A Rare Tick Tale: A Novel Case of the Australian Paralysis Tick Causing Multiple Cranial Neuropathies.

The Australian paralysis tick (Ixodes holocyclus) is found along the east coast of Australia. Tick bites may result in paralysis ranging from muscular weakness to ascending paralysis requiring respiratory support. Ocular complications and facial nerve involvement are rare. We present a rare occurrence of tick-bite-associated visual loss, proptosis, and multiple cranial neuropathies not previously reported in the literature. The tick was removed, and the patient's symptoms improved following treatment with steroids and oral doxycycline. The vision and sensory changes are not explained by the Ixodes toxin; thus, we hypothesize this is related to orbital apex inflammation.

Ocular trauma associated with falls in older people: A 10-year review from a state trauma service.

BACKGROUND: Falls are the leading cause of injury-related emergency presentations, hospital admissions and deaths in Victorians over the age of 65. While there is extensive literature analysing traumatic injuries resulting from falls in older patients, there is little data on ocular injuries in this patient group. METHODOLOGY: A retrospective audit of all patients over 65 years referred to the Ophthalmology Department of a tertiary hospital following fall from standing height between January 2009 and December 2018 to determine the demographics, injury setting, ophthalmic injuries, interventions and outcomes of ocular trauma secondary to falls. RESULTS: Two hundred and seventy patients (F = 155, M = 115) were included, with a mean age of 81 years. 180 falls (66.7%) occurred in a residential environment. The most common reason for referral was orbital fracture (n = 155). Severe ocular injuries included globe rupture (n = 23), retro-bulbar haematoma (n = 22), retinal detachment (n = 6) and traumatic optic neuropathy (n = 6). Forty patients (14.8%) presented with a visual acuity (VA) below 6/60 while 34 patients (12.5%) had a non-assessable VA secondary to delirium or intubation. Of these 34, 9 had a significant ocular injury. A total of 28 patients (10.4%) were permanently blinded by their injuries. Twenty-three patients (8.5%) required admission to ICU and 16 patients (5.93%) died during their in-hospital stay. Thirty-six injuries were referred beyond the 24-hour mark, including a globe rupture and a case of traumatic optic neuropathy. With the exception of the missed globe rupture, all other injuries requiring emergency surgery were operated on within 24 h. CONCLUSION: Falls in older people may be associated with sight-threatening ocular injuries which are common and easy to miss in this population demographic. The presence of ocular injuries in this patient group is associated with significant rates of in-hospital mortality and poor functional outcomes. It is therefore essential for trauma practitioners to perform a detailed and systematic assessment in order to identify sight-threatening ocular injuries and allow for expedient sight-saving intervention to be performed.

Refractive stability following uncomplicated cataract surgery.

BACKGROUND: Quality of life may be negatively impacted following cataract surgery if glasses prescription is delayed. This study aims to confirm the refractive stabilisation time in an Australian population to form the basis for suggesting an appropriate timeframe for spectacle prescription. METHODS: Participants (51 female and 35 male) were recruited one day after uncomplicated unilateral cataract surgery using a monofocal intraocular lens. Subjective refraction, automated refraction and central corneal thickness were measured at two, four and six weeks post-operatively. A short questionnaire assessing the impact of uncorrected near vision on daily activities was collected at two and four weeks. RESULTS: There was no significant change in the mean automated or subjective spherical equivalent refraction (peq < 0.001), mean corneal thickness (peq < 0.001), mean uncorrected distance visual acuity (peq < 0.001) or mean uncorrected near visual acuity (peq < 0.001) over the six-week study period. At week two, 59 per cent of patients stated that their uncorrected near vision affected their ability to perform daily tasks 'somewhat' or 'a lot', increasing to 75 per cent by week four. CONCLUSION: Uncorrected near vision affected quality of life for most participants. All measured visual and ocular parameters were stable from two weeks post-operatively. Patients need not wait longer than this for spectacle prescription following uncomplicated unilateral cataract surgery.

Peripheral refraction in different ethnicities.

PURPOSE: Peripheral refraction is commonly used to infer retinal shape. Because of the different prevalence of myopia in the white compared with East Asian populations, peripheral refraction along the horizontal meridian was compared in white and East Asian young adults with emmetropic, low myopic, and moderately myopic refractive errors. METHODS: Thirty-five white and 37 East Asian subjects were recruited with central refraction between +1.00 DS and -5.50 DS and ≤ -1.50 DC. Central and peripheral noncycloplegic autorefraction was measured along the horizontal meridian at 5° intervals up to ± 35°, and corneal topography maps were also quantified. RESULTS: There were no significant differences between whites and East Asians in peripheral refraction profiles in the emmetrope and low myope groups, which had peripheral myopic and emmetropic refraction, respectively. However, in the moderate myope group, there was a statistically significant difference between whites and East Asians in peripheral refraction, which was generally hyperopic. East Asian moderate myopes had more relative peripheral hyperopia than did whites of similar central refractive error. Corneal shape and power were comparable between white and East Asian subjects in the three refractive groups. CONCLUSIONS: East Asian moderate myopes have a greater degree of relative peripheral hyperopia and hence a more prolate ocular shape than do white subjects of similar central refractive error. Differences in ocular shape may play a role in the greater propensity for East Asians to develop and progress in myopia compared with whites.