Left Visual Disturbance Research Articles

Bilateral Choroidal Detachments following Novel CAR T-Cell Immunotherapy Regimen.

To describe a vision-threatening adverse event of a novel CAR T-cell immunotherapy for metastatic prostate cancer. Observational Case Report. 77-year-old male with history of metastatic prostate cancer and pulmonary embolism enrolled in a clinical trial investigating the use of CAR T-cell immunotherapy for treatment of metastatic prostate cancer presented with a subjective left temporal visual disturbance. The patient was found to have bilateral extensive choroidal detachments on examination. OCT macula demonstrated no intraretinal fluid or supraretinal fluid in both eyes. B-scan of both eyes redemonstrated choroidal detachments in both eyes and no retinal detachment in either eye. The patient was initiated on a topical and systemic steroid regimen and experienced symptomatic and clinical improvement. We exhibit a case of bilateral choroidal detachments secondary to systemic reaction to a novel immunotherapy for metastatic cancer successfully treated with systemic and topical steroids. Close follow up may be required for patients receiving similar novel immunotherapeutic regimens.

Dolichoectasia of the ophthalmic artery: a case report on the treatment strategy in endovascular therapy and literature review

BackgroundDolichoectasia is a rare arterial condition characterized by the dilatation, tortuosity, and elongation of cerebral blood vessels. The vertebrobasilar artery and internal carotid artery are the common sites of dolichoectasia. However, dolichoectasia of the branch arteries, such as the ophthalmic artery (OA), is extremely rare. To the best of our knowledge, this is the first case of ophthalmic dolichoectasia that was successfully treated with endovascular internal coil trapping.Case presentationA 54-year-old female patient presented with transient left ophthalmalgia and visual disturbance. Magnetic resonance imaging revealed a dilated and elongated left OA compressing the optic nerve at the entrance of the optic canal. However, a previous image that was taken 17 years back revealed that the OA was normal, which suggested the change in dolichoectasia was acquired. Cerebral angiography showed that the dilated and tortuous OA was running from the ophthalmic segment of the left internal carotid artery into the orbit. The symptoms could have been attributed to the direct compression of the dolichoectatic OA in the optic canal. A sufficient anastomosis between the central retinal artery and the middle meningeal artery was identified on external carotid angiography with balloon occlusion of the internal carotid artery. Endovascular treatment with internal trapping of the OA was performed due to ophthalmic symptom progression. Internal coil trapping of the OA was performed at the short segment between the OA bifurcation and the entrance of the optic canal. As expected, the central retinal artery was supplied via the middle meningeal artery after the treatment. The transient visual disturbance was immediately resolved. Ophthalmalgia worsened temporarily after the treatment. However, it completely resolved after several days of oral corticosteroid therapy. Postoperative angiography showed that the origin of the OA was occluded and that the OA in the optic canal was shrunk. The flow of the central retinal arteries via the middle meningeal artery was preserved.ConclusionsOA dolichoectasia is rare, and its pathogenesis and long-term visual prognosis are still unknown. However, endovascular therapy can improve symptom by releasing the pressure site in the optic canal.

Retrieved from the jaws of death – A successfully managed case of rhino- cerebral mucormycosis despite healthcare constraints due to economic turmoil

Rhino- orbital-cerebral mucormycosis is a rapidly progressive life-threatening fungal infection which primarily affects the nose, paranasal sinuses and orbit. It is an opportunistic fungal infection caused by fungi of order Mucorales. They are a group of ubiquitous fungi which grow on decaying vegetation and a wide variety of organic compounds, and they pose a huge threat to life by direct invasion of the vital structures in the body. Early identification and treatment of this disease is therefore of paramount importance for a better outcome. We report a case of a 65-year-old man with a background history of poorly controlled type 2 diabetes mellitus, hypertension and chronic kidney disease, who presented with a diffuse headache of 5 days along with left sided facial oedema, redness of left eye and visual disturbance. Imaging studies revealed sinusitis involving multiple sinuses and the nasal mucosal biopsy showed fungal hyphae. Considering the clinical presentation and the overall findings from the investigations a diagnosis of rhino-cerebral mucormycosis was made. Medical management was done with administration of intravenous Amphotericin B and IV itraconazole along with other supportive medication. Patient had a successful recovery after a lengthy hospital stay which included surgical debridement of affected tissues and the medical treatment even with challenges faced due to unavailability of drugs due to economic constraints on health.

