Síndrome de nieve visual y su relación con la migraña / Visual snow syndrome and its relationship with migraine

Introducción El síndrome de nieve visual (SNV) es un trastorno del sistema nervioso central que implica la visión de forma constante de pequeños puntos blancos y negros en la totalidad del campo visual. Desarrollo El SNV puede presentarse desde la infancia hasta la tercera edad, siendo más frecuente en jóvenes y sin diferencia entre géneros. En sus criterios diagnósticos se incluye la presencia de nieve visual, pero también otros fenómenos visuales como palinopsia, fotofobia, nictalopía y otros fenómenos visuales persistentes. La fisiopatología del SNV es desconocida, pero se postulan como mecanismos la hiperexcitabilidad del córtex visual y una disfunción en el procesamiento visual de orden superior. La prevalencia de migraña en los pacientes con SNV es alta en comparación con la población general y cuando se presentan conjuntamente los síntomas son más severos. No se dispone de un tratamiento eficaz, pero el fármaco con mejores resultados es la lamotrigina, recomendándose únicamente en casos seleccionados con alta limitación funcional. Conclusiones El síndrome de nieve visual es una entidad poco conocida e infradiagnosticada, pero el creciente número de investigaciones durante los últimos años ha permitido definir unos criterios diagnósticos y acercarnos a su fisiopatología. Es una entidad íntimamente relacionada con la migraña, con solapamiento de síntomas y probablemente mecanismos fisiopatológicos comunes. (AU)

Introduction Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. Development VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. Conclusions VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms. (AU)

Visual snow syndrome and its relationship with migraine.

INTRODUCTION: Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. DEVELOPMENT: VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. CONCLUSIONS: VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms.

Fotofobia intercrítica en el paciente migrañoso. Propuesta de criterios diagnósticos / Intercritical photophobia in the migraineous patient. Proposal for diagnostic criteria

Introducción: La fotofobia es un síntoma de intolerancia anómala a la luz sin sensación de dolor que requiere de una anamnesis y una exploración para el diagnóstico de una etiología subyacente.Procedimiento básico: El presente artículo se centra en 30 casos clínicos con fotofobia intensa aislada y su revisión de la bibliografía. Objetivo: El objetivo consiste en establecer unos criterios diagnósticos de la fotofobia. Resultados: La etiología de la fotofobia parece encontrarse a nivel de las células ganglionares de la retina intrínsecamente fotosensibles, conocidas como las células de la melanopsina, y a un nivel neuroquímico mediado por el péptido relacionado con la calcitonina y el péptido pituitario activador de la ciclasa. Conclusión: El tratamiento de la fotofobia podría consistir en anticuerpos monoclonales contra los péptidos relacionados con la calcitonina y/o el péptido pituitario activador de la ciclasa.(AU)

Introduction: Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. Basic procedure: This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. Objective: The purpose of this article is to establish diagnostic criteria for photophobia. Results: The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. Conclusion: The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.(AU)

Intercritical photophobia in the migrainous patient. Proposal for diagnostic criteria.

INTRODUCTION: Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE: This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE: The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS: The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION: The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.

Visual snow syndrome and its relationship with migraine. / Síndrome de nieve visual y su relación con la migraña.

INTRODUCTION: Visual snow syndrome (VSS) is a central nervous system disorder that consists of the constant perception of small black and white dots throughout the entire visual field. DEVELOPMENT: VSS can present from infancy to old age, with greater prevalence in the young population, and shows no difference between sexes. The diagnostic criteria include the presence of visual snow and such other visual phenomena as palinopsia, photophobia, nyctalopia, and other persistent visual phenomena. The pathophysiology of VSS is unknown, but hyperexcitability of the visual cortex and a dysfunction in higher-order visual processing are postulated as potential mechanisms. The prevalence of migraine among patients with VSS is high, compared to the general population, and symptoms are more severe in patients presenting both conditions. No effective treatment is available, but the drug with the best results is lamotrigine, which is recommended only in selected cases with severe functional limitation. CONCLUSIONS: VSS is a little-known and underdiagnosed entity, but the increasing number of studies in recent years has made it possible to establish diagnostic criteria and begin studying its pathophysiology. This entity is closely related to migraine, with overlapping symptoms and probably shared pathophysiological mechanisms.

Long-lasting disabling photophobia after uneventful cataract surgery.

The case concerns a 54-year-old woman, with a history of fibromyalgia and normal preoperative ocular and systemic study, who presented with a long-lasting disabling photophobia, after sequential bilateral cataract surgery without complications. Photophobia was accompanied by good uncorrected VA, with no pain or subjective eye discomfort, without migraine or indicators of psychic conflict. It was refractory to any prescribed treatment of the ocular surface, finally responding to oral anticonvulsants (carbamazepine) that are frequently used in neuropathic pain. To the best of our knowledge this is the first reported case of a long-lasting disabling photophobia without pain and good VA after cataract surgery.

