Terson syndrome in a course of cerebral aneurysm--clinical assessment

40 patients with ruptured cerebral aneurysm were screened by an ophthalmologist for the presence of Terson syndrome (TS) and other forms of ocular haemorrhages. Terson syndrome was found in 10% of cases and 37.5% of cases presented other forms of ocular bleeding. The most significant neurological symptom leading to diagnose TS, was coma episode occurring in any moment of clinical observation.     

Inter-observer comparisons of ophthalmoscopic assessment of diabetic retinopathy

Abstract
Five hundred patients attending a general diabetic clinic were examined ophthalmoscopically both by a non-ophthalmic practitioner (NOP) and by an ophthalmologist. The findings were recorded on separate data sheets and the staging of diabetic retinopathy (DR) and grading of diabetic maculopathy by the NOP is compared with that of the ophthalmologist.
Comparisons are made for NOPs collectively and for subgroups of NOPs of different levels of experience in ophthalmoscopic assessment of DR. A profile is presented of DR occurring in this diabetic clinic population. The comparison studies show significant variations in ability of different observer groups and also between observers of the same status. It is concluded that an ophthalmologist is a necessary member of a diabetic care team.     

Awareness of diabetic eye disease among general practitioners and diabetic patients in Yangon, Myanmar

Background: Diabetes is an increasing problem in Myanmar with more than three million people affected. There are no data on awareness of diabetic retinopathy among the general practitioners (GPs) or diabetic population of Myanmar. This study aims to evaluate the awareness of diabetes‐related eye disease among GPs and diabetic patients in Yangon, Myanmar. Design: A cross‐sectional survey. Methods: From the Myanmar Medical Association Registry of 978 practicing GPs in Yangon, 200 were randomly selected and a structured questionnaire was sent to each. Each GP was asked to give a separate questionnaire to the first five diabetic patients who attended their practice. Results: One hundred GPs and 480 patients returned the questionnaires. Although 99% of GPs were aware that diabetes could result in loss of vision, 49% never examined the fundi of their diabetic patients. Of the diabetic patients, 86% were aware that diabetes could damage their eyesight. Although 92% realized they should visit an ophthalmologist regularly, only 57% had seen an ophthalmologist. Patients who never attended school were less likely to visit an ophthalmologist than those with tertiary education (odds ratio 0.24; 95% confidence interval 0.09, 0.66). Patients with diabetes for less than 2 years were less likely to visit an ophthalmologist than those with diabetes for more than 10 years (odds ratio 0.21; 95% confidence interval 0.9, 0.44). There was no association between age, gender or work status and the likelihood of having seen an ophthalmologist. Conclusion: Although both GPs and diabetic patients are aware of the need for regular fundal screening, just over half the patients had been screened. There exists a need for programmes in Myanmar to induce a behavioural change in diabetic patients with regards to screening examinations.     

Nonocular manifestations of parenteral drug abuse

The nonocular manifestations of parenteral drug abuse are presented to familiarize the ophthalmologist with this ever growing, medical and psychosocial problem. The ophthalmologist, like other primary care physicians, may be the first professional to encounter these patients whose substance abuse may lead to a wider spectrum of physical and psychiatric illness. The variety, history, and manifestations of abused substances are discussed.     

Ophthalmic nurse practitioner led diabetic retinopathy screening. Results of a 3-month trial