A Case of Neuromyelitis Optica Spectrum Disorder of a Patient Who Present for Fungal Sinusitis

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system, characterized by repeatedly invading the brain, optic nerve, or spinal cord. In 2004, when a disease-specific antibody (aquaporin-4-immunoglobulin G) was discovered in the serum of an optic neuromyelitis patient, it was thought to be a separated disease from multiple sclerosis. Since 2004, however, the concept of the disease has been expanded to include NMO spectrum disorder (NMOSD). We experienced a rare case of NMOSD in a patient who presented with left visual disturbance and underwent endoscopic sinus surgery because of acute fungal sinusitis. We report this case with a review of the literature.

Late-onset Endophthalmitis Caused by Streptococcus Cristatus after Trabeculectomy

Purpose: To report a case of late-onset bleb-associated endophthalmitis caused by <i>streptococcus cristatus</i> (<i>S. cristatus</i>) after trabeculectomy.Case summary: A 59-year-old woman presented with left ocular pain and visual disturbance. She had undergone trabeculectomy of the left eye 2 years ago. At the initial visit, she was only able to count fingers from the left eye. Whitish thin bleb, conjunctival injection, and inflammation were observed in the left anterior chamber, and the fundus could not be visualized. Despite administering topical and systemic antibiotics, the chamber reaction worsened, and hypopyon and inflammatory membrane were noticed the next day. Vitrectomy with phacoemulsification and intravitreal antibiotic injection was performed, and the intravitreal antibiotic injections were repeated over the next two days. Bacterial culture of vitreous fluid showed a growth of <i>S. cristatus</i> 5 days after the surgery, and inflammation improved after 7 days. One month later, she was still only able to count fingers from the left eye, but there were no signs of endophthalmitis.Conclusions: Postoperative endophthalmitis after glaucoma filtering surgeries caused by <i>S. cristatus</i> has not been reported previously from Korea. To the best of our knowledge, this is the first Korean case of late-onset bleb-associated endophthalmitis caused by <i>S. cristatus</i>. If gram-positive cocci are grown in samples from the patients with endophthalmitis after trabeculectomy, resident oral microflora such as <i>S. cristatus</i> should be considered as the causative pathogen.

Bedside Transorbital Ultrasound in the Clinical Evaluation of Pediatric Optic Neuritis in the Emergency Department.

Headache and monocular visual disturbance are worrisome pediatric presenting complaints in the emergency department. Appropriate and timely initial evaluation is critical. Most would opt for urgent computer tomography in such cases. Pediatric optic neuritis is a rare condition and is better evaluated by magnetic resonance imaging. With the increase in the use and scope of bedside ultrasound, there might be a potential role for transorbital ultrasound to be part of the emergency department evaluation of pediatric optic neuritis. This is the first pediatric case report on the use of bedside transorbital ultrasound in the emergency department evaluation of a 15-year-old girl with optic neuritis who presented with unilateral headache and left visual disturbance. Transorbital ultrasound of her left eye revealed an irregularly enlarged optic nerve sheath with increased optic nerve sheath diameter (5.1mm) and an elevated optic disc height (0.5mm). Ultrasound examination of her right eye was contrastingly normal, showing an optic nerve sheath diameter of 3.8mm and that the optic disc was not elevated. The ultrasound findings correlated well with her magnetic resonance imaging of her orbits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The clinical findings and monocular ultrasound abnormalities facilitated the emergency department decision-making process and choice of neuroimaging. This highlights the use of transorbital ultrasound as a clinical adjunct and potential role in the emergency department clinical evaluation of a pediatric patient with optic neuritis. The finding of an irregularly enlarged optic nerve might be of potential clinical value but further studies are required.

