[Neuro-ophthalmological assessments in the Ophthalmology Department at University Medical Center, Brest: retrospective study of 269 patients (January 2004-October 2009)]. / Bilans neuro-ophtalmologiques dans le service d'ophtalmologie du CHU de Brest : étude rétrospective sur 269 patients (janvier 2004-octobre 2009).

AIMS: To evaluate the neuro-ophthalmological assessments carried out in the ophthalmology department of the university medical center, Brest, identifying the population seen, the examinations performed, the pathologies treated and patient outcomes, so as to suggest solutions to improve quality of care. METHODOLOGY: Retrospective study over a period of more than five years, between January 1st, 2004 and October 31st, 2009. Data were collected from each patient's chart with the help of a standardized spreadsheet including epidemiological, clinical, paraclinical and treatment data. RESULTS: Analysis of the 269 charts reveals that optic neuropathies are the most frequently encountered etiologies. In addition to the standardized assessment currently used on the service, we suggest adding a specific neuro-ophthalmological clinical intake form so as to standardize and perfect the diagnostic approach. CONCLUSION: Optimization of quality of care in neuro-ophthalmology involves a multidisciplinary approach, requiring close collaboration between ophthalmologists, neurologists and radiologists. A careful, regular analysis of our practice patterns with respect to scientific advances should improve consistency and quality of care for our patients.

[Endogenous bacterial endophthalmitis related to dental abscess: case report]. / Endophtalmie endogène bactérienne sur abcès dentaire: à propos d'un cas.

INTRODUCTION: Endogenous bacterial endophthalmitis (EBE) is an intraocular bacterial infection transmitted via a hemotogenous route, usually occuring in immunocompromised patients with bacteremia spreading from extraocular foci of infection. We report a case of EBE secondary to a dental infection occurring in an immunocompetent patient. CASE REPORT: A 61-year-old-man with no past medical history other than a dental bridge on the 13th tooth was referred for rapid onset hypertensive fibrinous panuveitis of the right eye. He presented with profound visual loss in this eye, an absent pupillary reflex and an obscured fundus. The left eye was normal. Neither fever nor constitutional symptoms were noted at presentation. Work-up revealed a mild inflammatory syndrome with increased C-reactive protein, a high antistreptolysin O titer, and an abscess of the dental bridge. The clinical picture worsened rapidly, suggesting the possibility of EBE secondary to an organism of dental origin. Aqueous humor polymerase chain reaction (PCR) was positive for streptococci, which could not be identified more specifically. Removal of the dental bridge in combination with systemic and intravitreal multiple antiobiotic therapy achieved a rapid cure of the EBE. Vitrectomy combined with phacoemulsification was performed later in order to clear media opacities. At 6 months follow-up, best-corrected visual acuity was 8/10 with no recurrent inflammation. CONCLUSION: This case shows that EBE can occur in the absence of predisposing factors but with an extraocular infectious focus as simple as a dental abscess. In the absence of associated septicemia, with the involved tooth superior and ipsilateral to the affected eye, a spread of the infection by retrograde venous flow should be suspected. The prognosis for visual function may be good if early diagnosis and immediate treatment can be provided.

[Vascular transient monocular visual loss]. / Les troubles visuels monoculaires transitoires d'origine vasculaire.

Diagnosis and management of transient monocular visual loss is an emergency. Ocular conditions causing transient visual loss are routinely managed by ophthalmologists. Vascular transient monocular visual loss may result from emboli, hypoperfusion, vasospasm, or venous congestion. Evaluation focuses on the carotid arteries, ophthalmic arteries, the aortic arch, the heart, and rarely hypercoagulable states. Secondary prevention of ischemic events is essential in order to prevent permanent visual loss as well as cerebral ischemic and cardiovascular death. Aggressive treatment of vascular risk factors is usually associated with antiplatelet agents. Anticoagulant and carotid surgery are only rarely required after vascular transient monocular visual loss.

[Post-traumatic orbital emphysema: a case report]. / Emphysème orbitaire post-traumatique: à propos d'un cas.

Orbital emphysema is often associated with orbital fracture or communication with paranasal sinuses. It is usually moderate but could be the cause of optic neuropathy or central retinal artery occlusion. We report a case of massive orbital emphysema with ocular hypertony and prethrombosis of the central retinal artery. Emergency surgical decompression performed by an ophthalmologist and an otorhinolaryngologist provided complete and prompt relief. The authors emphasize the importance of preventing nose blowing after orbital trauma or surgery.

[Pleomorphic adenoma mimicking dacryoadenitis]. / Adénome pléomorphe simulant une dacryoadénite.

A 56-year-old female patient displayed an increased volume of her left lacrimal gland with pain and inflammation. On CT scan, a hyperdense lacrimal mass was found in the left lacrimal fossa. Observation was the first course, for no steroid therapy could be applied because of evolving digestive ulcers. After 9 months of observation, the gland was surgically removed en bloc through a wide anterolateral approach. Pathological analysis of the gland showed a pleomorphic adenoma. This case illustrates the advantage of a wide surgical approach in treating lacrimal gland tumors, in order to avoid or limit the risk of recurrence.