scholarly journals Spontaneous globe subluxation: a case report and review of the literature

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Tesfaye Yadete ◽  
Ian Isby ◽  
Ketan Patel ◽  
Alex Lin
Keyword(s):  
Optic Nerve ◽  
Vision Loss ◽  
Traumatic Injury ◽  
Empty Sella ◽  
Anterior Dislocation ◽  
Post Discharge ◽  
Sterile Saline ◽  
Retrobulbar Hematoma ◽  
Serological Studies ◽  
The Face

Abstract Background Spontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management. Case presentation A 48-year-old female presented to the ED with her right eye out of its socket. She reported blurry vision, photophobia, and pain in the affected eye. She was unable to close her right eyelid and was in obvious distress. On arrival, her blood pressure was elevated. Her medical history was notable for hypertension and obesity. On physical examination, extraocular eye movements were not intact, and the globe appeared whole and round. She was also unable to count fingers with the affected eye. There was no visible trauma to the face. Multiple wet gauzes with sterile saline were placed over the displaced eyeball. Direct and even pressure was applied on the globe. Within 30 s, the globe was reduced back in. The patient was able to close her eyelids and reports substantial pain relief with reduction. A CT scan of the orbits was then obtained, demonstrating mild bilateral proptosis. The globes were normal and symmetric. No intraconal or extraconal abscess or infection was seen. There were no intraconal or extraconal masses. There was no acute orbital traumatic injury, no avulsion of the optic nerve, ocular rupture, or retrobulbar hematoma. After reviewing the case with an ophthalmologist, a follow-up appointment with the ophthalmologist was arranged. The patient was discharged on erythromycin ointment. Post-discharge investigation of the CT imaging revealed dilated optic nerve sheaths, tortuosity of the optic nerve, and empty sella. Conclusions In addition to causing distress and severe anxiety, SGS poses numerous immediate as well as long-term complications. Traction of the optic nerve and retinal vasculature may potentially cause retinal venous congestion and loss of visual acuity with potential vision loss. In the absence of known risk factors or disease processes, orbital imaging and serological studies for thyroid ophthalmopathy should be considered.

scholarly journals Spontaneous Globe Subluxation: A Case Report And Review Of The Literature

2021 ◽  
Author(s):  
Tesfaye Yadete ◽  
Ian Isby ◽  
Ketan Patel ◽  
Alex Lin
Keyword(s):  
Optic Nerve ◽  
Vision Loss ◽  
Traumatic Injury ◽  
Empty Sella ◽  
Anterior Dislocation ◽  
Post Discharge ◽  
Sterile Saline ◽  
Retrobulbar Hematoma ◽  
Serological Studies ◽  
The Face

Abstract BackgroundSpontaneous globe subluxation (SGS) is an atraumatic anterior dislocation of the eyeball. It is exceedingly rare. Understanding SGS predisposing factors may help uncover its etiology and undertake vision-saving management.Case presentationA 48-year-old female presented to the ED with her right eye out of its socket. She reports blurry vision, photophobia, and pain in the affected eye. She was unable to close her right eyelid and was in obvious distress. On arrival, her blood pressure was elevated. Her medical history was notable for hypertension and obesity. On physical examination, extraocular eye movements were not intact, and the globe appeared whole and round. She was also unable to count fingers with the affected eye. There was no visible trauma to the face. Multiple wet gauzes with sterile saline were placed over the displaced eyeball. Direct and even pressure was applied on the globe. Within thirty seconds, the globe was reduced back in. The patient was able to close her eyelids and reports substantial pain relief with reduction. A CT scan of the orbits was then obtained, demonstrating mild bilateral proptosis. The globes were normal and symmetric. No intraconal or extraconal abscess or infection was seen. There were no intraconal or extraconal masses. There was no acute orbital traumatic injury, no avulsion of the optic nerve, ocular rupture, or retrobulbar hematoma. After reviewing the case with an ophthalmologist, a follow up appointment with the ophthalmologist was arranged. The patient was discharged on erythromycin ointment. Post-discharge investigation of the CT imaging revealed dilated optic nerve sheaths, tortuosity of the optic nerve, and empty sella. ConclusionsIn addition to causing distress and severe anxiety, SGS poses numerous immediate as well as long-term complications. Traction of the optic nerve and retinal vasculature may potentially cause retinal venous congestion and loss of visual acuity with potential vision loss. In the absence of known risk factors or disease processes, orbital imaging and serological studies for thyroid ophthalmopathy should be considered.

