Ocular Motility Research Articles

OCULAR INVOLVEMENT IN SNAKEBITE PATIENT: A CASE TO REMEMBER

Introduction : Snake bite cases in Indonesia are not rare with mild to catastrophic consequences on the bitten subject due to its hemolytic and neurotoxic effects. This case represents a rare ocular neurotoxic effect of snake’s venom that cause binocular diplopia and ptosis in a child.
 Case Illustration : A 9 year-old boy was consulted to ophthalmologist with chief complaint of binocular diplopia. He was hospitalized after being bitten by a snake on his right hand and had an episode of delirious state. Ophthalmologic examination revealed ptosis and exotropia of his left eye in primary position. Further examination of anterior and posterior segments showed good results. His visual acuity was unaffected. Intravenous antivenom was administered and the bite wound was taken care. The boy was discharged from the hospital with a good general condition but still an opthalmoplegia. After a week of follow up the diplopia diminished and his ocular motility was recovered.
 Discussion : Ocular manifestations in snake bite case might be missed because of delirious state of the patients. Snake venom can cause ptosis and ophthalmoplegia (neurotoxic) along with uveitis, optic neuritis, central retinal artery occlusion or vitreous and retina hemorrhage due to its hemolytic effect. Time interval between the bite and treatment is one of crucial factor that indicate the patient’s prognosis.
 Conclusion : Thorough examination of anterior to posterior ocular segments is needed in every snake bitten patients to rule out any further ocular complication. An early administration of intravenous antivenom is still a mandatory.

Selenium supplementation in inactive moderate to severe Graves’ orbitopathy patients: a randomized controlled trial

ABSTRACT Purpose This study was designed to evaluate the effect of selenium supplementation in inactive moderate-severe Graves’ orbitopathy (GO) patients. Methods This study was a single-center, placebo-controlled, double-masked, randomized trial. Inactive moderate-severe GO participants were randomized to receive six months of 200 micrograms/day of selenium supplementation or placebo. Thorough eye exams, clinical activity score (CAS), Graves’ Ophthalmopathy quality of life questionnaire (GO-QOL), and serum selenium level were evaluated at baseline and 6 months after the interventions. The chi-squared or Fisher’s exact test was used to compare categorical variables. The t-test and the paired t-test were used to compare continuous variables between two independent samples and two dependent samples, respectively. Results A total of 25 participants were enrolled, 13 in the selenium group and 12 in the placebo group. Both groups had adequate baseline serum selenium levels at 98.96 ± 15.63 mcg/L and 102.55 ± 17.71 mcg/L, respectively. After 6 months of intervention, the selenium group showed a greater improvement in palpebral aperture (mean difference: −1.4 ± 1.7 mm, p = .04) compared to the placebo group (−0.3 ± 2.7 mm). Notably, 5(41.67%) people in the placebo group developed larger palpebral apertures. Proptosis, ocular motility, and soft tissue signs did not change significantly. GO-QOL and CAS score improvement showed no statistically significant difference between both groups. Minor adverse effects were observed. Conclusions Selenium supplementation has a positive effect on eyelid aperture even in inactive moderate-to-severe GO patients with a sufficient baseline selenium level.

