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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Optic neuropathy commonly occurs 2–6 weeks after onset of the rash.6 The patient can present with unilateral or bilateral vision loss. On eye examination, papillitis can be demonstrated. The role of corticosteroids is not clear although they are advocated to accelerate recovery. Usually majority patients recover vision. Optic neuropathy can be part herpes zoster ophthalmicus, either at time of rash or later in post-herpetic phase.7 Patient can report unilateral or bilateral vision. Optic disc is either normal or infrequently oedematous. Acyclovir and steroids are used for the treatment. The visual prognosis is generally good. Varicella zoster infection can also cause retinal necrosis in immunocompromised patient. In patients with retinal necrosis, optic nerve can also be affected. The visual prognosis in patients with retinal necrosis is generally poor.8
Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Vision loss with both forms of ischemic optic neuropathy usually occurs quickly over minutes to days, and is painless. With giant cell arteritis, additional symptoms include general malaise, headaches over the temples, muscle aches and pains, jaw claudication, pain when combing the hair, and tenderness over the temporal artery. These symptoms sometimes do not occur until vision is already lost. There is reduced visual acuity and an afferent pupillary defect. The optic disk swells and becomes elevated. Swollen nerve fibers obscure the thin surface vessels of the optic nerve. Hemorrhages may surround the optic disk in many cases. The disk is often pale in the arteritic form, but hyperemic in the nonarteritic form. With both forms, a visual field examination often reveals a central defect, an altitudinal defect, or both.
Ophthalmoscopy
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Once the retina has come into focus, you should clearly be able to see blood vessels. Follow these towards the patient’s nose, until you are able to visualise the optic disc. You should then comment on the following features of the disc: colourmarginscup-to-disc ratioblurring of the optic disc, if any.
Eye Abnormalities in Children with Fetal Alcohol Spectrum Disorders: A Systematic Review
Published in Ophthalmic Epidemiology, 2023
Tracey W Tsang, Amy Finlay-Jones, Kerrin Perry, John R Grigg, Svetlana Popova, Melissa Mei Yin Cheung, Carol Bower, Patrick Tam, Robyn V Jamieson, Elizabeth J Elliott
Our results highlight the need for examination of the eyes in children diagnosed with FASD, particularly for abnormalities we have identified as highly prevalent in FASD. Children presenting for assessment for FASD are best investigated by a multidisciplinary team including a paediatrician. All children having a FASD assessment should have their PFL measured, either directly or on a digital facial image, and compared to normative population values.8–10,71 As part of the paediatric examination, the eyes should be examined for epicanthic folds, ptosis, microphthalmos, and strabismus (which are frequently reported in FASD), and cataracts, coloboma and corneal opacities should be noted. When possible, the optic disc and retina should be examined using fundoscopy (ophthalmoscopy). Parents of children with PAE/FASD should be asked whether their child’s vision has been tested and whether they require glasses. If not, simple testing of visual acuity should be conducted using an age-appropriate method. Children with poor vision (Snellen equivalent ≤6/18) should be referred to an ophthalmologist or optometrist (>6/18) for further assessment, including slit-lamp examination for optic disc abnormalities if indicated.
Sympathetic Ophthalmia - An Overview
Published in Ocular Immunology and Inflammation, 2023
Mamta Agarwal, Aleksandra Radosavljevic, Mudit Tyagi, Francesco Pichi, Aisha A. Al Dhanhani, Aditi Agarwal, Emmett T. Cunningham
FA in SO demonstrates a delay in choroidal perfusion seen as choroidal hypofluorescence during the acute uveitic phase.91 Usually, the optic disc shows leakage from the disc vessels or staining of the nerve head. Vascular leakage can also be seen. In the acute phase of SO, two patterns of FA can be identified. Most commonly, multiple, bilateral, pinpoint hyperfluorescent dots at the level of the RPE are visualized during the early and mid-phase of the study, corresponding to the RPE bumps over the OCT undulations.98 In the late phase of the angiography, there is an increase in the fluorescence intensity that gradually enlarges and leaks with pooling of dye in the sub-membranous spaces (Figure 3).100,101 The pattern with initial pinpoint hyperfluorescent leaks is seen more frequently and is virtually identical to that seen in the acute phase of VKH disease.
Mimicking chronic glaucoma over 6 months with a single intracameral injection of dexamethasone/fibronectin-loaded PLGA microspheres
Published in Drug Delivery, 2022
Alba Aragón-Navas, María J. Rodrigo, David Garcia-Herranz, Teresa Martinez, Manuel Subias, Silvia Mendez, Jesús Ruberte, Judit Pampalona, Irene Bravo-Osuna, Julian Garcia-Feijoo, Luis E. Pablo, Elena Garcia-Martin, Rocío Herrero-Vanrell
Neuro-retinal structures were studied with the Spectralis OCT device (Heidelberg® Engineering, Germany) and with a contact lens adapted on the rat cornea to get higher quality acquisitions. It was performed at baseline and at 2, 4, 6, 8, 12, 18 and 24 weeks after the OHT injection. Protocols such as full Retina thickness posterior pole (R), Retina Nerve Fiber Layer (RNFL) and Ganglion Cells Layer (GCL) with automatic segmentation were used. These protocols analyzed an area of 3 mm around the center of the optic disk by 61 b-scans and subsequent follow-up examinations were acquired at this same location using the eye tracking software and follow-up application. The Retina and GCL were analyzed by mimicking the 9 ETDRS areas which included a central (C) 1 mm circle centered in the optic disk, (though no fovea exists in rats) and inner (inferior -II-, superior -IS-, nasal -IN-, temporal -IT-) and outer (inferior -OI-, superior -OS, nasal -ON-, temporal -OT-) rings measuring 2 and 3 mm in diameter, respectively, as well as total volume (TV). The RNFL protocol provides measurements of the 6 peripapillary sectors (inferotemporal -IT-, inferonasal -IN-, superotemporal -ST-, superonasal -SN-, nasal -N- and temporal -T-). Full retinal thickness posterior pole (R) comprises from the inner limiting membrane to the retinal pigment epithelium; RNFL from the inner limiting membrane to the GCL boundaries; and GCL from RNFL to the inner nuclear layer boundaries.