RESUMO
Although ocular manifestations of Lyme disease have long been noted, they remain a rare feature of the disease. The spirochete invades the eye early and remains dormant, accounting for both early and late ocular manifestations. A nonspecific follicular conjunctivitis occurs in approximately 10% of patients with early Lyme disease. Keratitis occurs often within a few months of onset of disease and is characterized by nummular nonstaining opacities. Inflammatory syndromes, such as vitritis and uveitis, have been reported; in some cases, a vitreous tap is required for diagnosis. Neuro-ophthalmic manifestations include neuroretinitis, involvement of multiple cranial nerves, optic atrophy, and disc edema. Seventh nerve paresis can lead to neurotrophic keratitis. In endemic areas, Lyme disease may be responsible for approximately 25% of new-onset Bell's palsy. Criteria for establishing that eye findings can be attributed to Lyme disease include the lack of evidence of other disease, other clinical findings consistent with Lyme disease, occurrence in patients living in an endemic area, positive serology, and, in most cases, response to treatment. Management of ocular manifestations often requires intravenous therapy.
Assuntos
Grupo Borrelia Burgdorferi , Oftalmopatias/microbiologia , Doença de Lyme/complicações , Grupo Borrelia Burgdorferi/isolamento & purificação , HumanosRESUMO
Four days after a 32-year-old woman was hit in the right eye with a racquetball, a paralysis of the right third nerve developed. Computerized axial tomography with metrizamide demonstrated an arachnoid cyst in the interpeduncular fossa. After the cyst was surgically decompressed, the third-nerve paralysis cleared.
Assuntos
Aracnoide-Máter/cirurgia , Traumatismos em Atletas/complicações , Cistos/complicações , Traumatismos Oculares/complicações , Oftalmoplegia/etiologia , Adulto , Aracnoide-Máter/diagnóstico por imagem , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Humanos , Metrizamida , Esportes , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To demonstrate spontaneous regression of large, clinically symptomatic optic pathway gliomas in patients with and without neurofibromatosis type 1 (NF-1). METHODS: Patient cases were collected through surveys at 2 consecutive annual meetings of the North American Neuro-Ophthalmology Society (NANOS) and through requests on the NANOSNET Internet listserv. Serial documentation of tumor signal and size, using magnetic resonance imaging in 11 patients and computed tomography in 2 patients, was used to evaluate clinically symptomatic optic pathway gliomas. All tumors met radiologic criteria for the diagnosis of glioma and 4 patients had biopsy confirmation of their tumors. In 3 patients, some attempt at therapy had been made many years before regression occurred. In one of these, radiation treatment had been given 19 years before tumor regression, while in another, chemotherapy had been administered 5 years before signal changes in the tumor. In the third patient, minimal surgical debulking was performed 1 year before the tumor began to shrink. RESULTS: Spontaneous tumor shrinkage was noted in 12 patients. Eight patients did not have NF-1. In an additional patient without NF-1, a signal change within the tumor without associated shrinkage was detected. Tumor regression was associated with improvement in visual function in 10 of 13 patients, stability of function in 1, and deterioration in 2. CONCLUSIONS: Large, clinically symptomatic optic gliomas may undergo spontaneous regression. Regression was seen in patients with and without NF-1. Regression may manifest either as an overall shrinkage in tumor size, or as a signal change on magnetic resonance imaging. A variable degree of improvement in visual function may accompany regression. The possibility of spontaneous regression of an optic glioma should be considered in the planning of treatment of patients with these tumors.
