RESUMEN
BACKGROUND: Coronavirus disease-2019 (COVID-19), caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been linked to ocular signs and symptoms in several case reports. Research has demonstrated that SARS-CoV-2 is spread primarily through close contact via respiratory droplets, but there is the possibility for ocular transmission, with the conjunctiva as a conduit as well as a source of infection. DISCUSSION: Ocular manifestations of SARS-CoV-2 include follicular conjunctivitis, and have been repeatedly noted as an initial or subsequent symptom of COVID-19-positive patients. Particularly in patients with ocular manifestations, there is evidence that the virus may present in tears, based on the detection of SARS-CoV-2 in conjunctival swab samples via reverse transcription polymerase chain reaction. The virus may therefore be transmittable from the ocular surface to a new host via contact with the ocular mucosa, tears, or subsequent fomites. CONCLUSIONS: All health care professionals should ask patients about ocular symptoms consistent with SARS-CoV-2, and use eye protection such as goggles or face shields as part of the standard personal protective equipment for high-risk patients in addition to wearing of masks by both the patient and provider, and should consider tears to be potentially infectious.
Asunto(s)
Infecciones por Coronavirus , Coronavirus , Pandemias , Neumonía Viral/epidemiología , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2 , TropismoRESUMEN
A 63-year-old woman with a 1-month history of blurred vision in the right eye was found to have a right optic nerve sheath meningioma. She was treated with fractionated proton beam therapy using a total dose of 50.4 cobalt gray equivalent (CGE) in 1.8 CGE fractions, with subsequent improvement in vision. Twenty-seven months later, the patient reported a 6-week history of progressive blurred vision in her right eye. Magnetic resonance imaging revealed enhancement of the right optic nerve consistent with radiation optic neuropathy (RON). We are unaware of any previous reports of RON when radiotherapy doses fall within the current recommended guidelines of <55 CGE fractionated into daily doses <2 CGE.
Asunto(s)
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Enfermedades del Nervio Óptico/etiología , Neoplasias del Nervio Óptico/radioterapia , Terapia de Protones/efectos adversos , Femenino , Humanos , Imagen por Resonancia Magnética , Neoplasias Meníngeas/complicaciones , Meningioma/complicaciones , Persona de Mediana Edad , Nervio Óptico/patología , Neoplasias del Nervio Óptico/complicaciones , Factores de Tiempo , Campos Visuales/efectos de la radiaciónRESUMEN
Victims of near-drowning incidents often suffer neurologic injury with long-term sequelae secondary to hypoxic-ischemic injury. We describe a case of profound visual loss due to bilateral occipital lobe infarcts in a 23-year-old male victim of a near-drowning incident.
Asunto(s)
Ceguera Cortical/etiología , Ahogamiento Inminente/complicaciones , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Lóbulo Occipital/patología , Agudeza Visual/fisiología , Adulto JovenRESUMEN
A 31-year-old woman with morning glory optic disc anomaly (MGDA) developed acute retrobulbar optic neuritis and a bullous macular detachment. MRI demonstrated truncation of the perineural space of the affected optic nerve as well as focal optic nerve enhancement. Optical coherence tomography (OCT) showed retinoschisis associated with the macular detachment. The MRI and OCT findings support the vitreous as the source of the subretinal fluid. This is the first reported case of optic neuritis in MGDA.
Asunto(s)
Mácula Lútea/patología , Disco Óptico/anomalías , Enfermedades del Nervio Óptico/patología , Neuritis Óptica/patología , Desprendimiento de Retina/patología , Enfermedad Aguda , Adulto , Progresión de la Enfermedad , Femenino , Humanos , Mácula Lútea/fisiopatología , Imagen por Resonancia Magnética , Metilprednisolona/uso terapéutico , Disco Óptico/fisiopatología , Nervio Óptico/patología , Nervio Óptico/fisiopatología , Enfermedades del Nervio Óptico/complicaciones , Enfermedades del Nervio Óptico/fisiopatología , Neuritis Óptica/etiología , Neuritis Óptica/fisiopatología , Nervios Periféricos/patología , Nervios Periféricos/fisiopatología , Retina/patología , Retina/fisiopatología , Desprendimiento de Retina/etiología , Desprendimiento de Retina/fisiopatología , Tomografía de Coherencia Óptica , Cuerpo Vítreo/patología , Cuerpo Vítreo/fisiopatologíaRESUMEN
Ocular trauma is a frequent result of sports-related injury during basketball and baseball. A screening sideline examination should be performed immediately to assess vision and evaluate the severity of damage. The team physician should be able to treat minor injuries and identify vision-threatening trauma for immediate referral. Injuries range from minor, including corneal abrasion and foreign bodies, to more severe, including hyphema, orbital fracture, and globe rupture. Resultant damage may be vision-threatening and permanent. Most of these injuries can be prevented with full-time use of sport-specific protective eyewear. Physicians should recommend appropriate eye protection and counsel patients accordingly.
