Neuro-ophthalmic Manifestations Research Articles

Eye damage in COVID-19. Part 2: posterior segment complications, neuro-ophthalmic manifestations, vaccination and risk factors

Posterior eye segment involvement in COVID-19 has varied manifestations: vascular, inflammatory, and neuronal. All of them are triggered by SARS-CoV-2 virus but they cannot be viewed as exclusively specific to COVID-19. According to the literature, the mean age of the patients varies from 17 to 75 with the median of 50 years. The median duration between the appearance of ophthalmic symptoms and the detection of COVID-19 was 12 days. The disease affects both men and women equally. Direct exposure to the virus, immune-mediated tissue damage, activation of the coagulation system, the prothrombotic state caused by a viral infection, concomitant diseases and medications used in the treatment contribute to the development of eye pathologies. Ophthalmologists should be aware of the possible relations of posterior eye segment pathologies, orbit and neuro-ophthalmic disorders with SARS-CoV-2, as well as the possible exacerbation of chronic forms of inflammatory eye diseases and autoimmune disorders due to anti-COVID-19 vaccination.

Disturbances of Ocular Circulation in Color Doppler Imaging, Retinal Changes and Electrophysiological Tests with Neuro-Ophthalmological Clinical Symptoms in the Course of CADASIL Syndrome—A Case Report

The authors present a new paper examining the disturbances in ocular circulation and electrophysiological changes in the presence of neuro-ophthalmic manifestations in a patient with cerebral autosomal dominant arteriopathy with subcortical infracts and leucoencephalopathy (CADASIL). Symptoms reported by the patient included: transient vision loss (TVL), migraines, diplopia, bilateral peripheral visual field loss and convergence insufficiency. CADASIL was confirmed by the presence of NOTCH3 gene mutation (p.Cys212Gly), the presence of granular osmiophilic material (GOM) in cutaneous vessels in an immunohistochemistry test (IHC) and bilateral focal vasogenic lesions in the white matter of the cerebral hemisphere, with micro-focal infarct in the left external capsule on a magnetic resonance imaging test (MRI). Color Doppler imaging (CDI) confirmed decreased blood flow and increased vascular resistance in the retinal and posterior ciliary arteries, with reduced P50 wave amplitude on a pattern electroretinogram (PERG). An eye fundus examination and fluorescein angiography (FA) revealed the constriction of retinal vessels and a peripheral retinal pigment epithelium (RPE) atrophy with focal drusen. The authors suggest that the cause of TVL may be changes in the hemodynamics of the retinochoroid vessels associated with the narrowing of small vessels and the presence of druses in the retina-which is supported by a decrease in the amplitude of the P50 wave in PERG, changes in OCT correlating simultaneously with changes in MRI imaging and other neurological symptoms.

Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 and Its Vaccination: A Narrative Review.

Coronavirus disease 2019 (COVID-19) is a current pandemic caused by SARS-CoV-2 that has vastly affected the whole world. Although respiratory disease is the most common manifestation of COVID-19, the virus can affect multiple organs. Neurotropic aspects of the virus are increasingly unfolding, in so far as some respiratory failures are attributed to brainstem involvement. The neuro-ophthalmic manifestations of COVID-19 and the neuro-ophthalmic side effects of vaccination were reviewed. The major findings are that the SARS-CoV-2 infection commonly causes headaches and ocular pain. It can affect the afferent and efferent visual pathways by ischemic or inflammatory mechanisms. Optic nerve may be the origin of transient or permanent visual loss from papillophlebitis, idiopathic intracranial hypertension, or optic neuritis. Cerebrovascular strokes are not uncommon and may lead to cortical visual impairment or optic nerve infarction. SARS-CoV-2 may affect the pupillomotor pathways, resulting in tonic pupil (Adie's syndrome) or Horner's syndrome. Cranial neuropathies including third, fourth, sixth, and seventh nerve palsies have all been reported. Rhino-orbital mucormycosis superinfections in COVID-19 patients receiving steroids or other immunosuppressive therapies may result in unilateral or bilateral visual loss and ophthalmoplegia. Autoimmune conditions such as Guillain-Barré, Miller-Fisher syndrome, and ocular myasthenia have been reported.

