The Diagnostic Dilemma of Pseudopapilledema
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URGENT/EMERGENT When to Refer Financial Disclosure
URGENT/EMERGENT When to Refer Financial Disclosure Speaker, Amy Eston, M.D. has a financial interest/agreement or affiliation with Lansing Ophthalmology, where she is employed as a ophthalmologist. 58 yr old WF with 6 month history of decreased vision left eye. Ache behind the left eye for 2-3 months. Using husband’s contact lens solution made it feel better. Seen by two eye care professionals. Given glasses & told eye exam was normal. No past ocular history Medical history of depression Takes only aspirin and vitamins 20/20 OD 20/30 OS Eye Pressure 15 OD 16 OS – normal Dilated fundus exam & slit lamp were normal Pupillary exam was normal Extraocular movements were full Confrontation visual fields were full No red desaturation Color vision was slightly decreased but the same in both eyes Amsler grid testing was normal OCT disc – OD normal OS slight decreased RNFL OCT of the macula was normal Most common diagnoses: Dry Eye Optic Neuritis Treatment - copious amount of artificial tears. Return to recheck refraction Visual field testing Visual Field testing - Small defect in the right eye Large nasal defect in the left eye Visual Field - Right Hemianopsia. MRI which showed a subacute parietal and occipital lobe infarct. ANISOCORIA Size of the Pupil Constrictor muscles innervated by the Parasympathetic system & Dilating muscles innervated by the Sympathetic system The Sympathetic System Begins in the hypothalamus, travels through the brainstem. Then through the upper chest, up through the neck and to the eye. The Sympathetic System innervates Mueller’s muscle which helps to elevate the upper eyelid. -
Optic Disc Edema, Globe Flattening, Choroidal Folds, and Hyperopic Shifts Observed in Astronauts After Long-Duration Space Flight
University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln NASA Publications National Aeronautics and Space Administration 10-2011 Optic Disc Edema, Globe Flattening, Choroidal Folds, and Hyperopic Shifts Observed in Astronauts after Long-duration Space Flight Thomas H. Mader Alaska Native Medical Center, [email protected] C. Robert Gibson Coastal Eye Associates Anastas F. Pass University of Houston Larry A. Kramer University of Texas Health Science Center Andrew G. Lee The Methodist Hospital See next page for additional authors Follow this and additional works at: https://digitalcommons.unl.edu/nasapub Part of the Physical Sciences and Mathematics Commons Mader, Thomas H.; Gibson, C. Robert; Pass, Anastas F.; Kramer, Larry A.; Lee, Andrew G.; Fogarty, Jennifer; Tarver, William J.; Dervay, Joseph P.; Hamilton, Douglas R.; Sargsyan, Ashot; Phillips, John L.; Tran, Duc; Lipsky, William; Choi, Jung; Stern, Claudia; Kuyumjian, Raffi; andolk, P James D., "Optic Disc Edema, Globe Flattening, Choroidal Folds, and Hyperopic Shifts Observed in Astronauts after Long-duration Space Flight" (2011). NASA Publications. 69. https://digitalcommons.unl.edu/nasapub/69 This Article is brought to you for free and open access by the National Aeronautics and Space Administration at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in NASA Publications by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Authors Thomas H. Mader, C. Robert Gibson, Anastas F. Pass, Larry A. -
Post-Cataract Cystoid Macular Oedema Prevention – Update 2019
Review Cystoid Macular Oedema Post-cataract Cystoid Macular Oedema Prevention – Update 2019 Andrzej Grzybowski,1,2 Reda Zemaitiene,3 Lina Mikalauskiene3 1. Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; 2. Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland; 3. Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania DOI: https://doi.org/10.17925/EOR.2019.13.1.37 seudophakic cystoid macular oedema (PCMO) is a common complication following both uncomplicated and complicated cataract surgery, becoming apparent about 6 weeks following surgery. PCMO may be asymptomatic in some cases, but in others is associated Pwith a reduction in visual acuity. The pathogenesis of PCMO is linked to postoperative inflammation and the release of inflammatory mediators. The use of topical steroids and/or nonsteroidal anti-inflammatory drugs can reduce the adverse effects of inflammation and have been used for the prevention and treatment of PCMO. However, the therapeutic effectiveness of these drugs is currently not well understood, partially because PCMO can spontaneously resolve as well as the multiple treatment protocols and the paucity of robust data exist. In this review we compare the various prophylactic options for PCMO and provide commentary on their efficacy. Keywords Various options for the prevention of pseudophakic cystoid macular oedema (PCMO) have been Pseudophakic cystoid macular oedema, offered. Nonsteroidal anti-inflammatory drugs (NSAIDs) seem to be beneficial in preventing post-operative inflammation, cataract surgery, postoperative inflammation; however, there is lack of evidence for long-term benefit after cataract nonsteroidal anti-inflammatory drugs surgery. What is more, topical NSAID preparations are difficult to compare, as studies differ in Disclosure: Andrzej Grzybowski, Reda inclusion criteria, patient characteristics, prescription and duration of treatment. -
Oct Institute
Low Vision, Visual Dysfunction and TBI – Treatment, Considerations, Adaptations Andrea Hubbard, OTD, OTR/L, LDE Objectives • In this course, participants will: 1. Learn about interventions involving specialized equipment to adapt an environment for clients with low vision. 2. Learn about the most typical low vision presentations/conditions. 3. Gain increased knowledge of eye anatomy and the visual pathway. Overview of TBI Reference: Centers for Disease Control and Prevention Overview of TBI Risk Factors for TBI Among non-fatal TBI-related injuries for 2006–2010: • Men had higher rates of TBI hospitalizations and ED visits than women. • Hospitalization rates were highest among persons aged 65 years and older. • Rates of ED visits were highest for children aged 0-4 years. • Falls were the leading cause of TBI-related ED visits for all but one age group. – Assaults were the leading cause of TBI-related ED visits for persons 15 to 24 years of age. • The leading cause of TBI-related hospitalizations varied by age: – Falls were the leading cause among children ages 0-14 and adults 45 years and older. – Motor vehicle crashes were the leading cause of hospitalizations for adolescents and persons ages 15-44 years. Reference: Centers for Disease Control and Prevention Overview of TBI Risk Factors for TBI Among TBI-related deaths in 2006–2010: • Men were nearly three times as likely to die as women. • Rates were highest for persons 65 years and older. • The leading cause of TBI-related death varied by age. – Falls were the leading cause of death for persons 65 years or older. -
Cranial Nerve Palsy
Cranial Nerve Palsy What is a cranial nerve? Cranial nerves are nerves that lead directly from the brain to parts of our head, face, and trunk. There are 12 pairs of cranial nerves and some are involved in special senses (sight, smell, hearing, taste, feeling) while others control muscles and glands. Which cranial nerves pertain to the eyes? The second cranial nerve is called the optic nerve. It sends visual information from the eye to the brain. The third cranial nerve is called the oculomotor nerve. It is involved with eye movement, eyelid movement, and the function of the pupil and lens inside the eye. The fourth cranial nerve is called the trochlear nerve and the sixth cranial nerve is called the abducens nerve. They each innervate an eye muscle involved in eye movement. The fifth cranial nerve is called the trigeminal nerve. It provides facial touch sensation (including sensation on the eye). What is a cranial nerve palsy? A palsy is a lack of function of a nerve. A cranial nerve palsy may cause a complete or partial weakness or paralysis of the areas served by the affected nerve. In the case of a cranial nerve that has multiple functions (such as the oculomotor nerve), it is possible for a palsy to affect all of the various functions or only some of the functions of that nerve. What are some causes of a cranial nerve palsy? A cranial nerve palsy can occur due to a variety of causes. It can be congenital (present at birth), traumatic, or due to blood vessel disease (hypertension, diabetes, strokes, aneurysms, etc). -
