scholarly journals Bilateral Syphilitic Optic Neuropathy with Secondary Autoimmune Optic Neuropathy and Poor Visual Outcome

2019 ◽  
Vol 10 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Tanya Kowalski ◽  
Dujon  Fuzzard ◽  
Isla Williams ◽  
Jonathan Darby ◽  
Heather Gwen Mack
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Nerve Palsy ◽  
Visual Loss ◽  
Visual Outcome ◽  
High Dose ◽  
Optic Nerve Atrophy ◽  
Poor Visual Outcome ◽  
Appropriate Treatment

We describe the case of a 65-year-old man who suffered progressive visual loss despite appropriate treatment of ocular syphilis. Our patient initially presented with a unilateral 6th nerve palsy and associated double vision, which self-resolved over 6 months. His ophthalmic examination was otherwise normal. 12 months after the initial complaint, he represented with dyschromatopsia, reduced visual acuity, tonic pupils, and optic nerve atrophy. He tested positive for syphilis and was admitted for treatment of neurosyphilis with high-dose benzylpenicillin. Despite treatment, at a 4-month review his visual acuity remained poor and progression of optic nerve atrophy was noted alongside the development of bilateral central scotomas. Further testing was congruent with a diagnosis of autoimmune optic retinopathy. We propose this to be secondary to his syphilitic infection. Syphilis is known as the “great mimicker,” and despite being quite treatable, this case highlights ongoing complexity in the diagnosis and management of syphilis, unfortunately with a poor visual outcome.

scholarly journals Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

2021 ◽  
Author(s):  
Bincy Joseph ◽  
Sapna S. Nambiar ◽  
K. Ramachandran ◽  
Suma Radhakrishnan
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
High Dose ◽  
Time Interval ◽  
Traumatic Optic Neuropathy ◽  
High Dose Steroid ◽  
Nerve Decompression ◽  
Prompt Treatment ◽  
Optic Nerve Decompression

<p><strong>Background: </strong>Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.</p><p><strong>Methods:</strong> A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.</p><p><strong>Results:</strong> In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve decompression. 11(57.9%) patients had improvement of vision, 7 (36.8%) patients had no improvement of vision and 1 (5.3%) patient had worsening of vision. The visual improvement was seen in 8 (80%) patients when treatment was initiated within 7 days and in only 3(33.3%) patients when treatment was initiated after 7 days. The visual acuity at presentation and time interval between trauma and intervention are factors that determine better visual outcomes.</p><p><strong>Conclusions:</strong> The decreased visual acuity in TON requires prompt treatment. High dose steroid must be started at once when it is suspected or diagnosed. The timely surgical intervention with trans-nasal endoscopic optic nerve decompression is a relatively safe and effective technique enabling better visual prognosis.</p>

Surgical treatment of progressive visual loss in traumatic optic neuropathy

1989 ◽  
Vol 70 (5) ◽  
pp. 799-801 ◽  
Author(s):  
John Guy ◽  
Mark Sherwood ◽  
Arthur L. Day
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Arachnoid Cyst ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Optic Nerve Sheath ◽  
Traumatic Optic Neuropathy ◽  
Axial Tomography ◽  
Nerve Sheath ◽  
First Case

✓ In two patients with traumatic optic neuropathy progressive visual loss was reversed by surgical decompression of the optic nerve sheath. The first patient with hemorrhage beneath the optic nerve sheath had progressive loss of vision from counting fingers to no light perception within 24 hours after the injury. Surgical evacuation of the hematoma improved visual acuity to 8/30. The second patient had progressive visual loss from 20/20 to 20/400 within the 1st week after injury. Drainage of an arachnoid cyst of the optic nerve sheath improved visual acuity to 20/25. Computerized axial tomography disclosed the hemorrhage in the first case and enlargement of the optic nerve sheath in the second. While the management of traumatic optic neuropathy is controversial, surgical intervention for an arachnoid cyst and hematoma involving the optic nerve is clearly beneficial.