Neuro-Ophthalmic Manifestations of Giant Cell Arteritis-Myelodysplastic Subtype.

Wang, Qiancheng BA; Mortensen, Peter MD; Lee, Andrew G. MDEditor(s): Avery, Robert DO; Golnik, Karl C. MD; Froment, Caroline MD, PhD; Wang, An-Guor MD Author Information

Neuro ophthalmic manifestations of intracranial aneurysms: A case series

ABSTRACT To report the various neuro-ophthalmic manifestations of patients with intracranial aneurysms at a tertiary eye care center in Southern India. This is a retrospective case series of patients in a single center between January 2017 and January 2018. We present a series of five cases of intracranial aneurysms in the age group of 13 to 66 years comprising four women and one boy. The patients had varied presentations on the initial examination. It is extremely rare that a patient visits a hospital due to visual symptoms caused by an aneurysmal compression of the optic nerve. An intracranial aneurysm needs to be ruled in cases of unexplained unilateral vision loss or nerve palsy. Early diagnosis and prompt treatment can save the patient from complete vision loss or other complications due to an aneurysm.

Sellar masses: diagnosis and treatment.

Sellar mases can cause a variety of neuro-ophthalmic manifestations, including compressive optic neuropathy, chiasmal syndrome, and ophthalmoplegia due to cranial nerve palsy. Diagnosis involves a thorough history, neuro-ophthalmic examination, and ancillary tests and investigations. Visual field testing is critical in diagnosing and localizing the lesion and determining the extent of visual field loss. Appropriate neuro-imaging is essential in characterizing and localizing the lesion. Neuro-ophthalmologic assessment include meticulous clinical examination and ancillary tests including,visual field testing, which is useful in localizing the lesion, and optical coherence tomography, which is helpful in assessing the degree of axonal and neuronal loss and predicting the visual outcome. Treatment requires a multidisciplinary approach by different specialties, including radiologists, neuro-ophthalmologists, and neurosurgeons. The two primary treatment modalities for these tumors are surgery and radiation therapy. We review the main types of sellar lesions, their neuro-ophthalmologic evaluation, and treatment options.

UNILATERAL PTOSIS AS A FIRST MANIFESTATION OF SARCOIDOSIS

UNILATERAL PTOSIS AS A FIRST MANIFESTATION OF SARCOIDOSIS

Efferent neuro-ophthalmic complications of coronavirus disease 2019.

We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus. Efferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described. Observed neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.

A Review Study on Ocular Posterior Segments & Neuro-Ophthalmic Manifestations Associated with Human Immunodeficiency Virus (HIV) Infection and its Management Options

To describe the various types of ocular posterior segment and neuro-ophthalmic manifestation associated with Human Immuno-deficiency virus (HIV) infection. And also describe the management or preventive measures associated with it. In all cases of ocular disease due to HIV, there is only one reason i.e. immune system. A Descriptive study was done to review the articles available on PubMed, Google Scholar, Medline, Publon, Orcid, Healthstar, Science Open, Cochrane Library, Paperity and others related to the ocular complications associated with HIV infections. Peer-reviewed articles/ studies were referred to ascertain the available screening tests, preventive measures, hygiene, neuro-ophthalmic manifestation and management options for HIV patients. Some authors suggest that ocular posterior segment & neuro-ophthalmic manifestation due to HIV infection is not recovered, but few authors suggest that it can be recovered with the help of highly active antiretroviral therapy (HAART) in combination with some preventive measures and hygiene. The Eye-care professional’s responsibility is to spread awareness about the complications related to the eye and their management or preventive measures. Ocular complications are very diverse and relatively frequent in the case of HIV infection. Commonly it is associated with a concurrent diagnosis of depression, anxiety, panic, attack and psychiatric disorders, etc. There are various management or preventive measures like regular eye examinations, follow-up of the HIV patients, following the preventive measures strategies, taking therapy properly, preventing to spread of the infection, etc.