Visual Dysfunction in Optic Chiasm Syndrome an Atomy
1 4/12/2019 Optic chiasm, most important Arrangement of visual fibers Characteristic of visual field VISUAL DYSFUNCTION Bitemporal defects: IN OPTIC CHIASM SYNDROME Superior Inferior Complete Peripheral, central M.HIDAYAT FACULTY OF MEDICINE, A N DALAS UNIVERSITY /M .DJAMIL HOSPITAL PADANG AN ATOMY OF CHIASM OPTIC CHIASM Width : 12 mm 53% fiber from nasal retina crossed to opposite — Length : 8 mmfantero posterior) contra lateral. ■ Inclined : 45 0 Inferior nasal fibers cross anterior loop in to contra lateral (Willbrand's knee) Location : anterior hypothalamus & anterior third Macular fiber cross posterosuperior ventricle 10 mm above sella Vascular supply: Anterior communicating artery Anterior cerebri artery Circle of Willis ANTERIOR ANGLE OF CHIASM Compression to anterior angle of chiasm Small lesion damages the crossing fibers of ipsilaferal eye -> field defect: monocular and temporal Damage of macular crossed fibers: monocular, temporal defects and parasentral scotoma Damage fiber from nasal contralateral, anterior extension : central ipsilateral scotoma and contralateral upper temporal quadrant {"Willbrand’s Knee") 1 4/12/2019 Chiasmal compression from below defects stereotyped pattern : bitemporal defect Example: pituitary adenoma Peripheral fiber damage, defects begin from superior quadrants of both eyes Can be not similar Similar defects causes from tubercullum sellae, meningioma, craniopharyngiomas, aneurysm t Sella or supra sella lesion : damage superior fiber defect bitemporal inferior Bitemporal Hemianopsia Example: angioma -
The Usefulness of Systemic Inflammatory Markers As Diagnostic
A RQUIVOS B RASILEIROS DE ORIGINAL ARTICLE The usefulness of systemic inflammatory markers as diagnostic indicators of the pathogenesis of diabetic macular edema A utilidade de marcadores inflamatórios sistêmicos como indicadores diagnósticos da patogênese do edema macular diabético Cagri Ilhan1 , Mehmet Citirik2, Mehmet Murat Uzel3, Hasan Kiziltoprak4, Kemal Tekin5 1. Department of Ophthalmology, Hatay State Hospital, Hatay, Turkey. 2. Department of Ophthalmology, University of Health Sciences, Ankara Ulucanlar Eye Education and Research Hospital, Ankara, Turkey. 3. Department of Ophthalmology, Balikesir University, Balikesir, Turkey. 4. Department of Ophthalmology, Bingol Maternity and Child Hospital, Bingol, Turkey. 5. Department of Ophthalmology, Ercis State Hospital, Van, Turkey. ABSTRACT | Purpose: To investigate the usefulness of sys- groups were similar (diabetic macular edema vs. non-diabetic temic inflammatory markers [i.e., white blood cell and platelet macular edema, p=0.08; diabetic macular edema vs. control, counts, mean platelet volume, and their ratios] as diagnostic p=0.02; and non- diabetic macular edema vs. control, p=0.78). markers of the pathogenesis of diabetic macular edema. Me- All other parameters were similar between groups (all p>0.05). thods: The study cohort included 80 diabetic macular edema Conclusion: The neutrophil/lymphocyte ratio and mean platelet patients (40 with diabetic retinopathy and 40 without) and 40 volume of the diabetic macular edema group were higher than healthy age- and sex-matched controls. Neutrophil, lymphocyte, those of the non-diabetic macular edema and control groups. monocyte, and platelet counts, and the mean platelet volume A neutrophil/lymphocyte ratio cutoff value of ≥2.26 was identified were determined from peripheral blood samples, and the as an indicator of the pathogenesis of diabetic macular edema monocyte/lymphocyte, platelet/lymphocyte, and mean platelet with high sensitivity and specificity. -
