Ophthalmic Presentation Research Articles

Quel choix pour un collyre de corticoïdes : solution ou suspension ?

The various forms of ophthalmic pharmaceutical presentation of steroids is proliferating on the market: solutions, gels, and suspensions. Suspensions are characterized by particles in solution and require agitation before instillation. This trial studied the impact of agitation on the corticoid concentration of eye drop solutions, gels, and suspensions. Corticosteroid levels in a drop of a dexamethasone solution or suspension or betamethasone suspension or gel were compared using liquid chromatography. These levels were measured after shaking for 5, 10, 30s, and 1 min using a vortex or without shaking. The results of this study show that, whatever shaking time was used, the suspension form seems less suited to instillation of corticosteroids. The suspension did not deliver consistent levels of corticosteroids (mean between 23 and 99%) compared to solutions and gels, which released about 100% of the corticosteroid content in each drop. Physicians, ophthalmologists, and pharmacists should remind the patient of the proper use of these suspensions before instillation. In cases of treatment failure, it is necessary to check the instillation method before questioning patient compliance.

Smoking and Strabismus Surgery in Patients with Thyroid Eye Disease

To investigate the relationship between smoking status at presentation and the use of strabismus surgery in the management of patients with thyroid eye disease. Retrospective review of a noncomparative series of patients with thyroid eye disease. All patients with thyroid eye disease under the care of a single consultant at Moorfields Eye Hospital between 1997 and 2002 (inclusive). Retrospective review of clinical case notes. Survival analysis of patients in cohort and the frequency of strabismus surgery in relation to smoking status at ophthalmic presentation. A subanalysis of patients who underwent orbital decompression and those that did not was undertaken. Of 501 patients seen during the study period, 425 (85%) of 501 sets of notes were available for review, and initial smoking status was recorded for 89% (378/425) of patients, of whom approximately one half (196/378; 52%) were active smokers. Of the smokers, 51 (26%) of 196 underwent strabismus surgery, compared with only 19 (14%) of 138 nonsmokers at presentation. When adjusted for age, the hazards ratio of having strabismus surgery during management for smokers at presentation versus nonactive smokers was 2.19. In the group who did not undergo orbital decompression, this hazard ratio increased to 4.86. Within this thyroid eye disease cohort, the proportion of smokers at presentation was much larger than that of the general population. There was an increased use of strabismus surgery in active smokers at presentation than in nonactive smokers. This finding was independent of the orbital decompression surgery. The results are consistent with those of previous reports of more severe thyroid eye disease in smokers and raise the possibility that smoking cessation early in the disease may reduce the severity of the changes and the number of rehabilitative strabismus operations needed. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Influence of weather conditions on ophthalmic emergency presentations

Clinical & Experimental OphthalmologyVolume 40, Issue 3 p. 322-323 Influence of weather conditions on ophthalmic emergency presentations Thomas K Young MBBS, Thomas K Young MBBS Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this authorJonathan B Ruddle FRANZCO, Jonathan B Ruddle FRANZCO Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this authorCarmel Crock FACEM, Carmel Crock FACEM Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this authorAlex W Hewitt PhD, Alex W Hewitt PhD Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this author Thomas K Young MBBS, Thomas K Young MBBS Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this authorJonathan B Ruddle FRANZCO, Jonathan B Ruddle FRANZCO Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this authorCarmel Crock FACEM, Carmel Crock FACEM Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this authorAlex W Hewitt PhD, Alex W Hewitt PhD Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye & Ear Hospital, East Melbourne, AustraliaSearch for more papers by this author First published: 18 April 2011 https://doi.org/10.1111/j.1442-9071.2011.02587.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume40, Issue3April 2012Pages 322-323 RelatedInformation

Varied Ophthalmic Presentations in Sphenoid Sinus Lesions

ABSTRACT Sphenoid sinus lesions can present with a multitude of symptoms/signs including ophthalmic disturbances. We describe a total of five patients, of which two had mucoceles and rest three had fungal infection. Ophthalmic symptoms/signs were the ones we were really interested in. We also present one case which had isolated sphenoid fungal sinus. We also give details of their presentation, investigations and treatment. Possible ocular manifestations of mucoceles and the diagnostic imaging techniques used are discussed. The treatment of mucoceles is reviewed. It is stressed that a team approach involving the ophthalmologist, otolaryngologist and radiologist is essential for accurate diagnosis and management.

