Giant cell arteritis: a case report with scalp necrosis and sudden blindness

In the summer of 2020, an elderly woman in her eighties sought medical attention due to headache and visual disturbances. The diagnosis was unclear, she became blind on both eyes and developed extended scalp necrosis. Later it was clear that these symptoms were due to accelerating symptoms of giant cell arteritis (GCA). GCA is one of the most common disease form of vasculitis and can have various symptoms. In this report, we describe a case of an advanced disease course, discuss the main symptoms, diagnosis and treatment.

Contents Vol. 36 No.1 January-June 2021

EDITORIAL4 Death and Dying During the COVID-19 Pandemic: Tahan Na, HumimlayLapeña JFF REVIEW ARTICLE6 Prevalence of Olfactory Dysfunction Among COVID-19 Patients with Self-Reported Smell Loss Versus Objective Olfactory Tests: A Systematic Review and Meta-Analysis Regalado JAF, Tayam MMH, Santos RA, Gelera JE ORIGINAL ARTICLES15 Self-Reported Assessment of Outcome-Based Education in Philippine Otolaryngology - Head and Neck Surgery Residency Training Programs by Consultants and ResidentsAlmazan MNA 24 Classification and Stages of Middle Ear Cholesteatoma at the Southern Philippines Medical Center Using the European Academy of Otology and Neurotology / Japan Otological Society (EAONO / JOS) System Toral DB, Laganao CRD 28 Predominant Endotype of Nasal Polyps in a Sample of Filipinos Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal PolyposisNable-Llanes KV, Roldan RA 33 Association of Anosmia and Positive SARS-CoV-2 (COVID-19) RT-PCR Test Results Among Patients in the Quezon City General Hospital Alega JJP, Cruz ETS CASE REPORTS37 Smell Training in Prolonged COVID-19 Post-Infectious Olfactory Dysfunction: A Case ReportVillar PMAC, Chua RU, Robles RP 41 Self-Inflicted Craniofacial Impalement Injury with a Screwdriver During the COVID-19 Pandemic: A Case ReportGatela JLJG 45 To the Lip and Beyond: A Case Report of a Midline Tessier 30 CleftSuarez JDC, Perez GCC SURGICAL INNOVATIONS AND INSTRUMENTATION 50 The Use of Commercially Available Non-Medical Grade USB Cameras for Physician Guided ENT Out-Patient Self-Examination During the COVID-19 PandemicCafino RY PRACTICE PEARLS 57 Understanding the Use of Polycaprolactone in East Asian Structural Rhinoplasty: Questions and AnswersYap EC FEATURED GRAND ROUNDS 62 Delayed Sudden Blindness From Unilateral Ophthalmic Artery Vasospasm Following Endoscopic Sinus Surgery?Chua RJ, Regalado JAF, Gelera JE FROM THE VIEWBOX 65 Fenestral Otosclerosis: A Subtle Lesion Easily MissedYang NW UNDER THE MICROSCOPE67 Inverted Ductal Papilloma of the Salivary Gland Carnate JM CAPTOONS69 Doknet’s WorldBillones WU PASSAGES70 Elvira I. Colmenar, MDColmenar MTI 71 Ruben G. Henson, Jr., MD Henson RD 72 Marlon V. del Rosario, MD Calderon AF 73 Oliverio O. Segura, MD Segura PPR

Evans syndrome in child with sudden blindness

A 3-year-old girl presented with sudden onset of bilateral vision loss on waking up from sleep. There had been no associated eye pain, eye redness, fever or history of trauma in the days leading up to the presentation. She had been diagnosed with Evans syndrome at the age of 18 months and started on a regular dose of oral prednisolone under regular follow-up at the paediatric clinic. Upon presentation, her visual acuity was light perception bilaterally, with relative afferent pupillary defect in the right eye and sluggish pupils bilaterally. Bilateral fundus examination showed normal macula and pink optic discs without papilloedema. Other systemic examinations were unremarkable. The provisional diagnosis was severe bilateral retrobulbar optic neuritis, prompting further investigations to rule out infectious or vasculitic causes. Extensive investigations were carried out during admission including infective screenings of blood and urine, all of which were negative. A contrasted magnetic resonance image of the brain showed both orbital segments were swollen and appeared hyperintense, with involvement of the intracanalicular and intracranial segments, suggesting an inflammatory or demyelinating aetiology. A visual evoked potential test to rule out demyelination disease was also normal. As intravenous methylprednisolone treatment appeared to have a slow effect, the treatment was switched to intravenous gammaglobulin. The patient responded well to treatment, and her latest visual acuity assessment 1 month after presentation showed bilateral vision of 6/24. This is the first-ever Evans syndrome patient to be reported worldwide with bilateral optic nerve sterile inflammation.

Optic Neuritis During Lactation: A Case Series

Background Optic neuritis is a rare condition that can lead to sudden blindness and also could be a precursor to multiple sclerosis. When it occurs postpartum during lactation, it is called lactation optic neuritis. Main issue We present four cases of optic neuritis in lactating mothers, two of which had additional features of demyelinating disease upon neurological imaging. Management All participants were treated with high dose intravenous steroids followed by 11 days of oral steroids, per the optic neuritis treatment trial, which led to complete recovery of vision. Two participants with demyelinating disease on magnetic resonance imaging scans were advised to wean, because of a need for immunosuppressive therapy later. Conclusion Optic neuritis during lactation should be suspected following acute loss of vision. Prompt referral to an ophthalmologist is mandated for early diagnosis and treatment to prevent long-term co-morbidities.