Two Cases of Infective Endocarditis in Patients with Atopic Dermatitis

Patients with atopic dermatitis have high rates of skin surface colonization of Staphylococcus aureus. At the same time, S. aureus is the major causative organism in infective endocarditis, approximately accounting for 30%~50% cases of infective endocarditis. A 22-year-old male with severe atopic dermatitis presented with fever and myalgia. He was diagnosed with active infective endocarditis causing multiple cerebral infarction, splenic infarction, and septic shoulder requiring synovectomy. Blood culture proved methicillinsensitive Staphylococcus aureus bacteremia, and the culture from the skin revealed same bacteria. After treated with intravenous antibiotics for 6 weeks, patient was improved. Another 42-year-old female with severe atopic dermatitis who presented with fever and chilling was hospitalized due to acute infective endocarditis. She also had left flank pain and visual disturbance, due to splenic infarction and acute cerebral infarction, respectively. As blood culture revealed methicillin-sensitive Staphylococcus aureus bacteremia, she treated with intravenous antibiotics for 6 weeks. The route of entry of two patients was attributed to the patient eczematous scratching lesion of poorly controlled atopic dermatitis. Infective endocarditis can result in the context of acute deterioration of atopic dermatitis. Dermatologists need to pay attention to this risk and actively manage such conditions in order to decrease the risk of infective endocarditis arising from skin lesions in atopic patients. For these reasons, we herein report two cases of infective endocarditis in patients with atopic dermatitis.

Simultaneous decompression of the orbital lateral wall and optic canal for fibrous dysplasia in early adolescence.

IntroductionPatients with fronto-orbital fibrous dysplasia (FD) occasionally present fronto-orbital protrusion, exophthalmos, and visual acuity disturbance. Simultaneous management of these conditions has not been previously described.Case descriptionA-10-year-old female with fronto-orbital FD complained of left visual acuity disturbance. Head computed tomography showed compressed optic canal secondary to thickened bone. Decompression of the optic canal via the left frontotemporal extradural approach, opening of the lateral orbital wall, and dissection of the prominent zygoma were done simultaneously. The patient’s visual acuity disturbance and exophthalmos subsequently improved postoperatively.Discussion and evaluationWhen optic canal decompression is performed by the fronto-temporal approach, opening of the lateral orbital wall can be done simultaneously to decrease the intraorbital pressure and to prevent exophthalmos. In addition, although aesthetic plastic surgery is not generally recommended during the growing phase (due to the possibility of recurrence), this approach can prevent skin loosening and adverse cosmetic outcomes.ConclusionsAesthetic plastic surgery for fronto-orbital FD is recommended to prevent skin loosening. Opening of the lateral orbital wall should be performed when optic canal decompression is planned.

Terson Syndrome Caused by Intraventricular Hemorrhage Associated with Moyamoya Disease

Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Terson syndrome can be caused by intracranial hemorrhage, subdural or epidural hematoma and severe brain injury but is extremely rare in intraventricular hemorrhage associated with moyamoya disease. A 41-year-old man presented with left visual disturbance. He had a history of intraventicular hemorrhage associated with moyamoya disease three months prior to admission. At that time he was in comatose mentality. Ophthalmologic examination at our hospital detected a vitreous hemorrhage in his left eye, with right eye remaining normal. Vitrectomy with epiretinal membrane removal was performed. After operation his left visual acuity was recovered. Careful ophthalmologic examination is mandatory in patients with hemorrhagic moyamoya disease.

A Case of Pituitary Metastasis from Breast Cancer That Presented as Left Visual Disturbance

Tumors that metastasize to the pituitary gland are unusual, and are typically seen in elderly patients with diffuse malignant disease. The most common metastases to the pituitary are from primary breast and lung cancers. We report a 65-year-old woman with pituitary metastasis from breast cancer who presented with recent-onset left progressive deterioration of visual acuity and visual field. The clinical diagnosis was made after brain and sellar magnetic resonance imaging showed a large sellar mass compressing the optic chiasm and invading the pituitary stalk. An otorhinolaryngology and neurosurgery team removed the tumor via a transsphenoidal approach, and this procedure obtained symptomatic relief. Postoperatively, metastasis from breast invasive ductal adenocarcinoma was confirmed histologically. We report this unusual case with a review of the relevant literature.

Anomalous Origin of the Ophthalmic Artery From the Anterior Cerebral Artery -Case Report-

A 39-year-old woman presented with left visual disturbance and diplopia. Magnetic resonance imaging revealed a well-enhanced tumor in the left tentorium, cavernous sinus, and suprasellar region. Angiography demonstrated an abnormal origin of the ophthalmic artery from the anterior cerebral artery. The tumor was partially removed by left frontotemporal craniotomy with orbitozygomatic osteotomy. Intraoperatively, the anomalous origin of the ophthalmic artery was confirmed. This anatomical variation is extremely rare.

