Visual Loss Secondary to Bioccipital Calcifications Associated with Coeliac Disease.

The purpose of this paper was to present a case report of permanent visual loss secondary to occipital lobe calcifications in coeliac disease. A 58-year-old grave digger was referred by his work place occupational health and safety department for vision assessment. His past medical history included coeliac disease (CD) diagnosed 20 years previously, as well as an over 40-year history of poor vision that had not been investigated. Examination showed bilaterally decreased visual acuity of <6/60 and a right homonymous inferior quadrantanopia confirmed on automated perimetry. The optic discs appeared normal with no pallor or neuroretinal rim loss. Computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed bilateral occipital calcifications. Diffusion tensor imaging showed reduced anisotropy and difficulty tracing the optic radiations to the occipital lobes. This is the first described case of visual loss secondary to occipital lobe calcifications in coeliac disease.

Refractive error in school children in an urban and rural setting in Cambodia.

PURPOSE: To assess the prevalence of refractive error in schoolchildren aged 12-14 years in urban and rural settings in Cambodia's Phnom Penh and Kandal provinces. METHODS: Ten schools from Phnom Penh Province and 26 schools from Kandal Province were randomly selected and surveyed in October 2010. Children were examined by teams of Australian and Cambodian optometrists, ophthalmic nurses and ophthalmologists who performed visual acuity (VA) testing and cycloplegic refraction. RESULTS: A total of 5527 children were included in the study. The prevalence of uncorrected, presenting and best-corrected VA ≤ 6/12 in the better eye were 2.48% (95% confidence interval [CI] 2.02-2.83%), 1.90% (95% CI 1.52-2.24%) and 0.36% (95% CI 0.20-0.52%), respectively; 43 children presented with glasses whilst a total of 315 glasses were dispensed. The total prevalence of refractive error was 6.57% (95% CI 5.91-7.22%), but there was a significant difference between urban (13.7%, 95% CI 12.2-15.2%) and rural (2.5%, 95% CI 2.03-3.07%) schools (P < 0.0001). Refractive error accounted for 91.2% of visually impaired eyes, cataract for 1.7%, and other causes for 7.1%. Myopia (spherical equivalent ≤ -0.50 diopters [D] in either eye) was associated with increased age, female gender and urban schooling. CONCLUSIONS: The prevalence of refractive error was significantly higher in urban Phnom Penh schools than rural schools in Kandal Province. The prevalence of refractive error, particularly myopia was relatively low compared to previous reports in Asia. The majority of children did not have appropriate correction with spectacles, highlighting the need for more effective screening and optical intervention.

Horner Syndrome: A Practical Approach to Investigation and Management.

Horner syndrome is typically described by the classic triad of blepharoptosis, miosis, and anhydrosis resulting from disruption along the oculosympathetic pathway. Because of the complex and extensive course of this pathway, there are a large number of causes of Horner syndrome ranging from benign to life-threatening diseases. This review article aims to provide a practical approach to investigation and management, including evaluation of the more recent use of apraclonidine for pharmacological testing.

A survey of severe visual impairment and blindness in children attending thirteen schools for the blind in sri lanka.

PURPOSE: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending schools for the blind in Sri Lanka, and to provide optical devices and ophthalmic treatment where indicated. METHODS: Two hundred and six children under 16 years from 13 schools for the blind in Sri Lanka were examined by a team of ophthalmologists and optometrists. Data were entered in the World Health Organization Prevention of Blindness Eye Examination Record for Childhood Blindness (WHO/PBL ERCB). RESULTS: Of the 206 children, 83.5% were blind (BL = Visual acuity [VA] <3/60), and 9.2% had severe visual impairment (SVI = VA <6/60 to 3/60 in the better eye). The major anatomical site of BL/SVI was the retina in 35.9% of cases, followed by the whole globe in 22.4% of cases. The major underlying aetiologies of BL/SVI were unknown in 43.8% of cases and hereditary in 37.5%. Avoidable causes of BL/SVI accounted for 34.9% of cases; retinopathy of prematurity made up the largest proportion of this subgroup. One third of the children required an optical device to improve their vision. CONCLUSION: Just over one third of the children in schools for the blind in Sri Lanka had potentially avoidable causes of BL/SVI. Vision could also be improved in a third of children. The data support the need to develop specialized pediatric ophthalmic services, particularly in the face of advancing neonatal life support in Sri Lanka, and the need for increased provision of optical support.

"Bong lung" in cystic fibrosis: a case report.

INTRODUCTION: Marijuana or "bong" lung has been recently described. Subjects typically develop large peripheral paraseptal lung bullae and are predisposed to spontaneous pneumothoraces. The underlying mechanism for bullae formation is uncertain, but probably relates to direct lung toxicity and repeated barotrauma as the smoker performs frequent valsalva manoeuvres in an attempt to derive a greater drug effect. CASE PRESENTATION: We describe a case of probable "bong lung" occurring in a 23-year-old Caucasian man with cystic fibrosis who had a history of recurrent pneumothoraces and unusual findings on sputum cytology. CONCLUSION: Our case highlights the importance of questioning young adult cystic fibrosis patients about illicit drug use and the utility of sputum cytology and computed tomography scanning when patients present with pneumothoraces and deteriorations in clinical status.