Human immunodeficiency virus-associated blepharoptosis.

PURPOSE: To better characterize an unusual blepharoptosis observed in HIV-positive patients and to evaluate histopathology. METHODS: This retrospective case series evaluated patients with HIV/AIDS and blepharoptosis with reduced levator excursion. Exclusion criteria included patients with identifiable causes of ptosis (e.g., aponeurotic dehiscences, prior eyelid trauma or surgery), known myopathic/neuropathic systemic disorders, congenital ptosis, cranial neuropathies, and systemic infiltrative processes. RESULTS: All 10 patients had bilateral symptomatic blepharoptosis. All patients (100%) were men with a mean age at presentation of 54 years (range, 42-77 years). Mean duration of HIV infection among 7 of 10 patients was 19 years (range, 13-24 years). Mean (±SD) MRD1 was 0.7 (±0.8) OD and 0.6 (±0.8) OS. Mean (±SD) levator excursion was 12 (±2.3) OD and 13 (±1.8) OS (normal levator excursion >15 mm). No patient was taking zidovudine (AZT) at the time of presentation. Nine patients (90%) underwent large bilateral levator resections for correction of blepharoptosis. Histopathologic specimens revealed abnormal levator muscle fibers with various degrees of atrophy, fibrosis, and regeneration without inflammation. CONCLUSIONS: The HIV-associated blepharoptosis observed among patients in this study is most consistent with a myopathy. Levator muscle histopathologic findings are virtually identical to muscle biopsies in individuals with HIV-associated myopathy, described before the advent of AZT or highly active antiretroviral therapy (HAART). Surgical management with levator resection provides optimal correction of HIV-associated blepharoptosis.

New Onset of Unilateral Orbital Myositis following Mild COVID-19 Infection.

Purpose: The authors present a case of unilateral orbital myositis of new onset following COVID-19 without a severe course.Methods: The patient had been received topical treatment with a preliminary diagnosis of conjunctivitis but no recovery had been noticed. The history revealed that the ocular signs had started 1 week after the COVID-19.Results: The examination revealed sectoral hyperemia of the temporal region in the bulbar conjunctiva together with marked limitation of right inward gaze. MRI of the orbits demonstrated diffuse fusiform enhancing enlargement of the right lateral rectus and superior rectus. The results of the laboratory tests and examination findings were normal. Systemic corticosteroids were started for the orbital myositis.Conclusions: Although conjunctivitis is the more common ocular disease following COVID-19, the possibility of orbital myositis should be considered in cases with resistance to topical treatment and/or gaze limitation. The possible role of orbital myositis as a trigger for COVID-19 could be explained with an immune-mediated mechanism.

Zonal organization of the vestibulo-cerebellar pathways controlling the horizontal eye muscles using two recombinant strains of pseudorabies virus.

Many studies have documented the influence of the flocculus upon vestibulo-ocular reflex eye movements. Electrical stimulation of Purkinje cells in a central longitudinal zone evoked slow ipsilateral eye movements in the horizontal plane. Recently, the organization of neurons in the vestibulo-cerebellar pathways controlling single lateral rectus and medial rectus muscles was identified in rats using the transynaptic transport of pseudorabies virus. Overlapping distributions of neurons innervating single muscles were located predominantly in a central longitudinal zone of ventral paraflocculi/dorsal flocculi, and the rostral half of ventral flocculi. This study used two isogenic pseudorabies virus recombinants to determine whether individual cells in those brain regions have collateralized projections to motoneuron pools innervating the right lateral rectus and the left medial rectus muscles using different survival times and dual injection paradigms. The infected neurons were detected using dual-labeling immunofluorescence. Three populations of labeled neurons were observed: two populations replicated only one reporter while a third contained both viruses (i.e. dual-labeled). Most dual-labeled cells were located in a central longitudinal zone of the ventral paraflocculus, ipsilateral to the injection into the medial rectus, whereas very few were in the flocculus. This finding suggests that the flocculus and ventral paraflocculus may exert influence upon distinct vestibulo-cerebellar pathways. Most Purkinje cells in the ventral paraflocculus may influence the vestibulo-ocular reflex pathways through collateralization, whereas those in the flocculus may instead provide a monocular control of eye movements.

