OCT was not a universal finding in our patients despite clinically observable papilledema.