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Adult Ocular and Orbital (Ocular Adnexa) Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
P.N. Plowman, Rachel Lewis, J.L. Hungerford
Malignant tumors of the uveal tract are predominantly malignant melanomas. Uveal melanoma is the most common of all primary intra-ocular tumors. The neoplasm is most commonly encountered in the choroid but also arises in the ciliary body and occasionally in the iris. This tumor was formerly managed by enucleation of the eye. The survival rate following enucleation has been shown to be dependent on the size of the tumor, histological cell type, tumor’s position within the eye, presence or absence of extra-scleral extension, and age of the patient. Large melanomas, ciliary-body melanomas, and melanomas containing epithelioid cells or extending extra-sclerally have a relatively bad prognosis, particularly in the elderly. For large tumors, the overall mortality rate approaches 50%, and classically the mean interval reported from treatment to the development of metastases is 43 months. Metastases are rarely detectable at the time of diagnosis of the ocular primary.
Diagnosing Parasitic Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Acute ocular presentations of parasitic infections are mostly limited to visual loss caused by Toxoplasma gondii. The parasite mostly infects newborns, infants and immunocompromised individuals and causes chorioretinitis leading to vision loss. Adult Loa loa worms can also migrate to the eye.
Ocular surface as mucosal immune site
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
Rachel R. Caspi, Anthony St. Leger
That said, immune responses occurring at the ocular surface must strike a balance between protection from a pathogen and direct bystander damage to the ocular surface as a result of the inflammatory process leading to pathogen eradication. Ocular herpes is a prime example where an exuberant local response to eradicate infection causes serious harm to the corneal surface, known as herpes keratitis, which can culminate in opacification of the cornea and blindness.
Ocular Toxoplasmosis Associated Dark Without Pressure
Published in Ocular Immunology and Inflammation, 2023
Paul J. Steptoe, Catherine M. Guly, Andrew D. Dick
Ocular toxoplasmosis occurs secondary to a retinal infection by Toxoplasma gondii, an obligate intracellular protozoan parasite.1 Typical ocular toxoplasmosis lesions are characterised by a unilateral, focal retinal lesion, which is usually described as necrotising retinitis2,3 and account for over 90% of presentations.4 The term dark without pressure (DWP) was originally coined by Nagpal et al. to describe homogeneous, geographical, flat, brown areas on the fundus5 and correspond to a thinned, hyporeflective ellipsoid zone band on optical coherence tomography (OCT).6–8 While most commonly seen in isolation5–7 and of unknown aetiology, their perilesional association with infective aetiology has been reported in recent studies of Ebola virus disease (EVD) retinal lesions.8,9 In EVD survivors, areas of DWP were also observed adjacent to lesions typical of ocular toxoplasmosis and in one patient observed to slowly expand over a 12-month observation (Figure 1).8 Here, we report a case further highlighting fluctuations of DWP associated with ocular toxoplasmosis reactivation.
The eye in migraine: a review of retinal imaging findings in migraine
Published in Clinical and Experimental Optometry, 2022
Allison M. McKendrick, Bao N Nguyen
As a primary headache disorder, the brain in migraine has unsurprisingly received considerable attention in the scientific literature. It is not the purpose of this review to discuss the plethora of evidence for cortical involvement in the pathophysiology of migraine (see e.g. reviews8–12 for recent perspectives on this topic). Instead, here we focus on the ocular involvement and potential ocular sequelae of migraine, with a specific focus on recent studies that have utilised modern ophthalmic imaging. Figure 1 schematically illustrates current models of the pathophysiology of migraine, noting the logic for considering retinal/ocular involvement. While it has long been recognised that migraine can involve the eye (the relatively uncommon cases of ‘retinal migraine’,3) recent advances in ophthalmic imaging have inspired numerous studies investigating whether the common forms of migraine (migraine without aura, migraine with aura) also manifest retinal abnormalities. The purpose of this review is to provide an update on the latest evidence for retinal involvement in migraine, derived from studies using spectral domain and swept source optical coherence tomography (OCT), including OCT angiography, with a particular emphasis on the relevance of this information for eyecare practitioners.
Ophthalmic Complications in Pediatric Uveitis
Published in Ocular Immunology and Inflammation, 2021
Natasha Gautam Seth, Savleen Kaur, Sonam Yangzes, Deepak Jugran, Reema Bansal, Vishali Gupta, Mangat Ram Dogra, Deepti Suri, Surjit Singh, Ramandeep Singh
The new finding from our study was the raised intraocular pressure occurring more commonly at follow-up than at baseline. The rise in IOP could be due to disease per se or to the treatment. We know that persistent steroid-induced ocular hypertension over time can lead to irreversible disc damage and glaucoma. Due to the chronicity of our cases; the low frequency of topical steroids given as a maintenance therapy might have been responsible for the raised intraocular pressure in these cases. Although we couldn’t differentiate secondary glaucoma into ocular hypertension and glaucoma at the presentation in our study, still the high numbers of raised intraocular pressures in these patients are a cause of concern. A high percentage of these patients with raised intraocular pressure needed surgery to control the IOP (58%). Hence, it is not only that raised intraocular pressure occurred more in these patients, but most children required surgical intervention for IOP control. Kanski et al18 reported that one-third of the glaucomatous eyes in JIA ended with no light perception, attributing it to low success rate of glaucoma surgery which was also seen by De Boer et al.12 The cumulative probability of survival (control with IOP limit of 21 mmHg) was 86.6% at 5 years using Kaplan- Meier survival analysis in patients who had pediatric uveitic glaucoma in a previous study by our department.19 We found favorable outcomes in patients with secondary glaucoma if managed appropriately and aggressively.