Bilateral orbital infiltration as the initial sign of a peripheral T-cell lymphoma presenting in a leukemic phase.

We describe the clinical course of a young woman with a peripheral T-cell lymphoma who presented in a leukemic phase of the disease with an initial complaint of bilateral conjunctival swelling.

Corticosteroid-induced exophthalmos.

We describe twenty-one patients on sustained corticosteroid therapy who presented with exophthalmos. Each patient received a complete ophthalmologic examination and further tests were conducted to rule out other causes of exophthalmos. Our data suggest that corticosteroid-induced exophthalmos is an entity more common than has been previously recognized.

Reversible optic neuritis secondary to paranasal sinusitis.

Three patients are described in whom optic neuritis was presumably caused by concurrent sinus infection. Aggressive treatment of the underlying sinus condition led to prompt visual improvement. Although underrecognized in clinical neurology, paranasal sinusitis is an uncommon but treatable cause of optic neuritis. Shortcomings of conventional radiological investigations and inappropriate use of corticosteroids may contribute to initial misdiagnosis.

Assessment of the Catford drum in visual acuity testing and its use as a measurement of visual performance in low-vision patients.

Objective measurements of visual acuity were determined with the Catford drum in 82 eyes of patients in our Low-Vision Clinic who typically suffered from visual loss due to macular disease. The results were compared with subjective measurements of visual acuity by the Snellen chart. The findings indicated a significant overestimation of Snellen visual acuities by the Catford drum in 90.2% of eyes tested by a factor of 1.05 to 20.0, average 4.73. The correlation coefficient for the study was +0.40. This differs from the original results of Catford and Oliver in 1971. In addition, the Catford drum was used on follow-up visits in the same patients to assess 'visual performance'. The initial results showed an improvement in visual acuities when the Catford drum was used in 12 of 15 patients, while the Snellen acuities remained stable when retested after one month of basic instruction and use of standard low-vision aids. This improvement in 'Catford' acuity was by a factor of 0.3 to 10.0, average 4.08. This is thought to represent the patient's ability to learn the use of eccentric viewing or parafoveal retinal areas for vision. It confirms previous intuitive findings and helps to explain why low-vision patients seem to function at a higher level than expected from their Snellen visual acuities.

Optic nerve atrophy and CT scanning: the target sign.

Three patients are described who demonstrate the "target-sign" of optic nerve atrophy on CT scanning. This sign is produced by the centrally located atrophic optic nerve surrounded by a patulous perioptic subarachnoid space. An explanation for this phenomenon is proposed.

[Isolated oculomotor paralysis in the aged]. / Des paralysies oculo-motrices isolées chez des sujets âgés.

Six patients aged between 57 and 78 years suddenly developped an oculomotor nerve paralysis without other ocular lesions, but with evidence of arterial hypertension of probable etiological significance. Recovery was complete in all cases.

Vitrectomy in two cases of bilateral Terson syndrome.

We report on two patients with bilateral vitreous haemorrhage after a subarachnoid haemorrhage (Terson syndrome). We performed vitrectomy in four eyes with complete recovery of vision in three eyes; one eye had visual acuity of 1/6 due to preretinal fibrosis. The patient who had 20/20 vision in both eyes had a retinal detachment in one eye two months after the vitrectomy; this was operated upon and vision did not deteriorate.

A discussion of 61 cases of optic nerve coloboma.

Colobomata of the optic disc result from failure of closure of the most anterior portion of the optic stalk. Therefore the great majority of these defects are found at the six o'clock position in the region of the embryonic defect. The authors examined 61 patients with optic nerve coloboma from 1972 to 1983. The clinical data of these patients are given. It was remarkable that the optic nerve colobomata occurred in combination with the same systemic and 'midline'-defects that are often seen in combination with optic nerve hypoplasia.

Automated visual field screening in the flying Dutch population.

Results of automated perimetry (Fieldmaster 200, Synemed) in 1,000 subjects are described. In 17 subjects (1.7%) a serious field defect was found. In 9 subjects (0.9%) aspecific defects were found. Computer aided perimetry was found to give reliable results compared with kinetic perimetry. Since the visual field is of the utmost importance in aviation, while mass conventional visual field screening is not possible, it is suggested that use should be made of automated perimetry testing.

Chiasmal syndrome. Ophthalmological and neuro-radiological aspects.

The chiasmal syndrome has distinct ophthalmological features such as visual field loss, optic disc changes, decrease in visual acuity, ocular motor disturbances and exophthalmos. However, the pathological processes in the chiasmal region often give rise to differential diagnostic problems. Before the era of computer tomography (CT) these processes could only be visualized by means of indirect or invasive examination techniques. After introduction of computer tomography these processes could be identified much more easily. The ophthalmological findings are discussed. The most frequent causes of chiasmal syndrome are demonstrated on CT scan. The neuroradiological differential diagnosis of an enlarged sella turcica is given.

Wyburn-Mason syndrome subcutaneous angioma extirpation after preliminary embolisation.

In a 38-year-old women, suffering from the Bonnet-Blanc/Wyburn-Mason syndrome, a very disfiguring, pulsating 'angioma', situated left frontally, was successfully extirpated after gelfoam embolisation of the supplying external carotid artery. The patient, suffering from this syndrome which until recently was hardly amenable to treatment, could thus, thanks to modern embolisation technique and the great importance of a multidisciplinary approach by the ophthalmologist, neurologist, surgeon and radiologist.

Rapid deterioration of visual fields during bromocriptine-induced pregnancy in a patient with a pituitary adenoma.

A 28-year-old woman with an amenorrhoea-galactorrhoea syndrome was suspected of a microadenoma of the pituitary. She was treated with bromocriptine. In the subsequent pregnancy she developed rapid deterioration of the visual fields (ODS). A large temporal defect in the right eye and a moderate temporal defect in the left eye appeared in the 28th week of pregnancy, threatening the visual acuity of both eyes. Other examinations showed no evident lesion of the sellar region. An adenoma of the pituitary was removed, and the visual fields returned to normal after operation.

The Tolosa-Hunt syndrome.

The signs and symptoms of the Tolosa-Hunt syndrome are described and the results of orbital phlebography discussed. Emphasis is placed on the importance of systemic administration of corticosteroids, both as a diagnostic test and as a therapeutic measure. A case history is presented.

Nystagmus induced by intermittent photic stimulation (flash induced nystagmus (FIN).

In man, as has been shown previously in rabbits and monkeys, a nystagmus can be elicited by monocular intermittent photic stimulation. The direction of nystagmus (FIN) is always towards the stimulated eye. This nystagmus strongly resembles latent nystagmus. Here the fast phase is always directed towards the 'non-occluded' eye. The FIN may, therefore, be used as a model for the study of mechanisms underlying these pathological conditions. For further elucidation of FIN, studies were made in rabbits.