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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Vision loss is a common complication of tuberculosis in South East Asia. Vision loss is seen both in pulmonary as well as in extrapulmonary tuberculosis. Tuberculous meningitis is the most frequent extrapulmonary tuberculosis that leads to vision impairment. Vision impairment occurs in approximately 25% tuberculous meningitis patients.29 In tuberculous meningitis, a variety of causes are responsible for vision loss. Causes include tuberculous optic neuropathy, optico-chiasmatic arachnoiditis, compression by enlarging third ventricle, optic nerve tuberculoma and ethambutol toxicity. Tuberculous optic neuritis can occur as a result of direct Mycobacterium tuberculosis infection, Bacillus Calmette-Guerin vaccination or hypersensitivity reaction.30 Tuberculous optic neuritis often presents with unilateral painless vision loss. Eye examination demonstrates papillitis along with neuroretinitis, optic nerve tubercle and papilledema.31
Neurology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
This is acute inflammation of the optic nerve; papillitis if the nerve head is involved – when the optic disc will appear swollen; retrobulbar neuritis if the inflammation is behind the nerve head – when the optic disc will appear normal. Causes include: MS and viral infections.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Bilateral optic disc swelling may be seen more commonly than unilateral and may be due to buried optic disc drusen (Figs 7.48, 7.49), papilloedema (Fig. 7.50), malignant hypertension, cavernous sinus thrombosis, and bilateral papillitis (Fig. 7.51). In papillitis, vision is always affected but not in papilloedema unless it is chronic.
Bilateral Vision Loss and Visual Hallucinations in Subacute Sclerosing Panencephalitis: A Case Report
Published in Neuro-Ophthalmology, 2023
Ravi Uniyal, Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Shweta Pandey, Imran Rizvi, Amita Jain, Nidhi Tejan, Rupesh Singh kirar
Bilateral acute vision loss occurs due to any disease process that involves either bilateral or optic nerves optic chiasm, bilateral optic radiation, or bilateral occipital cortex. Common conditions include bilateral optic neuritis, sellar, or parasellar tumour; infarcts, inflammatory granuloma, or tumours involving the occipital cortex. Colour desaturation can occur due to maculopathies and optic neuritis; however, flashes of light (phosphenes) on ocular movements are more suggestive of optic neuritis.2,3 Patient did not have pain in ocular movements. Pain during ocular movement occurs due to traction at the origins of the superior and medial recti on the inflamed optic nerve sheath. This is commonly associated with retrobulbar optic neuritis; however, it is uncommon in papillitis (inflammation of the optic nerve head).4 Fundus examination shows disc oedema in papillitis, whereas the optic disc remains normal in early retrobulbar optic neuritis. However, optic atrophy may ensue in retrobulbar optic neuritis depending upon the severity of involvement. Severe vision loss and fundus examination findings in this patient suggest papillitis.
Tocilizumab Employment in the Treatment of Resistant Juvenile Idiopathic Arthritis Associated Uveitis
Published in Ocular Immunology and Inflammation, 2021
Arash Maleki, Ambika Manhapra, Soheila Asgari, Peter Y. Chang, C. Stephen Foster, Stephen D. Anesi
Using linear and binary generalized estimating equations (GEE), the average decrease in LogMAR BCVA from the first visit with us to IV-TCZ therapy was significant (0.21 ± 0.47 LogMAR, P < .001). The average improvement in visual acuity after IV-TCZ employment was also significant (0.13 ± 0.28 LogMAR, P < .001). IV-TCZ success rate was inversely correlated with duration between starting treatment and vision improvement, duration between first diagnosis of uveitis and IV-TCZ treatment and duration between the first visit at our facility and IV-TCZ treatment. Furthermore, among ancillary tests findings, the presence of papillitis was directly correlated with mean visual acuity improvement. Final LogMAR visual acuity was directly correlated with the age of uveitis diagnosis (P = .012), and age of first visit (P = .049).
Clinical Features of Ocular Syphilis: a Retrospective Clinical Study in an Italian Referral Centre
Published in Seminars in Ophthalmology, 2020
Antonietta Moramarco, Fabiana Mallone, Maria Pia Pirraglia, Alice Bruscolini, Rosalia Giustolisi, Maurizio La Cava, Alessandro Lambiase
In this study, we observed an improved visual outcome in patients with papillitis at onset, while patients with chorioretinitis showed the worst visual recovery. An explanation of the different ‘behaviour’ assumed by these two forms of ocular syphilitic involvement can be found in the type of the affected structures. Chorioretinitis involves photoreceptoral structures, causing tissue re-alignment and widespread and irreversible alterations. On the contrary, papillitis affects the head of the optic nerve and causes mechanical and functional damage due to oedema and compression of the nerve fibres. Nevertheless, the initial reversible optic nerve damage can cause, if not early treated, serious complications such as optic atrophy. In the light of the above, it seems more reasonable to state that anterior optic neuritis, if still in the initial (reversible) stage and if promptly treated, can give better functional results (in terms of visual acuity) than other types of ocular involvement.22