Vision In Patients Research Articles

The effect of mental load on psychophysical and visual evoked potential visual acuity.

Under real-world conditions, tasks dependent on visual acuity may need to be performed in the presence of a mental load arising from concurrent, non-visual tasks. Therefore, measuring visual acuity concurrently with mentally demanding tasks may reflect a patient's vision more accurately. This study was designed to evaluate the impact of task-induced mental load on high contrast visual acuity, as measured using a letter chart and estimated via sweep visual evoked potentials (sweep VEP). Visual acuity was determined using the Freiburg Vision Test, and also using sweep VEP tested stepwise, from coarse to fine, over 13spatial frequencies, in 31healthy participants (aged 22.4±3.6years). Recordings were repeated while participants concurrently performed an auditory 2-back task. Mental load of the n-back task was confirmed through subjective ratings. Visual acuity determined with the Freiburg Vision Test worsened from -0.02±0.12 to 0.04±0.15logMAR under mental load (p=0.03). Visual acuities estimated by sweep VEPs worsened from 0.38±0.1 to 0.47±0.1logMAR (p<0.001). While the slope of the VEP amplitude versus spatial frequency function steepened significantly with mental load (p=0.01), VEP noise levels were not significantly affected (p=0.07). Visual acuity reduces significantly with a concurrent task that produces mental load. At least part of this reduction appears to be related to alterations in responses within the visual cortex, rather than being purely attributable to higher-level distraction effects.

Severe ophthalmic involvement in granulomatosis with polyangiitis resistant to cyclophosphamide

A 63-year-old female presented with acute right vision loss, optic disc edema, headache, and elevated inflammatory markers. She had positive cANCA and was diagnosed with granulomatosis with polyangiitis. She developed nodular scleritis (Fig. 1A) and evolved to right orbital apex syndrome with marked pain, diffuse ophthalmoplegia, and ptosis. Despite treatment with intravenous steroids and 3 doses of cyclophosphamide, her vision worsened to no light perception. Rituximab was started, and it stopped the disease progression. Unfortunately, the patient's vision remained unchanged with diffuse optic atrophy and scleromalacia. Enhancement of the sclera (Fig. 1B) and orbital apex (Fig. 1C, D) are demonstrated on T1-weighted magnetic resonance imaging with gadolinium enhancement.

Review on Diabetic Retinopathy Detection Using Molecular Segmentation In Convolution Neural Network

Abstract: People who suffer from diabetes are at risk of developing blindness since their pancreas doesn't produce enough insulin. Diabetic retinopathy is a condition in which a patient's vision gradually worsens as the disease advances. To better understand how diabetes affects the eye, retinal images captured with a fundal camera can be helpful. This study aims to detect blood vessels, identify hemorrhages, and classify different phases of diabetic retinopathy into normal, mild, and non-proliferative diabetic retinopathy (NPDR). When it comes to classifying the various stages of diabetes-related retinopathy, the retinal picture is used as a starting point. Using the contrast between the blood vessels and the surrounding background, the retinal vascular is segmented.. Density analysis and bounding box approaches were used to identify potential hemorrhage sites. According to blood vessel and hemorrhage area and perimeter, Random Forests technique was used to finally classify various phases of eye disease. Keywords: Retina, blood vessel, hemorrhages, classification, diabetic retinopathy.

Papilledema as a sign of intracranial hypertension

Papilledema (choked disk) is a sign of intracranial hypertension (ICH) - condition that presents danger not only for patient's vision, but also for their life. Despite the fact that ICH is usually a neurosurgical pathology, sometimes an ophthalmologist is the first doctor such patients visit, most often in a primary healthcare clinic. At the same time, as practice shows, not all ophthalmologists are well aware about in this pathology; difficulties occur in differential diagnosis of papilledema against similar changes of the optic nerve head seen during ophthalmoscopic examination. This article reviews scientific literature on ICH, including benign ICH, diagnosis and differential diagnosis of papilledema. The authors also share their decades-long experience of working in a neurosurgical facility.

