Ophthalmic manifestations of Rochalimaea species.

Rochalimaea henselae and R. quintana belong to the order Rickettsiales and are thought to be responsible for trench fever, bacillary angiomatosis, and cat scratch disease. We recently examined four patients with intraocular inflammation of unknown origin. Each patient had either unilateral or bilateral moderate loss of visual acuity ranging from 20/25 to counting fingers. Bilateral intraocular inflammation manifested by anterior and posterior segment cells, retinal lesions, macular exudate, and optic nerve head swelling was present to varying degrees. The R. henselae to R. quintana antibody titers were greater than or equal to 1:256 in each case. Marked improvement in vision occurred after treatment with either oral ciprofloxacin hydrochloride and prednisone or doxycycline hyclate. Rochalimaea species should be considered in the differential diagnosis of intraocular inflammation and inflammatory optic neuropathy. Appropriate treatment may result in marked improvement in visual acuity.

Retinal vein occlusion.

Retinal vein occlusion is a common form of retinal vascular disease, especially in middle-aged and older individuals. The diagnosis is based on the funduscopic finding of retinal vein dilatation in association with retinal hemorrhages and cotton-wool spots. The pathology can involve the entire venous system or can be limited to a branch of the central retinal vein. Retinal vein occlusion can be distinguished clinically from diabetic retinopathy and other retinal diseases. Treatment for the acute phase of retinal vein occlusion has been disappointing. However, some late complications, such as persistent macular edema and neovascularization of the iris and retina, respond well to retinal photocoagulation. The family physician has an important role in detecting and controlling risk factors for retinal vein occlusion, including hypertension, diabetes mellitus and hyperviscosity syndromes.

Trochlear nerve palsy as a false localizing sign.

A 12-year-old boy developed a fourth nerve palsy during the course of pseudotumor cerebri syndrome. False or nonlocalizing signs that occur during the course of intracranial disease are briefly reviewed. The rarity of a fourth nerve palsy as a false localizing sign is pointed out. However, the question is raised whether a number of subtle fourth nerve palsies go unnoticed and that the true incidence of false localizing fourth nerve palsies is higher.

Traumatic bilateral homonymous hemianopic scotomas.

A patient is presented who received a gunshot wound that injured both occipital poles. It resulted in a central scotoma that was due to the combined effect of both right and left homonymous hemianopic scotomas. A 15 degrees wedge of retained, functioning, central field permitted the retention of 20/20 visual acuity. This case illustrates the point that only a small portion of the central fixation area need to be retained in order to maintain normal central visual acuity. We stress the diagnostic significance of vertical steps demonstrated with central scotomas as an indication that the field defect is due to retrochiasmal disease rather than bilateral macular or optic nerve disease.