PURPOSE: To describe the design and implementation of a nurse led diabetic retinopathy screening clinic. To present the results of a 3-month trial period assessing the concordance of retinopathy grading between a nurse practitioner and an ophthalmologist. METHOD: Patients attending for annual diabetic eye review during an initial 3-month trial period were assessed in a dedicated diabetic eye clinic by an ophthalmic nurse practitioner and an ophthalmologist, with both grading the degree of diabetic retinopathy using to the Wisconsin grading system. Each was masked as to the other's findings. The concordance of retinopathy grading between ophthalmic nurse practitioner and ophthalmologist was assessed. RESULTS: A total of 95 patients (189 eyes) were assessed during the study period. A 92% concordance was achieved between the ophthalmologist and the ophthalmic nurse practitioner. In total, 72 eyes were graded as having some degree of retinopathy by the ophthalmologist. The sensitivity of the nurse practitioner for diagnosing the presence of diabetic retinopathy was 93%, and the specificity 91%. Nine eyes with severe nonproliferative diabetic retinopathy or worse, and four with clinically significant macular oedema were seen. All were correctly identified by the nurse practitioner. CONCLUSIONS: The structure and management protocols of the clinic are described. An excellent concordance between ophthalmologist and nurse practitioner was achieved in this group of patients with relatively less advanced retinopathy.     

Eye care in African Americans with type 1 diabetes: the New Jersey 725

OBJECTIVE: To examine the use of ophthalmologic care by African Americans with type 1 diabetes. DESIGN: Cross-sectional study between 1993 and 1997. PARTICIPANTS: Seven hundred twenty-two African Americans with type 1 diabetes. METHODS: A structured clinical interview was conducted to determine (1) the frequency of annual dilated eye examinations, health insurance, use of an ophthalmologist, and reasons for lack of eye care; and (2) factors associated with having a dilated eye examination by an ophthalmologist during the previous year. All patients also underwent a detailed ocular examination, including masked grading of 7-field stereoscopic fundus photographs. RESULTS: One third of the patients had never been examined by an ophthalmologist. Of those who had eye care, almost half did not have a regular ophthalmologist. During the previous 12 months, only 42% of patients had had a dilated eye examination by an ophthalmologist, despite the fact that approximately three fourths of the patients had been told to do so. The 2 most common reasons given for not seeing an ophthalmologist during the previous year were not having any eye problem (57.6%) and cost (23%). Patients more likely to have had a dilated eye examination by an ophthalmologist during the previous year were married, had higher socioeconomic status, had previously been told about annual dilated eye examinations, and had previously been diagnosed with either a cataract or proliferative diabetic retinopathy. CONCLUSIONS: A large percentage of African Americans with type 1 diabetes do not receive adequate eye care. Screening for diabetic retinopathy and improved access to ophthalmologists are needed to improve eye care in this ethnic group.     

Increasing the range of the keratometer

How can the ophthalmologist perform keratometry on a patient whose corneal curvature exceeds the limits of the keratometer? A technique for extending the range of the keratometer to test such patients, e.g., those suffering from keratoconus or corneal plana, is presented.     

The Spectrum of Associated Ocular and Systemic Malformations

The cases of Peters' anomaly seen over the past decade, at Hospital Ste-Justine in Montreal, are reviewed. Associated ocular anomalies were observed in 50% of cases while 60% of patients presented with associated systemic defects. It is clear, from these patients and those reported in the literature, that Peters' anomaly can be an isolated condition, or part of distinct syndromes: the Krause-Kivlin syndrome or the Peters'-plus syndrome. The authors emphasize the importance for the ophthalmologist to recognize these possibilities if proper management is to be provided.     

Diagnosis in a case total ophthalmoplegia – where time is life

Rhino-orbito-cerebral mucormycosis is a potentially fatal fungal infection seen in poorly controlled diabetics or immunocompromised patients who can present initially to an ophthalmologist, otorhinolaryngologist or a neurologist. The clinical presentation to an ophthalmologist may be that of painful ophthalmoplegia.The confirmation and further management of the infection requires an interdisciplinary approach. A timely diagnosis and intervention can be life-saving. This article depicts the typical fulminant course and diagnostic evaluation of rhino-orbito-cerebral mucormycosis.     

Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage

Background Vitreous hemorrhage (Tersons syndrome) and other intraocular hemorrhages have been reported in up to 40% of patients with subarachnoidal hemorrhage (SAH). Our objective was to determine prospectively the frequency of intraocular involvement and its relationship to the grade of SAH.Methods Seventy-four consecutive patients with SAH were prospectively examined. The patients were classified according to Hunt and Hess and ophthalmological examination was performed by an ophthalmologist.Results In all patients SAH was caused by a ruptured cerebral aneurysm. Intraocular hemorrhages were present in 28% of the patients, all of whom had retinal hemorrhages, which were detectable unilaterally in 45%, while 15% of these patients exhibited typical retrohyaloidal or vitreal hemorrhages. Ocular involvement was statistically more frequent in patients with a higher grade of SAH according to Hunt and Hess.Conclusions Due to ocular involvement in more than a quarter of the patients with SAH and due to the fact that ocular involvement is related to the severity of SAH, screening of patients with SAH is recommended, especially when no reliable data about visual function are available. Early vitrectomy of vitreous hemorrhages provides a more effective rehabilitation.     

Intraocular pressure elevation in a child due to the use of inhalation steroids--a case report

Inhalation steroid therapy can cause ocular hypertension or open angle glaucoma. The authors describe the case of a young girl who presented with raised intraocular pressure and headaches due to the prolonged administration of nasal and inhalation steroids. The ophthalmologist should monitor the intraocular pressure in patients who use inhalation or nasal steroid therapy on a regular base. The physician or paediatrician should be aware of this complication in children with headaches or diminished visual acuity.     

Diagnose von Schwindel mit besonderem Blick auf Augenbewegungsstörungen

With specialist knowledge ophthalmologists can make a valuable contribution to the interdisciplinary work-up of patients with vertigo as the leading symptom. The neuro-ophthalmological examination of eye movements by an ophthalmologist and/or orthoptist is an important contribution because the various vertigo syndromes can only be correctly evaluated by a combined examination of the vestibular and ocular motor systems. If the ophthalmologist is the first doctor to examine a patient suspected disorders from other specialist fields can be indicated, in particular neurology and otorhinolaryngology. When taking the patient history the ophthalmologist should inquire about the type and duration of the vertigo, triggering or modifying factors and accompanying symptoms. This is followed by a systematic examination of the eye position and the different types of eye movements, the head-impulse test and a special examination to check for the presence of nystagmus.     

Dacriocistorrinostomía endonasal: participación del oftalmólogo

ObjectiveTo evaluate the results of endoscopic dacryocystorhinostomy (DCR) with or without support of the ophthalmologist.Material and methodsA retrospective study of 100 cases of endoscopic DCR surgery conducted by an otolaryngologist between June 2008 and December 2009. Of the 100 cases, 50 were operated with surgical support of the ophthalmologist, who inserted Bowman probes in the upper and lower canaliculi, while in the other 50 cases it was the otolaryngologist who performed this, without support of the ophthalmologist. The evaluation of the results after 2 years included the subjective perception, the lacrimal patency after lacrimal syringing, and lacrimal functional test after modified Jones test.ResultsOf the 100 DCR reviewed, more than 50% required complementary treatment by the otolaryngologist, mainly septoplasty. As for the resolution of epiphora, without support of the ophthalmologist, 75% the patients reported an overall subjective improvement, but this reached 92% in the surgical group with support of the ophthalmologist, which was a statistically significant difference.ConclusionsEndoscopic DCR is effective in the treatment of epiphora, but its results improve when the ophthalmologist inserts the probes in the lacrimal canaliculi during the surgical procedure.     

Eyelid and orbital treatment following radical maxillectomy

Malignant lesions of the nasopharynx and paranasal sinuses often encroach upon the orbit. A series of nineteen patients who underwent partial or radical maxillectomy is presented to summarize the eyelid and orbital findings that required further treatment. Fifteen of these patients were left with an intact globe and a visually useful eye, but the defects of epiphora, eyelid malposition, dacryocystitis, and diplopia were visually threatening and required treatment. The cosmetic deformities and diplopia following maxillectomy and radiation are partially amenable to treatment with late bone grafting. Lacrimal outflow deficiencies were successfully treated with dacryocystorhinostomy. Only patients with ocular complications following maxillectomy are included in this series; therefore, the range of problems and their treatment confronting the ophthalmologist is summarized.     