Asunto(s)
Béisbol , Baloncesto , Lesiones Oculares/etiología , Lesiones Oculares/prevención & control , Adolescente , Adulto , Traumatismos en Atletas , Niño , Preescolar , Lesiones Oculares/diagnóstico , Lesiones Oculares/epidemiología , Lesiones Oculares/fisiopatología , Dispositivos de Protección de los Ojos , Humanos , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto JovenAsunto(s)
Endoscopía/efectos adversos , Epistaxis/cirugía , Complicaciones Posoperatorias/fisiopatología , Enfermedades del Nervio Troclear/etiología , Enfermedades del Nervio Troclear/fisiopatología , Nervio Troclear/fisiopatología , Adulto , Diplopía/etiología , Diplopía/fisiopatología , Hematoma/complicaciones , Hematoma/etiología , Humanos , Masculino , Arteria Maxilar/anatomía & histología , Arteria Maxilar/cirugía , Cavidad Nasal/irrigación sanguínea , Cavidad Nasal/cirugía , Arteria Oftálmica/anatomía & histología , Arteria Oftálmica/cirugía , Órbita/irrigación sanguínea , Órbita/cirugía , Recuperación de la Función/fisiología , Nervio Troclear/irrigación sanguíneaRESUMEN
Progressive supranuclear palsy (PSP) is rarely confused with other parkinsonian disorders once the vertical gaze palsy appears. Corticobasal degeneration is the most common differential diagnostic entity. We describe three cases diagnosed during life as PSP but found to have another neurologic disorder at autopsy. No explanation for the gaze palsies was found in any case.
Asunto(s)
Encéfalo/patología , Enfermedades Neurodegenerativas/patología , Enfermedades Neurodegenerativas/fisiopatología , Trastornos de la Motilidad Ocular/etiología , Parálisis Supranuclear Progresiva/fisiopatología , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Parálisis Supranuclear Progresiva/patologíaRESUMEN
PURPOSE: To report a case of monocular blindness resulting from intravascular bullet migration. DESIGN: Observational case report. METHODS: A 9-year-old boy presented to the emergency room with a penetrating BB gun injury to the chest. RESULTS: Carotid angiography localized the bullet to the right internal carotid artery. He subsequently suffered blindness in the right eye, a right pupil-involving third nerve palsy, left hemiparesis, and a probable left homonymous hemianopia. CONCLUSION: BB gun injuries may result in devastating ophthalmologic as well as systemic consequences due to bullet embolization.
Asunto(s)
Ceguera/etiología , Enfermedades de las Arterias Carótidas/etiología , Arteria Carótida Interna/patología , Embolia/etiología , Migración de Cuerpo Extraño/etiología , Lesiones Cardíacas/etiología , Heridas por Arma de Fuego/complicaciones , Angiografía , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/efectos de los fármacos , Niño , Embolia/diagnóstico por imagen , Embolia/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/tratamiento farmacológico , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/cirugía , Ventrículos Cardíacos/lesiones , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Derrame Pericárdico/etiología , Derrame Pericárdico/patología , Derrame Pericárdico/cirugía , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Visión Monocular , Agudeza VisualRESUMEN
PURPOSE: To present a case of a primary orbital leiomyosarcoma and the corresponding magnetic resonance imaging (MRI) appearance. DESIGN: Observational case report. METHODS: Correlation of MRI with clinicopathologic findings. RESULTS: A 56-year-old woman presented with a 10-month history of diplopia in left gaze and left exophthalmos. An enhanced MRI of the left orbit revealed an extraconal, peripheral-enhancing mass measuring 2 cm in maximal diameter with displacement of the medial rectus muscle. The mass was excised, and the diagnosis of leiomyosarcoma was made by pathologic examination. CONCLUSIONS: Although computed tomography scan and ultrasound have been the imaging modalities used previously to evaluate cases of primary orbital leiomyosarcoma, MRI can provide important additional information regarding tumor characterization that is useful in the diagnosis and treatment of this rare malignancy.
