[VASCULAR OPHTHALMIC MANIFESTATIONS IN COVID-19 PATIENTS].

INTRODUCTION: Although COVID-19 is mainly a respiratory disease, recent evidence has emerged of vascular and procoagulant pathologies even in young and otherwise healthy individuals. Ophthalmic manifestations include, among others, visual impairment due to arteritic and venous retinal obstructions, which at times precedes other aspects of the disease. We present two atypical cases of internal carotid dissection (ICAD) and review the different ocular symptoms of ICAD and its association with the COVID-19 pandemic. BACKGROUND: A 43-year-old otherwise healthy man was referred to the Emergency Department with a headache and monocular blurring of vision. A recent fever (2 weeks prior) was noted on anamnesis, in light of absence of available positive PCR test during the illness period, clinical suspicion of COVID-19 was assumed. An initial ophthalmic evaluation found a mild optic nerve function impairment with preserved visual acuity. Computed tomography (CT) showed sinusitis, and an initial diagnosis was made of mild optic neuropathy secondary to sphenoid sinusitis. A few hours after admission, the patient reported deterioration of symptoms and examination revealed no light perception in his right eye and pale edematous optic nerve. Urgent magnetic resonance angiography (MRA) demonstrated right ICAD with no additional findings. The second patient, a 43-year-old man developed an acute event of strabismus, left limb paralysis, and speech difficulties while on a hospital visit for his son. The patient underwent CT of the brain which demonstrated extensive infarction following the distribution of his right cerebral artery. Continued investigation using computed tomography angiography (CTA) demonstrated a dissection of the right internal carotid artery. The patient was positive for COVID-19. DISCUSSION: In this review, we discuss 2 cases of carotid artery dissection presenting with an acute ocular complaint in two otherwise healthy young individuals. Events were suspected to have been provoked by COVID-19 infection. The pathogenesis and mechanisms behind COVID-19 induced coagulopathy are not clear, and several mechanisms have been proposed including endothelial damage and dysfunction. The virus is thought to enter endothelial cells and lead to a pathological procoagulant state. Awareness should be drawn to uncommon signs especially in young adults. Clotting issues can arise and should be treated quickly as they might be life and vision threatening.

Simplifying the diagnosis of optic tract lesions.

Optic tract lesions (OTL) are often difficult to diagnose. We suggest an algorithm to simplify the often-challenging diagnosis of OTL. Clinical and imaging data were retrospectively collected from the electronic files of 6 patients diagnosed with OTL at a tertiary medical center in 2016-2020. The series included 4 children and 2 adults with an OTL caused by a glioma (n = 5) or motor vehicle accident (n = 1). Magnetic resonance imaging (MRI) revealed a suprasellar glioma involving the chiasm and tract alone (n = 1) and the ipsilateral optic nerve (n = 2) and only optic tract (3). Perimetry showed incongruent homonymous hemianopia in 3 patients. In two patients, perimetry could only be performed in one eye, and demonstrated hemianopia. In one patient perimetry was unreliable. Fundus examination revealed bow-tie atrophy in all patients. On optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (RNFL) horizontal thinning was observed in the contralateral eye (n = 6). By presenting the information in a predefined order-visual field damage, OCT RNFL thickness, and MRI-the diagnosis could be easily reached even in children, and when other structures like the chiasm were involved. Fundus photographs easily detect bow tie atrophy in children. Systematic presentation of the data in a predefined order can ease the diagnostic process of OTLs.

[ACUTE VISION LOSS ASSOCIATED WITH HYPEREOSINOPHILIC SYNDROME].

INTRODUCTION: Hypereosinophilic syndrome (HES) is a rare disorder, in which eosinophilic toxins damage capillary and coronary endothelium and neuronal axons, at different target organs; 12% of patients experience stroke as a result of endothelial dysfunction, cardiomyopathy with secondary embolism, hyperviscosity and hypercoagulability. The treatment target is to lower the eosinophil count and shorten its tissue survival time. Supportive care and anticoagulants are given as required. We report a case of myocarditis, respiratory failure and cortical blindness due to rapidly deteriorating HES. The case demonstrates how early recognition and appropriate treatment can reduce tissue toxicity and functional loss due to hypereosinophilic syndrome.

The Management of Congenital Microphthalmia With Orbital Cyst: A Case Series.

PURPOSE: To describe a series of patients treated for congenital microphthalmia associated with orbital cyst and recommend a management protocol. METHODS: This retrospective case series comprised 6 patients (7 eyes) who attended an oculoplastic tertiary medical center from 2001 to 2018. Clinical, treatment, and outcome data were collected from the electronic files. Main outcome measures were preservation of vision and cosmetic appearance. RESULTS: Four patients were diagnosed at birth. Six cysts were located inferiorly and one superiorly. Two patients had a visual potential of light perception or better in the affected eye. In 4 eyes, the cyst was initially retained and the eye was fitted with a custom-made conformer. In 1 eye, the fornices were too shallow for a conformer, warranting fornix reconstruction and cyst excision. Early surgery was required in 1 eye for an expanded cyst and large orbit volume, and in another eye the cyst had overgrown the orbit, causing bone erosion and remodeling. Cosmetic results were good in 3 of the eyes in which the cyst was retained in early childhood, stimulating orbital growth. CONCLUSIONS: Congenital microphthalmia with orbital cyst is rare. Management should focus on preserving visual potential, especially in unilateral cyst cases when the other eye is also microphthalmic. Otherwise cosmetic symmetry is the main concern; cyst retention combined with ocular conformers may stimulate socket expansion. The authors found that, in most cases, if treated early, enucleation was avoidable during cyst excision. Early assessment, meticulous follow-up, and individually tailored treatment are warranted. [J Pediatr Ophthalmol Strabismus. 2022;59(3):192-199.].

Novel In-Office Technique for Visual Confirmation of Demodex Infestation in Blepharitic Patients.

PURPOSE: To determine whether Demodex infestation in blepharitic patients can be confirmed by slit-lamp examination without the need for light microscopy. METHODS: Demodex infestation was evaluated in 16 patients presenting with blepharitis and cylindrical dandruff at a single medical center from November 2014 to February 2015. Two lashes with cylindrical dandruff were epilated from each lid (8 per patient, total 128), mounted on slides, and examined in the clinic under a slit lamp equipped with a 90D condensing lens followed by light microscopy in the pathology laboratory. All evaluations were performed by the same pathologist. Mites were identified by their characteristic morphology and movement patterns. Findings were compared between the 2 methods. RESULTS: The mean total Demodex count per lash was 1.5 ± 2.1 mites by using the slit lamp and 2 ± 2.9 mites by light microscopy. Corresponding counts per patient were 11.7 ± 9.4 and 16.1 ± 12.4. The correlation between the slit lamp and microscopy results was statistically significant, per lash (r = 0.922, P < 0.01) and per patient (r = 0.976, P < 0.01). On analysis by the more clinically relevant negative (no mites detected) or positive results (at least 1 mite detected), the accuracy of the slit-lamp examination for a single lash was 91.4% and the specificity and sensitivity were 89% and 94%, respectively; the negative predictive value was 93% [χ(1) = 87.94, P < 0.01)]. All 16 patients were positive for Demodex infestation by both methods (accuracy 100%). CONCLUSIONS: Demodex infestation in blepharitic patients with cylindrical dandruff can be confirmed using only a slit lamp and common eye clinic equipment.