Ophthalmic manifestations of allergic fungal sinusitis

Background: Orbital complications of allergic fungal rhinosinusitis (AFRS) are uncommon but can result in significant morbidity if inappropriately managed.Objective: To evaluate the clinical presentation, diagnosis, management, and outcome of orbital complications of AFRS.Methods: Retrospective chart review of 200 cases diagnosed with AFRS.Results: Thirty-two patients had orbital complications of which the most common ophthalmic presentation was proptosis (83%), followed by epiphora (33%), ophthalmoplegia (33%), diplopia (22%), visual loss (13%), and subperiosteal abscess (6%). CT sinus scans showed that 62% of patients had erosion of the lamina papyracea, 24% had intraorbital extension of the disease associated with skull base erosion, 16% presented with bilateral erosion of lamina papyracea, 50% presented with bilateral pansinusitis, and 61% had right-sided predominance.Conclusion: Although orbital complications of AFRS are uncommon, they can be serious and necessitate immediate surgical intervention. Ophthalmologists and otorhinolaryngologists should be familiar with these complications.

Syphilitic retinitis and uveitis in HIV‐positive adults

The incidence of new infection with syphilis is increasing, particularly in men who have sex with men, with HIV co-infection common. There has been a corresponding increase in ophthalmic manifestations that can be varied in presentation. Thirteen consecutive patients with syphilitic uveitis presenting to two ophthalmic departments in Sydney are described. Twelve patients were male, of whom 10 were homosexual and six HIV-positive. Peripheral retinitis with panuveitis was the commonest ophthalmic presentation (n = 7, 54%), and six cases were initially treated with vitreous tap and intravitreal foscarnet as a precaution in case of viral retinitis. Retinitis was present in six of six (100%) HIV-positive and only one of seven (14%) HIV-negative patients (χ² 10.6, P < 0.01). Other ophthalmic presentations included anterior uveitis, vitritis, multifocal choroiditis, scleritis and papillitis. All patients responded to 10-14 days' intravenous penicillin with good final visual outcomes (6/12 or better in all eyes). This case series reinforces the importance of considering syphilis in the differential diagnosis of many ocular presentations, but in particular retinitis. Retinitis appears to be the predominant presentation in HIV-infected individuals, suggesting that HIV infection may somehow modulate the disease.

Attention deficit hyperactivity disorder: diagnosis and treatment masking the ophthalmic clinical presentation of a pineal gland tumour in a teenager

A 17-year-old male was found to have a fourth cranial nerve palsy and chronic papilloedema following his presentation to our institution with a 6-week history of blurred vision in both eyes and vertical binocular diplopia. A diagnosis of pineal germinoma was made following imaging studies and endoscopic neurosurgical biopsy of the tumour. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) 3 years earlier and treated with amphetamines. Since this diagnosis, he continued to suffer from hyperactive behaviour, poor concentration, worsening headaches and insomnia. Pineal pathology has a known association with sleep disturbance through the disturbance of melatonin synthesis and/or metabolism. This case report serves to highlight how the presence of organic brain disease presenting to an eye department can be masked by a diagnosis of ADHD.

Operational Morbidity Analysis: Ophthalmic Presentations During Operation Telic

AimThis paper analyses all ophthalmic attendances to a deployed emergency department (ED) in Iraq to identify patterns of injury to optimise patient care, plan equipment tables for future operations and...

Hunter's syndrome and buphthalmos in a girl: an unusual ophthalmic association

Abstract Purpose To report an unusual ophthalmic presentation of a case of Hunter's syndrome/MPS II. Methods A sixteen‐year‐old girl presented to us with total loss of vision and forward protrusion OU since early childhood. Detailed examination, including slit lamp biomicroscopy, Intra ocular pressure (IOP) and fundoscopy was carried out. Thorough systemic evaluation including Computed Tomography (CT), metabolic and genetic analysis was undertaken in collaboration with internists. Results Characteristic facies, detection of glycosaminoglycan (GAG) variants in urine (chondroitin sulfate B and heparin sulfate) and iduronate‐2‐sulphatase activity in fibroblasts/leucocytes confirmed the diagnosis of MPS II. Child had severe photophobia but with no perception of light OU. OU buphthalmos with Haab's striae was noted, making a clear view of the fundus difficult. IOP OU was elevated, and 90D slit lamp biomicroscopy revealed a total glaucomatous optic atrophy in both eyes.On CT there was thickening and edema of preseptal and periorbital soft tissue with marked thinning of the optic nerves with prominent perineural CSF sleeves, indicative of marked optic atrophy. Conclusion Glaucoma is a known association of Hurler's, Scheie's and Maroteaux‐Lamy syndromes but not Hunter's. In fact, there is only one report of suspected angle closure glaucoma in MPS II. Buphthalmos is not a likely presentation as the sclera in these patients is known to be thickened due to deposition of GAG. To the best of our knowledge, this is the first case report of buphthalmos in association with MPS II. The importance of a meticulous examination in this subset of patients cannot be overemphasised. An appropriate and timely intervention may result in a better quality of life for them.