Asunto(s)
Leiomiosarcoma/diagnóstico , Órbita/patología , Neoplasias Orbitales/diagnóstico , Femenino , Humanos , Leiomiosarcoma/cirugía , Imagen por Resonancia Magnética , Persona de Mediana Edad , Músculos Oculomotores/patología , Órbita/cirugía , Neoplasias Orbitales/cirugía , Agudeza VisualRESUMEN
A 4-year-old boy presented with complete blindness in his left eye after accidentally walking into a merchandise display hook while shopping in a department store. An ophthalmologic examination revealed no light perception, an amaurotic pupil, and nasal conjunctival injection in the eye. Intravenous steroids did not improve his vision.
Asunto(s)
Ceguera/etiología , Comercio , Equipos y Suministros/efectos adversos , Lesiones Oculares Penetrantes/etiología , Traumatismos del Nervio Óptico/etiología , Órbita/lesiones , Ceguera/tratamiento farmacológico , Preescolar , Lesiones Oculares Penetrantes/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Traumatismos del Nervio Óptico/tratamiento farmacológicoAsunto(s)
Esclerosis Múltiple/complicaciones , Neuritis Óptica/etiología , Ensayos Clínicos como Asunto , Potenciales Evocados Visuales , Humanos , Imagen por Resonancia Magnética , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple/fisiopatología , Neuritis Óptica/diagnóstico , Neuritis Óptica/tratamiento farmacológico , Neuritis Óptica/fisiopatología , Pronóstico , RiesgoRESUMEN
PURPOSE: To report a case of syphilitic chorioretinitis mimicking an anterior chiasmal syndrome. METHODS: Observational case report. RESULTS: A 74-year-old man with a remote history of syphilitic chorioretinitis was noted to have an apparent junctional scotoma on a screening Humphrey visual field. Subsequent magnetic resonance imaging of the brain was normal, and the patient was referred for neuro-ophthalmologic evaluation. The fundus examination and a fluorescein angiogram demonstrated that the pattern of chorioretinal scarring corresponded to the visual field defects in both eyes. CONCLUSION: Syphilis, the great masquerader, may cause retinal disease that mimics a neurologic visual field defect.
Asunto(s)
Trombosis del Seno Cavernoso/diagnóstico , Encefalocele/complicaciones , Hematoma/complicaciones , Enfermedades Orbitales/complicaciones , Diagnóstico Diferencial , Encefalocele/diagnóstico , Hematoma/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Palinopsia, or perseveration of a previously viewed image, may be caused by drug use or by posterior visual pathway lesions. Most cases of palinopsia due to visual pathway lesions have an associated homonymous hemianopic visual field defect. We report two patients with palinopsia caused by structural lesions of the posterior visual pathway in the absence of visual field defects. Patients with palinopsia should undergo neuroimaging even in the presence of normal visual fields.
Asunto(s)
Trastornos de la Percepción/etiología , Trastornos de la Visión/etiología , Campos Visuales , Vías Visuales/lesiones , Adulto , Anciano , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Trastornos de la Percepción/patología , Trastornos de la Visión/patología , Vías Visuales/patologíaRESUMEN
A 55-year-old woman developed severe unilateral headaches, periocular numbness, and Horner syndrome after presenting with symptoms consistent with Lyme disease. The combination of Horner syndrome and periocular headache and numbness constituted a diagnosis of Raeder paratrigeminal neuralgia. Although the headaches resolved with antibiotic treatment, the Horner syndrome persisted for at least 1 year. This case expands the spectrum of neurologic manifestations of Lyme disease to include postganglionic Horner syndrome as well as Raeder paratrigeminal neuralgia.
Asunto(s)
Síndrome de Horner/complicaciones , Enfermedad de Lyme/complicaciones , Neuralgia del Trigémino/complicaciones , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Amiodarone is one of the most effective antiarrhythmic drugs currently available. Although a subject of intense controversy, a causal link between amiodarone and optic neuropathy has never been firmly established. Indications for treatment with amiodarone are outlined, and features of the optic neuropathy in patients on amiodarone are compared with those of nonarteritic anterior ischemic optic neuropathy. An approach to patients treated with amiodarone who present with optic neuropathy is outlined, and suggestions for a registry and prospective study of such patients are presented.