Unilateral Visual Loss Research Articles

Central retinal vein occlusion associated with Bartonella henselae infection

PurposeTo report the clinical features and treatment course of a case of central retinal vein occlusion (CRVO) as the initial sign of ocular Bartonella henselae (B. henselae) infection.ObservationA 36-year-old male was evaluated for unilateral vision loss. He denied prodromal symptoms but reported prior exposure to fleas. Best corrected visual acuity (BCVA) was 20/400 in the left eye. Clinical examination revealed a CRVO with atypical features including significant peripapillary exudates and peripheral vascular sheathing. Laboratory testing revealed elevated B. henselae IgG titers (1:512) with no abnormalities on hypercoagulability testing. The patient was treated with doxycycline and aflibercept with an excellent clinical response and improvement in BCVA to 20/25 in the left eye two months later.ConclusionCRVO is a rare but sight-threatening complication of ocular bartonellosis and can be the presenting sign of infection, even in the absence of cat exposure or prodromal symptoms.

Hyperacute optic neuritis in a patient with COVID-19 infection and vaccination: a case report

BackgroundAs scientific knowledge continues to grow regarding coronavirus disease 2019 (COVID-19) infection, several neuro-ophthalmological manifestations have emerged, including rare reports of optic neuritis. Optic neuritis is an inflammatory demyelinating condition of the optic nerve that typically presents as subacute, unilateral vision loss and pain on eye movement. Several cases of COVID-19 infection and COVID-19 vaccination related cases of optic neuritis have been reported. We present a case of hyperacute, unilateral optic neuritis after both recent COVID-19 infection and subsequent booster vaccination.Case presentationWithin two hours after receiving her COVID-19 booster vaccination, a 58-year-old female began experiencing bilateral eye pain, worsened by eye movements. The patient had previously contracted a mild COVID-19 infection three weeks prior to receiving her booster vaccination, confirmed by a rapid antigen test. The pain persisted in her right eye for a week at which time she presented to an ophthalmology clinic. She denied any changes to her visual acuity. Neuroimaging revealed right optic nerve enhancement, and the patient was admitted to the hospital for a course of intravenous steroids, which quickly resolved her eye pain.ConclusionTo our knowledge, this is the first reported case of COVID-19 related optic neuritis following both COVID-19 infection and vaccination. High clinical suspicion is needed to make the appropriate diagnosis, as cases of COVID-19 related optic neuritis may exhibit mild presentations, as was the case with our patient.

Neuro-ophthalmic Manifestations of Coronavirus Disease 2019 and Its Vaccination: A Narrative Review.

Coronavirus disease 2019 (COVID-19) is a current pandemic caused by SARS-CoV-2 that has vastly affected the whole world. Although respiratory disease is the most common manifestation of COVID-19, the virus can affect multiple organs. Neurotropic aspects of the virus are increasingly unfolding, in so far as some respiratory failures are attributed to brainstem involvement. The neuro-ophthalmic manifestations of COVID-19 and the neuro-ophthalmic side effects of vaccination were reviewed. The major findings are that the SARS-CoV-2 infection commonly causes headaches and ocular pain. It can affect the afferent and efferent visual pathways by ischemic or inflammatory mechanisms. Optic nerve may be the origin of transient or permanent visual loss from papillophlebitis, idiopathic intracranial hypertension, or optic neuritis. Cerebrovascular strokes are not uncommon and may lead to cortical visual impairment or optic nerve infarction. SARS-CoV-2 may affect the pupillomotor pathways, resulting in tonic pupil (Adie's syndrome) or Horner's syndrome. Cranial neuropathies including third, fourth, sixth, and seventh nerve palsies have all been reported. Rhino-orbital mucormycosis superinfections in COVID-19 patients receiving steroids or other immunosuppressive therapies may result in unilateral or bilateral visual loss and ophthalmoplegia. Autoimmune conditions such as Guillain-Barré, Miller-Fisher syndrome, and ocular myasthenia have been reported.

New onset unusual Wegener’s granulomatosis associated with COVID-19: a case report