A Case of Invasive Paranasal Aspergillosis with Opthalmopathy

Invasive paranasal aspergillosis has been considered to have a poor prognosis. We report a case of orbital apex syndrome due to left ethmoid-sphenoid aspergillosis. A 76-year-old woman with untreated diabetes mellitus, presented with left visual disturbance, oculomotor nerve palsy, ptosis and orbital pain. CT and MRI showed cloudy images with defects of the bone wall in the left posterior ethmoidal sinus. The serological examination revealed aspergillus antigen (+) and high levels of β-D glucan. Therefore, we diagnosed paranasal aspergillosis, and administrated voriconazol preoperatively as an antifungal agent. The patient underwent left ethmoid-sphenoidectomy and biopsy via the endonasal approach. In the histopathologic examination, aspergillus was found around the optic nerve canal. At the present, continucus administration of voriconazol has improved the patient's ptosis and orbital pain, but not her visual disturbance. This case suggests that invasive paranasal aspergillosis has the possibility of visual loss and high mortality rate so that he needs early diagnosis and treatment.

Acyclovir-induced Acute Renal Failure in a Patient With Suspected Acute Retinal Necrosis Syndrome

Purpose: To report a case of acyclovir-induced acute renal failure (ARF) suspected as acute retinal necrosis syndrome. Case summary: The authors report a 55-year-old male patient who presented with left eye visual disturbance due to suspected acute retinal necrosis syndrome. Non-oliguric ARF developed after the infusion of intravenous acyclovir (850 mg every 8 hours). The patient did not show any uremic symptoms or signs. The crystal was not discovered in the urine. After stopping the acyclovir infusion and hydration, acyclovir-induced ARF was reversed. Conclusions: Although possessing critical nephrotoxicity, acyclovir is a useful antiviral drug. Therefore, when using acyclovir, the importance of hydration and preventing acyclovir-induced ARF should be considered.

De Novo Formation of Orbital Cavernous Malformation 9 Years After Surgical Management of Dural Arteriovenous Fistula in the Anterior Middle Fossa -Case Report-

A 30-year-old man presented with recurrent dural arteriovenous fistula (dAVF) associated with de novo orbital cavernous malformation (CM), manifesting as progressive left visual disturbance. He had undergone transarterial embolization and subsequent surgical management for a left anterior middle fossa dAVF 9 years previously. External carotid angiography showed recurrence of the dAVF. Magnetic resonance imaging revealed a well delineated intraorbital mass lesion with hypointense signal rim by T(2)-weighted imaging, adjacent to the shunting point of the recurrent dAVF. Transcranial subtotal removal of the intraorbital mass lesion through the orbitopterional approach revealed continuity between the mass lesion and the draining vein of the recurrent dAVF. The histological diagnosis was CM. His symptom was relieved postoperatively, and no regrowth was seen during the follow-up period of one year. The coexistence of recurrent dAVF with newly formed orbital CM is extremely rare, but may indicate the underlying mechanism of the formation of CMs and recurrent dAVF.

A Case of Intraoperative Floppy Iris Syndrome in a Patient Using Tamsulosin

Purpose: To report a case of Intraoperative Floppy Iris Syndrome (IFIS) experienced during pars plana vitrectomy and phacoemulsification in a patient using tamsulosin, which is a selective alpha 1 adrenergic antagonist. Case summary: A 77-year-old male who had used tamsulosin for the previous month for prostate cancer visited our clinic with left visual disturbance, that had developed a week earlier. The best-corrected visual acuity of the left eye was 0.02 and both pupils showed incomplete mydriasis. Pars plana vitrectomy and phacoemulsification with PCL implantation were performed on his left eye to correct a left cataract and retinal vein occlusion with vitreous hemorrhage. Phacoemulsification idenfied a billowing iris and progressive pupillary constriction. Therefore, we administered an intracameral epinephrine injection and applied an iris hook. The procedure was completed successfully without any complications. The best-corrected visual acuity of the left eye was good as at 0.9, and iris depigmentation and atrophy were checked two months postoperatively in the right eye, which had not had any previous surgical history. Conclusions: A detailed medical history taking is essential because IFIS may raise the risk of intraoperative complications, such as posterior capsule rupture, especially when the small pupil is small. Safe procedures must be planned with cessation of tamsulosin at least a week preoperatively.

