Role of imaging in the management of neuro-ophthalmic disorders

Permanent Unilateral Vision Loss From Allergic Fungal Sinusitis

ABSTRACT

In the absence of trauma, sudden unilateral painless visual loss is an uncommon condition in the pediatric population requiring emergent medical evaluation. In the acute care setting, clinicians face the challenge of accurately assessing the patient and determining the initial diagnostic workup. A careful history alone helps guide diagnosis with sudden visual loss that is unilateral and persistent. Several neuro-ophthalmological conditions that present with these characteristics include retinal artery or vein occlusion, diseases affecting the cavernous sinus or orbital apex region, and optic neuropathy. Simple eye examination techniques have crucial diagnostic value in helping localize the disease process, determining the level of urgency, and need for timely intervention. Here we present an adolescent patient with nontraumatic, acute unilateral visual loss who had concerning ophthalmological examination findings and was subsequently diagnosed with optic neuropathy secondary to allergic fungal sinusitis.

Minimally invasive surgery for thyroid eye disease

Thyroid eye disease (TED) can affect the eye in myriad ways: proptosis, strabismus, eyelid retraction, optic neuropathy, soft tissue changes around the eye and an unstable ocular surface. TED consists of two phases: active, and inactive. The active phase of TED is limited to a period of 12–18 months and is mainly managed medically with immunosuppression. The residual structural changes due to the resultant fibrosis are usually addressed with surgery, the mainstay of which is orbital decompression. These surgeries are performed during the inactive phase. The surgical rehabilitation of TED has evolved over the years: not only the surgical techniques, but also the concepts, and the surgical tools available. The indications for decompression surgery have also expanded in the recent past. This article discusses the technological and conceptual advances of minimally invasive surgery for TED that decrease complications and speed up recovery. Current surgical techniques offer predictable, consistent results with better esthetics.

Brainstem anesthesia presenting as contralateral third nerve palsy following peribulbar anesthesia for cataract surgery

Brainstem anesthesia is a serious complication that has been reported to occur more commonly with retrobulbar anesthesia compared to peribulbar anesthesia. We herein report a case of contralateral third nerve palsy following administration of peribulbar anesthesia for cataract surgery. Two hours after the surgery, the patient recovered completely without any residual neurological deficit. The importance of immediate recognition of clinical signs and symptoms of central spread of the local anesthetic and the mechanical factors of the block that could have contributed to this complication are discussed in this report.