Hemi-Jensen Procedure as Heavy Eye Syndrome Treatment: A Case Series

Introduction : Heavy eye syndrome is an acquired myopia-associated strabismus characterized by esotropia and hypotropia accompanied by abduction and elevation limitations. This case series reports two heavy eye syndrome patients that underwent hemi-Jensen procedure combined with medial rectus recession with good postoperative result.
 Case Illustration : A 60-year-old female had right eye (RE) fixed inward and bilateral high myopia (S-13.00 D). RE Hirschberg test: >45° esotropia and hypotropia and RE axial length (AL) 28.3 mm. Second patient, a 53-year-old female, had both eyes fixed inward and bilateral high myopia (S-12.00 D). Both eyes Hirschberg test: >45° esotropia and hypotropia, left eye AL 31.4 mm, and prephthisis RE. Intraoperative identification of both patients revealed displacement of superior and lateral rectus muscles. No surgery performed on prephthisis eye. Hemi-Jensen procedure combined with medial rectus recession resulted in orthophoria (first patient) and central position in primary gaze (second patient), with improved ocular motility on both patients.
 Discussion : Heavy eye syndrome occurs in eyes with high myopia. The elongated globe in high myopia results in superotemporal herniation of the globe and superior and lateral rectus muscles displacement, which increases depression and adduction force. Hemi-Jensen procedure is a loop myopexy procedure which corrects the deviated muscle paths in heavy eye syndrome. Concurrent medial rectus recession can be performed with hemi-Jensen procedure if there is likely contracture of medial rectus.
 Conclusion : Heavy eye syndrome is a strabismus fixus condition which occurs in eyes with high myopia. Hemi- Jensen procedure is an effective treatment for heavy eye syndrome which improves ocular alignment and motility.

OCULAR INVOLVEMENT IN SNAKEBITE PATIENT: A CASE TO REMEMBER

Introduction : Snake bite cases in Indonesia are not rare with mild to catastrophic consequences on the bitten subject due to its hemolytic and neurotoxic effects. This case represents a rare ocular neurotoxic effect of snake’s venom that cause binocular diplopia and ptosis in a child.
 Case Illustration : A 9 year-old boy was consulted to ophthalmologist with chief complaint of binocular diplopia. He was hospitalized after being bitten by a snake on his right hand and had an episode of delirious state. Ophthalmologic examination revealed ptosis and exotropia of his left eye in primary position. Further examination of anterior and posterior segments showed good results. His visual acuity was unaffected. Intravenous antivenom was administered and the bite wound was taken care. The boy was discharged from the hospital with a good general condition but still an opthalmoplegia. After a week of follow up the diplopia diminished and his ocular motility was recovered.
 Discussion : Ocular manifestations in snake bite case might be missed because of delirious state of the patients. Snake venom can cause ptosis and ophthalmoplegia (neurotoxic) along with uveitis, optic neuritis, central retinal artery occlusion or vitreous and retina hemorrhage due to its hemolytic effect. Time interval between the bite and treatment is one of crucial factor that indicate the patient’s prognosis.
 Conclusion : Thorough examination of anterior to posterior ocular segments is needed in every snake bitten patients to rule out any further ocular complication. An early administration of intravenous antivenom is still a mandatory.

A peculiar case of idiopathic orbital myositis in adolescence

Abstract
 Introduction : Idiopathic orbital myositis, an inflammation localized at the extraocular muscles, is rarely reported in pediatrics. Until now, the prevalence and incidence of orbital myositis remain unknown. This paper aims to report a case of idiopathic orbital myositis in a young girl with headache.
 Case Illustration : A-16-year-old presented with a droopy eyelid of the left eye (LE) and double vision since 1 week before admission. She also experienced swollen eyelid and cluster headache for 5 months with no neurological abnormalities. Ophthalmic examinations showed exotropia with limited eye movement of LE. Ptosis of LE was noted with margin reflex distance 1 (MRD-1) +2 mm, while MRD-1 +6 mm for the right eye. Other examinations were unremarkable with normal funduscopy and negative RAPD. Non-contrast orbital sinus CT-Scan revealed an enlargement of the superior rectus and lateral rectus muscle. The laboratory result showed slight leucocytosis and normal ESR. High-dose intravenous corticosteroid was administered and tapered with oral steroid. The orbital clinical findings showed improvements, better ocular movements, and diminished headache complaints.
 Discussion : As a rare case, the diagnosis of orbital myositis in adolescence can be challenging and requires detailed examination, and proper imaging to exclude other diagnosis such as ophthalmoplegic migraine, infections, malignancies, or congenital lesions (hemangioma). The first-line therapy is a systemic corticosteroid, which well responded in this patient.
 Conclusion : In this patient, intravenous corticosteroid represent an effective treatment. Close monitoring of the disease progression is required after switching to oral therapy to prevent relapse.

