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One or More Bulging Eyes
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Lids and orbit: Examine and palpate for mass or swelling in the eyelid, around the globe or behind the globe on retropulsion. Document mass features: site, size, surface/overlying skin, colour, contour, consistency, temperature, transillumination, tethering and tenderness to underlying structure. Palpate for swelling in the head and neck lymph nodes, which may point towards an infective or neoplastic cause, with temporal fullness for example being due to sphenoid wing meningioma.
Examine the cranial nerves
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
Q: What are the causes of IIIrd nerve palsy? Ischaemic (microvascular) IIIrd nerve palsy. Usually painless with pupillary sparing in patients with diabetes and/or hypertension.Surgical causes such as posterior communicating artery aneurysm (painful) or brainstem tumour.Multiple sclerosis and migraine rarely cause an isolated IIIrd nerve palsy.IIIrd nerve palsy could be due to uncal herniation (an important sign to recognise in clinical practice, but not in the exam!).If there is involvement of the V (VI and V2) and VI, a lesion in the superior orbital fissure or cavernous sinus should be considered (metastasis, sphenoid wing meningioma, nasopharyngeal carcinoma, carotid siphon aneurysm or cavernous sinus thrombosis).Basal meningeal lesion as a result of infection (tuberculosis or fungal), carcinomatous, neurosarcoid or direct spread from nasopharyngeal tumour.
Cranial nerve disorders
Published in Hani Ts Benamer, Essential Revision Notes in Clinical Neurology, 2017
➤ Causes of 3rd nerve palsy include: ➣ Ischaemic (microvascular) – usually painless with pupillary sparing in patients with diabetes and/or hypertension. Spontaneous recovery within 3–4 months is the usual outcome.➣ Surgical causes – posterior communicating artery aneurysm (painful) or brainstem tumour.➣ MS and migraine rarely cause isolated 3rd nerve palsy.➣ A lesion in the superior orbital fissure or cavernous sinus such as metastasis, sphenoid wing meningioma, nasopharyngeal carcinoma, carotid siphon aneurysm or cavernous sinus thrombosis.➣ Basal meningeal lesion as a result of infection (tuberculosis or fungal), carcinomatous, neurosarcoid or direct spread from nasopharyngeal tumour.➣ Tentorial herniation and coning (seeChapter 16, p. 51).
Outcomes of surgical resection of sphenoid-orbital meningiomas with Sonopet ultrasonic aspirator
Published in Orbit, 2021
Jack Ao, Valerie Juniat, Garry Davis, Stephen Santoreneos, Amal Abou-Hamden, Dinesh Selva
Pre-operatively, six patients (86%) had visual deterioration in the form of decreased visual acuity, decreased Ishihara scores, optic disk pallor and visual field abnormalities (Tables 2 and 3). Five patients (71%) initially had afferent pupillary defects. Patient one later developed an afferent pupillary defect prior to the second procedure due to tumour recurrence. One (14%) patient had bilateral sphenoid wing meningiomas with optic neuropathy, hence did not display an afferent pupillary defect. All patients had proptosis. The mean proptosis was 5.1 mm ± 1.3 mm. Two patients (29%) had cranial nerve deficits with associated diplopia. Of these patients, one (14%) had a sixth nerve palsy whilst the other (14%) had a partial third and a fourth nerve palsy. Patient seven had undergone previous craniotomy and debulking of their sphenoid wing meningioma.
Shared Features of the Heimann–Bielshowsky Phenomenon and Ocular Neuromyotonia
Published in Neuro-Ophthalmology, 2020
Subhan Tabba, Ashwini Kini, Bayan Al Othman, Andrew G. Lee
A 57-year-old white female with no significant past medical history presented with 2 years of worsening right-sided headaches and worsening vision in the right eye. MRI revealed a sphenoid wing meningioma compressing the optic nerve on the right. The best corrected visual acuity was 20/40 in the right eye (OD) and 20/20 in the left eye (OS). The pupils measured 4 mm in the dark and 2 mm in the light OU with a right relative afferent pupillary defect. Extraocular motility was within normal limits. External and anterior segment examination was normal in both eyes. Fundus exam in OD showed diffuse optic atrophy and OS was normal. A Humphrey Visual Field showed a mean deviation of −5.45 decibels (dB) with an inferior arcuate defect OD and was normal OS. After the subtotal neurosurgical resection of WHO grade 1 meningioma, the patient lost vision to no light perception OD. Serial magnetic resonance imaging (MRI) studies showed a recurrence of the meningioma for which the patient underwent fractionated external beam radiation therapy. Serial MR imaging was stable for the next 7 years. The patient subsequently presented to the neuro-ophthalmology clinic with a new finding of a 25 degree vertical pendular oscillations that had a rate of 2 cycles per second in the right eye.These resembled the HBP, however, the oscillations were transient, lasting approximately 2 min and with intervals of no abnormal movements. Gaze position did not affect the onset, frequency, or severity of the findings. A trial of carbamazepine did not alleviate the physical examination findings in this patient.
Utilising the Alexis Retractor for lateral orbital access, a case series
Published in Orbit, 2018
Yun Wong, Princeton Lee, Timothy Sullivan
Thirteen operations using the Alexis retractor were performed over a two year period. The mean age of the patients was 57. Ten eyes had a lateral and medial wall orbital decompression for thyroid eye disease and the Alexis retractor was used when gaining access to the lateral orbit. Three patients had orbital lesions removed via a lateral orbitotomy utilising the Alexis retractor. Two of these were schwannomas which were completely excised and 1 patient had a sphenoid wing meningioma debulked (Table 1).