Purtscher’s retinopathy: a case report

Purtscher’s retinopathy is a rare haemorrhagic and vaso-occlusive vasculopathy following severe head trauma associated with sudden blindness. Here we report a case of 28 years old male pre­sented to out-patient department with history of sudden and painless loss of vision in his right eye for two days. He gave history of head injury following bike accident. At the time of presentation his best corrected visual acuity was 1/60 in the right eye and 6/6 in the left eye. On examina­tion, anterior segments of both eyes were normal. On fundus examination, right eye revealed retinal whitening in the peripapillary region (Purtscher’s flecken), an intraretinal hemorrhage and signs of macular edema whereas left eye was unremarkable. Findings were suggestive of right eye purtscher’s retinopathy. Optical coherence tomography and fundus fluorescence angiography was done to support the diagnosis. Purtscher’s retinopathy should not be neglected because it is associated with different systemic disease. Its pathophysiology remains unclear and there is no definite treatment but meticulous management is urgent to prevent from severe complications.

Four common diseases causing sudden blindness or death in the eye emergency department

Neuro-ophthalmological emergency disorders typically present with symptoms of visual loss, diplopia, ocular motility impairment or anisocoria. The ocular manifestations of these disorders are sometimes indicative of a more serious global neurology disease rather than an isolated ocular disease. The aim of this review is to highlight four important neuro-ophthalmological emergency disorders that must not be missed by an ophthalmologist. These include acute painful Horner’s syndrome, painful cranial nerve III palsy, giant cell arteritis and transient ischaemic attack with amaurosis fugax. The delayed diagnosis of these clinical entities puts the patient at risk of blindness or death. Therefore, prompt diagnosis and management of these conditions are essential. This can be acquired from understanding the main signs and symptoms of the disease presentation together with a high index of suspicion while working at a busy eye emergency department.

An old lady with acute headache and sudden blindness

A 60-year-old hypertensive lady experienced painless sudden visual loss in the right eye when resting at home. There was no traumatic injury, no eye pain, or flashes or floaters, or nausea, but mild right-sided headache for few days. She was not lifting heavy objects, nor straining. She managed to attend the emergency department within 1 h of onset of symptoms by herself walking into the consultation room unaided. Examination showed visual acuity with pinhole of hand movement over the right eye, right relative afferent pupillary defect and normal intraocular pressure of 15 mmHg. Extraocular movement was full without diplopia or pain. Eyes were not injected, and slit lamp examination was normal with clear cornea. Acute management of vascular causes of acute blindness and the role of hyperbaric oxygen therapy in ophthalmological disease in Hong Kong will be discussed.

Traumatic Orbital Subperiosteal Hematoma With Acute Visual Compromise: Role of the Head and Neck Surgeon

The primary goal was to report our institutional experience of a rare, vision-threatening complication following craniomaxillofacial trauma. A retrospective review was performed between January 2016 and January 2018 to identify 3 patients with traumatic orbital subperiosteal hematoma (OSPH). Visual acuity, intraocular pressures (IOPs), and the need for surgical intervention were abstracted. The age range was 36 to 88 years. Indications for surgical intervention include relative afferent pupillary defect, gaze restriction, visual impairment, and elevated IOP. Preoperatively, IOP range was 15.0 to 25.0. Two patients required OSPH evacuation via a medial brow approach. Follow-up after ocular injury ranged from 25 to 41 days, with IOP range of 13.0 to 16.0. Traumatic OSPH is an uncommon clinical finding; prompt assessment with consideration of surgical intervention may mitigate deleterious long-term morbidity, chiefly sudden blindness. Further research efforts may elucidate the optimal method in the management of this complex clinical entity.

Efficacy of High-dose Steroids for Visual Acuity Improvement in Methanol-induced Toxic Optic Neuropathy

Introduction : Methanol-induced toxic optic neuropathy (TON) is defined as a visual impairment due to optic nerve damage by methanol poisoning. Not only is this disease entity underdiagnosed at times, this sudden blindness is also often diagnosed at a stage where recovery of vision is no longer possible. Materials and Methods : A literature search was conducted using PubMed, ClinicalKey, Google Scholar and ScienceDirect by combining the keywords ‘methanol’ or ‘methyl alcohol’, ‘intoxication’ or ‘poisoning’, ‘toxic optic neuropathy’, and ‘visual acuity’ with ‘high-dose steroid’. Results : The total amount of subjects in each article varied from 2 to 37, with mean age distribution of 26.34 to 55 years old, where most patients were male. The follow up duration varied from 1 week to 1 year. Four articles do not mention high-dose steroids treatment as therapy while the other four mention use of 1000 mg of intravenous methylprednisolone per day with divided doses of either 2x500 mg or 4x250 mg. Improvement percentages show 100% improvement in all studies that used high-dose steroids, while in the non-high-dose steroids studies the improvement percentages range from 33.33% to 90%. Summary : High-dose steroids are showing efficacy in improving visual acuity and reducing the inflammation in methanol-induced TON. The period of how fast the therapy takes effect is inconclusive, as the mean follow-up time differs widely per study. However, because most of the reviewed studies here are retrospective case series, a larger, more comprehensive study is required to acknowledge more of the efficacy profile.