Acute direct traumatic optic neuropathy treated with steroids, minocycline and hyperbaric oxygen: a case report

2019 ◽  
pp. 709-712
Author(s):  
Janet L. Alexander ◽  
◽  
Matthew D. Shulman ◽  
Kinjal N. Sethuraman ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Hyperbaric Oxygen ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Therapeutic Option ◽  
Oral Prednisone ◽  
Clinical Findings ◽  
Visual Field Defects ◽  
Traumatic Optic Neuropathy ◽  
Neuroprotective Effects

We describe the emergency management of a man who experienced acute vision loss diagnosed as direct traumatic optic neuropathy (TON) in his right eye (no light perception) after falling from a height. TON is caused by a high-impact mechanism of injury. Clinical findings include acute vision loss, which is typically immediate, afferent pupillary defect, decreased color vision, and visual field defects. Treatment is controversial because of the lack of strong evidence supporting intervention over observation. In this case report, our treatment strategy comprised immediate hyperbaric oxygen (HBO2) and daily high doses of a steroid. On the second day, minocycline was added to the treatment regimen for its neuroprotective effects. The patient was discharged after receiving six HBO2 treatments and six days of intravenous solumedrol transitioned to oral prednisone. After the third HBO2 treatment, his vision improved to 20/100; after the fourth treatment, it was 20/40 and plateaued. At the time of discharge, it was 20/40. At two-month follow-up, his corrected visual acuity was 20/60+2 in the affected eye. Immediate HBO2 for ischemic and mechanical injury to the optic nerve following trauma is a therapeutic option.

scholarly journals Early Recognition of Stroke by Confrontation Visual Field Test – Is It Possible?

2020 ◽  
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Cerebral Artery ◽  
Vision Loss ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Past History ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Axial Tomography

Introduction: Visual field loss is often the first sign of lesion of the anterior or posterior visual pathways. Screening for visual field defects should be a part of all routine eye examinations, mainly when neurological lesions are suspected. A confrontation visual field (CVF) test provide a rapid and practical method of visual field assessment, allowing the recognition of major neurological deficits. Materials and Research Methods: To report a case of posterior cerebral artery (PCA) stroke early suspected by CVF test. Case-Report: A 77 year-old male presented to our emergency department with vision blurring complaints and a strange sensation of a vision loss on one side on the left eye (OS), for the previous 15 days. He explained that symptoms initiated after an episode of dizziness followed by lipothymia. He denied diplopia or headaches. Past history revealed hypertension and diabetes as cardiovascular risk factors. The best corrected visual acuity was 20/25 on right eye (OD) and 20/60 on OS and pupillary reflexes were normal. CVF test was performed and showed a decrease on left hemicampus of OS. The biomicroscopy was normal and the fundus examination showed optic nerve edema bilaterally, also documented by Optical Coherence Tomography. Considering the findings and the history, neuroimaging and a neurological observation were requested. Computerized axial tomography revealed a hypodense lesion in right occipital posterior region, with hematic density. He was hospitalized for proper treatment with the diagnosis of posterior cerebral artery ischemic stroke, with further hemorrhagic transformation. Discussion: In acute stroke, visual disorders may form all or part of the initial presentation. Homonymous visual field deficits are well-known almost universal characteristics of PCA ischemia, however, due to the absent of cognitive impairment or speech problems associated to many cases, the diagnosis can be challenging at early stages. Our case-report highlights the importance of using CVF test to an immediate inspection of the peripheral visual field, in order to detect acute major defects, including homonymous deficits, to understand if a further prompt neurological examination is mandatory.

scholarly journals RGC and Vision Loss From Traumatic Optic Neuropathy Induced by Repetitive Closed Head Trauma Is Dependent on Timing and Force of Impact

2021 ◽  
Vol 10 (1) ◽  
pp. 8
Author(s):  
Reas S. Khan ◽  
Ahmara G. Ross ◽  
Puya Aravand ◽  
Kimberly Dine ◽  
Evan B. Selzer ◽  
...  
Keyword(s):  
Head Trauma ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Traumatic Optic Neuropathy ◽  
Closed Head ◽  
Closed Head Trauma

scholarly journals Tacrolimus-induced bilateral optic neuropathy: A case report

2021 ◽  
pp. 4-4
Author(s):  
Lepsa Zoric ◽  
Aleksandra Ilic ◽  
Emina Colak ◽  
Milos Mirkovic ◽  
Jelica Pantelic ◽  
...  
Keyword(s):  
Case Report ◽  
Adverse Effects ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
White Male ◽  
Immunosuppressive Drug ◽  
Organ Rejection ◽  
Toxic Optic Neuropathy ◽  
Tacrolimus Therapy ◽  
Male Patients

