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Toxins in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
The diagnosis of toxic optic neuropathy can be made if the following criteria are fulfilled: There should be a temporal relationship between toxin exposure and visual loss.Presence of dose–response relationship.Withdrawal of drug/toxin leads to improvement or halting of the progression of vision loss.Biological plausibility between exposure and optic nerve toxicity.Presence of evidence from any prior animal experiment.
Neuro-ophthalmology
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Optic neuropathy refers to damage of the optic nerve. Optic atrophy occurs as a result of longstanding damage to the optic nerve. The common signs of optic nerve dysfunction are: Decreased visual acuity (dVA)DyschromatopsiaVisual field defects: Central scotomas, arcuate or altitudinal defectsDiminished contrast sensitivityAbsolute or relative afferent pupillary defect (RAPD)
Central Nervous System (Brain, Brainstem, Spinal Cord), Ears, Ocular Toxicity
Published in Tiziana Rancati, Claudio Fiorino, Modelling Radiotherapy Side Effects, 2019
Federica Palorini, Anna Cavallo, Letizia Ferella, Ester Orlandi
Kim et al. (2010) evaluated 93 patients treated for parapapillary melanoma. Diagnosis of radiation papillopathy was made by ophthalmologic examination if there was evidence of nerve fiber layer infarcts, hemorrhage, exudate, edema or pallor involving the disc. After a median follow-up of 5.5 years, they found 63/93 (67.7%) cases of optic neuropathy and an estimated vision loss lower than 20/200 in 48%, 71% and 77% of patients with optic neuropathy at 1, 3 and 5 years, respectively. The authors concluded that vision loss was not inevitable in the presence of radiation optic neuropathy, since more than 40% of patients retained counting fingers or better vision at 5 years after the diagnosis of papillopathy.
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
Optic neuropathy is a broad term describing damage to the optic nerve.13 It may occur secondary to a variety of aetiologies, and clinically manifest in a vast array of different presentations. Common optic neuropathies include but are not limited to optic neuritis; inflammation of the optic nerve, arteritic anterior ischaemic optic neuropathy (AAION); arteritis-related ischaemic to the nerve, non-arteritic anterior ischaemic optic neuropathy (NAION); ischaemia of the nerve due to other causes; and neuromyelitis optic spectrum disorder (NMOSD).14 While systematic reviews on ophthalmic irAEs secondary to ICIs do exist, the focus has traditionally been on uveitis. This systematic review aims to evaluate the relationship between ICI therapy and optic neuropathy, including incidence, presentation, diagnosis, and treatment outcomes.
Successful Treatment of Optic Neuropathy Associated with Sphenoid Sinus Aspergillosis
Published in Ocular Immunology and Inflammation, 2023
Sung-Dong Kim, Hyeshin Jeon, Hee-Young Choi, Kyung Un Choi
Vision loss due to orbital aspergillosis usually has a poor prognosis.5–8 Adulkar et al.6 reported that eight of 20 patients had poor visual outcomes due to optic nerve invasion or central retinal artery occlusion. Five patients presented with non-light perception, and the remaining three patients showed low visual acuity of less than 6/36. In another study, only 33% of patients with visual loss due to fungal sphenoid sinusitis showed improved visual acuity, but the degree of visual improvement was not presented.7 In recently published study, patients with invasive fungal rhinosinusitis showed an irreversible ophthalmological insult.8 These visual disturbances may be due to inappropriate management or aggressive disease with sinus involvement.3 Optic neuropathy may be attributed to direct optic nerve compression, secondary optic nerve inflammation due to the contiguous spread of inflammation, or a vascular obstructive process.7,9 In this case, the visual acuity started to improve 3 days after performing surgery and starting anti-fungal agent according to the biopsy results, rather than immediately after surgery. Considering that the functional deterioration caused by the compression of the optic nerve may be observed immediately after compression has resolved,10 it is presumed that infiltrative, as well as an compressive mechanism, may be involved in optic neuropathy.
Orbital abscess: 20 years’ experience at a tertiary eye care center
Published in Orbit, 2022
Md Shahid Alam, Varsha Backiavathy, Veena Noronha, Bipasha Mukherjee
Sight-threatening complications included optic neuropathy in 15 patients (44.12%), orbital apex syndrome in 4 patients (11.76%), central retinal occlusion, exposure keratopathy in two patients each (5.88%), and panophthalmitis in one (2.94%). Optic neuropathy was diagnosed based on the assessment of optic nerve function tests such as visual acuity, color vision, pupillary examination and fundus evaluation. Sight-threatening complications were seen in 80% (n = 12) of adults and 63.16%(n = 12) of children. Life-threatening complications were noted in four patients (11.77%), three in children and one in an adult. Cavernous sinus thrombosis was diagnosed in two patients (5.88%), epidural abscess and septicemia were seen in one (2.94%) each. The abscesses were located in the intraconal space in five (14.70%) patients, extraconal space in 26 (76.47%), while three (8.82%) had involvement of both the spaces with diffuse orbital involvement. The breakup of the locations of abscesses in the extraconal space was as follows, 11 in the superomedial space, seven in the inferior space, six in the superior space, four in the lateral space, and two in the superolateral space. Multiple abscesses were seen in seven patients, of whom three comprised the ones with diffuse involvement and the other four were multiple extraconal abscesses.