Inflammatory optic neuropathy in granulomatosis with polyangiitis can mimick isolated idiopathic optic neuritis

2019 ◽  
pp. 112067211988900
Author(s):  
Manon Clément ◽  
Antoine Néel ◽  
Frédérique Toulgoat ◽  
Michel Weber ◽  
Pascal Godmer ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Visual Acuity ◽  
Optic Nerve ◽  
Magnetic Resonance ◽  
Literature Review ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Granulomatosis With Polyangiitis ◽  
Orbital Apex ◽  
Resonance Imaging

Objective: We describe a clinico-radiological presentation of inflammatory optic neuropathy that mimicked optic neuritis. Methods: Retrospective single-center case series and literature review of optic neuropathy without orbital pseudotumor. Results: Five local patients fulfilled the inclusion criteria. Clinical presentation revealed rapidly progressive severe unilateral visual loss, retrobulbar pain (n = 4), and paralytic strabismus (simultaneous = 2, protracted = 2) without proptosis. Optic nerve abnormality was not appreciated on initial scan review. Patients did not have any general activity of the granulomatosis with polyangiitis. Upon follow-up magnetic resonance imaging and initial imaging review, all patients revealed orbital apex anomalies. Visual acuity improved in three patients who received high-dose intravenous glucocorticosteroids immediately. Relapse was frequent and visual outcome was poor (final vision > 20/40 in two patients only). Literature review identified 16 well-documented cases of granulomatosis with polyangiitis–related isolated optic neuropathies. Magnetic resonance imaging revealed no abnormality (n = 6), optic nerve and/or sheath involvement (n = 9), apex infiltration (n = 3), and/or pachymeningitis (n = 7). Conclusion: Granulomatosis with polyangiitis is a rare yet potentially blinding cause of inflammatory optic neuropathy. Optic neuropathy in granulomatosis with polyangiitis may occur in the absence of systemic symptoms of disease activity and is challenging to distinguish from other inflammatory and non-inflammatory disorders affecting visual acuity. Several clinical and imaging clues suggest that optic neuropathy results from the development of an extravascular granulomatous process within the optic nerve sheath in the orbital apex, a place that is difficult to image. In a granulomatosis with polyangiitis patient with unexplained visual loss and a seemingly normal workup (fundoscopy, biology, and imaging), clinician should keep a high index of suspicion.

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

2021 ◽  
pp. 112067212110006
Author(s):  
Xin Liu ◽  
Lufei Wang ◽  
Fengjuan Yang ◽  
Jia’nan Xie ◽  
Jinsong Zhao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Management ◽  
Pediatric Patients ◽  
Vitreous Hemorrhage ◽  
Visual Outcome ◽  
Poor Visual Outcome ◽  
Early Vitrectomy ◽  
Open Globe ◽  
Time From Injury ◽  
Ocular Sign

Purpose: To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Methods: Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Results: Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Conclusion: Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

scholarly journals Compressive Optic Neuropathy Caused by Orbital Non-Hodgkin's Lymphoma

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Mohammed M. Ziaei ◽  
Hadi Ziaei
Keyword(s):  
Optic Nerve ◽  
Paranasal Sinus ◽  
Optic Neuropathy ◽  
Hodgkin’S Lymphoma ◽  
Visual Loss ◽  
Hodgkin's Lymphoma ◽  
Compressive Optic Neuropathy ◽  
Acute Visual Loss ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Purpose. To present a unique case of Non-Hodgkin’s-Lymphoma- (NHL) associated compressive optic neuropathy.Method. An 89-year-old male presenting with acute unilateral visual loss and headache.Results. Patient was initially diagnosed with occult giant cell arteritis; however after visual acuity deteriorated despite normal inflammatory markers, an urgent MRI scan revealed an extensive paranasal sinus mass compressing the optic nerve.Conclusion. Paranasal sinus malignancies occasionally present to the ophthalmologist with signs of optic nerve compression and must be included in the differential diagnosis of acute visual loss.

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

2021 ◽  
Vol 104 (7) ◽  
pp. 1166-1171
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Poor Prognosis ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
Case Series ◽  
Light Perception ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

scholarly journals P.093 Visual outcomes after expanded endoscopic endonasal resection of suprasellar meningiomas and optic nerve decompression

2019 ◽  
Vol 46 (s1) ◽  
pp. S38
Author(s):  
K Yang ◽  
Y Ellenbogen ◽  
J Kim ◽  
A Rodriguez ◽  
D Sommer ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Outcome ◽  
Symptom Duration ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Visual Symptoms ◽  
Nerve Decompression ◽  
Optic Nerve Decompression