BackgroundGranulomatosis with polyangiitis (GPA) or Wegener’s granulomatosis is an autoimmune disorder with a wide spectrum of manifestations that mostly primarily presents with respiratory symptoms such as cough, dyspnea, and hemoptysis and leads to a high mortality rate if left untreated. It is a relatively uncommon condition, characterized by necrotizing granulomatous vasculitis of small- and medium-sized vessels. Recent studies have shown that hyperactivation of immune cells in patients with the coronavirus disease 2019 (COVID-19) leads to elevated levels of various autoantibodies and inflammatory cytokines including interferon-gamma (IFN-γ) and tumor necrosis factor-α (TNF-α). There are the same factors that involve in the pathogenesis of autoimmune diseases such as GPA.Case presentationWhile there have been several reported cases of COVID-19 occurring in patients receiving immunosuppressant treatment for GPA, here we report a case of a 72-year-old woman with a history of coronavirus disease 2019 (COVID-19) who suddenly suffered unilateral vision and hearing loss and peripheral facial palsy on the same side. Chest computed tomography (CT) demonstrated a subpleural consolidation in the inferior lobe of the left lung. Based on the radiology report, chest CT evidence was due to a history of COVID-19 pneumonia. CT scans of the paranasal sinus showed pansinusitis and necrosis of the nasal septum. According to the available evidence, mucormycosis was clinically suspected, and the patient underwent endoscopic sinus surgery. Eventually, the histopathological analysis revealed a diagnosis of Wegener’s granulomatosis.ConclusionsSince GPA and its complications can be prevented only through strong clinical suspicion and early diagnosis, our presentation of this case aims to increase awareness of autoimmune diseases in COVID-19 patients even after recovery.

Management of Arteritic Anterior Ischemic Optic Neuropathy Post Renal Transplant

This case report helps us to understand, in a comprehensive manner, the management of anterior ischemic optic neuropathy using a multidisciplinary approach. The case taken for this study involves a young female who underwent a kidney transplant due to chronic kidney disease and presented to us with a unilateral painless loss of vision. It has been reported that prompt administration of steroids may be associated with partial recovery of the eye involved. But otherwise, the prognosis in such cases is usually poor. However, since our patient was post-renal transplant and was already taking immunosuppressive drugs, the fear of impending infections due to severely compromised immunity by both steroids and immunosuppressive therapy was there. Hence, a multidisciplinary approach was applied, involving a nephrologist, a physician, and an anesthetist as well. The recommendation for admission in a hygiene room with a dialysis facility in the hospital, monitoring of immunosuppressive therapy, and pulse-dose steroids to be started under the care of an anesthesiologist was the appropriate management.

Macular and Optic Disc Head Morphology on OCT and Visual Prognosis in Non-Arteritic Anterior Ischemic Optic Neuropathy

Introduction: Non-arteritic anterior ischemic optic neuropathy (NAION) shows an acute painless unilateral visual loss due to a reduced perfusion of the optic nerve head (ONH). Aim of this study was to analyse ONH respective macula morphology after NAION by optical coherence tomography and the correlation to visual acuity.

Neuro ophthalmic manifestations of intracranial aneurysms: A case series

ABSTRACT To report the various neuro-ophthalmic manifestations of patients with intracranial aneurysms at a tertiary eye care center in Southern India. This is a retrospective case series of patients in a single center between January 2017 and January 2018. We present a series of five cases of intracranial aneurysms in the age group of 13 to 66 years comprising four women and one boy. The patients had varied presentations on the initial examination. It is extremely rare that a patient visits a hospital due to visual symptoms caused by an aneurysmal compression of the optic nerve. An intracranial aneurysm needs to be ruled in cases of unexplained unilateral vision loss or nerve palsy. Early diagnosis and prompt treatment can save the patient from complete vision loss or other complications due to an aneurysm.

Role of B-scan in Blunt Ocular Trauma: A Cross-sectional Study

Introduction: Ocular trauma is a significant cause of unilateral vision loss, especially in developing countries. Proper assessment of ocular damage and prompt treatment initiation after the injury have a crucial impact on the final outcome. B-scan Ultrasonography (USG) plays an important role in detecting findings that may not be evident during clinical examination. Aim: To assess the role of B-scan in blunt ocular trauma and to determine if B-scan provides any additional advantages over clinical examination. Materials and Methods: A cross-sectional study was conducted from May 1, 2021 to April 30, 2022, at Hind Institute of Medical Sciences, Sitapur, Uttar Pradesh, India. Fifty consecutive patients with blunt ocular trauma, presenting with hazy or opaque ocular media or unexplained visual loss during clinical examination, were evaluated in the casualty and ophthalmology Out Patient Department (OPD). The frequency of lesions such as traumatic cataract, vitreous degeneration, and retinal detachment was assessed clinically and using B-scan USG. Anterior and posterior segment manifestations of blunt trauma, including traumatic cataract, vitreous haemorrhage, and retinal detachment, were evaluated clinically and with B-scan imaging. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0, including frequency counts, percentage calculations, and Kappa’s statistical analysis to correlate B-scan USG and clinical findings. Results: Majority of patients (28%) were in the age group of 21-30 years. Workplace-related injuries, particularly agricultural injuries, were the most common cause of blunt ocular trauma (30%). Traumatic cataract (44%), vitreous degeneration (8%), vitreous haemorrhage (6%), and retinal detachment (4%) were the common clinical posterior segment findings. On B-scan USG, the most frequent findings were retinal detachment (30%) and vitreous haemorrhage (28%). Choroidal detachment was noted in 2% of cases. B-scan USG was more helpful in accurately diagnosing vitreous lesions and retinal lesions (52%, 30%) compared to clinical examination (16%, 6%). Conclusion: B-scan USG emerged as a superior diagnostic tool for identifying posterior segment lesions, including vitreous, retinal, and choroidal lesions. Lesions such as retinal detachment and vitreous haemorrhage were more easily identified using USG, especially in the presence of hazy or opaque media. Therefore, B-scan USG should be considered an integral part of all ophthalmic set-ups dealing with trauma to avoid missing significant posterior segment pathologies.

