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Clinical Examination in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Selvakumar Ambika, Krishnakumar Padmalakshmi
Optic disc pallor can occur due to the various pathological processes. Disc pallor can be primary or secondary depending on the etiology causing the same (Table 1.7). It can be of any nature temporal, diffuse, segmental, bowties, etc. The presence of disc pallor indicated chronic nature of optic neuropathy and poor visual prognosis. Optic disc appearance should always be correlated with the optic nerve function as the vision and fields can improve after treatment in few instances like compressive optic neuropathy, optic neuritis. Figure 1.9 shows different types of abnormal optic discs.5,6
Inflammatory Disorders of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Reduced visual acuity, which varies from a slight dulling of color vision to complete monocular blindness, together with pain around or behind the eye that is exacerbated by eye movement or touching the eye, are symptoms of optic neuritis. Flashes of light on eye movement may occur (phosphenes). The signs include a central or paracentral scotoma in most patients, particularly using a red target (most of the optic nerve fibers transmit information from the macula), and a swollen optic disc (papillitis) in the acute phase if there is demyelination of the anterior part of the optic nerve. A unilateral afferent pupillary defect may be observed. Optic disc pallor due to optic atrophy ensues later.
Surgical treatment of macular holes
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Kamal Kishore, Gholam A Peyman
Other side-effects attributed to ICG have included visual field defects in 35–50% of eyes,136,144,145 pigment epithelial atrophy (Fig. 33.15)146,147 and optic atrophy.144 Kanda et al148 demonstrated visual field defects in all eyes receiving 5.0 mg/ml ICG solution for three minutes, 25% incidence in eyes receiving 5.0 mg/ml ICG solution followed by immediate washout, and 0% incidence in eyes receiving 2.5 mg/ml ICG solution followed by immediate washout. Optic disc pallor was noted in most eyes exhibiting visual field defect. Although the sample size was small, this clinical study suggests that toxicity of ICG may be dose- and time-dependent.
Immune Checkpoint Inhibitors and Optic Neuropathy: A Systematic Review
Published in Seminars in Ophthalmology, 2023
James Pietris, Sanjana Santhosh, Gianni Ferdinando Cirocco, Antoinette Lam, Stephen Bacchi, Yiran Tan, Aashray K. Gupta, Joshua G. Kovoor, WengOnn Chan
Vogrig et al. documented three cases of optic neuropathy, each with a unique clinical presentation.21 The first was a 26-year-old male on pembrolizumab therapy for melanoma who presented with acute painless blurred vision of the right eye and a right relative afferent pupillary defect (RAPD). This patient also exhibited hyperintensity of the right optic nerve on MRI of the brain.21 A 58-year-old female also on pembrolizumab therapy for melanoma developed a painless reduction in visual acuity in the right eye, subsequently followed 3 weeks later by the same symptoms in the left eye. Examination showed bilateral optic disc pallor.21 Thirdly, a 75-year-old female prescribed ipilimumab–pembrolizumab combination therapy for melanoma experienced a bilateral painless reduction in visual acuity associated with extra-ocular symptoms including tinnitus, vertigo, and ear pain. This patient’s optical coherence tomography (OCT) scan showed oedema of the optic nerve head bilaterally, and MRI of the brain revealed hyperintensity of the right optic nerve. Interestingly, the left optic nerve was unremarkable on MRI despite similar symptoms clinically.21
Early diagnosis for cerebrotendinous xanthomatosis with juvenile cataract and family history
Published in Ophthalmic Genetics, 2023
Nurşen Öncel Acır, Burcu Taskiran Kandeger
Optic disc pallor was reported in some studies as the second most common ocular finding (17,18). Patients with optic disc pallor were frequently seen in the third, fourth, and fifth decades. Conversely, optic discs were normal in both eyes in all cases in our study, and visual acuity improved significantly in all cases after cataract surgery (approximating 20/20). In the study of Cruysberg et al. (18), all patients achieved at least 20/40 best corrected visual acuity after surgical treatment. In the study of Khan et al. (19), postoperative visual acuity was mentioned in only 1 patient, and it was 20/30 in both eyes. Since visual acuity after cataract surgery was not mentioned in studies other than these two, our study provides crucial evidence on the possibility that visual acuity can increase significantly in these cases after cataract surgery at an early age (18,19). Nonetheless, findings such as optic disc pallor or optic neuropathy that develop over time may seriously affect vision. For this reason, early diagnosis and treatment with chenodeoxycholic acid are highly critical before neurological manifestations such as optic disc pallor and cerebellar or pyramidal findings that emerge with advancing age.
Clinical and Imaging Findings One Year Following Traumatic Chiasm Transection
Published in Neuro-Ophthalmology, 2019
Ayman G. Elnahry, Gehad A. Elnahry
A 35-year-old male presented to our clinic for follow-up of a visual field defect. He had a history of a road traffic accident one year and three months ago that was associated with fronto-facial, skull base, and orbital fractures and required surgical repair. Examination revealed a corrected distance visual acuity of 20/20 in the right eye and 20/40 in the left eye. A macular splitting demonstrated by eccentric fixation of the left eye was suspected to be the cause of the diminution of vision in the left eye. Colour vision was 12/12 in the right eye and 8/12 in the left. Pupillary examination revealed a left relative afferent pupillary defect. Confrontation visual field testing revealed a temporal visual field defect in both eyes. Ocular motility testing was full in both eyes but showed progressive left hypotropia in the primary position of gaze (Figure 1) which may have been due to the hemifield slide phenomenon. Anterior segment examination was normal in both eyes. Posterior segment examination revealed bilateral optic disc pallor. Visual field testing using central 30–2 pattern of automated static perimetry showed bitemporal hemianopsia (Figure 2). Magnetic resonance imaging (MRI) of the brain and orbit showed complete transection of the optic chiasm with optic chiasm and frontal lobe encephalomalacia (Figure 3).