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Hemianopsia (and Scotoma)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
The causes of these symptoms of vision loss are, in most cases, relatively well understood. Hemianopsia and scotomas can be caused by many things such as vascular diseases in the eyes, nutritional deficiency, and diseases that affect the myelin sheaths of nerve cells (Gillig & Sanders, 2009). Hemianopsia and scotomas can also be caused by direct damage to the brain, such as area V1 in the occipital lobe (Corballis, 1994). Because that part of the brain is topographically organized, like a map of your visual field, you can actually predict which part of a person's vision a scotoma will appear in based on where their brain is damaged, and vice versa (Kosslyn et al., 2006).
Toxins in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
These are antimalarial agents now used in the treatment of autoimmune diseases. It is usually noted in patient taking >3 mg/kg/day of chloroquine or >6.5 mg/kg/day of hydroxychloroquine. They bind melanin and concentrate in the iris, ciliary body and RPE altering normal physiologic function. Symptoms are blurred vision, decreased vision, scotomas and photopsias. On examination, there is blunting of the foveal reflex and pigmentary retinal changes. Classic fundus pattern is bilateral bull's-eye. Optic disc pallor and arteriovenous narrowing are late stage findings.
Central Scotoma
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
The common causes of a central scotoma are: Retrobulbar neuritis, most commonly in cases of multiple sclerosis.Choroidoretinitis.Pressure on the optic nerve by a tumour.Optic atrophy due to toxins or vitamin B12 deficiency.
Multiple Evanescent White Dot Syndrome Following Adenovirus Vector-Based COVID-19 Vaccine (Covishield)
Published in Ocular Immunology and Inflammation, 2023
Abhilasha Baharani, Raja Rami Reddy
MEWDS following vaccination has been reported with rabies, human papilloma virus, hepatitis A, hepatitis B, meningococcal, Yellow fever, and influenza vaccines.6Table 1 summarizes all 15 cases of MEWDS following COVID-19 vaccination,7–15 including the present case: 88.6% patients were otherwise healthy, mostly young to middle aged (mean 34.06 years, median 28 years, range 15–71 years) and 73.3% were women. Ten patients (66.6%) received BNT162b2/Pfizer-BioNTech vaccine, 2 patients (13.3%) received mRNA-1273/Moderna vaccine and one patient (6.6%) each received inactivated vaccine (Sinovac Coronavac), MVC protein subunit vaccine and viral vector vaccine Covishield (present case). Symptoms appeared after the second dose in 9 patients (60%), after the first dose in 4 patients (26.7%). One patient developed symptoms after the booster dose and one patient manifested symptoms after the first as well as second doses. The average time for onset of symptoms was 9.2 days (median 7 days, range 1–30 days) after vaccination. The mean presenting visual acuity was 20/65 (median 20/32, range 20/20 to 20/400). The most common symptoms were photopsias (80%), blurred vision (73.3%) and scotomata (40%). Spontaneous resolution was seen in 11 out of 15 cases (73.3%) over an average of 5.7 weeks (median 4 weeks, range 2–16 weeks). Three patients (20%) were treated with oral corticosteroids and 1 patient (6.6%) was put on topical steroid eyedrops.
Association of EFEMP1 with juvenile-onset open angle glaucoma in a patient with concomitant COL11A1-related Stickler syndrome
Published in Ophthalmic Genetics, 2023
Viney Gupta, Bindu I Somarajan, Shikha Gupta, Karthikeyan Mahalingam, Manoj Kumar, Abhishek Singh
The family had two affected members (Figure 1), the proband (III.2) and her father (II.1). Age of onset was 20 years for the proband, and her father was diagnosed as ocular hypertension with high intra ocular pressure (IOP); right eye (RE) 30 mmHg, and left eye (LE) 28 mmHg at the age of 40 years. At presentation, IOP of the proband was 54 mmHg in RE and 52 mmHg in LE. The proband underwent glaucoma surgery for both eyes at the age of 24 years. The proband also had high myopia of −20D in RE and −22 D in LE. Her best corrected visual acuity was 6/9 in RE and 6/12 in LE. Corneal diameters were normal in both eyes. Goniophotography revealed a high iris insertion with prominent iris processes. Her vitreous showed degeneration with beaded appearance. Her fundus was myopic with tilted discs in BE. In both eyes, the disc was pale with a shallow cupping (Figure 2a). An evaluation of peripheral retina on Optos (Optos PLC Dunfermline, UK) did not show any lattice degeneration or holes (Figure 2b); however, there was posterior staphyloma in both eyes. There was no evidence of drusen. Visual field showed an enlargement of the blind spot with paracentral scotoma in her LE (Figure 2c). The proband had no other features suggestive of an arthropathy, midfacial hypoplasia, palatal defects, or micro/retrognathia. She had, however, a profound sensorineural loss in her right ear with mild hearing loss in left ear. We thus diagnosed her as a STL Type 2. Her father had no myopia and no other features suggestive of an STL phenotype. Her siblings and her mother did not have any ocular or systemic abnormalities.
Tacrolimus Induced Thrombotic Microangiopathy (TMA) Presenting as Acute Macular Neuroretinopathy
Published in Ocular Immunology and Inflammation, 2023
Ashish Markan, Nikitha Ayyadurai, Ramandeep Singh
Acute macular neuroretinopathy (AMN) is a rare disease entity characterized by paracentral scotomas and intraretinal wedge-shaped lesions near the fovea.1 It is believed to be the result of a microvascular abnormality in the deep capillary plexus of the retina, primarily affecting the photoreceptors. Some of the reported risk factors for AMN include fever or febrile illness, use of oral contraceptive pills, intravenous ephedrine, intravenous contrast, shock, trauma, pre-eclampsia, caffeine use, autoimmune diseases like Behçet disease, etc.2 It usually affects young healthy females and is mainly unilateral, though bilateral presentation has also been reported. Scotomas are usually paracentral and spare the foveal centre, thus maintaining a good visual acuity. The disease primarily affects the outer retina, causing disruption of the interdigitation zone (IZ) and EZ.3 We present a case of a young female who was on systemic tacrolimus therapy and subsequently developed systemic thrombotic microangiopathy (TMA) associated with AMN in the left eye.