An Unusual Presentation of Neurosarcoidosis.

BACKGROUND Sarcoidosis is a systemic granulomatous disease of unknown cause, often affecting the lungs and lymphatic system. Neurologic manifestations of sarcoidosis, called "neurosarcoidosis", can present as cranial neuropathies and occur in an isolated fashion or alongside other systemic findings. These findings occur in about 5% to 15% of individuals, and mainly in women between the ages of 30 and 40 years. Within those subsets of patients who develop neurologic manifestations, ocular manifestations occur 13% to 79% of the time. Less common presentations include secondary glaucoma, intermediate or posterior inflammation, or other neuro-ophthalmic findings. CASE REPORT A 63-year-old White man initially presented with blurry vision, acute glaucoma, and other symptoms closely simulating hypertensive retinopathy. He later developed diplopia and was not accurately diagnosed by general ophthalmologists and a retina specialist. Due to the unusual presentation, hypertensive retinopathy was the incorrect initial working diagnosis and the patient continued to develop more severe symptoms. A multidisciplinary approach to patient care through a nephrology referral led to the final diagnosis of neurosarcoidosis. Prompt treatment improved renal function and ocular disturbances. CONCLUSIONS Retinal cotton-wool spots, glaucoma, and optic nerve swelling are rare presentations of neurosarcoidosis. Unusual vascular symptoms warrant consideration of all vascular diseases and prompts for collaboration through a multidisciplinary team. This case serves to highlight the importance of sarcoidosis as a differential, even in patients with no previous signs of granulomatous disease, and how a team-based approach between multiple specialties improves accuracy, timeliness, and treatment regimen.

Effect of strabismus surgery on the reading ability of school-age children.

AIM: To evaluate if strabismus surgery on children between the ages 5 and 14 years leads to an improvement in reading ability by comparing reading performance of patients before and after surgery. METHODS: Pre- and postoperatively, the visual acuity, ocular alignment, and stereoacuity of 15 children with horizontal strabismus was recorded. The "3-Minute Reading Assessments: Word Recognition, Fluency, and Comprehension" for the appropriate age-group were used to assess children between the ages of 5 and 14 years. Thirteen of the 15 children presented with esotropic deviation, and the remaining 2 were exotropic. RESULTS: Postoperatively, 12 patients were orthophoric and 3 had significant residual esotropia. The 15 patients had an average improvement in reading speed (10.3 words per minute), accuracy (4%), and fluency (2 points). For the 12 orthophoric patients, reading speed increased by 12.2 (P = .003), accuracy by 3% (P = .064), and fluency by 1.33 (P = .006). CONCLUSION: Corrective strabismus surgery in school-age children showed an early improvement in reading ability that could translate into better academic performance. Our results suggest that reading ability could be an important factor when considering corrective surgery for children with strabismus.