Afferent Defect Research Articles

Validity of Administrative Coding for Nonarteritic Ischemic Optic Neuropathy.

Administrative claims have been used to study the incidence and outcomes of nonarteritic ischemic optic neuropathy (NAION), but the validity of International Classification of Diseases (ICD)-10 codes for identifying NAION has not been examined. We identified patients at 3 academic centers who received ≥1 ICD-10 code for NAION in 2018. We abstracted the final diagnosis from clinical documentation and recorded the number of visits with an NAION diagnosis code. We calculated positive predictive value (PPV) for the overall sample and stratified by subspecialty and the number of diagnosis codes. For patients with ophthalmology or neuro-ophthalmology visit data, we recorded presenting symptoms, examination findings, and laboratory data and calculated PPV relative to case definitions of NAION that incorporated sudden onset of symptoms, optic disc edema, afferent pupillary defect, and other characteristics. Among 161 patients, PPV for ≥1 ICD-10 code was 74.5% (95% CI: 67.2%-80.7%). PPV was similar when restricted to patients who had visited an ophthalmologist (75.8%, 95% CI: 68.4%-82.0%) but increased to 86.8% when restricted to those who had visited neuro-ophthalmologists (95% CI: 79.2%-91.9%). Of 113 patients with >1 ICD-10 code and complete examination data, 37 (32.7%) had documented sudden onset, optic disc swelling, and an afferent pupillary defect (95% CI: 24.7%-42.0%). Of the 76 patients who did not meet these criteria, 54 (71.0%) still received a final clinical diagnosis of NAION; for most (41/54, 75.9%), this discrepancy was due to lack of documented optic disc edema. The validity of ICD-10 codes for NAION in administrative claims data is high, particularly when combined with provider specialty.

Metastasis of small cell lung cancer to bilateral extraocular muscles: a case report

BackgroundOrbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature.Case presentationA 46-year-old white male with a past medical history of smoking and stage IV small cell lung carcinoma presented with loss of vision and pain in the left eye. Examination revealed bilateral proptosis and left afferent pupillary defect, and visual acuity was hand motion on the left eye and 4/10 on the right eye. An orbital computed tomography scan showed a compression of the left optic nerve between the extraocular muscles at the apex, and a lateral canthotomy was performed for a new-onset compressive optic neuropathy, with residual visual improvement. There was also significant enlargement of the extraocular muscles in the right orbit. The patient was maintained in palliative treatment with both chemotherapy and local medical and surgical (amniotic membrane cover for exposure keratopathy) ophthalmological treatments until he eventually died 5 months after.ConclusionBilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer and the palliative treatment in these cases is challenging.

Septic Cavernous Sinus Thrombosis: Clinical Characteristics, Management, and Outcomes.

Septic cavernous sinus thrombosis (CST) is a rare condition traditionally associated with high morbidity and mortality. More recent case series report more favorable outcomes, including full functional recovery. A comprehensive assessment of the clinical characteristics and prognostic factors of visual and survival outcomes in septic CST is warranted to contemporize current understanding and help guide management. A multicentered retrospective cohort study was conducted at 2 tertiary care centers using an electronic medical record search of the term, "thrombosis of cavernous venous sinus" between January 1, 2000, and December 31, 2021. Inclusion criteria consisted of active infection and radiographic evidence of associated CST. Demographic and clinical data extracted included age at presentation, sex, infection type and extent, and ophthalmic examination findings at presentation-best-corrected visual acuity (BCVA), presence of relative afferent pupillary defect (RAPD), intraocular pressure (IOP), and extraocular motility (EOM) limitation. Management data collected consisted of type and length of antimicrobial therapy, type and length of anticoagulation administration, and surgical intervention. Primary outcomes assessed were ophthalmic examination findings at final evaluation and same-hospitalization mortality. A total of 27 patients with imaging-confirmed septic CST were identified at 2 tertiary care centers. At presentation, 2 (8.7%) patients had no light perception (NLP) vision, 8 (29.6%) patients had RAPD, 17 (73.9%) patients had EOM limitation, and 13 (54.2%) had IOP >21 mm Hg. All patients received antimicrobial therapy, with vancomycin being the most common agent. Fifteen patients (55.6%) received anticoagulation, and 21 (81.5%) patients underwent surgical intervention. Same-hospitalization mortality was 3 (11.1%). Among the 21 patients with ophthalmic data at follow-up, 3 (16.7%) had NLP vision, 5 (23.8%) had a persistent RAPD, 7 (31.8%) had persistent EOM limitation, and no patients had IOP elevated above 21 mm Hg. Patients with RAPD at presentation had significantly worse BCVA at final evaluation (logMAR BCVA 1.43 higher on average, P = 0.01) and a significantly higher mortality rate (37.5% vs. 0.0%, P < 0.01) than non-RAPD patients. Demographic features, BCVA at presentation, EOM limitation at presentation, elevated IOP at presentation, and comorbid orbital cellulitis were not associated with worse visual or mortality outcomes. Septic CST may result in permanent ophthalmic functional deficit in almost one-third of cases and mortality in approximately 11% of patients under contemporary management. New RAPD at presentation may indicate higher risk of poor visual and survival outcomes.