Bass – Glaucomatous-Type Field Loss Not Due to Glaucoma
Glaucoma on the Brain! Glaucomatous-Type Yes, we see lots of glaucoma Field Loss Not Due to Not every field that looks like glaucoma is due to glaucoma! Glaucoma If you misdiagnose glaucoma, you could miss other sight-threatening and life-threatening Sherry J. Bass, OD, FAAO disorders SUNY College of Optometry New York, NY Types of Glaucomatous Visual Field Defects Paracentral Defects Nasal Step Defects Arcuate and Bjerrum Defects Altitudinal Defects Peripheral Field Constriction to Tunnel Fields 1 Visual Field Defects in Very Early Glaucoma Paracentral loss Early superior/inferior temporal RNFL and rim loss: short axons Arcuate defects above or below the papillomacular bundle Arcuate field loss in the nasal field close to fixation Superotemporal notch Visual Field Defects in Early Glaucoma Nasal step More widespread RNFL loss and rim loss in the inferior or superior temporal rim tissue : longer axons Loss stops abruptly at the horizontal raphae “Step” pattern 2 Visual Field Defects in Moderate Glaucoma Arcuate scotoma- Bjerrum scotoma Focal notches in the inferior and/or superior rim tissue that reach the edge of the disc Denser field defects Follow an arcuate pattern connected to the blind spot 3 Visual Field Defects in Advanced Glaucoma End-Stage Glaucoma Dense Altitudinal Loss Progressive loss of superior or inferior rim tissue Non-Glaucomatous Etiology of End-Stage Glaucoma Paracentral Field Loss Peripheral constriction Hereditary macular Loss of temporal rim tissue diseases Temporal “islands” Stargardt’s macular due -
Meeting Materials
BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY EDMUND G. BROWN JR., GOVERNOR STATE BOARD OF OPTOMETRY 2450 DEL PASO ROAD, SUITE 105, SACRAMENTO, CA 95834 0 P (916) 575-7170 F (916) 575-7292 www.optometry .ca.gov OPToMi fikY Continuing Education Course Approval Checklist Title: Provider Name: ☐Completed Application Open to all Optometrists? ☐ Yes ☐No Maintain Record Agreement? ☐ Yes ☐No ☐Correct Application Fee ☐Detailed Course Summary ☐Detailed Course Outline ☐PowerPoint and/or other Presentation Materials ☐Advertising (optional) ☐CV for EACH Course Instructor ☐License Verification for Each Course Instructor Disciplinary History? ☐Yes ☐No BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GOVERNOR EDMUND G. BROWN JR. ~~ TATE BOARD OF OPTOMETRY }I /~E{:fLi\1 ~1' DELWSO ROAD, SUITE 105, SACRAMENTO, CA 95834 op'i,otii~l~ 1~0-A~ifiF' t\,rffi-7170 F (916) 575-7292 www.optometry.ca.gov EDUCATION COU Rw1t;--ftf""~'-!-J/-i~--,--__:___::...:..::....::~-~ $50 Mandatory Fee APPLICATION ,-~Jg l Pursuant to California Code of Regulations (CCR) § 1536, the Board will app~romv~e~c~ott=nfli1~nuFTT1t;tngn'zeWl:uc~rRif'tf-:~MT~~=ilt,;;,,_J receiving the applicable fee, the requested information below and it has been determined that the course meets criteria specified in CCR § 1536(g). In addition to the information requested below, please attach a copy of the course schedule, a detailed course outline and presentation materials (e.g., PowerPoint presentation). Applications must be submitted 45 days prior to the course presentation date. Please type or print -
Bilateral Acquired Progressive Retinal Nerve Fiber Layer Myelination
Bilateral Acquired Progressive Retinal Nerve Fiber Layer Myelination Abstract We present the multimodal imaging findings of an unusual case of bilateral acquired progressive myelination of the optic disc over a 10-year follow up period, in a hyperopic adolescent patient in the absence of an underlying ocular or systemic abnormality. Myelination of the left optic disc was noted at age 7 and of the right optic disc at age 13 but no other ocular or systemic abnormalities were identified. Cross sectional OCT and en face OCT angiography confirmed the presence of myelination of the retinal nerve fiber layer and excluded other etiologic possibilities including an astrocytic hamartoma. Keywords: Optic Nerve; Optic Fiber Myelination, Acquired, Hyperopia INTRODUCTION Myelination of the retinal nerve fiber layer occurs in 1% of the population and is most frequently congenital and non-progressive. (1) Congenital cases are typically isolated but may be rarely associated with the syndrome of ipsilateral high myopia, strabismus and amblyopia (2,3), although cases have been reported in hyperopic eyes. Reports of acquired and progressive myelination associated with congenital optic nerve disorders such as Arnold-Chiari malformation, hydrocephalus, optic disc drusen, and iatrogenic causes such as optic nerve sheath fenestration, are relatively rare.