The Ocular Manifestations and Transmission of COVID-19: Recommendations for Prevention.

BACKGROUND: Coronavirus disease-2019 (COVID-19), caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been linked to ocular signs and symptoms in several case reports. Research has demonstrated that SARS-CoV-2 is spread primarily through close contact via respiratory droplets, but there is the possibility for ocular transmission, with the conjunctiva as a conduit as well as a source of infection. DISCUSSION: Ocular manifestations of SARS-CoV-2 include follicular conjunctivitis, and have been repeatedly noted as an initial or subsequent symptom of COVID-19-positive patients. Particularly in patients with ocular manifestations, there is evidence that the virus may present in tears, based on the detection of SARS-CoV-2 in conjunctival swab samples via reverse transcription polymerase chain reaction. The virus may therefore be transmittable from the ocular surface to a new host via contact with the ocular mucosa, tears, or subsequent fomites. CONCLUSIONS: All health care professionals should ask patients about ocular symptoms consistent with SARS-CoV-2, and use eye protection such as goggles or face shields as part of the standard personal protective equipment for high-risk patients in addition to wearing of masks by both the patient and provider, and should consider tears to be potentially infectious.

Radiation optic neuropathy after proton beam therapy for optic nerve sheath meningioma.

A 63-year-old woman with a 1-month history of blurred vision in the right eye was found to have a right optic nerve sheath meningioma. She was treated with fractionated proton beam therapy using a total dose of 50.4 cobalt gray equivalent (CGE) in 1.8 CGE fractions, with subsequent improvement in vision. Twenty-seven months later, the patient reported a 6-week history of progressive blurred vision in her right eye. Magnetic resonance imaging revealed enhancement of the right optic nerve consistent with radiation optic neuropathy (RON). We are unaware of any previous reports of RON when radiotherapy doses fall within the current recommended guidelines of <55 CGE fractionated into daily doses <2 CGE.

Syphilitic chorioretinitis mimicking an anterior chiasmal syndrome.

PURPOSE: To report a case of syphilitic chorioretinitis mimicking an anterior chiasmal syndrome. METHODS: Observational case report. RESULTS: A 74-year-old man with a remote history of syphilitic chorioretinitis was noted to have an apparent junctional scotoma on a screening Humphrey visual field. Subsequent magnetic resonance imaging of the brain was normal, and the patient was referred for neuro-ophthalmologic evaluation. The fundus examination and a fluorescein angiogram demonstrated that the pattern of chorioretinal scarring corresponded to the visual field defects in both eyes. CONCLUSION: Syphilis, the great masquerader, may cause retinal disease that mimics a neurologic visual field defect.

Cortical blindness following a near-drowning incident.

Victims of near-drowning incidents often suffer neurologic injury with long-term sequelae secondary to hypoxic-ischemic injury. We describe a case of profound visual loss due to bilateral occipital lobe infarcts in a 23-year-old male victim of a near-drowning incident.

Acute retrobulbar optic neuritis and macular detachment associated with morning glory optic disc anomaly.

A 31-year-old woman with morning glory optic disc anomaly (MGDA) developed acute retrobulbar optic neuritis and a bullous macular detachment. MRI demonstrated truncation of the perineural space of the affected optic nerve as well as focal optic nerve enhancement. Optical coherence tomography (OCT) showed retinoschisis associated with the macular detachment. The MRI and OCT findings support the vitreous as the source of the subretinal fluid. This is the first reported case of optic neuritis in MGDA.

Ocular injuries in basketball and baseball: what are the risks and how can we prevent them?

Ocular trauma is a frequent result of sports-related injury during basketball and baseball. A screening sideline examination should be performed immediately to assess vision and evaluate the severity of damage. The team physician should be able to treat minor injuries and identify vision-threatening trauma for immediate referral. Injuries range from minor, including corneal abrasion and foreign bodies, to more severe, including hyphema, orbital fracture, and globe rupture. Resultant damage may be vision-threatening and permanent. Most of these injuries can be prevented with full-time use of sport-specific protective eyewear. Physicians should recommend appropriate eye protection and counsel patients accordingly.