Lactational optic neuritis - A case series with a review of the literature.

Optic neuritis is the most common optic neuropathy affecting adults, especially women. Lactational optic neuritis is a rare entity occurring during the postpartum period with a high chance of recurrence. Through this study, we evaluated the clinical profile and visual outcome of lactational optic neuritis. This was a retrospective study where patients with optic neuritis presenting during the first year of the postpartum period to the neuro-ophthalmology clinic between January 2016 and December 2022 were included in the study. This study included seven eyes of six patients. The mean age of presentation was 24.6 years, with all patients presenting after the first 3 months of the postpartum period. All patients had unilateral involvement except one, presenting with painful vision loss. Best corrected visual acuity ranged from 6/18 to hand movements. Relative afferent pupillary defect and dyschromatopsia were present in all patients. Disc edema was seen in all but one case. Three patients were treated with steroids along with multivitamins, and the remaining three refused treatment with steroids, receiving multivitamins alone. All patients had complete recovery by the end of 12 weeks. Optic neuritis during lactation is attributed more to post-pregnancy immunological changes rather than lactation itself. The presentation and clinical features are similar to classic optic neuritis and remain an important differential diagnosis for visual dysfunction in the postpartum period.

Endoscopic Endonasal Transsphenoidal Resection of Pituitary Adenomas in Patients Presenting With Monocular Blindness

BACKGROUND AND OBJECTIVES: Suprasellar tumors, particularly pituitary adenomas (PAs), commonly present with visual decline, and the endoscopic endonasal transsphenoidal approach (EETA) is the primary management for optic apparatus decompression. Patients presenting with complete preoperative monocular blindness comprise a high-risk subgroup, given concern for complete blindness. This retrospective cohort study evaluates outcomes after EETA for patients with PA presenting with monocular blindness. METHODS: Retrospective analysis of all EETA cases at our institution from June 2012 to August 2023 was performed. Inclusion criteria included adults with confirmed PA and complete monocular blindness, defined as no light perception, and a relative afferent pupillary defect secondary to tumor mass effect. RESULTS: Our cohort includes 15 patients (9 males, 6 females), comprising 2.4% of the overall PA cohort screened. The mean tumor diameter was 3.8 cm, with 6 being giant PAs (&gt;4 cm). The mean duration of preoperative monocular blindness was 568 days. Additional symptoms included contralateral visual field defects (n = 11) and headaches (n = 10). Two patients presented with subacute PA apoplexy. Gross total resection was achieved in 46% of patients, reflecting tumor size and invasiveness. Postoperatively, 2 patients experienced improvement in their effectively blind eye and 2 had improved visual fields of the contralateral eye. Those with improvements were operated within 10 days of presentation, and no patients experienced worsened vision. CONCLUSION: This is the first series of EETA outcomes in patients with higher-risk PA with monocular blindness on presentation. In these extensive lesions, vision remained stable for most without further decline and improvement from monocular blindness was observed in a small subset of patients with no light perception and relative afferent pupillary defect. Timing from vision loss to surgical intervention seemed to be associated with improvement. From a surgical perspective, caution is warranted to protect remaining vision and we conclude that EETA is safe in the management of these patients.