A Review Study on Ocular Posterior Segments & Neuro-Ophthalmic Manifestations Associated with Human Immunodeficiency Virus (HIV) Infection and its Management Options

A Review Study on Ocular Posterior Segments & Neuro-Ophthalmic Manifestations Associated with Human Immunodeficiency Virus (HIV) Infection and its Management Options

Neuro-ophthalmic manifestations of cancer: a narrative review.

Neuro-ophthalmic manifestations of cancer are vast and early recognition of a serious ocular condition due to either cancer or its therapy is important for both vision preservation as well as providing valuable treatment and prognostic information regarding the underlying malignancy. This review focuses on direct and indirect effects of cancer on the eye and its adnexa, hematologic malignancy, complications of traditional and novel oncologic therapies, and paraneoplastic syndromes as they relate to the eye as these disorders can lead to potentially devastating or irreversible vision loss. PubMed was searched primarily for the following topics: optic nerve infiltration, primary vitreoretinal lymphoma (PVRL), ocular paraneoplastic disorders, and ophthalmic complications of cancer therapeutics. Literature was selected based on historical significance and landmark studies (e.g., Cross et al. series of paraneoplastic optic neuritis patients; Chan's textbook on primary intraocular lymphoma) as well as publications published after 2000. References from select studies were additionally included. Given the sparsity of literature on many subjects, most publications were included during this time frame in our review. There are several ophthalmic entities that the oncologist should be aware of including leukemic optic nerve infiltration, PVRL, paraneoplastic syndromes as they related to the eye, and adverse effects of therapeutics. Unfortunately, given the rarity of some of these entities [e.g., paraneoplastic optic neuropathy (PON), cancer-associated retinopathy (CAR)], diagnosis can be difficult and treatment options are often limited. Oncologists can develop a set of basic ophthalmology examination skills that will help to triage and manage patient eye complaints. In certain instances, oncologists have the potential to avert devastating vision loss with early recognition of neuro-ophthalmic complications.

Neuro-ophthalmological manifestations of sarcoidosis

Neuro-sarcoidosis has important ophthalmic and neuro-ophthalmic manifestations. Sarcoidosis most commonly affects the uveal tract (iris, ciliary body, and choroid) however the optic nerve is commonly involved. Sarcoid related optic neuritis is an important differential diagnosis in optic neuritis especially in atypical presentations. The use of multimodal imaging techniques available in the ophthalmic setting can enable the detection of choroidal or optic nerve granulomas and aid the diagnosis. Efferent manifestations of neuro-sarcoidosis are broad and can range from isolated cranial neuropathies or multiple as well as pupil abnormalities. Currently to date there are no diagnostic framework to assist in the diagnosis of ophthalmic manifestations in neuro-sarcoidosis in the absence of a tissue biopsy.

Cephalic Disorders with Neuro-Ophthalmic Manifestations

Purpose: To report three different cases of cephalic disorders with neuro-ophthalmic manifestations. Method: Descriptive case report. Case Summary Case 1: 14 years female came with Primary optic atrophy (POA) of both eyes associated with poor intelligence. MRI brain showed disproportionate dilatation of both occipital horn of lateral ventricle suggestive of Colpocephaly. Case 2: 16 years male presented with POA of eyes, horizontal jerky nystagmus and left sided hemiparesis with contracture of left hand since birth. MRI brain suggestive of Open lip Schizencephaly. Case 3: 12 years boy came with alternate exodeviation, left sided hemiparesis since birth. MRI brain suggestive of right sided Procencephalic cyst. Conclusion: Cephalic disorders caused by disturbance in development of fetal nervous system. For most cephalic disorder’s treatment is only symptomatic and supportive. Early diagnosis may ensure patient’s quality of living.

Ocular Manifestations of Antiphospholipid Syndrome in Jordan.