Seven hundred medicolegal cases in ophthalmology

Seven hundred medicolegal claims in ophthalmology were reviewed by one ophthalmologist who served as an expert for four decades. The ophthalmologist was personally involved in 620 claims. The 700 cases have been categorized and analyzed. The reasons for the claims and some lessons derived from them are presented. Familiarity with the claims encountered by others may enable ophthalmologists to avoid similar claims.     

OPHTHALMIC MANIFESTATIONS OF SYSTEMIC NEOPLASIA: A review and report of 11 cases

This paper describes 11 patients who presented over the last six years because of an ophthalmic problem related to either a known or unknown systemic neoplasm.  

Summary

A review of recent literature has been given, along with the histories of 11 patients with systemic neoplasia and ophthalmic manifestations. It is hoped that an increased awareness of such problems, by both the ophthalmologist and physician, and a useful scheme of classification, may improve patient management.
A review of the more recent literature on systemic neoplasms which affect the ocular and periocular structures is given, and a classification of ophthalmic manifestations of systemic neoplasia is suggested.     

Ophthalmological features of pseudo-tumor cerebri report on 18 cases

The aim of this paper is to point the attention of the ophthalmologist to the opthalmic symptoms of pseudo-tumor cerebri. The ophthalmologist needs to control periodically patients with this condition in order to decide for an urgent necessary operative decompression in case of initial visual deficits.     

The ophthalmology of internal carotid artery dissection.

PURPOSE: Carotid dissection is an important cause of cerebral and retinal ischemic symptoms, especially in young adults. This article presents a patient material and also includes a review of the ophthalmologic signs and symptoms of carotid dissection. MATERIAL AND METHODS: Twenty-eight patients with spontaneous dissection of the extracranial internal carotid artery dissection underwent a neuro-ophthalmological examination. RESULTS: Twenty-three patients had oculosympathetic paresis. Two experienced transient monocular blindness; in one the episodes were provoked by sitting up from a supine position. One patient presented with a monocular visual field defect, due to posterior ischemic neuropathy, and two others with homonym hemianopia. Diplopia, caused by an incomplete VIth cranial nerve palsy was recognised in one. CONCLUSION: All but one patient presented with detectable ophthalmologic symptoms or signs. Very often the ophthalmologist is the first medical contact for patients with internal carotid artery dissection. The condition is serious, and a prompt evaluation and treatment is indicated to prevent irreversible sequelae.     

Orbital infections in the immunocompromised patient

In humans, a variety of immunodeficiency states have been recognized whereby infectious agents gain access to the body and produce disease. The orbit may become involved following injury or surgery, through spread of infection from surrounding structures, or by metastatic seeding from a distant source. Orbital infections associated with immunodeficiency represent a special problem in diagnosis and management for the ophthalmologist. Twenty-four patients with immunodeficiency-associated orbital infections who illustrate a wide range of factors associated with immunodeficiency, agents that produce infection, ophthalmic signs that result, and effects of antimicrobial therapy are presented.     

Bilateral uveitis manifesting as a complication of chronic graft-versus-host disease after allogeneic bone marrow transplantation

PURPOSE: To document the rare occurrence of uveitis presumed secondary to chronic graft-versus-host disease (cGVHD). METHODS: Observational case report. RESULTS: A 52-year-old Filipino male who had undergone allogeneic BMT 10 years earlier presented with bilateral uveitis and biopsy-proven cutaneous cGVHD. There was no evidence of infection or other immune-related causes and the inflammation had a temporal correlation with his dermatological GVHD. The patient responded to treatment with oral cyclosporin A. CONCLUSION: The coexistence of uveitis and cGVHD is rare. The ophthalmologist should be aware of such an association and work together with the oncologist to treat these patients appropriately.