Ophthalmologic Signs Research Articles

Case Report: Atypical post-COVID Cogan's syndrome

Background Cogan’s syndrome is a rare autoimmune disorder characterized by ocular inflammation, vestibulocochlear dysfunction, and systemic vasculitis. Case Presentation We report a 28-year-old female who experienced decreased visual acuity and ocular redness one month after a COVID-19 infection, with ophthalmological signs linked to keratitis, uveitis and retinal vascularitis. Two weeks later, she developed vertigo, tinnitus, and sudden hearing loss, leading to a diagnosis of Cogan’s disease. The patient received corticosteroid therapy, resulting in regression of ophthalmological signs, but progressed to complete deafness. One month later, she presented with lymphocytic meningitis and high intracranial pressure, which improved under treatment. The patient later received cochlear implants. Objective This case report aims to highlight an atypical presentation of Cogan’s syndrome with neurological involvement following a COVID-19 infection. This case contributes to the limited literature on such presentations. Conclusion Our case is one of only two reported instances of Cogan’s syndrome presenting with neurological signs post-COVID-19 infection, underscoring the rarity and complexity of this condition.

A rare presentation of saccular aneurysm at junction of middle carotid artery and internal carotid artery mimicking the normal tension glaucoma

Acquired (pathologic) excavation of the optic cup is not always due to glaucoma. Ophthalmological signs of pathological disc cupping have been recognised in patients with normal intraocular pressures and with optic atrophy of various causes including ischaemic and compressive optic neuropathy, optic neuritis and trauma. Intracranial lesions have been reported to mimic the clinical presentation of glaucomatous optic disc changes and have also resulted in misdiagnosis. Optic atrophy caused by intracranial lesions shows pallor more than cupping. The macular nasal–temporal ratio compares the nasal and temporal thickness of the macular ganglion cell and inner plexiform layer and can be used to differentiate between compressive and non-compressive lesions as depicted in this case. This case report also suggests the importance of different imaging modalities in diagnosing compressive lesions and differentiating them from similar conditions.

Ophthalmological Disorders and Laboratory and Clinical Indicators in Women with Hypertensive Pregnancy Complications

Introduction. Hypertensive disorders during pregnancy, despite many epidemiological studies, scientific developments, and the improvement of laboratory and instrumental techniques for searching for predictors of preeclampsia, are a serious problem of perinatal obstetrics. One of these areas may be an in-depth ophthalmological examination.The aim of the work is to perform an analysis of ophthalmological disorders and laboratory, clinical parameters in women with hypertensive complications of pregnancy.Materials and methods. A retrospective analysis of 573 cases of hypertensive pregnancy complications was performed. The age of the patients ranged from 15 to 50 years. All patients received a standard general clinical and obstetric examination, examined by an ophthalmologist. A correlation analysis of some laboratory and clinical signs of arterial hypertension (AH) and preeclampsia (PE), including ophthalmological signs of PE, was carried out. Results: PE was accompanied by retinal angiopathy in 67 % of cases. In 9 cases (1.86 %), peripapillary edema was detected in PE. In the presence of peripapillary edema, earlier delivery dates and a lower Apgar score were observed in the newborn. Macular edema was registered in 3 cases (0.62 %) against the background of gestational diabetes mellitus.Conclusion. Comparative analysis has shown the presence of correlations between signs of hypertensive complications of pregnancy and changes in the organ of vision. The expansion of ophthalmological research may provide new markers-indicators for the differential diagnosis of hypertensive complications of pregnancy, assessment of the severity of the condition, dynamic monitoring and choice of management tactics for patients with hypertensive complications of pregnancy.