Chorioretinitis with retinal ablation complications in patients with cytomegalovirus infections and high myopia: a case report

Background: Chorioretinitis is uveitis that causes choroidal and retinal inflammation. Chorioretinitis in general due to cytomegalovirus (CMV) infection has been recognized as a major cause of congenital virus infections. A common complication in patients with uveitis is retinal detachment. In addition, high myopia can also cause retinal detachment.Case Illustration: We reported a 33-year-old male patient who came with chief complaints of a sudden blurred left eye the couple of weeks before admission. The patient had a history of high myopia -5D in both eyes and was HIV positive. One week before the complaint, patient underwent laser therapy because of retinal detachment and was also given Neomicin and Potassium Iodide eye drops. Patients presented with vision 1/60. In funduscopy examination, we found vasculitis, retinal detachment, bleeding and exudate. The patient was then diagnosed with OS Rhegmatogenous Retinal Detachment (RRD) caused by CMV chorioretinitis and high myopia ODS. The patient was treated with valganciclovir 1x900mg, methylprednisolone 2x32mg, prednisone eye drops 6x1 OD and underwent pars plana vitrectomy (VPP). The patient had complicated cataracts, therefore phacoemulsification, evacuation and reinjection of silicon oil and endolaser were performed. Unfortunately, the results obtained are not optimal where the patient's vision becomes the patient's no light perception (NLP).Discussion: Retinal detachment is a frequent complication in patients with CMV chorioretinitis. The main therapy is HAART, anti-CMV and operative management. This therapy regimen is proven to improve overall patients’ prognosis.Conclusion: Early diagnosis and appropriate treatment have a very important role in determining the prognosis of patients with CMV chorioretinitis.

Monoclonal Gammopathy of Ocular Significance (MGOS) - a Series of Corneal Manifestations and Treatment Outcomes

IntroductionMonoclonal gammopathy of ocular significance (MGOS) is a rare subset of monoclonal gammopathy of clinical significance (MGCS) occurring secondary to plasma cell dyscrasia resulting in ocular manifestations. Given the rarity of these conditions, optimal management strategies are not defined; the approach is dependent upon the underlying cause of the monoclonal gammopathy and whether or not the patient's vision is affected. We report our review of 23 cases with MGOS, more specifically on paraproteinemic keratopathy (PPK) the most common form, to obtain a better understanding of the patient characteristics, diagnosis and treatments.MethodsWe report an international retrospective series of patients with MGOS. Data was collected on patients with MGOS:there were no other inclusion criteria besides monoclonal gammopathy with an ophthalmologic manifestation; however, this report focuses only on patients with PPK. Efficacy outcomes were the hematologic and the ocular responses in patients with PPK. Hematologic responses were reported according to the IMWG response criteria. The ophthalmologic response to treatment was assessed by each contributing physician and reported as either complete, partial or no sight recovery.ResultsWe identified 23 patients with PPK in the setting of monoclonal gammopathy of unknown significance (MGUS), smoldering multiple myeloma (SMM), or multiple myeloma (MM) diagnosed between 2006 and 2019 in 7 countries. Table 1 summarizes the patients' characteristics. The ocular diagnosis was typically made at the same time or after the hematologic diagnosis. Eleven of 23 patients presented decreased vision. Four were treated by penetrating keratoplasty with or without systemic therapy, including chemotherapy with new generation anti-MM agents with or without autologous stem cell transplantation (ASCT). All patients with MM and 40% of those with other diagnoses such as SMM or MGUS received systemic therapy. In most cases, neither ocular nor hematologic treatment, even when ASCT was performed, afforded a durable improvement in the visual acuity despite initial responses. MGOS typically relapsed within one year of the initial response (Table 2).ConclusionTo date, this is the largest retrospective study focusing on MGOS patients with monoclonal immunoglobulin deposits accumulating in the cornea and resulting in visual impairment. Further studies will be required to determine the optimal strategy to treat and prevent the relapse of ocular symptoms in patients with PPK and specifically to address the timing of keratoplasty and systemic chemotherapy and the role of maintenance therapy. Patients with corneal manifestation of unknown origin should undergo a hematologic check-up and patients with paraproteinemia should have a periodic ocular health assessment. [Display omitted] DisclosuresGarderet: Takeda: Consultancy; Sanofi: Consultancy; Amgen: Consultancy; Janssen: Consultancy; Celgene: Consultancy. Munder: Janssen: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Abbvie: Consultancy; Takeda: Consultancy, Honoraria; Amgen: Honoraria; Sanofi: Consultancy; GSK: Consultancy; Incyte: Research Funding. Gozzetti: AbbVie: Honoraria; Janssen: Honoraria. Rosinol: Janssen, Celgene, Amgen and Takeda: Honoraria. Jurczyszyn: Janssen-Cilag, Amgen: Honoraria, Speakers Bureau.