Terson Syndrome: what an ophthalmologist should know?

Abstract
 Introduction : Terson syndrome is the occurrence of any intraocular hemorrhage in patients with intracranial hemorrhage or traumatic brain injury. In this article we present a case of patient with Terson Syndrome after craniotomy.
 Case Illustration : Forty-six yo female patient consulted from neurosurgery department with chief complain of blurry vision in both eyes since 1 day before. Pain or red eyes were denied. There was no history of visual field defect. She had history of breast cancer and she underwent craniotomy four days before because of her brain metastases. Her Glasgow Coma Scale was 15. In ophthalmology examination, her visual acuity is 6/6 with correction in both eyes with good ocular motility. RAPD was positive in her left eye, and posterior segment showed bilateral optic disc edema with intrapapillary and peripapillary hemorrhage. Humphrey examination revealed enlargement of blind spot in the right eye. Brain CT Scan demonstrated hemorrhagic lesion with pneumoencephal within post operative defect area in right parietal lobe. Laboratory examination showed normal fibrinogen and thrombocyte aggregation with elevation of d-dimer. After two weeks observation, visual acuity still 6/6 in both eyes with decreasing intrapapillary and peripapillary hemorrhage.
 Discussion : The exact pathophysiology of Terson Syndrome is still unknown. Even though, it has association with high intracranial pressure. Patient with Terson Syndrome will develop 5 times higher mortality rate compare to subarachnoid hemorrhage without Terson Syndrome.
 Conclusion : Terson Syndrome needs to be recognized early since it will bring significant prognostic effect and cause permanent vision loss if left untreated

Prospective Study on the Surgical Outcome of Eyelid Carcinoma

Abstract
 Introduction & Objectives : Introduction Resection of eyelid carcinoma may lead to a risk of recurrences which might increase if excision was incomplete. Risk factors of incomplete surgical removal and recurrences are deep infiltration, spreading outside the macroscopic border, eye socket penetration, and histological type of the eyelid carcinoma. Objective To evaluate the surgical outcomes of eyelid carcinomas.
 Methods : This is a hospital based prospective observational study involving 16 patients. Prior to the surgery patients were evaluated for visual acuity, intra ocular pressure, extra ocular motility, fundus examination, and local clinical examinations. The eyelid carcinomas were histological detected concerning carcinoma type and margin involvement. Local anesthesia was applied. Patients were evaluated 1 month, 3 months and 6 months after surgery for local complications, patients satisfaction on surgical results, and recurrences. The surgical technic applied in this study were also observed.
 Results : Dominant tumor type were basal cell carcinoma and squamous cell carcinoma (87, 44%). The locations were at right and left lower eyelid with percentage of 68. 7 % and 31. 3 % respectively. All patients satisfied on surgery outcomes (100%). Three patients (6. 25 %) with complications were found within 6 months after the surgery. There were no recurrences during follow up period. Surgery procedures applied were modified hughe’s procedure (56. 25%) and mass excision and reconstruction (43. 75%).
 Conclusion : There was less complications and no recurrences within 6 months after surgery. All patients satisfied with the surgical outcomes.