Sensitivity and specificity of neuroimaging signs in patients with idiopathic intracranial hypertension

2021 ◽  
pp. 197140092110006
Author(s):  
Nandita Prabhat ◽  
Shivani Chandel ◽  
Dr Aastha Takkar ◽  
Chirag Ahuja ◽  
Ramandeep Singh ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Visual Outcome ◽  
Empty Sella ◽  
Primary Role ◽  
Clinical Scenarios ◽  
Treatment Naïve ◽  
Magnetic Resonance Imaging Mri

Background The primary role of neuroimaging in idiopathic intracranial hypertension (IIH) is to exclude secondary causes of raised intracranial pressure. Recently, a few imaging markers have been described which may suggest diagnosis of IIH in atypical cases. We carried out this study to assess the prevalence and accuracy of these neuroimaging signs in predicting the diagnosis of IIH. Methods Eighty treatment-naive patients with IIH and 30 controls were recruited as per a predefined criterion. Magnetic resonance imaging (MRI) brain with detailed sella imaging was done in all patients. Results The most common abnormality noted was optic nerve tortuosity in 82.5% of patients, followed by posterior scleral flattening in 80%, perioptic subarachnoid space (SAS) dilatation in 73.8% and partial empty sella in 68.8% of patients. The presence of optic nerve tortuosity was the most sensitive sign on neuroimaging, though the highest specificity was seen for posterior scleral flattening and perioptic SAS dilatation. The presence of more than three neuroimaging features correlated with severity of vision loss. Conclusion In suggestive clinical scenarios, posterior scleral flattening, perioptic SAS dilatation and optic nerve tortuosity are highly sensitive and specific signs in IIH. This study also highlights the utility of MRI as a valuable tool for prognosis of visual outcome in patients with IIH.

Management of Optic Neuritis in Ayurveda - A Special Case Report

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Harsha S. ◽  
Dr. Mamatha KV.
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Visual Information ◽  
Vision Loss ◽  
Specific Treatment ◽  
Interesting Case ◽  
Treatment Modalities ◽  
Further Development ◽  
Special Case

The optic nerve carries visual information from your eye to your brain. Optic neuritis is when your optic nerve becomes inflamed. Optic neuritis can flare up suddenly from an infection or nerve disease. The inflammation usually causes temporary vision loss that typically happens in only one eye. Those with Optic neuritis sometimes experience pain. As you recover and the inflammation goes away, your vision will likely return. There are no direct references in our classics regarding optic neuritis but can be contemplated as a condition by name Parimlayi Timira. The specific management as such is not cited but a transcendence approach can be done with adopting the treatment which has the ability to pacify the already occurred pathology and prevent the further development of the disease. One such interesting case study on Optic neuritis is elaborated here where in specific treatment modalities (Shodana, Shamana and Kriyakalpas) played role in pacifying the condition.