On the issue of the treatment of trachomatous pannus

Pannous inflammation of the cornea, as one of the earliest and most dangerous complications of trachoma, in its severity, course and significance for the patient's vision is not always in one way or another correlated with the strength or duration of the trachomatous process in the mucus of the eye. If in some cases the pannus disappears soon and without a trace, so to speak, by itself or solely under the influence of appropriate treatment of the conjunctiva of the arches and eyelids alone, then in other cases, most often encountered in the practice of an eye doctor, despite the most vigorous therapy of trachoma, the pannus not only does not show a tendency to reverse development, but, gradually or by leaps, from the initial, lighter degrees (pannus incipiens, R. levis) to more severe and persistent forms (R. crassus, R. sarcomatosus), often ulcerating at the same time and ending in cicatricial degeneration of the cornea (p membranaceus), leads the trachomaticus to complete inactivity for his entire subsequent existence. And since, in heavily overworked areas, an eye doctor has to deal with the most severe forms of this disease and its most diverse complications, of which corneal pannus accounts for more than a third of all of them, and the consequences, it is natural that the question of not mediocre treatment of pannus becomes urgent and requires practical measures of a special nature.

Canadian Vision Standards

As primary vision care providers, optometrists are often asked whether a patient's vision meets the stan­dard established for a particular occupa­tion. In order to address these inquiries appropriately, optometrists must have knowledge of the various vision stan­dards. This article provides a summary of federally-mandated vision require­ments as a reference. However, because these standards are under continual revi­sion, it will be necessary to update them from time to time.

Evaluation of the red reflex: An overview for the pediatrician.

BACKGROUNDRed reflex test (RRT) is a simple, non-invasive method that can be performed easily by pediatricians during the clinical examination in neonatal period, infancy and childhood. Abnormal reflexes can lead to prompt diagnosis of several ocular disorders, with potentially severe consequences on patient’s vision, cognitive function and even life.AIMTo underline the contribution of pediatricians to early detection of vision and life threatening diseases by using RRT effectively.METHODSFor the present systematic review, PubMed searches were performed using the key words “red reflex and newborn”; “red reflex and neonate”; “red reflex and complications”; “red reflex and necessity”; “red reflex and retinoblastoma”; “red reflex and congenital cataract”; “red reflex and glaucoma”; “red reflex and prematurity”; “red reflex and leukocoria”; “red reflex and blindness”; “red reflex sensitivity and specificity”; “red reflex and differential diagnosis”; “red reflex and guidelines”. The relevant articles were selected without language restrictions. When a full-text publication was not available, their English abstracts were used. In some cases, studies from the reference lists of the selected articles provided useful information. The research took place in September 2020, in the Ophthalmology Department of University Hospital of Alexandroupolis.RESULTSA total of 45 articles were selected according to the used key words. After reviewing data from these articles, it is supported that red reflex remains an effective tool of undeniable importance for early detection of severe eye conditions, such as cataract, retinoblastoma, retinopathy of prematurity and glaucoma. Although literature reports some limitations of RRT, including a notable percentage of false positive tests, the inability to detect small, peripheral retinoblastomas and the lower sensitivity for posterior segment pathology, it is widely accepted that the benefits from the regular evaluation of the test on public health are significant. Therefore, RRT has been established by international guidelines and should be an essential component of pediatricians clinical practice. Red reflex implementation should be incorporated in pediatricians educational programs, so that they would be able to provide quality services and safe diagnoses.CONCLUSIONThe implementation of RRT should be encouraged in all neonatal/pediatric departments. Prompt education of pediatricians should be empowered in order to achieve careful vision screening, according to current guidelines.