Hemangioblastoma of the Optic Nerve-Case Report-

A 64-year-old man presented with a rare sporadic hemangioblastoma arising in the left optic nerve manifesting as left visual disturbance gradually progressive over 5 years. Magnetic resonance imaging revealed a well-enhanced mass in the left optic nerve. Partial resection of the tumor was performed via the frontoorbital approach. The histological diagnosis was optic nerve hemangioblastoma. Hemangioblastoma must be considered in the differential diagnosis of optic nerve tumors even in the absence of other lesions associated with von Hippel-Lindau disease.

巨大な原発性蝶形骨洞嚢胞例

We report a case of huge primary mucocele of the left sphenoid sinus. The patient was a 55-year-old male with a one-month history of left visual disturbance. The patient did not have a history of paranasal sinus surgery nor injury. CT and MRI findings demonstrated that the expansive cystic lesion measured about 5cm, and primarily occupied the parapharyngeal space. The interior the lesion appeared uniform and there was no imaging effect. Since the occupation part of this lesion differed from the general part of paranasal sinus mucocele, discrimination between tumor and mucocele was needed. Endoscopic sinus surgery was performed under local anesthesia. Mucus secretions within the mucocele were removed, and a wide opening was made in the nasal cavity. Left visual disturbance gradually improved postoperatively.There have been 88 cases of paranasal sinus mucocele treated at Yoka Public Hospital in the past 11 years. The majority consisted of postoperative maxillary mucocele, whereas primary mucocele comprised only 4 cases. In postoperative paranasal mucocele, the period from the last surgery to symptom appearance was 26.9 years on average. As treatment, surgery was performed on about 70 percent of the paranasal sinus mucocele cases, and about 10 percent were left intact. The period from symptom appearance until surgery was 10.7 months on average, and that was for one week to a maximum of ten years. Many patients had long periods of illness, therefore, it is better to perform surgery when patients have symptoms.

Endonasal Endoscopic Transsphenoidal Chiasmapexy With Silicone Plates for Empty Sella Syndrome-Technical Note-

Silicone plates sutured together to form blocks were used for extradural elevation of the sella floor in two patients who underwent chiasmapexy for visual disturbance associated with empty sella syndrome. A 36-year-old woman had been treated for prolactinoma for about 19 years with bromocriptine and then presented with left visual disturbance. A 79-year-old man presented with right blurred vision of unknown cause other than empty sella. The sella turcica was accessed via the endonasal transsphenoidal approach under endoscopic guidance. The bony sellar floor was opened with a drill. Two or three pieces of 1-mm-thick silicone plate were sutured to make a block. Two or three blocks were inserted into the epidural space to elevate the sellar contents. Visual symptoms improved in both patients. Silicone is biocompatible and not absorbable. Silicone plates are elastic and easy to handle during insertion, but firm enough to support the sella. The elevation can be adjusted by changing the number of plates in the block. The endonasal endoscopic approach is minimally invasive and particularly suitable for transsphenoidal extradural chiasmapexy for empty sella syndrome.

Doença encéfalo-vascular como primeira manifestação de arterite temporal: relato de dois casos

Brain vascular disease as the first presentation of temporal arteritis is unusual. We present two cases in which the diagnosis emerged from the anamnesis. A 54 years old woman has had a left cerebral infarct 3 months ago. She was getting better when severe visual loss occurred and the family decided to get a second opinion. The patient have had right hemiparesis, aphasia and a left visual disturbance in the first episode; now she had severe bilateral visual disturbance. We suspected temporal arteritis was the etiology. HSR was 97 mm and fundoscopy disclosed severe ischemic optic neuritis. A 75 years old man presented Wallenberg syndrome. The history disclosed temporal headache and the examination showed inflammation in temporal artery. HSR was 70 mm and biopsy confirmed the diagnosis. "Tecnolatry" is affecting medical practice; it's necessary to put back in the center the clinical sovereignty.