Cerebral venous thrombosis and the eye: the neuro-ophthalmology of cerebral venous blood clot

Introduction: Cerebral venous thrombosis (CVT) is a form of venous thromboembolism which has varied clinical presentation. Ocular clinical features are quite common in CVT and may be the sole presenting feature and often tend to get misdiagnosed. This study was conducted to analyse clinical features especially neuro ophthalmological manifestations in CVT patients. Materials and Methods: In this prospective study 60 patients were enrolled in a study period of 3 years at tertiary care hospital. Follow up visits were performed at 1 month, 3 months, 6 months and 12 months after the initial diagnosis. We analysed the clinical features as well as aetiology of CVT, special focus was on the ocular symptoms and signs. Results: Headache was the most common clinical symptom with 93.33% patients. Among ocular symptoms 43.33 % patients presented with complaint of blurring of vision. Among ophthalmological signs papilledema was reported in 40.0 % patients, cranial nerve involvement in 10.0 % patients, diplopia was seen in 6.66 % patients. In patients with papilledema the intensity reduced as time progressed. Vision loss was seen in 2 patients who had secondary optic atrophy. Conclusion: To avoid misdiagnosis and for the prevention of vision deterioration the ophthalmologist must pay attention to CVT symptoms and signs when patients present with ocular symptoms as the initial manifestation.

Endovascular treatment of intracranial dural arteriovenous fistulas with Onyx: A consecutive series of 62 patients from a single-center.

Intracranial intracranial dural arteriovenous fistulas (DAVFs) are mainly treated with an endovascular approach and various embolic agents. The aim of this study was to investigate the efficacy and safety of Onyx embolization in the treatment of DAVFs and characterize the factors as sociated with complete obliteration. This retrospective study was based on 62 patients with DAVFs who underwent endovascular treatment with Onyx alone or in combination with coils at our institution. Clinical and imaging data were collected and analyzed. A total of 62 patients with 64 DAVFs were treated with endovascular embolization. The most common primary symptom was ophthalmological signs with a rate of 37.1%. Cognard type III was the most commonly seen subtype (32.8%). The immediate complete occlusion and follow-up rate was 92.2% and 93.5%, respectively. Transvenous balloon-assisted sinus protection was used in 12 patients (18.8%). The pressure cooker technique was used in eight patients (12.5%). Complications were seen in five patients including intracerebral hemorrhage (n = 2), venous thrombotic events (n = 2), and glued microcatheter (n = 1). Endovascular Onyx alone or in combination with coils embolization is a safe and effective therapy for DAVFs. Favorable angiographic and clinical outcomes can be achieved using different endovascular approaches. Transvenous balloon-assisted sinus protection and the pressure cooker technique may help achieve complete occlusion of DAVFs.

Ophtalmologic, Serologic and Therapeutic Aspects of Ocular Toxoplasmosis Toxoplasmose Oculaire: Aspects Ophtalmologiques, Sérologiques et Thérapeutiques

Ocular toxoplasmosis (OT) is the most frequent cause of inflammation of the posterior segment of the eye due to infectious causes. It can occur in congenital toxoplasmosis, in the immunocom promised and, more rarely, in the immuno competent. It is a critical disease, as it can lead to blindness. The aim of our study was to investigate the clinical, serological, and therapeutic features of TO. Methods: A bicentric retrospective study was conducted at the Parasitology-Mycology laboratories of two Tunisian Hospitals(2017-2021), involving toxoplasma serologies performed on 175 patients in the context of exploration for uveitis and on six babies with congenital toxoplasmosis. As screening technique, we used was electrochemilum inescence (Cobas® e411) and Enzyme Linked Filtration Assay (mini-Vidas®). If IgM and/or IgG were positive, and depending on ophthalmo logical signs, we added a comparative Western Blot (WB) of serum and aqueous humor. Results Serological results were: – no immunity in 71 patients, rejecting OT – long-standing immunity in 103 patients, 15 of whom underwent comparative WB tests, four of which were positive- recent primary infection in one case with a positive WB. Thus, five cases of OT were confirmed(Three panuveitis and two anterior uveitis). Their respective ages were 14, 25, 33, 43 and 50 years old.Ophthalmological follow-up of five babies during the first year of life (one lost at six months) revealed chorioretinitis in one baby only. Conclusion Ocular involvement may represent a late revelation of unrecognized congenital toxoplasmosis. Its occurrence in immuno competent is not exceptional, but remains underestimated, as aqueous humor puncture is not systematically performed due to its invasive nature.