Photo Quiz: a Woman with a Pruritic Rash and Unilateral Vision Loss.

A 39-year-old female with a history of hypertension and allergic rhinitis presented with a 4-week history of a diffuse pruritic skin eruption and a 2-week history of progressive vision loss in the right eye. Physical exam was notable for a diffuse eruption of pink, scaly coalescent plaques with a thin rim of white scale on the face, trunk, and extremities (Fig. 1, left). There was no involvement of the mucous membranes. One to 2 weeks following the skin eruption, she experienced blurry vision progressing to complete vision loss without associated trauma. On fundoscopic exam, blood was noted in the anterior chamber of her right eye (hyphema). There was concern for uveitis on exam without other focal neurologic deficits. The patient denied recent travel or prior adverse effects of medications. She smoked cigarettes and marijuana occasionally without recent intravenous drug use.

Decreased macular deep capillary plexus is associated with functional progression of normal tension glaucoma patients with unilateral visual field loss

PurposeTo investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina are associated with the development of visual field (VF) loss in the fellow eyes of...

Arthrodesis of the Ankle by Retrograde Nail Associated with an Iliac Corticocancellous Bone Graft and a Femoral Head Allograft after Failure of a Total Ankle Prosthesis: A Case Report

For several years, the surgical treatment of post-traumatic osteoarthritis of the ankle was essentially based on arthrodesis. Currently, ankle arthroplasty has become a reliable alternative with the development of new prostheses. However, the total ankle prosthesis cannot be offered to all patients and it is often a source of medium and long-term complications. The management of these complications, in particular that of the loosening of the prosthesis, is generally done by a definitive treatment by arthrodesis after removal of the prosthesis. It is necessary to combine it with a bone graft in order to fill the gaps left after the removal of the prosthesis and thus allow consolidation with fixation of the joint.

Unilateral Papilledema Revealing a Subdural Hematoma in a Sickle Cell Patient

The authors report a case of papilledema revealing a subdural hematoma in a 24-year-old male subject with known SS homozygous sickle cell disease. The patient presented with a sudden unilateral visual acuity loss on the right side and violent headaches that were resistant to level 1 analgesics. The discovery of unilateral papilledema on fundus examination led to a CT scan which revealed a subdural hematoma. The evolution was favorable under corticoid and hypotonizing treatment with the total resorption of the papillary edema, a significant regression of the subdural hematoma after 10 days of treatment and a recovery of the visual acuity. The authors insist on the necessity of performing a fundus examination accompanied by a CT scan in all sickle cell patients in the context of intractable headaches.

Elderly Woman With Painless Visual Loss

A 93-year-old woman presented to the emergency department for evaluation of nontraumatic, unilateral acute vision loss in the left eye. Visual acuity was 20/50 bilaterally. Intraocular pressure was normal. Bedside ultrasound was performed as an adjunct to evaluate for potential etiologies of her symptoms. The symptomatic left eye appeared normal on ultrasound, whereas the unaffected contralateral eye (right eye) appeared grossly abnormal (Figure). Further history revealed the absence of any acute or chronic visual disturbances associated with the abnormal ultrasound findings.

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) Associated with Mucormycosis Sinusitis in Geriatric Patient

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) Associated with Mucormycosis Sinusitis in Geriatric Patient