Stellate Ganglion Block Improved Loss of Visual Acuity Caused by Retrobulbar Optic Neuritis After Herpes Zoster

Retrobulbar optic neuritis associated with trigeminal herpes zoster is very rare [1,2]. In most published cases, this condition was treated with steroids and acyclovir, but the efficacy of these treatments is controversial [3-7]. We report a woman with retrobulbar optic neuritis caused by varicella-zoster virus in whom loss of visual acuity was markedly improved by stellate ganglion block (SGB) and minimally improved by aggressive administration of steroids. Case Report A 50-yr-old woman developed herpes zoster in the first division of the left trigeminal nerve, including the nasociliary nerve. The skin lesions and pain gradually resolved with intravenous (IV) administration of acyclovir 750 mg/day for 5 days, followed by 250 mg/day for 3 days. Six weeks after the onset of herpes zoster, the patient noticed a gradual decrease in visual acuity in her left eye and severe itching of her left forehead. She developed complete loss of visual acuity in her left eye over a 24-h period and was admitted to the hospital. Her left eye had no light perception; the visual acuity of her right eye was normal. The mobility of her eyes was unaffected. The left pupil was slightly larger than the right one, with left eye reaction almost absent to direct light and normal to indirect light. Slit lamp examination and ophthalmoscopy disclosed no abnormal signs. Intraocular pressure was within the normal range in both eyes. General physical and neurologic examinations were normal. Brain computed tomography and magnetic resonance imaging revealed no abnormalities. The serum complement fixation titer of varicella-zoster virus was 1:128 (normal range less than 1:4). Retrobulbar optic neuritis due to varicella-zoster virus was suspected, and treatment was initiated with IV methylprednisolone 1000 mg/day for 3 days, followed by oral prednisolone 30 mg, which was tapered 10 mg/wk. She received a second course of IV methylprednisolone 1000 mg/day for 3 days from the 15th hospital day, when visual acuity gradually improved to finger counting at 30 cm. Visual field testing at that time revealed a central scotoma in her left eye. Left eye visual acuity remained 20/330 on the 29th hospital day. On the 30th hospital day, she was referred to the pain clinic for treatment of left visual disturbance and severe itching. We performed left SGB using 6 mL of 1% mepivacaine daily for 2 wk. Within 30 min after the first SGB, she noticed marked improvement of vision, and this improvement lasted until the following day, when her left eye visual acuity was 20/220. Visual acuity then improved to 20/70 after the third SGB and to 20/33 after the seventh SGB. Her severe itching eased slightly through the series of SGBs. Eight months after the onset of optic neuritis, left eye visual acuity remained at 20/33, and color perception was impaired. Ophthalmoscopic examination revealed temporal pallor of the disc, and brain computed tomography revealed left optic nerve atrophy. Discussion Optic neuritis after trigeminal herpes zoster appears weeks to months after the onset of skin lesions, and loss of visual acuity varies from severe bilateral impairment to moderate unilateral impairment. Because pathologic examination of the optic nerve cannot be performed, the definitive confirmation of the link between varicella-zoster virus and optic neuritis depends on clinical findings and the exclusion of other etiologies. In the present case, a diagnosis of retrobulbar optic neuritis associated with herpes zoster was made based on the history of herpes zoster infection, profound loss of vision, and absence of other abnormal findings. Optic neuritis after herpes zoster is usually treated with steroids but often has a fulminant course unresponsive to steroids [3-5]. In our patient, loss of visual acuity was markedly improved by SGB, and only minimally improved by aggressive administration of steroids. In some cases, steroids improved visual acuity disturbed by optic neuritis after herpes zoster [6,7], but these improvements were more gradual and slighter than the marked improvement in our patient with SGB. The process by which herpes zoster leads to subsequent optic neuritis is not well understood, but it may be related to multiple mechanisms, including viral spread, ischemic vasculitis, demyelination, and host-immune response to infection [8-10]. The mechanism by which SGB improves the visual acuity is equally unclear. SGB may relieve optic nerve ischemia, because sympathetic blockade by SGB increases central retinal blood flow [11]. Further clinical study is required to determine whether SGB should be used with steroid therapy for the treatment of optic neuritis after herpes zoster. In summary, we treated a patient with retrobulbar optic neuritis after herpes zoster. SGB performed 30 days after the onset of visual disturbance was more effective than steroid therapy. Early initiation of SGB may have the potential to improve visual acuity decreased by optic neuritis after herpes zoster.