Case of lightning strike in a cow

The article presents a case of two cows struck by lightning, one of which survived. The cows sought shelter under an old, withered willow. Clinical examination involving inspection and palpation revealed neurological signs: right-sided facial nerve palsy characterized by flabby ear droop, ptosis of the upper eyelid and forehead, drooling, palsy of the right orbicular nerve of the eye and ophthalmological signs, such as conjunctival redness, lacrimation, local corneal opacity of the right eye and optic nerve palsy (the pupil did not react to light). The cow also exhibited notable aggression, restlessness and hypersensitivity to touch. The patient was administered NSAID meloxicam twice with a 24-hour interval between doses and a preparation containing butaphosphan and cyanocobalamin. After several days, the signs disappeared, except for a slight right ear droop, which persisted for a long time. The article also discusses the risk of such cases occurring in temperate climate areas. Lightning strikes pose a threat, killing many people and animals worldwide every year.

Odontogenic orbital cellulitis: literature review

Introduction: Odontogenic origin is a rare cause (1.3–5%) of cases of orbital cellulitis, but it can lead to very important morbidity such as blindness or thrombosis of the cavernous sinus. It is therefore important to know how to recognize it. Methods: A literature review was performed. The parameters analyzed included age, sex, ethnicity, clinical presentation, imaging to determine orbital involvement, etiology, microbiology, treatment (medical and/or surgical), and final outcome of each case. Chandler's classification was used to classify the different types of cellulitis. Results: Thirty-five cases of odontogenic orbital cellulitis have been described in literature from 1980 to 2022. In 42.9% of cases, the cellulitis corresponded to an intra-orbital abscess (Chandler stage IV). Thrombosis of the cavernous sinus (stage V) was detected in 5.7% of cases. Periorbital edema (100%), ocular or facial pain (82.9%) and limitation of eye movements (82.9%) were the three most common ophthalmological signs. The anamnesis revealed an element pointing to a dental origin in 97.1% of the cases, the two most frequent being a dental avulsion (20%) or an endodontic treatment (14.3%), in days or weeks preceding the onset of symptoms. Imaging was performed on admission in 94.3% of cases. Regarding the most frequently encountered germs, commensal streptococcus of the oral cavity or anaerobic bacteria were found in 25.7% of cases, and coagulase-negative staphylococcus in 22.9% of cases. In 94.3% of cases, broad-spectrum intravenous antibiotic therapy was initiated as soon as the diagnosis was made. The common feature was the use of metronidazole in 51.4% of cases, combined with a third-generation cephalosporin (11.4%) or amoxicillin-clavulanic acid (8.6%). Orbital drainage was necessary in 71.4% of cases to allow resolution of symptoms, associated with drainage of the maxillary sinus in 45.7% of cases. Finally, the treatment allowed a recovery without sequelae in 80% of cases. Discussion: In case of suspected orbital cellulitis, imaging is crucial to confirm the diagnosis, the type of cellulitis and plan the appropriate surgical treatment. The first step of treatment will be the quick start of a broad spectrum intravenous antibiotic therapy, targeting aerobic and anaerobic bacteria. However, it seems imperative to associate a surgical treatment consisting in a first step of an oral drainage and an elimination of the oral infectious source, as well as an orbital drainage whose approach will have been determined by the imaging. Conclusion: Orbital cellulitis is a rare complication of oral cavity infections, but it must be recognized and treated in time to avoid serious morbidity. An early medical and surgical treatment will usually allow good results and a healing process without sequelae.

Recidiva orbital da leucemia linfoide aguda LLA em crianças: relato de caso

INTRODUCTION: The recurrence of childhood ALL involving the eyeball is a rare event, occurring in 2.2% of children. The presence of specific orbital and ocular lesions is associated with a higher frequency of bone marrow relapses and CNS involvement, leading to a lower survival rate. OBJECTIVES: Conduct a longitudinal observational analysis of cases of orbital recurrences of ALL in children undergoing treatment at a reference oncology hospital in Western Paraná. CASE REPORT 1: 1-year-old female patient, undergoing treatment for ALL, presented with a whitish lesion in her left eye. In consultation with an ophthalmologist, an alteration of the red reflex with vitritis was observed in the left eye, and in the right eye an elevated lesion suggestive of an intraocular mass was seen. After months of investigation, it was concluded that there was orbital recurrence of ALL, and treatment was initiated according to BFM-90 for recurrences. CASE REPORT 2: 2-year-old female patient, undergoing treatment for ALL, presented skin lesions, right periocular edema and divergent strabismus. MRI of the orbit showed diffuse thickening of the optic nerves in their intraconal and canicular segments and part of the cisternal path, suggestive of infiltration of the optic nerves by the underlying disease. After confirming the diagnosis of ALL orbital recurrence, treatment was carried out according to the BFM-90 protocol. CONCLUSION: Through this research, the importance of a thorough evaluation of ophthalmological signs and symptoms in patients diagnosed with ALL was evidenced, for an early diagnosis and treatment.