At this junction…

An 81-year-old woman developed painful vision loss to hand motions in the right eye over a several-day period. Dilated fundus examination revealed no acute pathology, but automated perimetry showed a superotemporal visual field defect in the asymptomatic left eye, suggestive of a junctional defect. Magnetic resonance imaging demonstrated enhancement of the right optic nerve extending to its junction with the optic chiasm. The patient's vision failed to improve with intravenous corticosteroids, but demonstrated significant improvement with therapeutic plasma exchange. She was subsequently found to be seropositive for aquaporin-4 autoantibodies, confirming the diagnosis of neuromyelitis optic spectrum disorder.

A Rare Case of Anti Phospholipid Syndrome Associated Intermediate and Posterior Uveitis

Introduction: Autoimmune disorders are often associated with Uveitis. Anti-Phospholipid syndrome(APS) is characterized by increased hypercoagulability and divergent ocular features.&#x0D; Case Presentation: A 45-year-old male patient presented with complaints of headache for 2 days. The patient gives a history of fever and loss of consciousness 20 days back and was treated symptomatically. On examination Visual acuity was 6/6 in the right eye and 6/12 in the left eye. On slit-lamp examination, the anterior segment was normal, vitreous cells were 2+ suggestive of vitritis in the left eye. Dilated fundus examination showed exudates in both eyes with macular parafoveal edema in the left eye. Laboratory investigations showed Antiphospholipid Antibody Immunoglobulin M (IgM) and Beta 2 glycoprotein IgM positive and raised ESR, PTT, and triglycerides. MRI brain showed acute embolic infarcts in multiple areas.&#x0D; Management: Topical Steroids and cycloplegic for uveitis and systemic steroids and anticoagulants for systemic manifestations were given and the patient's vision improved to 6/6 and macular edema reduced in the left eye during the follow-up.&#x0D; Conclusion: APS is a life and vision-threatening multisystem disorder, needs monitoring for INR and Anti phospholipid antibodies. A rare manifestation of uveitis is noted and prompt treatment with topical, oral steroids resolves the uveitis. But to prevent recurrences and further thrombotic events long-term immunosuppression, anticoagulation treatment is required.

CRISPR-Based Genome Editing as a New Therapeutic Tool in Retinal Diseases.

Retinal diseases are the primary reasons for severe visual defects and irreversible blindness. Retinal diseases are also inherited and acquired. Both of them are caused by mutations in genes or disruptions in specific gene expression, which can be treated by gene-editing therapy. Clustered regularly interspaced short palindromic repeats (CRISPR-Cas9) system is a frontier of gene-editing tools with great potential for therapeutic applications in the ophthalmology field to modify abnormal genes and treat the genome or epigenome-related retinal diseases. The CRISPR system is able to edit and trim the gene include deletion, insertion, inhibition, activation, replacing, remodeling, epigenetic alteration, and modify the gene expression. CRISPR-based genome editing techniques have indicated the enormous potential to treat retinal diseases that previous treatment was not available for them. Also, recent CRISPR genome surgery experiments have shown the improvement of patient's vision who suffered from severe visual loss. In this article, we review the applications of the CRISPR-Cas9 system in human or animal models for treating retinal diseases such as retinitis pigmentosa (RP), Leber congenital amaurosis (LCA), age-related macular degeneration (AMD), proliferative diabetic retinopathy (PDR), and proliferative vitreoretinopathy (PVR), then we survey limitations of CRISPR system for clinical therapy.

