Ocular amyloid: adnexal and systemic involvement.

Purpose: To investigate the natural history of ocular adnexal and orbital amyloidosis.Methods: In a retrospective, non-comparative case series, the clinical records of patients with biopsy-proven ocular, adnexal, and orbital amyloidosis managed at our institution between 1980 and 2016 were evaluated.Results: Forty-one patients (29 female; 71%) were identified. The mean interval from presentation to diagnosis was 24 months (median 12 months, range 1-84 months). Whilst most patients presented with a conjunctival mass (34/41; 83%) or ptosis (15/41; 37%), the diagnosis was not immediately evident in all - two patients had 3 ptosis operations prior to obtaining a tissue biopsy that revealed amyloid deposition. Three-quarters (31/41; 76%) of patients had localised primary ocular adnexal and orbital amyloidosis, 4 (10%) had associated systemic disease, and 6 (15%) were found to have underlying haematological malignancy on further investigation. During a mean follow-up of 8 years (median 7 years; range 6 months - 36 years), 2 (5%) patients lost vision, 21 (51%) had surgical intervention other than biopsy, and 2 (5%) had local radiotherapy for amyloid deposition secondary to lymphoproliferative disease.Conclusions: The varied presentations of ocular adnexal and orbital amyloidosis and the need for confirmatory biopsy often leads to a significant delay between first symptoms and diagnosis. While rarely sight-threatening, ocular adnexal and orbital amyloidosis carries significant morbidities and has a systemic association in a quarter of patients.

Early partial division of a hughes tarso-conjunctival flap with secondary intention healing of the anterior.

A 61-year-old man had a highly myopic amblyopic right eye since birth but retained good unaided vision of 6/5 in his left eye. He presented with an enlarging lesion of his left lower lid. The clinical appearance was consistent with a large basal cell carcinoma. Excision biopsy resulted in a defect measuring 18mm horizontally and 8mm vertically. The left eye was padded for 2 days and urgent paraffin section histology confirmed complete excision of a basal cell carcinoma. The lower lid defect was repaired with a Hughes tarsoconjunctival flap and the eye was padded for a further 5 days to aid the healing process. At this time, the flap was partially divided at the medial end to allow earlier visual rehabilitation, whilst the undivided lateral part of the flap continued to provide lift. The anterior lamella was left to heal by secondary intention and division of the remaining lateral portion of the flap was finally completely divided 4 weeks later by which time the anterior lamella was well healed. Both functional and cosmetic results were very satisfactory.

Understanding Visual Impairment and Its Impact on Patients: A Simulation-Based Training in Undergraduate Medical Education.

INTRODUCTION: Simulation activities are valuable teaching aids for understanding about living with visual impairment (VI). Our medical students used low-vision simulation spectacles (Sim-specs) to enable learning about VI. METHODS: Students made tea and filled dosette boxes using Sim-specs simulating central visual loss (age-related macular degeneration) and navigated using Sim-specs simulating peripheral visual loss (glaucoma). Facilitators recorded errors made for each task. Students completed questionnaires to grade the tasks' difficulty on a 4-point Likert-type scale. The students also participated in focus groups to discuss how their approach to working with patients may change following this training. RESULTS: In total, 252 out of 254 students participated. Central visual loss provided the greatest challenge when undertaking fine motor skilled activity (dosette box). Highest average number of errors made was for dosette box task (0.70 error), followed by navigation (0.59), then making tea task (0.34). Students scored the most difficult task on average as the dosette box task (3.23 Likert-type points), followed by navigation (2.97), then making tea task (2.63). Our students have shown learning in recognising the challenges of VI and have adapted their approach to patients. CONCLUSIONS: Simulation activities are valuable additions to the undergraduate curriculum. Such activities can potentially enable greater empathy for our visually impaired patients.

Sex, gender and blindness: a new framework for equity.

Four-fifths of all blind or vision impaired people live in middle-income and low-income countries with the African region and parts of Asia and the Middle East bearing the heaviest burden. At the same time, we know that around two thirds of all blind people in the world are female. Hence, the poorest (and usually the oldest) women are most likely to have their lives limited by visual impairment. While recent strategies have focussed on international variations in eye health, very few have paid attention to the gender differences that are an inextricable element in these inequalities. This review will explore possible explanations for the advantage of men in the exercise of one of the most basic of human senses. It will show that this cannot be understood through the use of a biomedical approach alone. Broader social perspectives will also be needed in order to create an appropriate knowledge base for tackling global inequalities in blindness.

Visual loss secondary to eosinophilic mucin rhinosinusitis in a woman: a case report.

INTRODUCTION: Eosinophilic mucin rhinosinusitis is an inflammatory pathological condition of the nose and paranasal sinuses. It is rare, occurs in immunocompetent patients and is characterised by peripheral eosinophilia and extensive bilateral sinus disease. To the best of our knowledge, visual loss with this condition has not been previously reported. CASE PRESENTATION: We present the case of a 26-year-old Asian woman with a background history of chronic sinusitis who presented with acute left-sided visual loss. Imaging showed significant opacification in the frontal, ethmoidal and sphenoidal sinuses as well as evidence of a unilateral optic neuritis. Histological analysis of sinus mucin revealed dense eosinophilic infiltrate and, despite medical and surgical intervention, vision was not restored in her left eye. CONCLUSION: We introduce visual loss as a complication of eosinophilic mucin rhinosinusitis. This adds further evidence to previous reports in the literature that optic neuropathy in sinusitis can occur secondary to non-compressive mechanisms. We also describe a rare finding: the vision in this patient did not improve following steroid therapy, antifungal therapy or surgical intervention. There are very few such cases described in the literature. We conclude that chronic sinusitis is an indolent inflammatory process which can cause visual loss and we reiterate the importance of recognizing and considering sinusitis as a cause of visual loss in patients in order that prompt medical and surgical treatment of the underlying disease can be initiated.

Emergency department management of penetrating eye injuries.

Penetrating injuries are rare but important for the patient both visually and socioeconomically. This guide intends to provide a structure for emergency department personnel to enable targeted history taking, effective examination, appropriate investigation and timely referral for those presenting with penetrating eye trauma.