Assuntos
Neoplasias Encefálicas/fisiopatologia , Regressão Neoplásica Espontânea , Neurofibromatose 1/fisiopatologia , Glioma do Nervo Óptico/fisiopatologia , Adolescente , Neoplasias Encefálicas/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Neurofibromatose 1/diagnóstico , Glioma do Nervo Óptico/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Ocular myasthenia is a localized form of myasthenia clinically involving only the extraocular, levator palpebrae superioris, and/or orbicularis oculi muscles. Ocular manifestations can masquerade as a variety of ocular motility disorders, including cranial nerve and gaze palsies. A history of variable and fatiguable muscle weakness suggests this diagnosis, which may be confirmed by the edrophonium (Tensilon) test and acetylcholine receptor antibody titer. Anticholinesterases, corticosteroids and other immunosuppressive agents, and other therapeutic modalities, including thymectomy and plasmapheresis, are used in treatment. As the pathophysiology of myasthenia has been elucidated in recent years, newer treatment strategies have evolved, resulting in a much more favorable prognosis than several decades ago. This review provides historical background, pathophysiology, immuno-genetics, diagnostic testing, and treatment options for ocular myasthenia, as well as a discussion of drug-induced myasthenic syndromes.
Assuntos
Miastenia Gravis/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Ritmo Circadiano/efeitos dos fármacos , Humanos , Miastenia Gravis/diagnóstico , Miastenia Gravis/imunologia , Miastenia Gravis/terapia , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/imunologia , Transtornos da Motilidade Ocular/terapiaRESUMO
A 17-year old girl received prednisone and azathioprine for the treatment of systemic lupus erythematosus. She developed a fever and hallucinations 18 months later; cryptococcal meningitis was diagnosed. An internal ophthalmoplegia with loss of accommodation and dilation of the pupils developed together with bilateral lateral rectus palsy. Treatment with intravenous amphotericin resulted in disappearance of papilledema, muscle palsy, and internal ophthalmoplegia. We believe that the internal ophthalmoplegia was secondary to involvement of the accommodative and pupillary fibers of both third nerves at the base of the brain.
Assuntos
Criptococose/complicações , Lúpus Eritematoso Sistêmico/complicações , Oftalmoplegia/etiologia , Papiledema/etiologia , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Azatioprina/uso terapêutico , Criança , Pré-Escolar , Criptococose/líquido cefalorraquidiano , Criptococose/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Meningite/líquido cefalorraquidiano , Meningite/complicações , Meningite/tratamento farmacológico , Pessoa de Meia-Idade , Prednisona/uso terapêuticoRESUMO
We studied eight patients who had visual field defects secondary to prolactin-secreting macroadenomas and who had improved visual function with bromocriptine treatment without surgery or radiation. We recommend bromocriptine as a primary treatment for prolactin-secreting macroadenomas. If therapy is effective, continued regular neuro-ophthalmologic, endocrine, and imaging studies are necessary, because treatment with bromocriptine must be continued indefinitely.
Assuntos
Bromocriptina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Visão Ocular/efeitos dos fármacos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prolactina/sangue , Tomografia Computadorizada por Raios X , Acuidade Visual/efeitos dos fármacos , Campos Visuais/efeitos dos fármacosRESUMO
A 49-year-old man developed ataxia, myoclonic jerks, cortical blindness, and dementia. In 3 1/2 months, he rapidly deteriorated and died. Clinical and autopsy diagnosis confirmed Creutzfeldt-Jakob disease. The eyes were examined and bilateral optic atrophy was noted. No other ocular changes were noted. Optic atrophy had not been noted before death.
Assuntos
Síndrome de Creutzfeldt-Jakob/complicações , Atrofia Óptica/complicações , Córnea/patologia , Síndrome de Creutzfeldt-Jakob/patologia , Doenças Desmielinizantes/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Occipital/patologia , Atrofia Óptica/diagnóstico , Atrofia Óptica/patologia , Nervo Óptico/patologia , Retina/patologia , Campos VisuaisRESUMO
Basal encephaloceles are often associated with other midline anomalies such as hypertelorism, broad nasal root, cleft lip, and cleft palate. Optic disc anomalies such as pallor, dysplasia, optic pit, coLoboma, and megalopapilla have been reported to occur in patients with basal encephalocele We report a case of a child with a sphenoethmoidal encephalocele and morning glory syndrome of the optic nerve. The presence of such optic nerve anomalies with facial midline anomalies should alert the clinician to the possible presence of a basal encephalocele.