Ophthalmic Presentation of Plasma Cell Neoplasm

A 64-year-old white man presented with a plasma cell neoplasm in the right lacrimal sac. After successful surgical excision and radiation treatment, he developed a local adjacent recurrence, which again responded to radiation. He subsequently developed a distant plasma cell neoplasm in the humerus, but he continues to have no sign of multiple myeloma on systemic evaluation during 2 years of follow-up. This unusual case is compared with other reported cases of plasma cell neoplasm in the published literature.

Common ophthalmic emergencies

Ophthalmic emergencies are immediate threats to the visual system that can lead to permanent loss of visual function if left untreated. These emergencies should be detected by physicians and immediately treated and referred to an ophthalmologist if necessary. This article reviews the most common ophthalmic emergency room presentations, the history and physical examination for an ophthalmic emergency, and the diagnosis and management of each condition.

Traumatic extracranial pseudoaneurysm on the peripheral ophthalmic artery presenting as delayed intraparenchymal hematoma: case report

Background Extracranial pseudoaneurysm is barely noticed after head injury, and therefore, recognizing such sequels is amenable when there is severe initial injury, unexplained intracranial bleeding, or neurologic sequelae. We report such an unexpected case of intraorbital pseudoaneurysm presenting as delayed intraparenchymal hemorrhage. Case Description A 71-year-old man with traumatic brain injury sustained delayed intraparenchymal hemorrhage after unremarkable surgical evacuation. Suspicious intraorbital mass was shown adjacent to the fracture line of medial orbital wall. Catheter angiogram revealed peripheral, extracranial ophthalmic artery pseudoaneurysm, and endovascular occlusion was attempted. The patient made gradual recovery with radiographic evidence of disappeared pseudosac and resolved intracranial hematoma. Conclusion Traumatic aneurysm of peripheral ophthalmic artery should be strongly suspected when there is skull fracture at the orbital wall or persistent or delayed intraparenchymal hemorrhage despite proper surgical hematoma evacuation, and in such case, swift endovascular occlusion can be done safely.

Neuro-Ophthalmic Manifestations of Intracranial Cavernous Hemangiomas

To describe the neuro-ophthalmic manifestations of patients with intracranial cavernous hemangiomas (cavernomas). A retrospective review of all patients with intracranial cavernomas with neuroophthalmic manifestations who were treated at the Royal Adelaide Hospital in Australia between 1994 and 2004. There were nine patients (three men and six women), with a mean age of 39 years (range 22-61). There was one cerebellar lesion, two thalamic, four pontine, one midbrain/pontine, and one midbrain. Ophthalmic presentations included internuclear ophthalmoplegia (one patient), third cranial nerve (CN) palsy (one patient), fourth CN palsy (one patient), and sixth CN palsy (six patients). Three patients underwent extraocular muscle surgery, and six were treated medically or observed. In five patients the diplopia resolved, in three it was only mild, and in one patient no significant change was noted during the follow-up period. Diplopia is the main neuro-ophthalmic manifestation of intracranial cavernomas. Sixth CN palsy is the most common cause. Neurosurgical or conservative treatment leads to improvement in most cases, and later use of spectacles or extraocular muscle surgery may lead to further improvement.

A Case of Multiple Cranial Nerve Palsies as the Initial Ophthalmic Presentation of Antiphospholipid Syndrome

PurposeTo report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS).MethodsMedical records of a 16 year old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed.ResultsA 16 year old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH2O. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS.ConclusionsTo our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.

Clinical Ophthalmic Presentations of Central Neurocytoma

Central neurocytoma is a rare tumor of the central nervous system occurring in young adults, typically located in the lateral ventricles and around the foramen of Monro. The neoplasm is composed of uniform round cells with neuronal differentiation and is associated with a varied biologic behavior. We report 2 cases of central neurocytomas presenting to the ophthalmologist as chronic progressive blurring of vision. The available literature on the presentation, pathology, and treatment of central neurocytomas is also reviewed.