Fotofobia invalidante de larga duración tras cirugía no complicada de cataratas / Long-lasting disabling photophobia after uneventful cataract surgery

Paciente mujer, de 54 años, con antecedente de fibromialgia y estudio preoperatorio ocular y sistémico normal, que presenta fotofobia invalidante de larga duración, tras cirugía bilateral secuencial de cataratas sin complicaciones. La fotofobia se acompañaba de buena AV no corregida, sin dolor ni molestias subjetivas oculares y sin migraña ni indicadores de conflictos psíquicos. Fue refractaria a cualquier tratamiento de la superficie ocular pautado, respondiendo finalmente a anticonvulsivantes orales (carbamazepina) frecuentemente utilizados en dolor de tipo neuropático. Según nuestro conocimiento es el único caso descrito de fotofobia invalidante de larga duración sin dolor y buena AV tras cirugía de cataratas (AU)

The case concerns a 54-year-old woman, with a history of fibromyalgia and normal preoperative ocular and systemic study, who presented with a long-lasting disabling photophobia, after sequential bilateral cataract surgery without complications. Photophobia was accompanied by good uncorrected VA, with no pain or subjective eye discomfort, without migraine or indicators of psychic conflict. It was refractory to any prescribed treatment of the ocular surface, finally responding to oral anticonvulsants (carbamazepine) that are frequently used in neuropathic pain. To the best of our knowledge this is the first reported case of a long-lasting disabling photophobia without pain and good VA after cataract surgery (AU)

Intercritical photophobia in the migraineous patient. Proposal for diagnostic criteria. / Fotofobia intercrítica en el paciente migrañoso. Propuesta de criterios diagnósticos.

INTRODUCTION: Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE: This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE: The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS: The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION: The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.

Carcinoma epidermoide córneo-conjuntival. Presentación de un caso / Squamous cell, corneal-conjunctival carcinoma of. Case report

RESUMEN Se presentó el caso de un paciente masculino de 60 años, blanco, que fue atendido en la Consulta de Oftalmología, del Hospital "Dr. Mario Muñoz", del municipio de Colón, provincia de Matanzas. Refirió que llevaba aproximadamente 20 días, con sensación de cuerpo extraño en el ojo izquierdo, enrojecimiento, secreción constante, fotofobia y una lesión que le había aumentado de tamaño durante este período; la que se tornaba dolorosa durante el parpadeo. Se decidió realizar este trabajo con el objetivo de mostrar los beneficios obtenidos al concluir el tratamiento aplicado a este tipo de tumor (AU).

ABSTRACT The authors present the case of a white male patient, aged 60 years, who assisted the Consultation of Ophthalmology of the Hospital "Dr. Mario Muñoz", of the municipality of Colon. He referred feeling a foreign body in the left eye for already 20 days, presence of redness, constant secretion, photophobia and a lesion that had grown during that period, painful when blinking. The authors decided to write this article with the objective of showing the benefits obtained with the applied treatment in this kind of tumor (AU).

Photophobia and neuropathic pain in Sudecks syndrome. / Fotofobia y dolor neuropático en el síndrome de Sudeck.

The case is presented of a 14 year-old patient diagnosed with Sudeck's syndrome secondary to uneventful foot trauma. The patient complained of decreased visual acuity along with photophobia and intense ocular pain not correlated with the exploratory findings. Sudeck's syndrome is an idiopathic neuropathic inflammatory disease characterised by disproportionate pain, unrelated to a previous traumatic event, which can evolve to severe and generalised pain. A new explanation has recently described this as "neuropathic eye pain" for those patients with severe eye pain that do not correlate with clinical signs. In the case presented here, the pain became widespread and led to photophobia and very intense ocular neuropathic pain. It is believed that this was the cause of the visual decrease presented by this patient. It is proposed that the Sudeck syndrome should become part of the differential diagnosis of neuropathic eye pain.

[Non-organic visual loss. A series of 5 cases]. / Pérdida visual no orgánica. Serie de 5 casos.

Non-organic visual loss is the presence of ocular symptoms without an organic base that justifies it, and can occur in up to 5% of the children attending Ophthalmology Outpatients. A suspicion and the management of this situation are essential for a proper diagnosis, not only to avoid unnecessary referrals to other specialties, but also to avoid health spending, in addition to reducing parental distress by the possible presence of eye disease in their children.