Assuntos
Encefalocele/complicações , Meningocele/complicações , Nervo Óptico/anormalidades , Osso Etmoide , Humanos , Lactente , Macula Lutea/anormalidades , Masculino , Osso Esfenoide , SíndromeRESUMO
A 68-year-old black woman who was put on D-penicillamine therapy (250-500 mg per day, total dose 15 g) for rheumatoid arthritis developed ocular myasthenia gravis. Two weeks after she discontinued D-penicillamine her signs and symptoms cleared with no other treatment. Review of previous cases and possible immunological mechanisms are discussed.
Assuntos
Blefaroptose/induzido quimicamente , Diplopia/induzido quimicamente , Miastenia Gravis/induzido quimicamente , Penicilamina/efeitos adversos , Idoso , Feminino , HumanosRESUMO
A 52-year-old man with mild diabetes and acute stem cell leukaemia developed an orbitofacial mucormycosis. Cultures showed the fungus to be Rhizopus oryzae. Vigorous treatment with amphotericin B and other bactericidal and bacteriostatic antibiotics for a concurrent sepsis failed to suppress the infections, and the patient died. On post-mortem examination characteristic haematoxylin-staining, broad, aseptate fungal hyphae were found in the right eye, orbit, and lung. A striking and unusual feature of this case is the presence of brightly birefringent crystals within the severely degenerated eye. These were found by histochemical staining and x-ray diffraction studies to be calcium salts of fatty acids, apparently liberated from necrotic adipose tissue of the orbit.
Assuntos
Oftalmopatias/patologia , Mucormicose/patologia , Calcinose/patologia , Dermatomicoses/complicações , Complicações do Diabetes , Olho/patologia , Oftalmopatias/complicações , Dermatoses Faciais/complicações , Humanos , Leucemia/complicações , Masculino , Pessoa de Meia-Idade , Mucormicose/complicações , RhizopusRESUMO
Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi. It is transmitted to human and animal hosts primarily by ticks of the Ixodes ricinis complex. Recognition of its characteristic skin and eye manifestations facilitates diagnosis and treatment.
Assuntos
Grupo Borrelia Burgdorferi , Eritema Migrans Crônico/microbiologia , Infecções Oculares Bacterianas/microbiologia , Doença de Lyme/complicações , Acrodermatite/diagnóstico , Antibacterianos/uso terapêutico , Artrite/diagnóstico , Artrite/etiologia , Grupo Borrelia Burgdorferi/isolamento & purificação , Conjuntivite Bacteriana/diagnóstico , Conjuntivite Bacteriana/etiologia , Eritema Migrans Crônico/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Testes SorológicosRESUMO
Anterior staphylomas developed in two young patients as a postoperative complication of hyphema extractions through corneoscleral sections. The patients, aged five and nine years, underwent evacuation of the hyphemas after rebleeding caused medically unmanageable intraocular pressure elevations. Postoperatively, both patients received corticosteroids and had elevation of intraocular pressure. To repair the staphyloma, a scleral overlay patch graft was performed in one patient, but the intraocular pressure remained elevated and the staphyloma gradually recurred. Enucleation of the eye was eventually required. Resection of the staphylomatous area with lensectomy and complete vitrectomy was performed in the second patient. After four years of follow-up this patient continues to do well.