The great escape- preserved cilioretinal artery with transient central retinal artery occlusion following snake bite

A 24-year female sustained a snake bite on the lateral side of the left ankle, followed by localized pain and blurring of vision in right eye. Her best corrected visual acuity was 20/20 in the both eyes. Relative afferent pupillary defect was noted in right eye. Fundus examination of right eye showed clear media, normal optic disc and retinal whitening with sparing of small area on macula, temporal to disc with small cilioretinal artery, suggestive of central retinal artery occlusion (CRAO) with presence of cilioretinal artery sparing. Ophthalmic manifestations following a snake bite are uncommon and can arise through diverse mechanism such as hematotoxicity from the snake bite, resulting in CRAO. Although CRAO following snake bite has been reported, we present a very rare case of snake bite induced transient CRAO with presence of spared cilioretinal artery.

Clinical and paraclinical characteristics of optic neuritis in the context of the McDonald criteria 2017

Optic neuritis is often an initial symptom in multiple sclerosis (MS) or clinically isolated syndrome (CIS), yet comprehensive studies using the 2017 McDonald criteria for MS are scarce. Patient records from our academic centre (2010–2018) were reviewed. Using the 2017 McDonald criteria, three groups were formed: MS optic neuritis (optic neuritis with confirmed MS), CIS optic neuritis (optic neuritis without confirmed MS) and suspected optic neuritis (sON). We compared clinical and paraclinical findings among the groups to identify predictors for CIS- or MS-optic neuritis. The study included 129 MS, 108 CIS, and 44 sON cases. The combination of visual impairment, dyschromatopsia, and retrobulbar pain was observed in 47% of MS patients, 42% of CIS patients, and 30% of sON patients. Dyschromatopsia was the strongest indicator of MS or CIS diagnosis in the backward regression model. 56% of MS patients had relative afferent pupillary defect, 61% optic nerve anomalies within magnetic resonance imaging, and 81% abnormal visual evoked potentials. Our results emphasize the challenges in diagnosing optic neuritis, as not all patients with objectively diagnosed MS exhibit the triad of typical symptoms. To address potentially missing clinical features, incorporating additional paraclinical findings is proposed.

Atypical Form of Unilateral Optic Neuropathy Caused by Ocular Toxocariasis

Purpose: To report an atypical form of ocular toxocariasis presenting as unilateral optic neuropathy.Case summary: A 75-year-old man was referred to our clinic owing to the recently developed visual difficulty in his right eye. The visual acuity of the right eye was 0.4, a relative afferent pupillary defect was positive in the right eye. On slit lamp biomicroscopy, anterior chamber inflammation and vitreous cells and haze were detected in the right eye. On fundus examination, optic disc swelling and focal retinitis around the optic disc were found in the right eye. Fluorescein angiography revealed focal retinitis along with leakage near the optic disc in the right eye. Serology was positive for Toxocara IgG. Under the suspicion of an atypical form of ocular toxocariasis, the patient was treated with local and oral steroids and albendazole. Subsequently, optic disc swelling and vitreous inflammation improved, but the final visual acuity was 0.125 with pale optic disc and central visual field defects in the right eye.Conclusions: In patients suspected of optic neuritis, when the anterior chamber and vitreous inflammation and uveitis are accompanied, ocular toxocariasis can present atypically and requires attention because may have a bad prognosis owing to irreversible optic nerve damage.