Posterior embryotoxon as the initial ophthalmological sign of Axenfeld–Rieger syndrome

Posterior embryotoxon as the initial ophthalmological sign of Axenfeld–Rieger syndrome

Observation and assessment of the immediate use of a silicon hydrogel contact lens after transepithelial corneal cross linking: a prospective study

BackgroundTransepithelial corneal crosslinking (CXL) is a novel surgical approach for the treatment of keratoconus, which is a bilateral asymmetrical ophthalmological disease accompanied by progressive corneal ectasia. Silicon hydrogel (SiH) contact lenses have been extensively used in clinical ophthalmologic medicine, as a postoperative ophthalmological intervention. However, the ideal lens application duration after transepithelial CXL remains uncertain. Here, we aimed to investigate the effects and comfort of immediate corneal contact lens use after transepithelial CXL for keratoconus.MethodsIn this prospective study, 60 patients with keratoconus who underwent transepithelial CXL treatment were enrolled from September 2021 to January 2023 with a male:female ratio of 39:21, and an average age of 25.42 ± 5.47 years. The patients were divided randomly into two groups: group A contained 30 patients wearing silicone hydrogel contact lenses for 7 days postoperatively, and group B contained 30 patients wearing the same contact lenses for 3 days.Ten subjective ophthalmologic symptoms were surveyed by the patients, including pain, photophobia, foreign body sensation, tearing, burning, blurred vision, dry eyes, difficulty opening the eyes, astringency, and stinging. Ophthalmologic signs, including corneal edema and conjunctival congestion, were recorded by a single clinician on postoperative days 1, 3, and 7.ResultsEach surgical procedure was readily performed without complications, and both groups postoperative day 7 (P = 0.04), where group B scored (0.01 ± 0.41) lesser than group A (0.12 ± 0.29), whilst corneal edema in both groups recorded significantly different on postoperative days 5 and 7 (group A demonstrated the result of 0.17 ± 0.14 and 0.08 ± 0.11 for the respective days, whereas group B indicated 0.10 ± 0.13 and 0.03 ± 0.07 at the corresponding times).ConclusionsImmediate use of silicone hydrogel corneal lenses after transepithelial CXL effectively alleviates postoperative ocular distress, particularly with a three-day use period as the ideal duration.

Not a usual sight: A rare case of pineal gland tumor associated with Down syndrome presenting with absence of ophthalmologic signs: A case report

We describe a 24-year old man diagnosed with Down syndrome who developed intracranial germinona located at the pineal region who presented with no ophthalmologic signs on neurologic examination on admission. However, after external ventricular device (EVD) insertion, the patient developed upward gaze palsy and convergence retraction nystagmus.

Craniopharyngioma Revealed by Strabismus in a Child: A Case Report

Craniopharyngiom as are rare epithelial tumors, arising from the pituitary gland or pituitary gland and developing in the sellar and supra sellar region. Their diagnosis is often late and is based on the triad of neurological, ophthalmological and endocrine signs. Their treatment is multidisciplinary and includes surgical and hormonal treatment. Their prognosis depends on the precocity of the diagnosis, the location and the size of the tumor.