GLAUCOMA SECONDARY TO NONSPECIFIC ORBITAL INFLAMMATION: A DIAGNOSIS NOT TO OVERLOOK

Introduction : Nonspecific Orbital Inflammation (NSOI) is an inflammatory condition of unknown etiology manifesting as pain, ocular motility disturbances, eyelid edema, chemosis, and increased intraocular pressure (IOP). We illustrate a case of glaucoma secondary to NSOI and the importance of understanding the cause-effect relationship between the two conditions.
 Case Illustration : An eighteen-year-old girl presented with severe pain, ptosis, chemosis, ophthalmoplegia, and increased IOP (38 mmHg) despite a leaking trabeculectomy bleb, on the left eye. She was referredwith the diagnosis of primary angle-closure glaucoma (PACG) and a history of twice trabeculectomy surgeries done elsewhere two months before she came to our hospital. She could not move her lefteye nasally five months before the first surgery and felt joint pains for a year. After thorough diagnostics, she was assessed with left eye NSOI and secondary glaucoma with spondyloarthropathy. Oral prednisone 30 mg/day was given to manage the inflammation and the resultant glaucoma. One week follow-up showed an improved condition with decreased IOP (16 mmHg) despite the same anti-glaucoma therapy regimen.
 Discussion : NSOI can mimic various diseases, making diagnosis challenging. The raised IOP in NSOI is often caused by extraocular muscles and orbital tissue swelling, which compresses the superior and inferior ophthalmic veins, resulting in choroidal circulation problems. The IOP was quickly reduced once the inflammation was managed. This is a case of secondary glaucoma caused by an overlooked NSOI, aggravated by the immunological process in the orbit after trabeculectomy surgeries.
 Conclusion : Secondary glaucoma should be considered as a differential diagnosis of PACG in patients with NSOI.

Levator Resection in Neurogenic Ptosis Oculi Sinistra et causa Third Nerve Paresis + Type II Diabetes: A Case Report

Introduction : Neurogenic ptosis is abnormal position of the upper eyelid caused by dysfunction or damage to the oculomotor or sympathetic nerves supplying the eyelids. Third nerve palsy (35.7%) is the most common cause among others. We report a case of neurogenic ptosis managed surgically by levator resection.
 Case Illustration : A 67-year-old male complained of drooping left upper eyelid, getting worse in 7 months. He had history of falling off motorcycle 6 months ago. Clinical histories of hypertension and diabetes mellitus were found. Right and left eyelids measurements in millimeter showed horizontal palpebral fissure (HPF) 28/26, vertical palpebral fissure (VPF) 6/3, margin reflex distance 1 (MRD1) 2/-2, margin reflex distance 2 (MRD2) 6/5, margin limbal distance (MLD) 8/4, and levator function (LF) 8/3. Bell’s phenomenon was negative in both eyes. Ice pack test was negative. There were ocular movement restriction in his left eye. Patient underwent a maximum levator resection and had better levator function after 3 weeks follow up.
 Discussion : Neurogenic ptosis caused by third nerve injury is associated with microvascular ischemia such as diabetes mellitus and hypertension. Operative management is carried out after 3 to 6 months observation. Evaluation of levator function allows the clinician to correctly classify the degree and type of ptosis. Maximal levator resection is the treatment of choice for ptosis with poor levator function.
 Conclusion : Although various surgical techniques have been developed, ptosis correction should be performed according to the indications and clinical condition of the patient.

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

POSTOPERATIVE COMPLICATIONS OF ORBITAL TUMOR REMOVAL IN SARDJITO GENERAL HOSPITAL

Abstract
 Introduction & Objectives : Orbital tumor removal surgery represent a small but significant portion of ophthalmologic surgery, and few reports of the associated complications are available. The aim of this study is to report the complications of orbital tumor removal surgery in Sardjito General Hospital, Yogyakarta.
 Methods : Descriptive retrospective study was carried out 138 patients who undergone orbital tumor removal surgery during July 2021-March 2023. Surgery approach and postoperative complications were collected from medical record.
 Results : Of approximately 138 patients, 12 (8%) patients had postoperative complications. Five (5%) of 75 patients who undergone anterior orbitotomy had postoperative complications. One percent had lagophthalmos, 1% had ptosis, 2% had decreased vision, and 1% had ocular movement disorders. Lateral orbitotomy was done in 21 patients. Three (12%) patients had postoperative complications. Four percent had ptosis, 4% had decreased vision, and 4% had ocular movement disorders. Four (60%) of 6 patients who undergone medial orbitotomy had ptosis (16%) and decreased vision (50%). Posterior orbitotomy was done in 8 patients. One (12,5%) patient had complication of ptosis.
 Conclusion : Anterior orbitotomy was the most common surgery approach for orbital tumor removal. The most common postoperative complications were ptosis and decreased vision. Informed consent is an important aspect to improve patient’s knowledge of postoperative complications.