(4–8) PLEASE ADJUST THE REFERENCE CITATIONS While affected patients are typically asymptomatic, retinal nerve fiber layer myelination can be rarely associated with visual loss. Even more unusual are reports of acquired and progressive myelination of the nerve fiber layer. We present the multimodal imaging findings of such a case in a healthy young patient with a 10-year follow up. -
98796-Anatomy of the Orbit
Anatomy of the orbit Prof. Pia C Sundgren MD, PhD Department of Diagnostic Radiology, Clinical Sciences, Lund University, Sweden Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lay-out • brief overview of the basic anatomy of the orbit and its structures • the orbit is a complicated structure due to its embryological composition • high number of entities, and diseases due to its composition of ectoderm, surface ectoderm and mesoderm Recommend you to read for more details Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 3 x 3 Imaging technique 3 layers: - neuroectoderm (retina, iris, optic nerve) - surface ectoderm (lens) • CT and / or MR - mesoderm (vascular structures, sclera, choroid) •IOM plane 3 spaces: - pre-septal •thin slices extraconal - post-septal • axial and coronal projections intraconal • CT: soft tissue and bone windows 3 motor nerves: - occulomotor (III) • MR: T1 pre and post, T2, STIR, fat suppression, DWI (?) - trochlear (IV) - abducens (VI) Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Superior orbital fissure • cranial nerves (CN) III, IV, and VI • lacrimal nerve • frontal nerve • nasociliary nerve • orbital branch of middle meningeal artery • recurrent branch of lacrimal artery • superior orbital vein • superior ophthalmic vein Lund University / Faculty of Medicine / Inst. Clinical Sciences / Radiology / ECNR Dubrovnik / Oct 2018 Lund University / Faculty of Medicine / Inst. -
Eye60. Instrumental Eye Examination.Pdf
INSTRUMENTAL EYE EXAMINATION Eye60 (1) Instrumental Eye Examination Last updated: May 9, 2019 “BEDSIDE” EXAMINATIONS ..................................................................................................................... 1 OPHTHALMOSCOPY (FUNDUSCOPY) ........................................................................................................ 1 DIRECT OPHTHALMOSCOPY .................................................................................................................... 1 INDIRECT OPHTHALMOSCOPY ................................................................................................................. 2 OPHTHALMOSCOPIC FINDINGS ............................................................................................................... 2 Hypertensive retinopathy ................................................................................................................. 6 Diabetic retinopathy ......................................................................................................................... 7 PEDIATRIC ASPECTS ............................................................................................................................... 9 APPLANATION TONOMETRY .................................................................................................................... 9 SLIT LAMP EXAMINATION (BIOMICROSCOPY) ........................................................................................ 9 ULTRASONOGRAPHY ..............................................................................................................................