Unilateral Exophthalmia Revealing Postpartum Thrombophlebitis

Introduction: Cerebral thrombophlebitis of the peripartum is a rare entity but its occurrence is serious and can compromise the vital prognosis. The clinical picture is variable, which makes early diagnosis difficult. Patients and Methods: We report the case of a 28-year-old patient, on oral contraception for 3 years, with no previous history; who presented rapidly progressive bilateral visual acuity loss associated with headaches. The examination revealed a painless exophamia of the left eye without motor deficit, a slight chemosis with subconjunctival venous vasodilatation, associated with a bilateral papillary edema confirmed by OCT. CT scan showing a cerebral thrombophlebitis of the superior longitudinal sinus extended to the jugular vein with slight cerebral edema. The patient was immediately admitted to the intensive care unit and put on heparin therapy and additional immunological tests. Discussion: Pregnancy and postpartum increases the risk of thrombotic events. The most common cause in women of childbearing age is hypercoagulability, associated with the postpartum period, pregnancy, or oral contraceptives which is the case of our patient. Clinical symptoms are very polymorphic. The main thing is to think about it in order to make an early diagnosis. The positive diagnosis is neuroradiological. Improved diagnostic methods and consequent earlier treatment have markedly improved the prognosis of CVT in recent year. Conclusion: Postpartum cerebral venous thrombosis is a rare but serious pathology. The clinical diagnosis is not easy because of the clinical polymorphism, it is necessary to know how to think about it even in front of purely ophthalmological signs and to ask for neuro-radiological examinations to confirm it. The prognosis remains good if the diagnosis is made in time and if the treatment is started early.

BILATERAL PRIMARY OPTIC ATROPHY IN A PATIENT WITH HYDROCEPHALUS – A RARE CASE

Objective – To report the rare ophthalmological ndings in a patient diagnosed with hydrocephalus Material And Methods – We report the case of a 2yr old female child who presented with hydrocephalus. CT Brain was done which was suggestive of gross dilatation of both the lateral ventricles and fourth ventricle and thinning of the cortex was seen. A detailed ophthalmological evaluation was done which showed reduced ocular motility, lagophthalmos and right esotropia. Fundus examination showed bilateral primary optic atrophy with blurred margins of the optic disc. The Results – clinical history, detailed ophthalmological examination and investigations suggest that hydrocephalus and thinning of the cortex led to retrograde optic atrophy in this patient. Hydrocephalus and thinning of the cort Conclusion – ex led to retrograde optic atrophy. Due to high degree of thinning of the occipital lobe caused by hydrocephalus, we do not expect the patient's visual functions to develop in future. Awareness regarding consequences of untreated cases of hydrocephalus and screening for ophthalmological signs is important. Timely intervention can prevent progression of the disease and lead to improved quality of life in such patients.

Keratitis-ichthyosis-deafness Syndrome with Heterozygous p.D50N in the GJB2 Gene in Two Serbian Adult Patients.

Keratitis-ichthyosis-deafness (KID) syndrome is a rare congenital ectodermal dysplastic syndrome presenting with keratitis, ichthyosis and sensorineural hearing loss. The most common causes of KID syndrome are heterozygous missense mutations in the GJB2 gene that codes for connexin 26. During the ophthalmological examination, two adult females complained of recent worsening of visual acuity in both eyes. Anamnesis revealed that their eyes were red and irritated from early childhood onwards. Both of them had thickening and keratinisation of eyelid margins, lash loss, diffuse opacification of cornea and conjunctiva caused by keratinisation of eye surface, superficial and deep corneal vascularisation and corneal oedema. Partial sensorineural hearing loss and difficulties in speech were also noted along with typical ichthyosiform erythroderma. Genetic testing of the GJB2 gene revealed a heterozygous p.D50N mutation in both patients.Patients were treated with a combined topical corticosteroid and artificial tears therapy, with steroid therapy being intensified during the last month. The therapy increased the visual acuity by decreasing corneal oedema and by forming a more regular air-tear interface during the six months follow up. Subsequently, the disease progressed despite the continuation of the therapy. This is the first report of Serbian patients with KID syndrome. Despite the administration of the combined topical corticosteroid and artificial tears therapy the disease is relentlessly progressive and therapeutic success of ophthalmological signs with local therapeutic modalities used so far had been disappointing.