Palinopsia from posterior visual pathway lesions without visual field defects.

Palinopsia, or perseveration of a previously viewed image, may be caused by drug use or by posterior visual pathway lesions. Most cases of palinopsia due to visual pathway lesions have an associated homonymous hemianopic visual field defect. We report two patients with palinopsia caused by structural lesions of the posterior visual pathway in the absence of visual field defects. Patients with palinopsia should undergo neuroimaging even in the presence of normal visual fields.

Lyme disease associated with postganglionic Horner syndrome and Raeder paratrigeminal neuralgia.

A 55-year-old woman developed severe unilateral headaches, periocular numbness, and Horner syndrome after presenting with symptoms consistent with Lyme disease. The combination of Horner syndrome and periocular headache and numbness constituted a diagnosis of Raeder paratrigeminal neuralgia. Although the headaches resolved with antibiotic treatment, the Horner syndrome persisted for at least 1 year. This case expands the spectrum of neurologic manifestations of Lyme disease to include postganglionic Horner syndrome as well as Raeder paratrigeminal neuralgia.

Neurodegenerative disorders mimicking progressive supranuclear palsy: a report of three cases.

Progressive supranuclear palsy (PSP) is rarely confused with other parkinsonian disorders once the vertical gaze palsy appears. Corticobasal degeneration is the most common differential diagnostic entity. We describe three cases diagnosed during life as PSP but found to have another neurologic disorder at autopsy. No explanation for the gaze palsies was found in any case.

Reversible carotid artery narrowing in morning glory disc anomaly.

A 14-year-old boy with morning glory disc anomaly (MGDA) and normal visual and neurologic function displayed marked carotid artery narrowing on magnetic resonance angiography (MRA). This narrowing disappeared on a follow-up MRA six months later. Optic coherence tomography and scanning laser polarimetry disclosed a normal retinal nerve fiber layer in the eye with MGDA. MGDA has been reported in association with irreversible carotid artery stenosis leading to moya moya disease. This case suggests that mild cases of MGDA may be associated with reversible carotid artery narrowing owing to vasospasm.

Amiodarone and optic neuropathy: the heart of the matter.

Amiodarone is one of the most effective antiarrhythmic drugs currently available. Although a subject of intense controversy, a causal link between amiodarone and optic neuropathy has never been firmly established. Indications for treatment with amiodarone are outlined, and features of the optic neuropathy in patients on amiodarone are compared with those of nonarteritic anterior ischemic optic neuropathy. An approach to patients treated with amiodarone who present with optic neuropathy is outlined, and suggestions for a registry and prospective study of such patients are presented.

Permanent visual deficits secondary to the HELLP syndrome.

A 34-year-old woman with eclampsia and the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome developed encephalopathy, cardiomyopathy, pulmonary edema, liver failure, and disseminated intravascular coagulation (DIC), all of which resolved. She also had retinal hemorrhages in both eyes and a hemorrhagic infarct in the left occipital lobe that resulted in a permanent right homonymous hemianopia and a persistently depressed acuity of 20/100 OS. This case is unusual in demonstrating permanent visual deficits. In nearly all cases of preeclampsia or eclampsia, visual deficits are reversible. The superimposition of the HELLP syndrome may create more neurologic damage. Clinicians should be alert to patients at risk for HELLP syndrome and manage them aggressively.

Traumatic optic neuropathy caused by a merchandise display hook.

A 4-year-old boy presented with complete blindness in his left eye after accidentally walking into a merchandise display hook while shopping in a department store. An ophthalmologic examination revealed no light perception, an amaurotic pupil, and nasal conjunctival injection in the eye. Intravenous steroids did not improve his vision.