Unilateral asymptomatic optic disc edema: do not forget sinusitis

Background: Optic disc edema is a pathological condition with various causes. Cases of optic disc swelling should be dealt with a multidisciplinary approach to rule out those causes. Unilateral optic disc edema is seen in papillitis, non-arteritic anterior ischemic optic neuropathy, retinal vein occlusion, and infection or inflammation of the contiguous sinus or orbit. Here, we report a rare case of unilateral asymptomatic optic disc edema due to posterior ethmoid sinusitis. 
 Case Presentation: A 53-year-old man presented for a routine 3-monthly follow-up after an uneventful cataract surgery of the right eye. All examinations were unremarkable, except for the right eye optic disc edema on fundus examination, consistent with an enlarged blind spot in the visual field test. Contrast-enhanced magnetic resonance imaging revealed mucosal thickening with muco-inflammatory exudates of the posterior ethmoidal sinus overriding the optic disc on the right side, leading to optic disc edema of the right eye. The patient was diagnosed with unilateral asymptomatic optic disc edema in the right eye due to posterior ethmoid sinusitis and referred to an otorhinolaryngologist for the management. The otorhinolaryngologist performed functional endoscopic sinus surgery and prescribed antibiotics and anti-histamines for 6 weeks. At the final examination, his visual acuity was 6/6, and the fundus examination revealed no optic disc edema.
 Conclusions: We reported a rare case of unilateral optic nerve edema and visual field loss with a treatable cause. Contemporary imaging provided the accurate diagnosis. Therefore, in cases of disc edema, sinusitis of the adjacent paranasal sinuses should be ruled out as a possible cause of compressive optic neuropathy or inflammation overriding the optic nerve.

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) in Geriatric Patients, a Series of Three Cases

Acute Unilateral Vision Loss and Optic Perineuritis (OPN) in Geriatric Patients, a Series of Three Cases

Unilateral Vision Loss Unmasking Underlying Acute Leukemia

Unilateral Vision Loss Unmasking Underlying Acute Leukemia

A case of severe endogenous endophthalmitis with orbital cellulitis post COVID-19

Coronavirus disease 2019 (COVID-19) is a novel pandemic viral illness which may lead to severe respiratory diseases. However, its ophthalmic manifestations are still not well understood. There could be serious complications involving various organs in patients with the disease and in those who are recovering, or have recovered, from COVID-19. Endogenous endophthalmitis, was a rare occurrence in the past but has increased in the post-COVID-19 pandemic. Endogenous endophthalmitis results from hematogenous spread from a remote primary source. A 55-year-old man with confirmed COVID-19 presented to a local hospital with unilateral gradual loss of vision and swelling of the left eye that occurred 10 days after discharge from the hospital. Based on detailed ophthalmic examination, this patient with a co-morbidity, namely diabetes mellitus was placed in the intensive care unit where he was given corticosteroids and ventilation for two weeks. Most patients requiring mechanical ventilation may experience disorders of the eye, and it may be difficult to treat these occurrences while the patient remains in ICU. COVID-19 can lead to ocular complications especially in the late stages of infection. Follow-up of post COVID-19 patients is crucial to monitor possible ocular complaints including endophthalmitis as early diagnosis and treatment is essential to salvage vision.ContributionThere is a possible link between COVID-19 and endophthalmitis, which is a rare but devastating eye infection. The medical community should consider the eye when evaluating the role of anti-infectious treatment and immunomodulation.

A new classification for diagnosis of optic neuritis

In 1991, the Optic Neuritis Study Group defined the typical profile of acute optic neuritis as unilateral visual loss, an afferent pupillary defect, and eye pain, with normal ophthalmoscopy in most cases.1 However, despite advances in imaging and antibody testing, the misdiagnosis of optic neuritis remains a major concern.2

Bilateral Orbital Tuberculosis with Unilateral Severe Irrversible Vision Loss in Children: A Case Report

Introduction: Tuberculosis is a transmissible infectious disease caused by mycobacterium tuberculosis. Ocular tuberculosis is rare representing between 1% to 18% of all forms of tuberculosis and only 0.3% of patients develop the orbital form. The focus is usually unilateral, we report through this observation a case of bilateral orbital tuberculosis in a 12 year old girl. Observation: A 12-year-old girl was admitted to the department of infectious and tropical diseases of the National Hospital of Zinder for long term fever and violent headache. The ophthalmological examination revealed a visual acuity of 1/10 on the right, absence of light perception on the left and bilateral exophthalmos. Biomicroscopic examination showed superficial punctate keratitis bilaterally, a normal fundus on the right and left atrophy. In view of the long-lasting fever and the biological inflammatory syndrome, the diagnosis of tuberculosis was evoked. The tuberculin intradermal test (IDR) was positive and the search for BK in the bronchial lavage revealed BAARs. HIV serology was negative. The standard chest X-ray was normal but the CT scan of the orbito- cerebral cavity showed two cystic foci with grade III exophthalmos. After 3 months of anticillary treatment the evolution was considered satisfactory. Conclusion: The orbital involvement of tuberculosis was generally unilateral, its bilateral localization is unusual. It must be systematically evoked in front of any case of bilateral exophthalmos especially in an infectious context in order to avoid irrevesible vsion loss.