Detection of diabetic retinopathy using a fusion of textural and ridgelet features of retinal images and sequential minimal optimization classifier.

Diabetes is one of the most prevalent diseases in the world, which is a metabolic disorder characterized by high blood sugar. Diabetes complications are leading to Diabetic Retinopathy (DR). The early stages of DR may have either no sign or cause minor vision problems, but later stages of the disease can lead to blindness. DR diagnosis is an exceedingly difficult task because of changes in the retina during the disease stages. An automatic DR early detection method can save a patient's vision and can also support the ophthalmologists in DR screening. This paper develops a model for the diagnostics of DR. Initially, we extract and fuse the ophthalmoscopic features from the retina images based on textural gray-level features like co-occurrence, run-length matrix, as well as the coefficients of the Ridgelet Transform. Based on the retina features, the Sequential Minimal Optimization (SMO) classification is used to classify diabetic retinopathy. For performance analysis, the openly accessible retinal image datasets are used, and the findings of the experiments demonstrate the quality and efficacy of the proposed method (we achieved 98.87% sensitivity, 95.24% specificity, 97.05% accuracy on DIARETDB1 dataset, and 90.9% sensitivity, 91.0% specificity, 91.0% accuracy on KAGGLE dataset).

Genetically-Caused Blindness Reversed with Single Injection of Antisense Therapeutic

Clinical OMICsVol. 8, No. 3 NewsFree AccessGenetically-Caused Blindness Reversed with Single Injection of Antisense TherapeuticPublished Online:18 Jun 2021https://doi.org/10.1089/clinomi.08.03.04AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail A patient with a genetic form of childhood blindness gained vision for more than a year after receiving a single injection of an experimental antisense oligonucleotide, sepofarsen, into the eye.The clinical trial was conducted by researchers at the University of Pennsylvania. According to their study, which appeared in Nature Medicine, the treatment led to marked changes at the fovea, the most important locus of human central vision.Almost a dozen antisense treatments have been approved by the FDA to date. Almost all of these are for orphan diseases, including the drug used in this study. It targets Leber congenital amaurosis (LCA), but is specifically designed for LCA patients with the CEP290 mutation – one of the more commonly implicated gene variants. Patients with this form of LCA suffer from severe visual impairment, typically beginning in infancy.In an international clinical trial led by Penn Medicine researchers Artur Cideciyan, Ph.D., and Samuel Jacobson, M.D., Ph.D., participants received an intraocular injection of sepofarsen. This oligonucleotide works by increasing normal CEP290 protein levels in the eye's photoreceptors.In a previous study, Cideciyan, Jacobson, and collaborators found that injections of sepofarsen every three months resulted in continued vision gains in ten patients.The eleventh patient, whose results are reported in this study, had only one injection and was examined over a 15-month period. Prior to treatment, the patient had reduced visual acuity, small visual fields, and no night vision.After a single injection, more than a dozen measurements of visual function and retinal structure showed large improvements supporting a biological effect from the treatment, which were retained at month 15. The patient's vision reached a peak effect after month two.FiguresReferencesRelatedDetails Volume 8Issue 3May 2021 InformationCopyright © GEN PublishingTo cite this article:Clinical OMICs.May 2021.5-5.http://doi.org/10.1089/clinomi.08.03.04Published in Volume: 8 Issue 3: June 18, 2021PDF download

Damage To Eyes, Orbit And Visual Nerve , Combined With Cranial Injury In Emergency Medicine