CRANIOPHARYNGIOMA REVEALED BY PAPILLEDEMA IN A CHILD: A CASE REPORT

Craniopharyngiomas are rare epithelial tumors, arising from the pituitary gland or pituitary gland and developing in the sellar and supra sellar region. We present an unusual case of a craniopharyngioma in a 9-year-old child reveled by a bilateral papilledema, with strabismus and extraocular neurological signs. The diagnosis of this tumor is often late and is based on the triad of neurological, ophthalmological and endocrine signs. Their treatment is multidisciplinary and includes surgical and hormonal treatment. Their prognosis depends on the precocity of the diagnosis, the location and the size of the tumor. Our aim is to describe a clinical case with bilateral papilledema revealing a craniopharyngioma in a child.

When Pediatric Headaches Are Not Benign—Eye Findings

Headache is the most common neurologic complaint that presents to the pediatrician. While most headaches are benign in nature, patients must be carefully evaluated to rule out life- or vision-threatening causes. Non-benign etiologies of headache may exhibit ophthalmologic signs and symptoms that can help narrow the differential diagnosis. It is also important for physicians to know in what situations appropriate ophthalmologic evaluation is necessary, such as evaluating for papilledema in the setting of elevated intracranial pressure. In this article we discuss life- and/or vision-threatening etiologies of headache, including infection, autoimmune disease, cerebrovascular pathologies, hydrocephalus, intracranial neoplasia, and idiopathic intracranial hypertension, and their associated ophthalmologic manifestations. Due to less familiarity of the disease amongst primary care providers, we discuss pediatric idiopathic intracranial hypertension in more comprehensive detail.

Ocular complications of plasma cell dyscrasias.

Plasma cell dyscrasias are a wide range of severe monoclonal gammopathies caused by pre-malignant or malignant plasma cells that over-secrete an abnormal monoclonal antibody. These disorders are associated with various systemic findings, including ophthalmological disorders. A search of PubMed, EMBASE, Scopus and Cochrane databases was performed in March 2021 to examine evidence pertaining to ocular complications in patients diagnosed with plasma cell dyscrasias. This review outlines the ocular complications associated with smoldering multiple myeloma and monoclonal gammopathy of undetermined significance, plasmacytomas, multiple myeloma, Waldenström's macroglobulinemia, systemic amyloidosis, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes (POEMS) syndrome, and cryoglobulinemia. Although, the pathological mechanisms are not completely elucidated yet, wide-ranging ocular presentations have been identified over the years, evolving both the anterior and posterior segments of the eye. Moreover, the presenting symptoms also help in early diagnosis in asymptomatic patients. Therefore, it is imperative for the treating ophthalmologist and oncologist to maintain a high clinical suspicion for identifying the ophthalmological signs and diagnosing the underlying disease, preventing its progression through efficacious treatment strategies.

Ocular manifestations in Arnold Chiari syndrome

AbstractPurpose: Arnold‐Chiari disease is a rare congenital malformation of the cerebellum. Symptoms are dominated by occipital headache, torticollis, and sometimes swallowing disorders. Regarding ophthalmological manifestations, convergence abnormalities, oculomotor paralysis and diplopia are the main clinical signs. We report two cases of ocular manifestations in Arnold Chiari type 1 syndrome.Methods: Two case reports and a literature review.Results:Case 1: A 40‐year‐old patient with no medical history presented an acute loss of vision in both eyes. On examination, the patient had a visual acuity limited to 5/63. Biomicroscopic examination of the anterior segment was without abnormalities. Fundus examination revealed a bilateral papillary edema. Visual field test showed a borderline diffuse loss in both eyes.Case 2: A 17‐year‐old patient with no medical history presented intermittent headaches and a progressive loss of vision in both eyes. On examination, the patient had a visual acuity limited to 5/80. Biomicroscopic examination of the anterior segment was without abnormalities. Fundus examination revealed atrophy not excavated in both eyes. Visual field test showed nasal and temporal scotomas in both eyes. Temporal, superior and inferior RNFL defects were detected in both eyes. A brain MRI revealed a Chiari type 1 malformation without associated hydrocephalus in both patients.Conclusions: Arnold Chiari type 1 malformation is an uncommon pathology. The discovery of ophthalmologic signs requires a neurosurgical intervention as soon as possible to stop progression towards the loss of visual function by optic atrophy.