Clinical Challenge: Looking beyond blurred margins

A 60-year-old man presented to an outside ophthalmology clinic with 1 month of progressive vision loss in the right eye (OD). Right optic disc edema was noted. Brain and orbit magnetic resonance imaging revealed right optic nerve and left occipital lobe enhancement. He was seen initially by neurology and neurosurgery and subsequently referred to neuro-ophthalmology for consideration of optic nerve biopsy. He was seen 3 months after his initial symptom onset where vision was light perception OD and a relative afferent pupillary defect with optic nerve edema. OS was unremarkable. A lumbar puncture with flow cytometry was negative for multiple sclerosis and lymphoma. At his oculoplastic evaluation for optic nerve biopsy, his vision was noted to be no light perception OD. Optic nerve biopsy demonstrated non-caseating granulomatous inflammation. The patient was started on high-dose oral steroids with improvement of disc edema, as well as significant improvement in optic nerve and intracranial parenchymal enhancement, although his vision never improved.

Spontaneous large subperiosteal orbital hematoma in a patient with neuroblastoma

Abstract: We present a case of spontaneous large subperiosteal orbital hematoma in a 2-year-old boy causing compressive optic neuropathy. On physical examination, he was found to have an abdominal mass. The patient underwent urgent drainage of the subperiosteal orbital hematoma along with a biopsy of the abdominal mass which confirmed the diagnosis of neuroblastoma. Following surgery, proptosis, optic disc swelling, and afferent pupillary defect (APD) improved, and after one month of receiving two doses of chemotherapy, his general condition improved.

Orbital pseudolymphoma: a benign condition mimicking malignancy

Orbital lymphomas are not a rare condition that causes systemic and ocular morbidity, in which vision loss often occurs due to compressive optic neuropathy, and whose treatment is complex, involving chemotherapy and radiotherapy. We report a 54-year-old male with protrusion of the right eye associated with mild diminution of vision for one year, limitation of extraocular movements, and a relative afferent pupillary defect with optic disc edema. Imaging revealed a well-defined soft tissue lesion filling the retro-orbital intraconal space, suggestive of orbital lymphoma. Incisional biopsy and fine needle aspiration cytology revealed the lesion to be a reactive lymphoid hyperplasia. Following the administration of oral steroids, the patient showed significant improvement. To our knowledge, a benign lesion with an aggressive presentation is rare, and histopathology plays an important role in diagnosis and management.

FOSTER-KENNEDY SYNDROME: WHAT FUNDUSCOPY WON'T MISS

Abstract&#x0D; Introduction : Optic nerve is the only visible extension of central nervous system and often represents several intracranial diseases. This case demonstrates the importance of funduscopy in detecting intracranial mass.&#x0D; Case Illustration : A 45-year-old woman suffered progressive blurry vision in both eyes for a year and severe headaches and seizures. The right eye (RE) had no light perception, and the left eye (LE) had 6/60 visual acuity. The relative afferent pupillary defect (RAPD) was positive on the RE. A funduscopic examination revealed a pallor optic disc on the RE and papilledema on the LE, consistent with type 1 Foster- Kennedy Syndrome (FKS). A Head CT scan showed a 5.3x6x5 cm mass in the right frontotemporal lobe. We referred the patient to the neurology and neurosurgery department for further management and surgical intervention.&#x0D; Discussion : FKS is a condition associated with tumors in the frontal lobe, characterized by ipsilateral optic disc atrophy due to direct compression, contralateral papilledema due to increased intracranial pressure, and ipsilateral anosmia in advanced stages. RAPD is a sluggish pupillary response to light stimuli due to unilateral retinal or optic nerve disease that occurs anterior to the lateral geniculate body. True FKS is extremely rare nowadays because of advances in neuroimaging to detect intracranial masses earlier.&#x0D; Conclusion : As a primary care physician, performing a direct funduscopy on patients complaining of decreased vision, headaches, and impaired mental status is essential. Although rare, FKS should be kept in mind while finding a patient with optic disc atrophy and papilledema.