The features of the clinical course, symptoms and the difficulty of diagnosing traumatic injuries of the eye, orbit and optic nerve are described. A total of 952 patients with concomitant craniocerebral injuries and injuries to the eye, orbit, optic nerve were studied in 2018. The possibilities of computer tomography in the diagnosis of traumatic injuries of the visual tract combined with traumatic brain injury and differential diagnosis of intracranial injuries of the visual tract before the hospital and hospital stages were studied. In the structure of craniocerebral trauma, craniofacial accounted for 187 (19.6%), of which 118 (6%) eye injuries, 20 (10.6%) orbit injuries, 4 (2.1%) optic nerve injuries, 19 (10 %) of patients were diagnosed with a fracture of the walls of the orbit. In 5 (2.6%) patients, an isolated fracture of the lower orbital wall was revealed. Total: 158 men (84.4%), 29 women (15.5%). The patients underwent examination, including examination by a multidisciplinary team (neurosurgeon, maxillofacial surgeon, ENT and ophthalmologist). Anamnesis was studied in all patients, a comprehensive ophthalmological examination was performed: visometry (with optimal correction), refractometry, biomicroscopy, ophthalmoscopy and neuro-ophthalmological examination. All patients underwent radiography of the orbits and skull in frontal and lateral projections, CT, MRI of the brain and orbits. To obtain additional information, 24 (12.8%) patients underwent a two-dimensional ultrasound examination - ultrasound - B SCAN of the eyeball, extraocular muscles and retrobulbar space. Timely topical diagnostics and qualified reconstructive surgeries performed in the early period of craniofacial trauma allows achieving regression of oculomotor disorders in 86.6%, prevents severe consequences and preserves the patient's vision.

Mobile‐aided screening system for proliferative diabetic retinopathy

AbstractNeoVascularization (NV) occurs in the Proliferative Diabetic Retinopathy (PDR) stage, where the development progress of new vessels presents a high risk for severe vision loss and blindness. Therefore, early NV detection is primordial to preserve patient's vision. Several automated methods have been proposed to detect the NV on retinograph‐captured fundus images. However, their employment is constrained by the reduced ophthalmologist‐per‐person ratio and the expensive equipment for image capturing.This paper presents a novel method for NV detection in smartphone‐captured fundus images. The implementation of the method on a smartphone having an optical lens for fundus capturing leads to a Mobiles‐Aided‐Screening system of PDR (MAS‐PDR). The challenge is to ensure accurate and robust detection even with moderate quality of fundus image, on reduced execution time. Within this objective, we identify the major criteria of neovascularized vessels which are tortuosity, width, bifurcation, and density. Our main contribution consists in proposing a sharp feature to reflect each criterion on reduced computational complexity processing. Therefore, the features are provided to a random forest classifier to deduce the PDR stage.A dataset raised from publicly databases is used on a 10‐cross validation process where 98.69% accuracy, 97.73% sensitivity, and 99.12% specificity are achieved. To evaluate the robustness, the same experimentation is repeated after applying motion blur filters to the fundus image dataset, where 98.91% accuracy, 96.75% sensitivity, and 100% specificity are deduced. Moreover, NV screening is performed under 3 s when executed in smartphone devices demonstrating the appropriateness of our method to MAS‐PDR.

Development of Cytomegalovirus Corneal Endotheliitis During Long-Term Topical Tacrolimus and Steroid Treatment for Chronic Ocular Surface Inflammatory Diseases

Purpose: We report 3 cases of patients with chronic ocular surface inflammatory disease who developed cytomegalovirus (CMV) corneal endotheliitis during immunosuppressant and steroid treatment. Patients and Methods: This is a retrospective observational study analyzing the clinical characteristics and outcomes of 3 patients with ocular surface inflammatory diseases (2 with Mooren ulcer and 1 with idiopathic scleritis) who developed CMV corneal endotheliitis. All patients developed CMV corneal endotheliitis between 8 and 14 months of starting steroid and immunosuppressant treatment, including topical 0.1% tacrolimus. Decimal visual acuity, endothelial counts, and intraocular pressure were analyzed. Results: All patients received topical 0.5% ganciclovir after the diagnosis of CMV corneal endotheliitis, which improved endothelial inflammation. However, all patients developed irreversible mydriasis and required additional surgeries, including endothelial keratoplasty, cataract surgery, and glaucoma surgery. At the final follow-up (14–46 months post-CMV corneal endotheliitis onset), fair outcomes were achieved, as demonstrated by a mean decimal best-corrected visual acuity of 0.3 and a well-controlled intraocular pressure. Conclusions: Topical steroids and immunosuppressants can induce fulminant CMV corneal endotheliitis with cataract progression and irreversible mydriasis. In these cases, early diagnosis and treatment, including topical 0.5% ganciclovir, glaucoma surgery, cataract surgery, and endothelial keratoplasty, are necessary for preserving the patient's vision.