Intrduction. Tacrolimus (fujimycin or FK506) is a potent immunosuppressive drug with growing usage. It is usually used in prevention of transplanted organ rejection. Its use is highly valuable, but like other immunosupressants, it has adverse effects. One of them is optic neuropathy. Case report. A 47-year-old white male patients who had received tacrolimus therapy for nine years, after kidney transplantation, developed a subacute, painless vision loss on both eyes. He was thoroughly examined on different possible optic neuropathies and other causes of vision loss. After exclusion of other possible causes, the diagnosis of toxic optic neuropathy was established. His therapy was converted to cyclosporine, by his nephrologist, but his vision had improved only slightly. Conclusion. Toxic optic neuropathies are presented in everyday ophthalmological practice, but they are underestimated. Diagnosis can be demanding, especially when it comes to drugs and substances whose possible toxic effect on the optic nerve is not widely known. Unlike other adverse effects of tacrolimus therapy on nervous system, optic neuropathy can causes great and permanent functional impairment.

scholarly journals Blunt Facial Trauma Causing Isolated Optic Nerve Hematoma

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
R. Parab ◽  
C. I. Fung ◽  
Gerrit Van Der Merwe
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Current Literature ◽  
Vision Loss ◽  
Early Recognition ◽  
Facial Trauma ◽  
Traumatic Optic Neuropathy ◽  
Rare Injury

Traumatic optic neuropathy is an uncommon, yet serious, result of facial trauma. The authors present a novel case of a 59-year-old gentleman who presented with an isolated blunt traumatic left optic nerve hematoma causing vision loss. There were no other injuries or fractures to report. This case highlights the importance of early recognition of this rare injury and reviews the current literature and management of traumatic optic neuropathy.

Vision loss following denileukin diftitox treatment: A case report of possible posterior ischemic optic neuropathy

2007 ◽  
Vol 48 (4) ◽  
pp. 808-811 ◽  
Author(s):  
Meyeon Park ◽  
Grant T. Liu ◽  
Jody Piltz-Seymour ◽  
Catherine L. Wisda ◽  
Alain H. Rook ◽  
...  
Keyword(s):  
Case Report ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Ischemic Optic Neuropathy ◽  
Denileukin Diftitox ◽  
Posterior Ischemic Optic Neuropathy

scholarly journals Ethambutol toxic optic neuropathy: A case report and review

2018 ◽  
Vol 77 (1) ◽  
Author(s):  
Kevin C. Phillips ◽  
Peter C. Clarke-Farr
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Early Recognition ◽  
Treatment Cessation ◽  
Toxic Optic Neuropathy ◽  
Vision Restoration

This article presents a case of ethambutol toxic optic neuropathy determined during the routine optometric examination of a 66-year-old man. Ethambutol is an established drug for the treatment of tuberculosis, but has significant side effects, notably optic neuropathy. The prognosis for vision restoration is unpredictable, with the possibility of permanent vision loss. Treatment cessation is the only option to limit ocular damage; therefore, the early recognition of ethambutol optic neuropathy by optometrists is essential.

scholarly journals Traumatic Optic Neuropathy Our Experience with Combined Therapy

2021 ◽  
Author(s):  
Sudesh Kumar ◽  
Amit Joshi ◽  
Rajeev Tuli ◽  
Narvir Chauhan
Keyword(s):  
Prognostic Factors ◽  
Steroid Therapy ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Combined Therapy ◽  
Closed Head Injury ◽  
Significant Prognostic Factor ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression ◽  
The Status

Abstract Objective Traumatic optic neuropathy (TON) is an important cause of severe vision impairment after sustaining a closed head injury. This study describes the safety and efficacy of combined therapy in the management of TON. Methods A retrospective analysis of 23 consecutive cases of unilateral TON managed with combined therapy (steroid and surgery) were performed. Statistical analysis of patient characteristic, timing of vision loss, radiological and intraoperative findings, and pre- and post-treatment vision were compared to assess the prognostic factors. Results Seventeen patients (85%) had vision improvement with combined therapy. Three patients (15%), who recorded no improvement, initially presented with no perception of light, and loss was sudden and immediate. With steroids, 9 patients improved, all of them presented with perception of light (PL) or better and vision improved to (6/6 in five, 6/9 in one, 6/18 in 3). Eleven patients (6 PL–ve and 5 PL + ve after failed steroid therapy) underwent endoscopic optic nerve decompression and eight had improvement in vision. The status of vision at presentation was only statically significant prognostic factor (p < 0.02). Others prognostic factors, for example, time of starting treatment, surgery, and presence of fracture in optic canal, were not found statistically significant (p > 0.05). There were no significant intra- and postoperative complications. Conclusion Combined therapy is safe and effective in management of TON. Mild form injury with some preserved vision at presentation respond well to steroids, while endoscopic nerve decompression should be reserved in cases with failed steroid therapy.

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