Zonal organization of the vestibulo-cerebellum in the control of horizontal extraocular muscles using pseudorabies virus: I. Flocculus/ventral paraflocculus.

Much literature has studied the relationship between the organization of neurons in the flocculus/ventral paraflocculus and vestibulo-ocular reflex pathways. Although activation of a flocculus central zone produces ipsilateral horizontal eye movement, anatomical tracing evidence in rats suggests that there may not be a simple one-to-one correspondence between flocculus/ventral paraflocculus zones and control of single extraocular muscles or coplanar pairs of antagonistic extraocular muscles. This study used the retrograde transynaptic transport of pseudorabies virus to identify the topographical organization of Purkinje cells in the flocculus/ventral paraflocculus that control the lateral rectus (LR) and medial rectus (MR) muscles in rats. A survival time of 80 h and 84 h was necessary to observe consistent transynaptically labeled cells in the flocculus/ventral paraflocculus following injections of pseudorabies virus into the MR and LR, respectively. The organization of Purkinje cells in the dorsal flocculus and ventral paraflocculus abided by the traditional boundaries, whereas the labeling pattern in the ventral flocculus showed a more complex, interdigitated arrangement. In agreement with prior studies, transynaptically labeled neurons were also observed in specific vestibular nuclear regions within the medial and superior vestibular nuclei and dorsal Y group. The distribution of labeled neurons in ipsilateral and contralateral vestibular nuclei was associated with features of ipsilateral and contralateral retrograde labeling of Purkinje cells in flocculus/ventral paraflocculus. Importantly, this study provides the first evidence of vestibulo-cerebellar zones controlling individual extraocular muscles and also overlapping distribution of neurons in flocculo-vestibular zones that influence the LR and MR motoneuron pools. This suggests that some of these neurons may be responsible for controlling both muscles.

Orbital myositis involving the oblique muscles associated with herpes zoster ophthalmicus.

An 81-year-old woman with right orbital inflammation and acute retinal necrosis following Herpes zoster ophthalmicus was evaluated and treated. CT showed right massive superior and inferior oblique enlargement and moderate enlargement of the remaining extraocular muscles with tendon sparing. The myositis and acute retinal necrosis dramatically improved following prednisone and intravenous acyclovir therapy.

Blood stem-cell transplantation for chronic active Epstein-Barr virus with lymphoproliferation.

A boy with chronic active Epstein-Barr virus infection (EBV) developed bilateral exophthalmos by infiltrating EBV-infected natural-killer cells during combined chemotherapy. This unusual presentation resolved completely after allogeneic bone-marrow transplantation, and EBV-infected peripheral T and natural-killer cells were also eradicated.

[Zona of the cranial nerves. Current aspects]. / Zona des nerfs crâniens. Aspects actuels.

Recurrence of the chickenpox virus, herpes zoster localizes in cranial nerves in 30% of cases, with a predilection for the ophthalmic nerve. In young patients, clinicians must search for a herpes zoster-HIV association as well as oculomotor proprioception impairment in herpes zoster ophthalmicus. Enhanced MRI allows good objective view of the facial nerve lesions in herpes zoster facial paralysis. Finally, the gravity and aftereffects of cephalic herpes zoster can be decreased by an appropriate therapeutic approach.

Mapping the oculomotor system: the power of transneuronal labelling with rabies virus.

Neuronal networks underlying and related to horizontal eye movements were visualized by retrograde transneuronal tracing with rabies virus from the left medial rectus muscle in guinea pigs. Time-sequenced labelling revealed distinct circuitries involved in particular oculomotor functions, i.e. vestibulo-ocular reflex and saccade generation (brainstem circuitry), adaptive plasticity (cerebellar modules) and possibly motivation and navigation (limbic, hippocampal and cortical structures). Our results provide a first comprehensive road map of the oculomotor system that is unsurpassed by any previous tracing study. We report a number of unexpected findings that illustrate a much vaster and more complicated network for the control of the relatively simple horizontal eye movements than had been envisioned previously.