Spontaneous Ocular Haemorrhage

Introduction : Hemorrhagic complications are one of the major complications encountered with reperfusion therapies but rarely involve the ocular, especially hyphema.&#x0D; Case Illustration : a 61-year-old woman presented with blurred vision, discomfort, and red eye in her right eye. She had been treated for hypertension, diabetes mellitus, and coronary artery disease with antiplatelet and other oral medication for 5 years. There was no history of eye trauma or Valsalva-like maneuver effort. The best corrected visual acuity was 20/40 in both eyes and there was no relative afferent pupillary defect. Both eyes had normal IOP. A slit lamp examination revealed pool blood in the anterior chamber as hyphema grade 1. Fundus examination showed dot and blot hemorrhage with cupping discs 0.6 and 0.7. USG examination showed no mass and clear vitreous. The antiplatelet was stopped and evaluated by the internal department. The patient was observed and treated with topical medication, and the hyphema resolved within less than 7 days.&#x0D; Discussion : Although it is still not clear if there is any increase in intraocular bleeding has been recognized with antiplatelet agents, the concern would be greatest amongst those at high baseline risk due to predisposing conditions, such as elderly with diabetes, hypertension, and usage of antiplatelet agents to maintain cardiovascular disease.&#x0D; Conclusion : This case emphasizes that though the most common cause of hyphema is a traumatic injury, it can be a rare complication of antiplatelet therapy. Patients on antiplatelet therapy should be carefully monitored for ocular bleeding, especially if they have associated systemic or ocular comorbidity.

Reversible visual recovery in Optic Neuritis patient with No Light Perception VA

Abstract&#x0D; Introduction : Optic neuritis is characterized by an inflammation and demyelination of the optic nerve and is traditionally treated with corticosteroids. The findings of the ONTT, reported in more than 50 publications during the past 20 years, have numerous implications&#x0D; Case Illustration : A 48-year-old woman presented to the ophthalmology outpatient clinic with a 12-day history of blurred vision. The best-corrected visual acuities and Ishihara colour vision was unilaterally reduced with a non light perception on left eye. There were also relative afferent pupillary defect with slow respons of pupillary reflect. Slit-lamp examination was otherwise normal. Funduscopy was Papillary edema on left eye, with all quadrant blurry edge. Optic neuritis (ON) was presumed as she had suffered with this previously. She was hospitalized and undergone (optic neuritis treatment trial) ONTT . Thereafter, a trial of pulsed methylprednisolone was commenced, resulting in near complete resolution of the Visual acuity that become 6/40 UCVA from NLP.&#x0D; Discussion : The original ONTT, along with three follow-up studies at five-year intervals, generated more than three dozen papers in scientific journals. Collectively they show what happens to an individual over the course of 15 years following about of optic neuritis.&#x0D; Conclusion : Prior to the ONTT well-established guidelines for treating optic neuritis did not exist, this case were demonstrates the importance of keep starting ONTT with a point valuable to patient with NLP.

Navigating Through The Diagnostic and Management Maze of Atypical Optic Neuritis Due To Autoimmune

Abstract&#x0D; Introduction : Typical and atypical optic neuritis (ON) have many overlapping characteristics; however, atypical ON have different features, with more lasting visual impairment and devastating prognosis. This paper describes a challenging case of recurrent, atypical ON due to autoimmune.&#x0D; Case Illustration : 42-year-old female complained of recurrent attacks of bilateral blurry vision, eye pain, and headachefor the past two years. Patient had been on multiple rounds of high-dose oral methylprednisolone, but symptoms reappeared every time it was tapered down. Visual acuity of both eyes was 3/60 and 6/45 (without and with correction, respectively), with normal intraocular pressure, anterior and posterior segment, and cranial nerves. No relative afferent pupillary defect was present. Brain magnetic resonance imaging (MRI) revealed intracerebral chronic small vessels; with no lesion in both optic nerves nor signs of neuromyelitis optica. Blood work-up showed elevated C-reactive protein, platelet aggregation, fibrinogen, D-dimer; positive rheumatoid factor, antinuclear antibody, and lupus anticoagulant; and negative Aquaporin-4 IgG. Diagnosis of atypical ON was established. Internal medicine and neurology departments diagnosed her with non-radiographic axial spondyloarthritis and migraine due to attributed autoimmune, respectively. After administration of intravenous pulse dose of methylprednisolone, her vision recovered to 6/7,5 of both eyes and symptoms alleviated.&#x0D; Discussion : Atypical features usually give hints for atypical ON, while laboratory examination and imaging modalities may aid in etiology identification. Early immunosuppressant therapy is commonly required.&#x0D; Conclusion : Recognizing symptoms of ON and necessitating further evaluation through ancillary tests, and collaborations with other specialties can minimize long-lived ailment and improve patients’ quality of life.

