Topical ocular anaesthetic abuse in a contact lens wearer: a case of microbial keratitis.

We describe the abuse of a topical ocular anaesthetic in a contact lens wearer who developed microbial keratitis.

Access to low-vision rehabilitation services: barriers and enablers.

BACKGROUND: The current mismatch between the need for and uptake of low-vision services has been attributed to various barriers including different service delivery models and referral pathways. This study evaluates the referral pathway and low-vision service provision of the Royal Society for the Blind (RSB) in South Australia. METHODS: All new referrals from the 2008-2009 financial year to the RSB were reviewed. Initially, patients were contacted by a triage officer within one week of referral. Initial appointments were made in the Low Vision Clinic with a multidisciplinary team. Reasons for declining the appointment or non-attendance were tracked via telephone. RESULTS: There were 1116 patients referred over a 12-month period and 1082 (97 per cent) were reviewed in the Low Vision Clinic. Most attendees (92 per cent) lived within 50 kilometres of the clinic. There were 34 referred patients, who declined or did not attend the assessment. All non-attendees also lived within 50 kilometres of the Low Vision Centre. Concurrent major health problems (27 per cent) and patients not feeling the need for low-vision rehabilitation (27 per cent) were the most common reasons for not accessing the service. Only 125 patients (11.6 per cent) accessed volunteer transport services and only 24 patients (2.2 per cent) needed an interpreter service. CONCLUSION: The attendance rate is significantly higher than in other published studies. The distance to travel or transport difficulties were not significant barriers. Patient perception that either the service was not required or would not help them was the main barrier. The referral and triage process appeared to be a major enabler of low-vision service uptake.

Multiple sclerosis: patients' information sources and needs on disease symptoms and management.

OBJECTIVE: To investigate the current information sources of patients with multiple sclerosis (MS) in the early stages of their disease and to identify patients' preferred source of information. The relative amounts of information from the different sources were also compared. METHODS: Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources. RESULTS: A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources. CONCLUSION: This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future. PRACTICE IMPLICATIONS: More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse.

Traumatic vertebral artery dissection presenting with incomplete congruous homonymous quadrantanopia.

BACKGROUND: To describe a rare presentation of vertebral artery dissection (VAD) as a small but congruous incomplete homonymous hemianopia demonstrating use of visual field testing in the diagnosis. CASE PRESENTATION: A 30 year old woman had been unwell for 4 months with difficulty focusing, vertigo, dizziness and a feeling of falling to the right. A small but congruous right inferior homonymous quadrantanopia was found on examination leading to further investigation that uncovered a vertebral artery dissection and multiple posterior circulation infarctions including a left occipital stroke matching the field defect. CONCLUSIONS: We describe an atypical case of VAD presenting with a small congruous quadrantanopia. This is a rare but significant condition that predisposes to multiple thromboembolic infarction that may be easily misdiagnosed and a high index of suspicion is required to make the diagnosis.

Patients' knowledge and perception on optic neuritis management before and after an information session.

BACKGROUND: Patients' understanding of their condition affect the choice of treatment. The aim of this study is to evaluate patients' understanding and treatment preferences before and after an information session on the treatment of acute optic neuritis. METHODS: Participants were asked to complete a questionnaire consisting of 14 questions before and after an information session presented by a neuro-ophthalmologist. The information session highlighted the treatment options and the treatment effects based on the Optic Neuritis Treatment Trial in plain patient language. The information session stressed the finding that high dose intravenous steroid therapy accelerated visual recovery but does not change final vision and that treatment with oral prednisone alone resulted in a higher incidence of recurrent optic neuritis. RESULTS: Before the information session, 23 (85%) participants knew that there was treatment available for ON and this increased to 27 (100%) after the information session. There were no significantly change in patients knowledge of symptoms of ON and purpose of treatment before and after the information session. Before the information session, 4 (14%) respondents reported they would like to be treated by oral steroid alone in the event of an optic neuritis and 5 (19%) did not respond. After the education session, only 1 patient (4%) indicated they would undergo treatment with oral steroid alone but 25 (92%) indicated they would undergo treatment with intravenous steroid treatment, alone or in combination with oral treatment. Results indicated that there were significant differences in the numbers of participants selecting that they would undergo treatment with a steroid injection (n = 22, p = 0.016). CONCLUSIONS: In this study, patients have shown good understanding of the symptoms and signs of optic neuritis. The finding that significant increases in the likelihood of patients engaging in best practice can be achieved with an information session is very important. This suggests that patient knowledge of available treatments and outcomes can play an important role in implementing and adopting guideline recommendations.

Isolated unilateral abducens cranial nerve palsy: a rare presentation of pituitary apoplexy.

PURPOSE: To describe a rare presentation of pituitary apoplexy as unilateral abducens nerve palsy demonstrating the various presentations of the condition. METHODS: Case report. RESULTS: A 48-year-old man presented with isolated right abducens nerve palsy. Magnetic resonance imaging showed a large pituitary macroadenoma with evidence of recent bleed into the right cavernous sinus and surrounding the right internal carotid artery. CONCLUSIONS: Pituitary apoplexy may present subtly with an isolated sixth nerve palsy but the condition is critical and high index of suspicion needs to be governed.