Background: The Endoscopic endonasal approach (EEA) has become increasingly popular in the treatment of suprasellar meningiomas, which often cause visual symptoms due to compression of the anterior optic apparatus. Methods: We performed a retrospective chart review on patients who underwent EEA optic nerve decompression and resection of suprasellar meningiomas between January 1st 2005 and December 1st 2018 at McMaster University. Results: The mean age of our patients was 59.8 years. We treated 9 male and 23 female patients, with a mean follow up of 6.29 years. 23 patients (71.9%) presented with visual symptoms, with a mean duration of 8.65 months. In our patient cohort, 95.5% had stable or improved visual acuity postoperatively. Less than six months of visual decline was more likely to be associated with postoperative improvement of visual acuity, with an odds ratio (OR) of 0.0222 (95% CI: 0.0017–0.289, p&lt;0.05); as well as visual field (OR:0.0625; 95% CI, 0.0042–0.915, p&lt;0.05). Additionally, the absence of RAPD was associated with improved postoperative visual acuity (OR: 0.0675; 95% CI, 0.0354–0.706, p&lt;0.05). Conclusions: Endoscopic endonasal approach can achieve good visual outcome in patients harboring suprasellar meningiomas. Symptom duration of less than six months and absence of RAPD were positive predictor of postoperative visual outcome.

scholarly journals Presentation, surgery and 1-year outcomes of childhood cataract surgery in Tanzania

2020 ◽  
pp. bjophthalmol-2020-316042
Author(s):  
Furahini Godfrey Mndeme ◽  
Blandina Theophyl Mmbaga ◽  
Mchikirwa Msina ◽  
Judith Mwende ◽  
Sonia J Vaitha ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Low Income ◽  
Visual Outcome ◽  
Low Income Countries ◽  
Similar Proportion ◽  
Poor Visual Outcome ◽  
A Prospective Study ◽  
Good Vision ◽  
Childhood Cataract

BackgroundRecent reports have suggested a significant change in the causes of blindness in children in low-income countries cataract becoming the leading cause. We aimed to investigate the presentations and surgical outcomes in children with cataract operated at different ages in Tanzania.MethodsWe conducted a prospective study of 228 children aged ≤192 months at three tertiary centres, 177 with bilateral cataracts and prospectively followed them for 1-year postsurgery. We collected demographic, surgical, preoperative and postoperative clinical characteristics using the standard childhood cataract surgical assessment questionnaire. Families were encouraged to return for follow-up by phone with travel reimbursement where necessary.ResultsPreoperatively, 76% bilateral children were blind in the better eye. 86% of children were followed up at 1 year and 54% bilateral children achieved visual acuity of 0.48 logMAR or better in the better eye and 5% were blind. 33% of unilateral children achieved visual acuity of 0.48 logMAR or better and 17% were blind. Preoperative blindness (adjusted OR (AOR) 14.65; 95% CI 2.21 to 97.20), preoperative nystagmus/strabismus (AOR 9.22; 95% CI 2.66 to 31.97) and aphakia (AOR, 5.32; 95% CI 1.05 to 26.97) predicted poor visual outcome in bilateral cases. 9% of 342 refracted eyes had initial postoperative cylinder of 1.5 D or more, as did a similar proportion (11%) of 315 eyes refracted 1 year after surgery. Acute fibrinous uveitis occurred in 41 (12%) eyes.ConclusionThree-quarters of children were blind preoperatively whereas over half had good vision 1-year postoperatively. Preoperative blindness, nystagmus/strabismus and aphakia predicted poor visual outcome, suggesting that cataract density determines density of amblyopia.

Visual Loss from Pituitary Tumor Masked by Optic Nerve Drusen

Neurosurgery ◽  
1981 ◽  
Vol 8 (4) ◽  
pp. 473-476 ◽  
Author(s):  
Careen Y. Lowder ◽  
Robert L. Tomsak ◽  
Nicholas Z. Zakov ◽  
Joseph Hahn
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Pituitary Tumor ◽  
Visual Loss ◽  
Strong Indication ◽  
Progressive Loss ◽  
Optic Nerve Drusen

Abstract A case of optic nerve drusen and progressive loss of central visual acuity is reported. Despite the presence of optic nerve drusen. the loss of central visual acuity that cannot be explained by a retinal abnormality is a strong indication for further neuro-ophthalmological evaluation.

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