The purpose of the study was to evaluate the prevalence of various ocular manifestations in diagnosed cases of antiphospholipid syndrome (APS) in Jordan. It will also find the association of these manifestations with primary and secondary APS. It was a retrospective cross-sectional study to analyze the ocular manifestations of APS in Jordan. Data of 90 cases were obtained from public hospitals from January 2018 to January 2021. There should have been at least two positive tests with a minimum of 12-week gap between them. The electronic data regarding Schirmer tests, examination of visual acuity (Snellen acuity), neuro-ophthalmic manifestations, dilated fundus examination for posterior eye segment manifestations, and slit-lamp examination for anterior eye segment were also recorded and analyzed. Using SPSS version 25, the frequency and percentages of the categorical data were computed. Pearson's Chi-square test was conducted to find the associations. Among 90 APS cases, 52 (58%) patients had primary APS and 38 (42%) had secondary APS. At the same time, systemic lupus erythematosus was diagnosed in 31 (34%) patients. Keratoconjunctivitis sicca (dry eyes), decreased vision, and retinal vasculitis were the most common manifestations observed. The high prevalence of ocular manifestations warrants ophthalmologists to look for APS, as ocular manifestations could be the initial symptoms and/or signs of APS.

Neuro-Ophthalmic Manifestations of Covid-19 Infection and Vaccination

Neuro-Ophthalmic Manifestations of Covid-19 Infection and Vaccination

Neuro-ophthalmic manifestations of central nervous system tuberculosis: Compilation of three diverse unique presentations

Tubercular meningitis is the most devastating form of tuberculosis. Neuro-ophthalmic involvement can manifest as cranial nerve palsies, pupil abnormalities, disc changes, like papillitis, papilloedema, or optic atrophy and choroidal tubercles. The rate and extent of recovery are strongly. Related to early diagnosis and treatment. Herein, we describe a constellation of three cases of central nervous system tuberculosis with aberrant regeneration of oculomotor nerve, optochiasmatic arachnoiditis presenting as bilateral primary optic atrophy and the last case of parietal lobe tuberculoma presenting as homonymous hemianopia, each one with its own characteristic ocular findings.

Neuro-Ophthalmic Manifestations of Intracranial Space Occupying Lesions in Adults.

The purpose of this study is to evaluate the epidemiology, neuro-ophthalmic, and clinical characteristics of intracranial space occupying lesions (ICSOLs) in adult patients. All patients above 16 years presenting with brain tumors confirmed by magnetic resonance imaging and treated surgically in our institute were included in this study. Epidemiology of the patients along with neurological and ophthalmic manifestation was evaluated. A total of 252 patients were included in the study ranging from 18 years to 79 years. Supratentorial location was more common than infratentorial location. The most common neurological symptom in our study was headache followed by seizures. Ophthalmic manifestations were present in (73.4%) of patients. The most common visual symptoms and signs were visual loss, strabismus, papilledema, and visual field defects. The most common histopathological diagnosis seen in our study was meningiomas followed by high-grade gliomas. Ocular signs and symptoms can be considered as a window to the brain through which ICSOLs can be detected. The most common neurological manifestation of ICSOL in our study was headache with or without true localizing signs and symptoms. More frequently, these patients present to an ophthalmologist before a neurosurgeon with related ocular manifestations. Hence, through our study, we emphasize the importance of a detailed ophthalmological examination in these patients which can aid in early diagnosis and prompt management of such lesions.

Spectrum of Ocular Findings in Closed Head Injuries, Correlation With Severity of Neurological Involvement, and Treatment Outcome: A Hospital-Based Cross-Sectional Study.