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

ORBITAL TRAUMA IN A CHILD WITH RETROBULBAR HEMORRHAGE

Introduction : Retrobulbar hemorrhage vision threatening condition associated with cranio- facial trauma. Rapidly fill the orbit and cause an “orbital compartment syndrome” that subsequently cuts off perfusion to vital ocular structures. Treatment must be initiated immidietly to prevent permanent visual loss.
 Case Illustration : 10-year-old boy, with left eye blurring of vision, swelling and multiple facial injury post motor accident. Visual acuity was perception of light on left eye, 6/5 and right eye with upper and lower lid laceration wounds. He had a dense afferent pupillary defect and the ocular movements of the left eye were limited in all directions of gaze. The orbit was tense with significant resistance to retropulsion. Diagnosed with acute retrobulbar haemorrhage following blunt trauma with medial wall fracture. Intravenous acetazolamide and timolol was commenced continued with emergency lateral canthotomy. His vision immediately improved to 6/60 and 3 hours later was 6/18. He was treated for left traumatic optic neuropathy with IV Mehtylprednisolone for 3 days followed two weeks oral prednisolone
 Discussion :
 Conclusion : Retrobulbar haemorrhage is a vision-threatening emergency often necessitating immediate lateral canthotomy for preservation of vision. In children, as the optic nerve canal is smaller, a lesser volume is available for the nerve to expand, thus early visual impairment could occur following trauma. Prompt recognition and appropriate treatment of this ocular emergency is imperative, for timely management determines the ultimate outcome.

POSTOPERATIVE COMPLICATIONS OF ORBITAL TUMOR REMOVAL SURGERY IN SARDJITO GENERAL HOSPITAL

Introduction: Orbital tumor removal surgery represent a small but significant portion of ophthalmologic surgery, and few reports of the associated complications are available. Methods: Descriptive retrospective study was carried out 138 patients who undergone orbital tumor removal surgery during July 2021-March 2023. Surgery approach and postoperative complications were collected from medical record. Results: Of approximately 138 patients, 12 (6%) patients had postoperative complications. Five (5%) of 75 patients who undergone anterior orbitotomy had postoperative complications. One percent had lagophthalmos, 1% had ptosis, 2% had decreased vision, and 1% had ocular movement disorders. Lateral orbitotomy was done in 21 patients. Three (12%) patients had postoperative complications. Four percent had ptosis, 4% had decreased vision, and 4% had ocular movement disorders. Four (60%) of 6 patients who undergone medial orbitotomy had ptosis (16%) and decreased vision (50%). Posterior orbitotomy was done in 8 patients. One (12,5%) patient had complication of ptosis. Conclusion: Anterior orbitotomy was the most common surgery approach for orbital tumor removal. The most common postoperative complications were ptosis and decreased vision. Informed consent is an important aspect to improve patient’s knowledge of postoperative complications.

Competing Visual Cues Revealed by Electroencephalography: Sensitivity to Motion Speed and Direction.

Motion speed and direction are two fundamental cues for the mammalian visual system. Neurons in various places of the neocortex show tuning properties in term of firing frequency to both speed and direction. The present study applied a 32-channel electroencephalograph (EEG) system to 13 human subjects while they were observing a single object moving with different speeds in various directions from the center of view to the periphery on a computer monitor. Depending on the experimental condition, the subjects were either required to fix their gaze at the center of the monitor while the object was moving or to track the movement with their gaze; eye-tracking glasses were used to ensure that they followed instructions. In each trial, motion speed and direction varied randomly and independently, forming two competing visual features. EEG signal classification was performed for each cue separately (e.g., 11 speed values or 11 directions), regardless of variations in the other cue. Under the eye-fixed condition, multiple subjects showed distinct preferences to motion direction over speed; however, two outliers showed superb sensitivity to speed. Under the eye-tracking condition, in which the EEG signals presumably contained ocular movement signals, all subjects showed predominantly better classification for motion direction. There was a trend that speed and direction were encoded by different electrode sites. Since EEG is a noninvasive and portable approach suitable for brain-computer interfaces (BCIs), this study provides insights on fundamental knowledge of the visual system as well as BCI applications based on visual stimulation.