Radiation retinopathy masquerading diabetic retinopathy

Background: Radiation retinopathy (RR) can occur years after irradiation as a chronic and progressive retinal micro-angiopathy. The presentations of RR are similar to other retinal vaso-occlusive disorders like diabetic retinopathy, hypertensive retinopathy. The patient was referred to us as a case of diabetic retinopathy who had received intravitreal injections for macular edema without any improvement. A thorough evaluation revealed it to be a case of Radiation retinopathy. RR treatment includes laser photocoagulation, intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, intravitreal steroid injections, and surgery. Case presentation: We report a case of a 47-year-old diabetic male patient in whom RR developed following 30Gy of radiation therapy for Ethmoidal sinus carcinoma masquerading as Diabetic retinopathy. FFA was showing extensive ischemia of the retina, and OCT showing Macular edema. He received Pan retinal photocoagulation in both eyes followed by multiple intravitreal Anti-VEGF injections on a PRN basis and underwent Pars plana vitrectomy in the right eye for non-resolving vitreous hemorrhage. Conclusion: The patient's vision improved only after treating the retinal ischemia with photocoagulation and later treating the macular edema. This report emphasizes the importance of differentiating this disease entity from other vaso-occlusive retinopathy by eliciting a detailed patient history and planning further management accordingly.

Lateral canthotomy and cantholysis in a child with head trauma: a case report

Background: Ocular compartment syndrome (OCS) is a severe ophthalmological emergency that should be diagnosed and treated immediately to prevent permanent loss of vision. It is usually caused by a retro-orbital bleed that increases intraorbital pressure and threatens the patient's vision. This paper aims to present a rare case of OCS and the procedure of lateral canthotomy and acantholysis. Case Presentation: We present a 13-year-old boy who presented with facial injuries caused by a motorbike accident. The patient had vomited multiple times and was fully conscious. The patient had profound signs of increased intra-orbital pressure, which was found to be 70 mmHg. A significant right peri-orbital edema and ecchymosis of the right eye were present. The diagnosis of OCS was made, and lateral canthotomy with acantholysis procedure was performed. After the procedure, the pressure dropped, and vision was saved. Upon opening the eye, a flat retina, pale macula, and disc with intact venous pulsation were observed. Conclusions: This study highlighted the importance of diagnosing OCS as an ophthalmological emergency. Moreover, we discussed how to perform the sight-saving procedure of lateral canthotomy and cantholysis.

A mysterious case of transient proptosis

A 42-year-old Indian woman presented with a slowly progressive and painless swelling in the superomedial aspect of right orbit over past 5 years. She succumbed to homeopathic treatment which controlled the swelling for some time, but eventually recurred. The swelling led to protrusion of her right eye down and out. The patient's vision in her right eye was reduced, with restricted movement on elevation and adduction. The right eye pupil was sluggishly reacting to light. The fundus examination of the right eye revealed hyperemic disc with disc edema and retinal folds. Whereas, left ocular examination was normal. The computed tomography and magnetic resonance imaging scans of the right orbit revealed an intraconal, multiloculated lesion in the superomedial aspect of the orbit, adhering to the optic nerve, giving us an array of differential diagnosis. She underwent right anterolateral orbitotomy under general anesthesia; the masses excised were sent for histopathological examination, which gave the definitive diagnosis of a schwannoma.