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Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Vision loss with both forms of ischemic optic neuropathy usually occurs quickly over minutes to days, and is painless. With giant cell arteritis, additional symptoms include general malaise, headaches over the temples, muscle aches and pains, jaw claudication, pain when combing the hair, and tenderness over the temporal artery. These symptoms sometimes do not occur until vision is already lost. There is reduced visual acuity and an afferent pupillary defect. The optic disk swells and becomes elevated. Swollen nerve fibers obscure the thin surface vessels of the optic nerve. Hemorrhages may surround the optic disk in many cases. The disk is often pale in the arteritic form, but hyperemic in the nonarteritic form. With both forms, a visual field examination often reveals a central defect, an altitudinal defect, or both.
The Moral Ophthalmologist
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Follow up your own patients. If you don't know what is going on, it is tempting to bring a patient back to someone else's clinic. Perhaps they can work out what is going on. Perhaps they can sort out what you can't. Similarly if you see a retinal tear, treat it yourself. Do not dump on others. If you do not know how to laser tears, learn. If you think a patient has giant cell arteritis investigate it yourself. It is absolutely not acceptable to bring back patients to another doctor's clinic and have the bare-faced cheek to write things such as ‘consider GCA’ in the notes, thereby protecting yourself and causing problems for others. If you think they should consider GCA then ‘consider’ it yourself. It may well be annoying having to wait for blood tests to come back, but it is much more work for someone else unfamiliar with the case to do it rather than you. Following up your own patients is the best way to learn because you are forced to know things yourself and take responsibility for your own actions. It is best for the patient too. There will always be doctors who take advantage of the system, but don't be one of them. Some people also like to decant responsibility for their own decisions on to a senior colleague by calling them up and ‘discussing’ the patient, so that they can then write this clearly in the notes. Discuss things with senior colleagues if you need genuine assistance with the decision-making process, but not to simply pass the buck.
Ocular manifestations of systemic disease
Published in Mary E. Shaw, Agnes Lee, Ophthalmic Nursing, 2018
Giant cell arteritis, or temporal arteritis, is a condition affecting those from the over-60s age group, affecting all arteries, and having an effect especially on the heart and kidneys. It is also associated with polymyalgia rheumatica. In the eye, it causes a sudden loss of vision in one or both eyes. This is caused by infarctions in the ciliary arteries which supply the optic nerve head, causing ischaemia and swelling of the optic disc. The temporal artery is often prominent, hard and tender to touch.
Causes and Outcomes of Patients Presenting with Diplopia: A Hospital-based Study
Published in Neuro-Ophthalmology, 2021
Nitin Kumar, Savleen Kaur, Srishti Raj, Vivek Lal, Jaspreet Sukhija
In our study cohort, out of 160 patients, 153 patients were managed medically (95.6%) and seven (4.3%) patients had surgical intervention. Medical management included counselling, fogged glasses, multi-vitamin tablets, and oral and intravenous corticosteroids. Corticosteroids were administered in patients with giant cell arteritis and orbital apex syndrome. Four patients were managed with prism correction and one patient was advised to use an aphakic contact lens for correction of diplopia. Corrective surgery in the form of anterior transposition of the inferior oblique muscle was performed in four patients (all diagnosed with superior oblique palsy), Knapp’s procedure was done in one patient and two patients underwent orbital floor repair. In patients who underwent corrective surgery, diplopia resolved in three but remained after surgery in four.
Is Kimura’s disease associated with juvenile temporal arteritis? A case report and literature review of all juvenile temporal arteritis cases
Published in Modern Rheumatology Case Reports, 2021
Takafumi Tomizuka, Hirotoshi Kikuchi, Kurumi Asako, Daisuke Tsukui, Yoshitaka Kimura, Yoshinao Kikuchi, Yuko Sasajima, Hajime Kono
A biopsy of the left temporal artery revealed eosinophil infiltration in all layers of the arterial wall, accompanied by stenosis of the lumen due to intimal thickening, thrombus formation, and fibrinoid degeneration. Capillary hyperplasia and fibrosis were seen around the artery, and eosinophil infiltration was observed. No morphological difference in eosinophils was observed between the Kimura’s disease lesion and the JTA lesion by optical microscopy. No granulomas were noted, but a few multinucleated giant cells were focally observed (Figure 4). IgG4-related disease was excluded by IgG4 staining. These findings are consistent with the diagnosis of JTA, although some multinucleated giant cells were observed. The patient was not diagnosed with giant cell arteritis because of the absence of systemic symptoms and increase in erythrocyte sedimentation rate; moreover, our histological findings did not match with those reported by Wakugawa et al. [5]. The patient was treated with 30 mg/day prednisolone followed by gradual tapering, which led to a decrease in size of the masses of the posterior auricle. No recurrence of JTA has been detected for 2 years to date.
Ocular Involvement in Systemic Lupus Erythematosus: The Experience of Two Tertiary Referral Centers
Published in Ocular Immunology and Inflammation, 2018
Rosanna Dammacco, Pasquale Procaccio, Vito Racanelli, Angelo Vacca, Franco Dammacco
The second patient experienced a central retinal artery occlusion (CRAO), an emergency condition that is considered the ocular analogue of cerebral stroke52 and has been described as possible initial manifestation of SLE.45,53 At the time of the first diagnosis of a severely active SLE, she complained of headache and dizziness associated with rapidly increasing, painless vision loss in her right eye, which eventually resulted in hand motion as BCVA. No signs and symptoms of giant cell arteritis of the temporal artery (such as fever, malaise, temporal tenderness, jaw claudication, shoulder and pelvic girdle pain) were present. Fundus examination was normal in the left eye, whereas retinal artery attenuation and whitening of the retina with a cherry-red spot in the fovea were observed in the right eye. SD-OCT of the same eye revealed marked edema of the macula and a delay in arterial filling at the early to late phase, but no emboli were detected by FFA. Cherry-red spots and a ground-glass retina became visible the next morning.