Alteration Ocular Motility in Retinitis Pigmentosa: Case-Control Study.

To evaluate ocular motility (OM) disorders and strabismus in a sample of patients with retinitis pigmentosa (RP) and a control sample. In this cross-sectional retrospective analysis, we studied a sample of RP patients with a mean age of 48.74 years and an average visual acuity of 7/10 based on Snellen optotype and a sample of control patients with similar mean age (49 years [men], 47 years [women]) and sex and an average visual acuity of 9.9/10, with the aim of assessing correlations between alteration of OM and strabismus in RP patients based on age, high refractive defect, or severely impaired binocular vision. The examination followed a protocol of testing for anamnesis and best-corrected visual acuity, as well as a complete eye examination, corneal reflex, cover test, OM, Hess screen, and Lang test. At the first orthoptic evaluation, 45.16% of patients showed strabismus, 41.93% exotropia (25% of cases intermittent), 3.22% esotropia, and 6.45% vertical deviation. Later evaluation showed strabismus in 25.80% of patients, exotropia in 19.35% (9.67% intermittent), esotropia in 3.22%, and vertical deviation in 3.22%. Assessment of eye motility study showed 51.6% overaction of the inferior oblique and hypofunction of the superior rectus, and 18% overaction of the lateral rectus and hypofunction of the medial rectus. According to our results, alterations in OM and strabismus in RP patients are not correlated with age or high refractive defect. Therefore, motility disorders and strabismus are attributed to a genetic factor to which men are more susceptible. The incidence of OM disorder was 77.42%, and strabismus was present in 45.16% of patients.

Understanding Visual Disorders through Correlation of Clinical and Radiologic Findings.

Patients presenting with visual disturbances often require a neuroimaging approach. The spectrum of visual disturbances includes three main categories: vision impairment, ocular motility dysfunction, and abnormal pupillary response. Decreased vision is usually due to an eye abnormality. However, it can also be related to other disorders affecting the visual pathway, from the retina to the occipital lobe. Ocular motility dysfunction may follow disorders of the cranial nerves responsible for eye movements (ie, oculomotor, trochlear, and abducens nerves); may be due to any abnormality that directly affects the extraocular muscles, such as tumor or inflammation; or may result from any orbital disease that can alter the anatomy or function of these muscles, leading to diplopia and strabismus. Given that pupillary response depends on the normal function of the sympathetic and parasympathetic pathways, an abnormality affecting these neuronal systems manifests, respectively, as pupillary miosis or mydriasis, with other related symptoms. In some cases, neuroimaging studies must complement the clinical ophthalmologic examination to better assess the anatomic and pathologic conditions that could explain the symptoms. US has a major role in the assessment of diseases of the eye and anterior orbit. CT is usually the first-line imaging modality because of its attainability, especially in trauma settings. MRI offers further information for inflammatory and tumoral cases. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Amblyopia rehabilitation: A preliminary study on the efficacy of an alternative therapeutic method within Italian patients.

