Orbital apex syndrome secondary to optic nerve cysticercosis.

A 22-year-old male presented to us with complaints of sudden painful loss of vision in left eye 10 days ago along with inward deviation of the left eye. Best-corrected visual acuity (BCVA) in right eye was 20/20 and 20/50 in left eye. Left eye showed limitation of abduction, a relative afferent pupillary defect, normal anterior segment with optic disc oedema. Contrast-enhanced MRI of the brain and orbit showed thickening of left optic nerve along with a cystic lesion near the orbital apex with a central iso- to hyperintense spot resembling a scolex. A diagnosis of left orbital apex syndrome secondary to optic nerve cysticercosis was made. Patient was treated with oral albendazole and intravenous corticosteroids for 3 days followed by oral corticosteroids. Ten weeks post-treatment, his BCVA in the left eye improved to 20/20 and colour vision and visual fields improved. Pallor of the left optic disc was noted, and ocular motility improved completely. MRI after treatment showed a decreased thickness of left optic nerve with disappearance of the cystic lesion.

Toxocariasis of the optic disc.

A healthy 46-year-old man presented with decreased vision in the right eye after ingestion of raw meat. On funduscopic examination, a cystic lesion was found on an edematous right optic disc with adjacent serous retinal detachment. Optical coherence tomography confirmed a peripapillary serous retinal detachment and a well-demarcated cystic lesion (200 × 200 × 500 µm) in the right eye. The patient had moderate eosinophilia and was seropositive for anti-Toxocara IgG antibody. Diagnosed with ocular toxocariasis, he was treated with systemic corticosteroids and albendazole with improvement in vision and fundus appearance.

Presumed toxoplasmosic anterior optic neuropathy.

PURPOSE: To describe the clinical findings and course of toxoplasmic anterior optic neuropathy and to differentiate primary and secondary involvement. METHODS: Retrospective observational case series from a tertiary referral institution. Clinical and photographic charts of 13 patients with toxoplasmosis with direct optic nerve head involvement were reviewed and data were collected throughout the length of follow-up. RESULTS: Toxoplasmic anterior optic neuropathy was divided into two types. Type I was defined as secondary infectious involvement of the optic nerve head from an adjacent focus of chorioretinitis that resolved with chorioretinal scarring. Type II was defined as primary involvement of the optic nerve head that resolved without chorioretinal scarring. Visual acuity improved after treatment in both Type I and Type II patients; however, the visual prognosis was worse in Type I patients due to macular involvement. Eighty-three percent of Type II patients had a final visual acuity equal to or better than 20/25 compared to 50% of Type I patients. Visual field defects were present in all patients, most frequently arcuate or altitudinal (62%). Delay in diagnosis was common (54%), especially in Type II patients (71%). Vitreous inflammation was absent on the initial examination in 31% of the patients. CONCLUSION: Toxoplasmic anterior optic neuropathy is an uncommon manifestation of ocular toxoplasmosis. Delays in diagnosis are common because of the frequent lack of typical chorioretinitis or vitreous inflammation. Adjacent macular involvement strongly influences visual outcome.

Ophthalmomyiasis interna posterior. Report of a case with optic atrophy.

PURPOSE: The prognosis for patients with ophthalmomyiasis Interna posterior is variable. In many patients the larva remains in the eye for years without inducing inflammation or loss of vision. Sometimes, however, the migrating larva involves the macula and optic nerve and results in permanent visual loss or even blindness. METHODS: Our patient presented with sudden painless loss of vision in the right eye that was caused by ophthalmomyiasis interna posterior. Hemorrhage of the optic nerve head suggested that the fly larva had entered the vitreous cavity from the optic nerve head. Subretinal tracts were sequelae of the subretinal migration of the organism. Sequential photographs documented the fly larva migration into the optic nerve head head from the vitreous cavity. The organism was removed by pars plana vitrectomy and retinectomy. RESULTS: In spite of the successful removal of the first stage fly larva, the visual acuity remained poor because of optic nerve atrophy. CONCLUSION: We suggest early removal of fly larvae to prevent damage and visual loss in cases of ocular myiasis interna posterior.