Neuroblastoma with orbital metastasis: ophthalmic presentation and role of ophthalmologists

Neuroblastoma is predominantly a tumour of early childhood, which metastasises to the orbits. In such cases, ophthalmologists are involved in the multidisciplinary management. This unique series from a tertiary referral centre is used to elaborate the ophthalmic associations and the ophthalmologist's role in this rare condition. A review of case notes was performed on six patients who presented to the paediatric ophthalmology - oncology liaison service at the Leeds teaching hospitals between 1998 and 2003. The ophthalmic outcome and role of the ophthalmologist were assessed. Average age of presentation was 29.8 months (range 15-69 months). Average duration of follow-up was 19.5 months (range 2-58 months). One child died during treatment. Two have completed treatment and are under follow-up. Presenting features of the six children were proptosis in four, periorbital ecchymosis in two, ocular motility restriction in two, and subconjunctival haemorrhage in one. Only one case developed blindness. The role of the ophthalmologist in patients with metastatic orbital neuroblastoma can vary from a supportive role to one of active intervention and management of ophthalmic complications. The ophthalmologist is involved in diagnosis and staging as well as monitoring response to treatment of both the primary disease and secondary ophthalmic complications.

Rare Extra-articular Manifestation of Rheumatoid Arthritis: Scleromalacia Perforans

Rheumatoid arthritis is a systemic disease with manifestations in many organs. In most cases, involvement of the locomotor system dominates the clinical picture. However, extra-articular manifestations can be detected in almost any organ system with varied incidence in different series. Ophthalmic presentations include Sjogren's syndrome, episcleritis, and scleritis. The most severe form of scleritis, scleromalacia perforans, is a very rare ophthalmic manifestation. We present the case of a 60-year-old man who had had rheumatoid arthritis for more than 10 years. He had scleromalacia perforans but no other extra-articular manifestations.

Ophthalmic Presentations in Leprosy Patients in (South-Eastern) Nigeria

Objective: To determine the magnitude and pattern of ocular disorders and blindness among leprosy patients, presenting at three leprosy clinics in South —Eastern Nigeria. Methodology: All the in- patients, as well as the out- patients that presented to the 3 leprosy clinics during the 2- month period of the study were examined. Altogether, 171 patients were studied. All data were entered into the computer and analyzed using the SPSS software package. Results: Ocular examinations revealed that 60.2% of the patients had leprotic lesions. Other findings were cataract 24.6%; pterygium 24.6%; refractive errors 21.6%; glaucoma 12.3%; age- related macular degeneration 4.6%; presumed toxoplasmosis 1.2%; optic atrophy 1.2% and squint 0.6%.A total of 10.5% of patients were blind and 39.8% visually impaired. Cataract accounted for 55.6% blindness. Conclusion: It is concluded that non- leprotic lesions, particularly cataract were responsible for most of the blindness. We recommend that ophthalmic surgeons should organize regular and periodic surgical outreaches to leprosy centers with the aim of dealing with non- leprotic causes of avoidable blindness in such centres. Key Words: Leprosy, Leprotic eye lesions, non-leprotic eye lesions, surgical outreaches. Orient Journal of Medicine Vol.16(3&4) 2004: 18-24

Metastatic mesothelioma presenting with proptosis

Purpose To describe the clinical presentation and histologic findings in a patient with metastatic mesothelioma presenting to the ophthalmologist with nonaxial proptosis. Design Case report. Methods A 55-year-old man presented with a short history of progressive ocular discomfort and vertical diplopia. Clinical examination identified nonaxial proptosis. Subsequent computed tomography showed a large extraconal mass consistent with a malignant process. Three months earlier the patient had been diagnosed with pleural mesothelioma. Unfortunately, he died 3 months after his ophthalmic presentation. Postmortem examination confirmed metastatic mesothelioma in the orbital roof that was histologically identical to the primary pleural malignancy. Conclusion Pleural mesothelioma can metastasize to the orbit, causing proptosis.

Cataract in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD)

Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is a rare metabolic disorder that can lead to acute encephalopathy, liver disease, cardiomyopathy, rhabdomyolysis, and long-term complications involving the eye and peripheral nerves. LCHADD is a peroxisome biogenesis disorder (PBD). Except for the series presented by Tyni and colleagues ( Ophthalmology 1998;105:810–824), which described visually insignificant lens opacities in association with LCHADD, previous ophthalmic papers have only reported retinal complications. We report on one case with progressive asymmetrical cataract. The more mildly affected eye had a similar morphology to that previously reported and the more severely affected eye had an unusual morphology we believe is unique to LCHADD. We discuss the range of ophthalmic presentations in our cases and in the literature. The variability of the severity of ocular complications, even between eyes in one individual, makes it difficult to test the effectiveness of therapeutic options upon the ophthalmic complications.