Toxins in Neuro-Ophthalmology
Vivek Lal in A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
It is a class III antiarrhythmic agent, and ocular side effects are reported in literature [30–32]. Two-thirds of cases develop reversible verticillate keratopathy. More than half patients develop blue-white anterior subcapsular cataract resulting in mild blue color vision defects. There can be slowly progressive binocular vision loss with prolonged disc swelling. Non-arteritic ischemic optic neuropathy (NAION) was also reported in patients taking amiodarone, although bilaterally [33]. Mean duration of treatment before development of vision disturbance was 9 months (1–84 months). Discontinuation of drug is the treatment after consulting cardiologist. Visual symptoms improve gradually over several months.
Chronic Hyperglycemia Impairs Vision, Hearing, and Sensory Function
Robert Fried, Richard M. Carlton in Type 2 Diabetes, 2018
The journal Investigative Ophthalmology and Visual Science featured a report titled “Advanced glycation end products in diabetic corneas.” The aim of this study was to determine the role of AGEs in the pathogenesis of diabetic keratopathy because, as the authors pointed out, corneas in diabetic patients are exposed to increased glucose concentration despite their relatively avascular property, and this condition may contribute to the accumulation of AGEs. Keratopathy is any corneal disease, damage, dysfunction, or abnormality. There are several varieties.
Ophthalmology
Janesh K Gupta in Core Clinical Cases in Surgery and Surgical Specialties, 2014
A6: What treatment options are appropriate? Conservative management: relief of diplopia is of major concern to the patient. Temporary prisms incorporated on to the patient’s spectacles, or occlusion of one eye, may be necessary until muscle function improves and ocular alignment is re-established. Sometimes permanent prisms are necessary. The patient should be advised to stop driving unless the two images can be aligned.Medical treatment: primary treatment of dysthyroid eye disease must include making the patient euthyroid. Corticosteroids and radiotherapy may be necessary if there is keratopathy from corneal exposure or optic nerve compression.Many treatment options are available for myasthenia gravis. Initial treatment usually consists of oral pyridostigmine or neostigmine. Systemic prednisolone may be administered together with the anticholinesterase. Azathioprine and plasmapheresis are also effective. Thymectomy in patients with thymoma often results in remission of the disease.Surgical treatment: in patients with temporary problems of extraocular muscle innervation or muscle function (e.g. palsy of cranial nerve VI), botulinum toxin may be injected into the overacting antagonist (medial rectus) of the affected muscle (lateral rectus). This induces deliberate temporary paralysis of the medial rectus by chemodenervation until recovery of lateral rectus function occurs.Orbital decompression alleviates symptoms and signs of exposure keratopathy or optic nerve compression. Strabismus surgery is sometimes required.
Orbital abscess: 20 years’ experience at a tertiary eye care center
Published in Orbit, 2022
Md Shahid Alam, Varsha Backiavathy, Veena Noronha, Bipasha Mukherjee
Intracranial complication such as cavernous sinus thrombosis (n = 2) and epidural abscess (n = 1) was noted in 8.82% This is high compared to other studies (0.07 − 1.92%).3,10 Emergent drainage with appropriate intravenous antibiotics enabled us to salvage life in all cases. However, vision could not be salvaged in two cases as the visual acuity at presentation was no perception to light in one and inaccurate projection of rays in the other due to the presence of associated optic neuropathy as well. In our case series, all patients underwent drainage of the orbital abscess. Favorable outcomes were obtained in all except 2 (5.88%). An evisceration had to be performed along with drainage of the abscess in one patient due to associated panophthalmitis. MRSA was grown in culture. It was probably a sequelae to the orbital abscess. Prolonged exposure keratopathy led to the formation corneal ulcer, hypopyon and further spread of the infection. The other patient was diabetic with poor glycemic control. His vision deteriorated to hand movement from 3/60 at presentation. The causative organism was MSSE. These findings emphasize the need for urgent drainage of the abscess to prevent the high rate of sight and life-threatening complications as noted in our study. Any delay in surgical management may lead to permanent visual and neurological damage.
Incidence of corneal adverse events in patients with multiple myeloma and their clinical and economic impact: A real-world retrospective cohort study
Published in Journal of Medical Economics, 2022
Feng Wang, Leah Sansbury, Shannon Ferrante, Eric M. Maiese, Jenny Willson, Chi-Chang Chen, Sasikiran Nunna, Kainan Sun, David M. Kleinman
Patients without any ICD-9/10 diagnosis codes or treatments indicative of diagnosis of corneal AEs in the baseline period (defined as up to 12 months prior to the index period for both cohorts) but who had incidence of corneal AEs during any line of therapy were assessed. Corneal AEs were identified by cross-walking from MedDRA “corneal disorders” codes to ICD codes (ICD-9 or ICD-10). The incidence of any corneal AE as well as individual corneal AEs are reported as a percentage of patients with incident corneal AEs (patients without corneal AE in the baseline period but who had an incidence in the follow-up period) among all patients, irrespective of the baseline presence of corneal AEs. This study specifically investigated the incidence of keratopathy/keratitis, blurred vison/decreased acuity, and dry eye, as well as eye pain and photophobia. The incidence of corneal AE was assessed by LOT (1, 2, 3, and 4+).
Sinus pericranii in the upper eyelid: diagnosis and management guidelines
Published in Orbit, 2020
Sruti S. Akella, Jinesh Shah, Anne Barmettler
SP is benign but may cause visual axis obstruction, necessitating removal. Other concerning symptoms include exposure keratopathy, proptosis, and compressive optic neuropathy. Prior to surgery, angiography should demonstrate the brain is not using the SP as the only or dominant venous outflow. In cases where SP is the dominant outflow, excision or injury could result in neurological complications. Intraoperative hemorrhage is common and in the orbit can cause optic nerve damage. Increased risk of intraoperative hemorrhages have been noted with sizes of SP (>6cm) and transcranial channel (>3mm).2 Bleeding was also seen with SP when blood from the dural venous sinus drained into scalp veins (rather than coming from and draining into the dural venous sinus). Given the risk of large hemorrhage in the orbit, we suggest that adult-onset SP in the eyelid be observed unless there is risk of visual axis obstruction. If surgery is planned, compulsory angiography followed by a staged, multi-disciplinary approach of embolization and craniotomy with interventional radiology and neurosurgery may be attempted.
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