Assuntos
Traumatismos Oculares/complicações , Hifema/cirurgia , Pressão Intraocular , Complicações Pós-Operatórias/cirurgia , Criança , Lesões da Córnea , Endoftalmite/complicações , Endoftalmite/cirurgia , Oftalmopatias/cirurgia , Fístula/complicações , Fístula/cirurgia , Humanos , Hifema/etiologia , Pressão Intraocular/efeitos dos fármacos , Subluxação do Cristalino/complicações , Masculino , Soluções Oftálmicas , Esclera/transplanteAssuntos
Aberrações Cromossômicas , Transtornos Cromossômicos , Cromossomos Humanos 13-15 , Neoplasias Oculares/genética , Retinoblastoma/genética , Câmara Anterior/patologia , Pré-Escolar , Aberrações Cromossômicas/patologia , Corpo Ciliar/patologia , Córnea/patologia , Endotélio/patologia , Epitélio/patologia , Neoplasias Oculares/complicações , Neoplasias Oculares/patologia , Feminino , Gânglios , Humanos , Deficiência Intelectual/complicações , Cariotipagem , Retina/patologia , Retinoblastoma/complicações , Retinoblastoma/patologiaAssuntos
Doenças Cerebelares/diagnóstico , Manifestações Oculares , Movimentos Oculares , Adulto , Idoso , Eletroculografia , Humanos , MasculinoRESUMO
We report a patient with bilateral "acute idiopathic blind spot enlargement" (AIBSE) in whom visual symptoms and enlarged blind spots persisted for over 6 years and preceded the development of peripapillary hyperfluorescence on fluorescein angiography. These findings confirm the prolonged course that AIBSE can sometimes take and the suggestion that this rare disorder is due to peripapillary retinal dysfunction.
Assuntos
Disco Óptico/patologia , Doenças do Nervo Óptico/patologia , Doença Aguda , Adulto , Feminino , Angiofluoresceinografia , Humanos , Hipertrofia , Doenças Retinianas/patologia , Acuidade Visual , Campos VisuaisRESUMO
Systemic mastocytosis is characterized by an increased number of mast cells in multiple organs particularly skin. A 55-year-old man with mastocytosis presented with nyctalopia caused by malabsorption of vitamin A. Diagnosis was made by documenting a low vitamin A level and an ERG that showed rod-cone deficiency with rods affected more than cones. Vitamin A therapy led to return of good visual function. To our knowledge, this is the first reported case of mastocytosis induced nyctalopia. Vitamin A deficiency should be considered as a potential cause of visual loss in patients with sudden onset of night blindness.
Assuntos
Mastocitose/complicações , Cegueira Noturna/etiologia , Eletrorretinografia , Humanos , Masculino , Mastocitose/patologia , Pessoa de Meia-Idade , Cegueira Noturna/metabolismo , Cegueira Noturna/fisiopatologia , Acuidade Visual , Campos Visuais , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/metabolismoRESUMO
We report two patients who developed isolated visual symptoms and signs as initial manifestations of Creutzfeldt-Jakob disease (CJD). Both patients had normal conventional T1- and T2-weighted brain magnetic resonance (MR) images; in one patient, early cortical abnormalities were detected by diffusion-weighted and fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). Results from the cerebrospinal fluid assay for the 14-3-3 brain protein were also negative in one patient, despite pathologic confirmation of CJD at autopsy. The Heidenhain variant of CJD should be considered in all patients who present with isolated visual manifestations, including homonymous hemianopsia and normal conventional brain MRI. Diffusion-weighted and FLAIR MRI may demonstrate early cortical abnormalities in patients with CJD. The CSF assay for the 14-3-3 protein may be normal, even in pathologically confirmed cases.
Assuntos
Encéfalo/patologia , Síndrome de Creutzfeldt-Jakob/diagnóstico , Hemianopsia/diagnóstico , Proteínas 14-3-3 , Idoso , Síndrome de Creutzfeldt-Jakob/líquido cefalorraquidiano , Evolução Fatal , Feminino , Hemianopsia/líquido cefalorraquidiano , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada de Emissão , Tirosina 3-Mono-Oxigenase/líquido cefalorraquidianoRESUMO
Lyme disease, caused by the spirochete Borrelia burgdorferi, has ophthalmic manifestations. The authors describe two cases of Lyme keratitis characterized by multiple focal, nebular opacities at varying levels of the stroma which may progress to edema, neovascularization, and scarring. Close observation, in addition to systemic antibiotic therapy, may be sufficient if the visual axis is not involved, and the patient is asymptomatic.