Orbital Tumor Misdiagnosed as Optic Neuritis in Rheumatoid Arthritis Patient: A Case Report

Abstract&#x0D; Introduction : Unilateral blurred vision and optic nerve swelling are the two most common signs of optic neuritis (ON). However, ON is rarely reported in patients with rheumatoid arthritis (RA), thus necessitating further diagnostic workup.&#x0D; Case Illustration : A 42-year-old woman visited our hospital with strabismus and progressive loss of vision in her left eye since three months ago. She had been treated with pulse dose steroid for suspected ON. She had been diagnosed with RA over five years and treated with immunomodulatory medication. Left eye examination revealed best corrected visual acuity of 20/50, proptosis, esotropia with painless limitation in temporal movement. Afferent pupillary defect (RAPD) and optic nerve swelling were present. OCT assessment revealed reduction in RNFL thickness. Further magnetic resonance imaging (MRI) investigation revealed a 2.35 x 2.6 x 1.8 cm mass in the left intraconal retrobulbar, in proximity to the medial optic nerve, which suggests a case of orbital Schwanoma. Excisional biopsy was performed and revealed a benign tumor.&#x0D; Discussion : Intraconal tumor may falsely be diagnosed as an optic neuritis in autoimmune patient. Neuro- ophthalmologic symptoms of systemic inflammatory in the optic nerve includes unilateral acute visual loss and pain in eye movement. Signs of ON includes RAPD, disc edema, and corresponding visual field defect. MRI of the optic nerve can assist diagnostic workup.&#x0D; Conclusion : The exact diagnosis of rheumatoid arthritis-associated ocular manifestations is challenging. Imaging using MRI might be needed to provide clarity in the diagnosis.

CHARACTERISTIC OF PATIENTS WITH ORBITAL MENINGIOMA IN DR. KARIADI GENERAL HOSPITAL SEMARANG

Abstract&#x0D; Introduction &amp; Objectives : Meningioma is a neoplasm arising from arachnoid cap cells in the meninges. They can arise in the orbit as primary or secondary orbital meningioma. The characteristic and risk factors of orbital meningioma are essential to acknowledge. The aim of this study is to describe the characteristic and risk factors of patients with orbital meningioma in Dr.Kariadi Hospital.&#x0D; Methods : A retrospective study was held from the medical record of patients with a diagnosis of meningioma between January 2020-December 2022. The data of 58 patients included age, sex, duration of proptosis, length of proptosis, history of seizure, diplopia, history of contraceptive and trauma, RAPD, fundus examination, and CT-Scan results.&#x0D; Results : Most of the meningioma patients had female 98,27%, 70,68% in the fourth decade of life. The visual acuity of 25,88% of patients &gt;6/18, and 22,41% were blind. Around 72,41% of proptosis occurred ≥ 1 year, 87,93% had signs of headache, only 1,72% underwent seizure, 8,62% had double vision, and 5,17% had a history of head trauma. Relative afferent pupillary defect occurred in 53,44% of the affected eye with 20,68% atrophic papil and 15,51% edema papil. CT-Scan result of 86,2% had sphenoid meningioma, and only 13,79% had optic sheath meningioma. Most of the patients (72,41%) used 3 months cycle hormonal injection contraceptive.&#x0D; Conclusion : The characteristic of orbital meningioma patients in DR.Kariadi Hospital were mostly women in the fourth decade of life, had proptosis and headache as primary signs and 3 months of intramuscular hormonal contraceptives were suspected to have a correlation.

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.&#x0D; 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&#x0D; Discussion :&#x0D; 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.&#x0D; 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&#x0D; Discussion :&#x0D; 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.&#x0D; 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&#x0D; Discussion :&#x0D; 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.