Identification of risk for posttraumatic stress disorder symptom clusters early after trauma

2020 ◽  
pp. 135910532093419
Author(s):  
Sydney C Timmer-Murillo ◽  
Joshua C Hunt ◽  
Timothy Geier ◽  
Karen J Brasel ◽  
Terri A deRoon-Cassini
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Traumatic Injury ◽  
Symptom Clusters ◽  
Post Discharge ◽  
Cognitive Risk ◽  
Disorder Symptom ◽  
Life Threat ◽  
Mood And Cognition

The current study examined how the injured trauma survivor screen (ITSS), a hospital-administered screener of posttraumatic stress disorder (PTSD) and depression, differentially predicted PTSD symptom cluster severity. Participants from a Level 1 trauma center ( n = 220) completed the ITSS while inpatient and PTSD symptoms were assessed one-month post discharge. Perceived life threat and intentionality of injury were key predictors of avoidance, re-experiencing, and hyperarousal symptom clusters. However, negative alterations in mood and cognition cluster seemed best predicted by mood and cognitive risk factors. Therefore, the ITSS provides utility in differentially predicting symptom clusters and treatment planning after traumatic injury.

scholarly journals Neuroglobin effectively halts vision loss in Harlequin mice at an advanced stage of optic nerve degeneration

2021 ◽  
pp. 105483
Author(s):  
Hélène Cwerman-Thibault ◽  
Christophe Lechauve ◽  
Vassilissa Malko-Baverel ◽  
Sébastien Augustin ◽  
Gwendoline Le Guilloux ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Vision Loss ◽  
Nerve Degeneration ◽  
Advanced Stage ◽  
Optic Nerve Degeneration

scholarly journals Optic neuropathy after anterior communicating artery aneurysm clipping: 3 cases and techniques to address a correctable pitfall

2018 ◽  
Vol 128 (6) ◽  
pp. 1808-1812 ◽  
Author(s):  
Joseph R. Linzey ◽  
Kevin S. Chen ◽  
Luis Savastano ◽  
B. Gregory Thompson ◽  
Aditya S. Pandey
Keyword(s):  
Optic Nerve ◽  
Vision Loss ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Mechanical Compression ◽  
Visual Examination ◽  
Microsurgical Clipping ◽  
Complete Restoration

Brain shifts following microsurgical clip ligation of anterior communicating artery (ACoA) aneurysms can lead to mechanical compression of the optic nerve by the clip. Recognition of this condition and early repositioning of clips can lead to reversal of vision loss.The authors identified 3 patients with an afferent pupillary defect following microsurgical clipping of ACoA aneurysms. Different treatment options were used for each patient. All patients underwent reexploration, and the aneurysm clips were repositioned to prevent clip-related compression of the optic nerve. Near-complete restoration of vision was achieved at the last clinic follow-up visit in all 3 patients.Clip ligation of ACoA aneurysms has the potential to cause clip-related compression of the optic nerve. Postoperative visual examination is of utmost importance, and if any changes are discovered, reexploration should be considered as repositioning of the clips may lead to resolution of visual deterioration.

scholarly journals Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns

2016 ◽  
Vol 9 (4) ◽  
pp. 299-304 ◽  
Author(s):  
Matthew Shew ◽  
Michael P. Carlisle ◽  
GuanningNina Lu ◽  
Clinton Humphrey ◽  
J.David Kriet
Keyword(s):  
Postoperative Complications ◽  
Vision Loss ◽  
Average Length ◽  
Case Reports ◽  
Postoperative Management ◽  
Facial Trauma ◽  
Outpatient Basis ◽  
Retrospective Assessment ◽  
Retrobulbar Hematoma ◽  
Orbital Blowout Fractures

Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on an outpatient basis postoperatively ( p = 0.04). For orbital blowout fractures, the number of immediate postoperative complications at our institution is low. In addition, North American trends in postoperative management of orbital blowout fractures may suggest that selected patients can be managed on an outpatient basis, which would have a positive effect on conservation of diminishing healthcare resources.

