Optic neuritis caused by intraocular angiostrongyliasis.

A 21-year-old Thai man first presented with eosinophilic meningitis. One week later he developed visual impairment of the left eye with a visual acuity of 20/600. He had a Marcus Gunn pupil, constricted visual field, prolongation of visual evoked potential and the presence of inflammatory cells in the vitreous cavity of the affected eye. On funduscopic examination there was disc swelling with hyperemia of the left eye. These ocular findings are compatible with optic neuritis. The causative agent, Angiostrongylus cantonensis, was identified in the vitreous cavity. To our knowledge this is the first case of optic neuritis caused by intraocular angiostrongyliasis. Ten days after administration of corticosteroid his severe headache was resolved, and by 4 weeks the disk swelling of the left eye subsided. Eight months after treatment the visual acuity of the left eye had not improved due to permanent damage to the retinal pigment epithelium caused by the intraocular parasite.

Ocular manifestations of suprasellar tumors.

OBJECTIVE: To determine ocular manifestations of suprasellar tumors and to identify the pre-operative factors that might influence final visual outcomes. MATERIAL AND METHOD: Medical records of 69 patients with a diagnosis of suprasellar tumor at Srinagarind Hospital between January 1995 and December 2005 were retrospectively reviewed. RESULTS: The present study focused on 69 patients (39% men and 61% women) with averaged 37.74 years of age (range, 6 to 75). The duration of symptoms was between 4 days and 5 years (average, 7.7 months). The ocular manifestations included visual loss in 59 (86%), eye pain in six (9%), diplopia in three (4%), and ptosis in one (1%) patient. The respective definite diagnosis were pituitary adenoma, suprasellar meningioma, and craniopharyngioma in 33 (48%), 19 (28%), and 17 (25%) patients. According to the pre-operative visual acuity in the worse eye, seven (10%), seven (10%), and 55 (80%) patients were stratified to Group I (VA 6/5 to 6/12), Group II (VA 6/18 to 6/36), and Group III (VA 6/60 to no vision), respectively. Post-operatively two (29%) patients in Group II and 14 (25%) in Group III had improved visual acuity. Three groups of visualfield defect were revealed, viz., Group A (normal visual field), Group B (typical field defect) and Group C (atypical field defect) in seven (10%), 49 (71%), and 13 (19%) patients, respectively. Positive relative afferent pupillary defect was detected in 31 patients (45%) and optic disc atrophy was detected in 26 patients (38%). CONCLUSION: Pituitary adenoma was the most frequent suprasellar tumor and visual loss was the most common ocular presentation. Bitemporal hemianopia frequently occurred in these patients, but was usually asymmetrical and unpredictable in its evolution.

Effect of horizontal strabismus surgery on the astigmatism.

OBJECTIVE: To investigate the effect of horizontal rectus muscle surgery on astigmatism. MATERIAL AND METHOD: A prospective descriptive study was conducted between July 2004 and June 2005, we recruited 16 strabismic patients with bilateral recession or recession of one horizontal muscle or monocular recession and resection for this study at Srinagarind Hospital. The authors measured the patients' best-corrected visual acuity and ocular alignment using the prism cover test and the Modified Krimsky tests, respectively. Auto-refraction was performed on the pre- operative and first post operative day by a technician not apprised of the type and/or amount of surgery. Any differences between the pre-operative and post operative astigmatism were calculated using the x-y coordinate system and the mean value for astigmatism. Descriptive statistics were used to analyze the data. RESULTS: Included were 23 eyes from 16 patients who met the inclusion criteria; 8 females; 8 males; average age 14.75 +/- 11.76 (range, 4-40) years. Seven patients (43.75%) had esotropia and nine (56.25%) exotropia. For all procedures, the respective mean cylinder of the pre- operative and first post-operative day were 0.74 +/- 1.20 D in 67.56 degrees axis and 0.69 +/- 0.86 D in 56.30 degrees axis, in the same direction as the cylinders for each type. There was no statistically significant change in the refractive error between the pre- operative and first postoperative day. CONCLUSION: In contrast to previous studies, astigmatism was not significantly affected by horizontal rectus muscle surgery; however, the present study population was small. Therefore, a larger prospective control trial would be necessary to definitively answer this question.

Ocular myasthenia gravis and auto-immune thyroiditis in children.

A 7-year-old girl presented at a university hospital with ptosis of the left eye. This resolved spontaneously within 4 weeks but then the right eye became similarly affected but responded to prostigmine. Left hypertropia with restriction of the right inferior rectus, mild exophthalmos, non-tender diffuse enlargement of the thyroid, normal thyroid function tests, anti-thyroglobulin, and anti-microsomal antibodies indicated an association of autoimmune thyroiditis and ocular myasthenia. The ptosis was remedied with pyridostigmine and short-course oral prednisolone, but the hypertropia persisted.

Orbital aspiration as treatment of microphthalmos with orbital cyst: a case report.

A 6-month-old girl came to the hospital with swelling of the right lower eyelid, exophthalmos, chemosis and upward deviation of the eyeball--all of which had been present since birth. Iris, optic disc, and chorioretinal coloboma were also apparent. Magnetic resonance imaging revealed a small globe with a large cystic lesion in the orbit of the right eye. Pre- and post-operative photographs and magnetic resonance imaging indicated a safe, simple single orbital aspiration as an alternative treatment for mild microphthalmos with an orbital cyst.

Upward gaze paralysis as the initial manifestation of HIV-infected patient: a case report.

Upward gaze palsy developed in a 23-year-old man without any other abnormal findings except pupillary light-near dissociation in ocular examination. The neuroradiologic examination was consistent with cerebral toxoplasmosis--the most frequent opportunistic infection of the brain in AIDS patients. The serologic work-up revealed a positive HIV test. Symptoms and neuroradiologic abnormality improved after treatment for cerebral toxoplasmosis. HIV infection should be considered in patients who have upward gaze paralysis and neuroimaging compatible with cerebral toxoplasmosis. Empirical treatment may alleviate the upward gaze palsy.