Purpose: To study the various ocular findings in patients with closed head injuries, to find any association with the degree of neurological involvement, and to analyze the treatment outcome after the necessary intervention.Setting: Tertiary referral hospital in Eastern India.Design: Prospective observational study.Methods: Patients with closed head injuries attending our Outpatient department as well as referred from the Neurosurgery department for ophthalmic evaluation between October 2017 and September 2019 were recruited for the study. All patients meeting the inclusion criteria were examined by an experienced ophthalmologist. The Glasgow coma scale (GCS) was applied to grade the neurological involvement by the neurosurgery team. Ocular findings were recorded and necessary imaging was requested. Appropriate neurosurgery consultations were done in patients with neurological findings. All ocular injuries were managed as per institutional protocol. Descriptive statistics were used for analysis with p< 0.05 taken as statistically significant.Results: A total of 207 patients (414 eyes) were included in the study. The mean age was 33.82 years, with the prevalence of male patients (82.12%). The most common cause of head injury was RTA (57.01%) followed by assault (11.59%). The majority of patients (53.14%) were classified as having moderate, 46.37% patients with mild, and 0.48% with severe neurological involvement as per GCS scoring. Isolated ocular findings were seen in 70.04% of patients while 29.95% of patients had both neurological and ophthalmic features. Ocular adnexal involvement was observed in 38.6%, anterior segment involvement in 86%, neuro-ophthalmic manifestations in 33.3%, and posterior segment involvement in 38.6% of patients. Ocular signs were resolved over due course of time in 48.8% of patients, completely resolved in 28%, while there was no improvement in 6.28% of patients. The final best-corrected visual acuity of >6/18 was achieved in 51.69% of patients. Statistical significance was observed in the correlation between the GCS scoring and general ocular findings (p= 0.02) as well as a relative afferent pupillary defect (p=0.003). The association between age > 50 years and neuro-ophthalmic features was not found to be statistically significant (p=0.56).Conclusion: Poor visual acuity at presentation, optic canal fractures, the presence of multiple fractures of orbital walls, no improvement in vision within 48 hours of starting intravenous corticosteroids, were indicators of a poor visual prognosis in this study. The GCS, neuro-deficit, and ocular signs contribute significantly to the prediction of outcomes. Prompt treatment and referral can lead to a good resolution of symptoms and signs.

Ocular manifestations in road traffic accidents

Road traffic accidents (RTAs) are the most common cause of polytrauma. This study aims to evaluate the various ocular manifestations in cases of RTAs. A retrospective review of patients who were treated for RTAs in a tertiary hospital in 6 months from December 2018 to May 2019. A total of 126 patients were reviewed. Age ranged from 2 to 85 years. The mean age was 32 years. Ophthalmological examination was undertaken in all patients involved in RTA. Out of 126 patients, 112 were males and 14 were females. Young adult males (21-30 years) were most vulnerable to RTAs. Soft tissue injuries were the most common manifestations (57.93%) followed by neuro-ophthalmic manifestations (26.98%) and orbital fractures (15.07%). The presence of CT abnormalities especially intra cranial haemorrhage was associated with neuro-ophthalmic deficits. Soft tissue injuries were the most common ocular manifestations. It was found that head trauma causes many neuro-ophthalmic manifestations. Relative afferent pupillary defect (RAPD) was the most common neuro-ophthalmic manifestation. The most common cranial nerve involved was found to be oculomotor nerve. Retrobulbar neuritis was a rare finding.

The Role of MicroRNAs in Mitochondria-Mediated Eye Diseases.

The retina is among the most metabolically active tissues with high-energy demands. The peculiar distribution of mitochondria in cells of retinal layers is necessary to assure the appropriate energy supply for the transmission of the light signal. Photoreceptor cells (PRs), retinal pigment epithelium (RPE), and retinal ganglion cells (RGCs) present a great concentration of mitochondria, which makes them particularly sensitive to mitochondrial dysfunction. To date, visual loss has been extensively correlated to defective mitochondrial functions. Many mitochondrial diseases (MDs) show indeed neuro-ophthalmic manifestations, including retinal and optic nerve phenotypes. Moreover, abnormal mitochondrial functions are frequently found in the most common retinal pathologies, i.e., glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR), that share clinical similarities with the hereditary primary MDs. MicroRNAs (miRNAs) are established as key regulators of several developmental, physiological, and pathological processes. Dysregulated miRNA expression profiles in retinal degeneration models and in patients underline the potentiality of miRNA modulation as a possible gene/mutation-independent strategy in retinal diseases and highlight their promising role as disease predictive or prognostic biomarkers. In this review, we will summarize the current knowledge about the participation of miRNAs in both rare and common mitochondria-mediated eye diseases. Definitely, given the involvement of miRNAs in retina pathologies and therapy as well as their use as molecular biomarkers, they represent a determining target for clinical applications.