Amblyopia is the medical term for a "lazy eye." It occurs when vision in one or both eyes does not develop properly during childhood even though there is no structural abnormality of the eye. It consists of an interocular difference of two lines or more in a visual acuity table (without specifying any), or visual acuity worse than or equal to 20/30 Snellen Feet equivalent to 0.2 LogMAR, with the best optical correction. (American Academy of Ophthalmology) Patching is the international gold standard amblyopia treatment, based on a monocular stimulation of the eye with lower vision. It needs high compliance and a long period of treatment during plastic age. The purpose of our work is to evaluate the efficiency of a different and faster method for amblyopia rehabilitation, useful even for patients out of the plastic age: specifically homebased binocular rehabilitation therapy through specific smartphone/tablet games combined with anagliphyc glasses. This method, due to its ease of use, high compliance and cheap cost, could reach a great number of patients that until now have the risk of being abandoned if they are not able, for different reason, to follow the others common therapies. Fifty-five patients: mean age 8.98 ± 5.38, underwent ophthalmologic and orthoptic evaluations for amblyopia: BVCA with ETDRS logMAR, stereoacuity with Lang Stereotest I, ocular motility examination, fundus oculi and cycloplegic refraction examination. Eligible children had ⩾0.2 (as applicable) logMAR interocular difference, or BVCA worse or equal to 0.2 LogMAR. Patients were rehabilitated with specific dichoptic treatment by digital videogames for 1 hour/day for 2 months. Children wore red-blue anaglyphic glasses to play the games (with low-contrast components visible to 1 eye and high-contrast components visible to the other eye) for 7 hours per week (1 hour per day) for 8 weeks, with 2 outcome examinations programmed by protocol at 4 and 8 weeks from baseline. After 8 weeks of treatment, amblyopic eye BCVA improved from 0.28 ± 0.13 logMAR at baseline to 0.10 ± 0.09 (P < .05) logMAR, with an improvement of 0.18 ± 0.09 logMAR. Achieved results relating to visual acuity improvements using binocular rehabilitation by digital videogames were statistically significant and encouraging. It is important that research and experimentation does not cease at this stage. Larger sample sizes, extended rehabilitation treatment periods and longer follow-up must be undertaken, in order to obtain objective data relating to visual acuity maintenance and also to obtained visual acuity results linked to age.

Metastasis to orbit: A case series from tertiary eye center in Western India

This study aims to understand the pattern of the metastatic tumors to orbit in a tertiary eye center. Metastasis to orbit is extremely rare and challenging to diagnose and often mimics with primary orbital tumor. Due to the tremendous recent advances in cancer therapy, surveillance, ancillary histopathology, and imaging techniques for primary tumor diagnosis, the longevity of patients increases, leading to more chances of detection of orbital metastasis. We retrospectively studied and reviewed a case series of five patients with orbital metastasis from various systemic malignancies from 2018 to 2023. Out of five patients, three patients were from metastasis from breast carcinoma, one from neuroblastoma, and monophasic synovial sarcoma each, found a median age of 49 years (range=3–70 years). The most common symptoms and sign were painful proptosis and restriction of ocular motility, respectively.

A systematic literature review and narrative synthesis on the use of autologous cartilage in the repair of orbital fractures

Introduction: Fractures of the orbit are common injuries within the maxillofacial skeleton, and can often result in restrictions to ocular movement, diplopia, and enophthalmous if herniation of globe content occurs. Various studies have demonstrated the use of autologous cartilage grafts in the reconstruction of orbital fractures. Methods: A systematic review protocol was registered with PROSPERO, and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies of four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. Results: Seven thousand one hundred seventy-one articles were identified following a comprehensive literature search. These articles were filtered for relevance and duplication, which reduced the number of articles to 16. A total of 259 patients underwent orbital reconstruction with the use of autologous cartilage. Conchal cartilage was harvested in 148 patients, auricular cartilage in 22 patients, nasoseptal cartilage in 72 patients, and costal cartilage in 17 patients. Thirty, seven, twelve, and four complications were observed in patients where cartilage was harvested from the concha, auricle, nasoseptum and rib, respectively. Most common complications included diplopia (n=23), infra-orbital para/anaesthesia (n=27), and enophthalmos (n=7). No failure of graft or donor site morbidity were observed in the studies. Conclusion: Autogenous materials such as cartilage can be used as an alternative for orbital reconstruction. Cartilage was considered by the authors to provide adequate structural support to the orbital contents, and that it was easy to harvest, shape, and position.