Distrofia Retiniana Familiar. Reporte de dos casos / Retinal Dystrophy Family. Report of two cases

La distrofia de conos es un grupo de enfermedades retinianas hereditarias en forma monogenética que siguen los patrones de herencia mendeliana, se caracterizan por baja de agudeza visual por afectación macular, con poca o ninguna repercución en retina periférica y deben diferenciarse de otras patologías como las degenerativas o las tóxicas. Es muy poco frecuente encontrar esta afectación en la consulta, sobre todo en dos miembros de una familia de edades 11 y 13 años de edad respectivamente, que se presentan con baja de agudeza visual con largo tiempo de evolución, sin antecedentes personales ni patológicos de importancia, es por eso que vemos por conveniente la presentación de estos casos clínicos. Se realizó una revisión oftalmológica completa con los exámenes disponibles en Cochabamba entre los cuales no se incluyo Electroretinograma. De acuerdo a las características del cuadro clínico baja de visión, heme-ralopía y fotofobia, y los exámenes realizados, retinografía, campo visual, test de color de FM 100, los cuales se encontraron alterados y, se llega presunción diagnóstica de una presencia de distrofia de conos dominante,con mal pronóstico visual, al no existir actualmente un tratamiento efectivo para evitar la progresión de la enfermedad, y en éstos casos se recomienda ayudas visuales con anteojos y lupas.

The cone dystrophy is a group of hereditary retinal diseases in a single gene that follow Mendelian inheritance patterns are characterized by low visual acuity macula, with little or no repercussion in the peripheral retina and should be distinguished from other pathologies such as degenerative or toxic. It is very rare to find this involvement in the consultation, especially two family members ages 11 and 13 years respectively, presented with low visual acuity with long evolution, no personal or important pathological , that is why we see presenting appropriate clinical cases. We performed a complete ophthalmologic examination with in Cochabamba, including Elec-troretinogram was not included. According to the characteristics of clinical low vision, night blindness and photophobia, and previous tests, fundus, visual field, color test FM 100, which were found altered and will reach a presumptive diagnosis of Duchenne presence of dominant cones, with poor visual prognosis, as there currently an effective treatment to prevent disease progression, and in these cases it is recommended visual aids and magnifying glasses.

Manejo a nivel primario de cuerpo extraño en ojo / Manage in primary care of foreign bodies in the eye

Los cuerpos extraños en ojo es quizás la forma más común de presentación del trauma ocular. En la consulta de emergencias es usual observar traumas oculares de los cuales la mayoría son asociados con cuerpos extraños en cornea o a nivel tarsal. Dada la dificultad de acceso de algunas zonas del país a los servicios especializados en oftalmología, en el Servicio de Emergencias de Valverde Vega nació la necesidad de redactar esta actualización con lo más reciente en manejo de cuerpos extraños, con el fin de brindar la mejor atención a los usuarios con este tipo de patologías. Durante este proceso hemos concluido que el manejo ha variado en relación a la enseñanza básica del médico general en las escuelas de medicina.

Probably the most frequent presentation of ocular trauma is foreign bodies in the eye; it is a usual consultation in the emergency service, and most are associated to foreign bodies in the cornea or at the tarsus. SincetheaccesstoophthalmologicconsultationinCostaRica is limited, the Emergency Service in Valverde Vega needed to update procedures for a correct management of foreign bodies in the eye, in order to give the best attention possible to those pathologies. During this process we concluded that the management of the foreign bodies has evolved from the basic training the physicians had in medical school.

Ichthyosis follicularis, alopecia and photophobia syndrome (IFAP): report of the first case with ocular and cutaneous manifestations in Brazil with a favorable response to treatment / Síndrome de ictiose folicular, alopécia e fotofobia (IFAP): relato do primeiro caso com acometimento ocular e cutâneo do Brasil e da resposta favorável ao tratamento

Ichthyosis follicular, alopecia, and photophobia (IFAP) syndrome is a rare disease, with possible X-linked mode of inheritance. The patient presented with ocular findings of photophobia, corneal scarring and erosions, superficial and deep corneal vascularization and myopia. He was treated with artificial tears and punctal occlusion with small improvement of photophobia. After three months using systemic retinoid (Acitretina) and posterior amniotic membrane transplantation in the left eye, there was a significant improvement of photophobia, corneal erosions and neuropsychomotor development.

A síndrome de ictiose folicular, alopecia e fotofobia (IFAP) é uma doença rara, com possível modo de herança ligado ao cromossomo X. O paciente apresentou achados oftalmológicos de fotofobia, cicatrizes e erosão corneanas, neovascularização superficial e profunda da córnea e miopia. Foi iniciado uso de lubrificantes e oclusão do ponto lacrimal com discreta melhora da fotofobia. Após uso de retinóide sistêmico (Acitretina) por três meses e posterior transplante de membrana amniótica no olho esquerdo apresentou melhora importante da fotofobia, das erosões corneanas e do desenvolvimento neuropsicomotor.