Compressive Optic Neuropathy

2011 ◽  
pp. 21-24
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak ◽  
Robert B. Daroff
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Clinical Signs ◽  
Monocular Vision ◽  
Compressive Optic Neuropathy ◽  
Imaging Characteristics ◽  
Optic Nerve Sheath Meningioma ◽  
Common Causes ◽  
Optic Nerve Compression

Optic nerve compression results in progressive, and often painless, monocular vision loss. In this chapter, we review the clinical signs and common causes of compressive optic neuropathy. We discuss in more detail the imaging characteristics and management of optic nerve sheath meningioma.

scholarly journals Septo-optic dysplasia

2010 ◽  
Vol 68 (3) ◽  
pp. 400-405 ◽  
Author(s):  
Karina de Ferran ◽  
Isla Aguiar Paiva ◽  
Daniel Luiz Schueftan Gilban ◽  
Monique Resende ◽  
Micheline Abreu Rayol de Souza ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Thyroid Stimulating Hormone ◽  
Empty Sella ◽  
Optic Nerve Hypoplasia ◽  
Brain Abnormalities ◽  
Development Delay ◽  
Congenital Condition ◽  
Pituitary Hypoplasia ◽  
De Morsier Syndrome ◽  
Congenital Hypopituitarism

Septo-optic dysplasia (SOD), also referred to as de Morsier syndrome, is a rare congenital condition, characterized by two of the classic triad features: midline brain abnormalities, optic nerve hypoplasia (ONH) and pituitary endocrine dysfunction. We report 5 children with SOD, originally referred to be evaluated due to short stature, who also presented bilateral optic nerve hypoplasia, nystagmus and development delay. In 4 of the patients, we identified neuroimaging abnormalities of the hypothalamo-pituitary axis such as anterior pituitary hypoplasia (3/5), ectopic posterior pituitary (4/5), thin or absent stalk (3/5) and empty sella (1/5). We also encountered diverse pituitary deficiencies: growth hormone (3/5), adrenocorticotropic hormone (3/5), thyroid-stimulating hormone (2/5) and antidiuretic hormone (1/5). Only one child presented intact pituitary function and anatomy. Although rare, SOD is an important cause of congenital hypopituitarism and it should be considered in children with optic nerve hypoplasia or midline brain abnormalities for early diagnosis and treatment.

Is a virtual clinic model a safe and effective way for assessing patients referred with suspiciously blurred optic discs? The blurred disc clinic

2020 ◽  
pp. 112067212097604
Author(s):  
Joanna M Jefferis ◽  
Nigel Griffith ◽  
Daniel Blackwell ◽  
Ruth Batty ◽  
Simon J Hickman ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Direct Contact ◽  
Visual Fields ◽  
Referral Letter ◽  
Face To Face ◽  
The Face ◽  
Optic Discs ◽  
Eye Clinic ◽  
Virtual Clinic

Background: There are increasing numbers of referrals to ophthalmology departments due to blurred optic disc margins. In light of this and the COVID-19 pandemic we aimed to assess whether these patients could be safely assessed without direct contact between the clinician and patient. Methods: We retrospectively reviewed the records of consecutive patients seen in our ‘blurred disc clinic’ between August 2018 and October 2019. We then presented anonymous information from their referral letter, their visual fields and optic nerve images to two consultant neuro-ophthalmologists blinded to the outcome of the face-to-face consultation. In the simulated virtual clinic, the two consultants were asked to choose an outcome for each patient from discharge, investigate or bring in for a face-to-face assessment. Results: Out of 133 patients seen in the blurred disc clinic, six (4.5%) were found to have papilloedema. All six were identified by both neuro-ophthalmologists as needing a face-to-face clinic consultation from the simulated virtual clinic. One hundred and twenty (90%) patients were discharged from the face-to-face clinic at the first consultation. The two neuro-ophthalmologists chose to discharge 114 (95%) and 99 (83%) of these respectively from the simulated virtual clinic. The virtual clinic would have potentially missed serious pathology in only one patient who had normal optic discs but reported diplopia at the previous face-to-face consultation. Conclusions: A virtual clinic model is an effective way of screening for papilloedema in patients referred to the eye clinic with suspicious optic discs. Unrelated or incidental pathology may be missed in a virtual clinic.

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