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Optic Neuropathies Associated with Systemic Disorders And Radiation-Induced Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Ocular involvement is seen in approximately 50–60% of GPA patients and 8% of affected individuals experience disease-related vision loss (10). Any part of eye may be affected, albeit the condition most often manifests as orbital disease, followed by scleral, episcleral, corneal and nasolacrimal abnormalities (10). Early recognition of the ocular features can be pivotal to identifying active disease, and preventing vision loss. Optic nerve involvement may develop from contiguous inflammation in the setting of orbital inflammation, or local compression (1). When orbital disease occurs, it can extend from its origin in the maxillary or ethmoid sinuses, and spread to involve the extraocular muscles, nerves or blood vessels (1, 10). Alternatively, inflammation can arise in the orbit, and spread throughout the retrobulbar space (1, 10). Patients may present with proptosis, ocular motility deficits and pain (1). In some cases, affected individuals develop exposure keratopathy and corneal ulceration, which in turn, leads to permanent vision loss.
Blepharoplasty
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Patients should be specifically questioned about previous eyelid surgery. Patients who have previously undergone a cosmetic blepharoplasty or a facelift may omit such information, particularly if accompanied by a new partner. A history of contact lens wear, dry eye, facial palsy or thyroid dysfunction identifies a patient at risk of exposure keratopathy symptoms following an upper lid blepharoplasty.
Vision Impairment and Its Management in Older Adults
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Rajeev S. Ramchandran, Holly B. Hindman, Silvia Sörensen
Ischemic insults on the optic nerve result in optic neuropathy and lesions affecting the parietal or occipital lobes can result in peripheral or hemispheric vision loss. If the all nerve fibers in the optic nerve are compromised, complete vision loss results. Older adults are at higher risk due to the increased risk of atherosclerotic disease and other systemic diseases, including cancer. Cerebral vascular accidents, compression and tissue destruction from cerebral neoplasms or aneurysms, and traumatic brain injury, which increase with age, can led to visual field loss. The specific region of field loss is relative to the region of the visual pathway affected with manifestation on the opposite field of the side of the brain affected. There are currently no medical or surgical interventions to correct this field loss. In addition to visual field loss, oculomotor coordination and alignment of the eyes and blink response may be affected if the cranial nerves controlling these movements have been affected. Double vision and exposure keratopathy may result. Occupational and visual rehabilitation via retraining have been helpful as is time. If visual recovery occurs, it usually does so within the first 6 months.
Management of Marcus Gunn jaw wink syndrome with tarsofrontalis sling vis a vis levator excision and frontalis sling: a comparative study
Published in Orbit, 2023
Parinita Singh, Kirthi Koka, Md Shahid Alam, Bipasha Mukherjee
Data analyzed included demographic details, clinical details, and pre- and post-operative severity of ptosis and MGJWS. Ptosis was classified as mild (2 mm), moderate (3 mm), and severe (≥4 mm) based on the difference in marginal reflex distance (MRD-1) between the two eyes or considering MRD-1 of 4 mm as normal in bilateral cases.6 The lid excursion due to jaw winking was graded as mild (<2 mm), moderate (2–5 mm), and severe (>5 mm).3 In patients with associated strabismus, the measurements were recorded following strabismus correction. All patients were given the option of either TFS alone or LPS excision plus TFS. The patients who had undergone the former surgery were categorized under group A and the latter under group B. Follow-up ptosis measurements and amount of lid excursion were recorded at 6 weeks and 6 months post-surgery. The resolution of MGJWS was defined as an excursion of less than or equal to 1 mm following surgery.7 Lagophthalmos was measured with gentle lid closure at 6 weeks and 6 months. Early and late complications in both the groups and their management were recorded. Exposure keratopathy was defined as damage to the ocular surface resulting from inadequate eyelid closure and it ranges from superficial punctate keratopathy to epithelial defect, ulcer. A difference of more than 1 mm in MRD-1 was defined as under-correction.8
Orbital abscess: 20 years’ experience at a tertiary eye care center
Published in Orbit, 2022
Md Shahid Alam, Varsha Backiavathy, Veena Noronha, Bipasha Mukherjee
Intracranial complication such as cavernous sinus thrombosis (n = 2) and epidural abscess (n = 1) was noted in 8.82% This is high compared to other studies (0.07 − 1.92%).3,10 Emergent drainage with appropriate intravenous antibiotics enabled us to salvage life in all cases. However, vision could not be salvaged in two cases as the visual acuity at presentation was no perception to light in one and inaccurate projection of rays in the other due to the presence of associated optic neuropathy as well. In our case series, all patients underwent drainage of the orbital abscess. Favorable outcomes were obtained in all except 2 (5.88%). An evisceration had to be performed along with drainage of the abscess in one patient due to associated panophthalmitis. MRSA was grown in culture. It was probably a sequelae to the orbital abscess. Prolonged exposure keratopathy led to the formation corneal ulcer, hypopyon and further spread of the infection. The other patient was diabetic with poor glycemic control. His vision deteriorated to hand movement from 3/60 at presentation. The causative organism was MSSE. These findings emphasize the need for urgent drainage of the abscess to prevent the high rate of sight and life-threatening complications as noted in our study. Any delay in surgical management may lead to permanent visual and neurological damage.
Thyroid-Associated Orbitopathy: Management and Treatment
Published in Journal of Binocular Vision and Ocular Motility, 2022
Lauren Hennein, Shira L. Robbins
Botulinum toxin A injections can also be useful in treating patients with TAO. Botulinum toxin A injections into the levator palpebrae superioris muscle can improve upper eyelid retraction, however this treatment is short term with a risk of transient diplopia.75 This treatment can be very effective in severe cases of exposure keratopathy producing a transient protective effect until the proptosis is more definitively addressed or the natural history lessens. The effect of transcutaneous injection of 5 units of Botox (0.1 mL) may last longer in patients with fibrotic orbitopathy compared to congestive orbitopathy.59 Subconjunctival injection of botulinum A toxin may also be effective in treating upper eyelid retraction.61 Botulinum toxin A injections have also been utilized in the treatment of restrictive TAO strabismus. Chemodenervation may help some patients avoid surgical intervention while success rates may be higher with chemodenervation if the pre-treatment deviation is less then 20 prism diopters.62 When compared with paralytic and comitant strabismus, there can be many differences in the natural history of using botulinum toxin including the dosage of botulinum A toxin may be higher in TAO patients, the degree of treated deviation may be smaller, the interval between injections may be shorter, and the duration of effect may be shorter.76