Association of ocular findings and outcome in cerebral venous thrombosis.

BACKGROUND: Cerebral venous thrombosis (CVT) is a potentially life-threatening underdiagnosed disease. Headache is a common but nonspecific finding in CVT. Other features such as ocular finding can assist to correct diagnosis, but their frequency in CVT has not been previously evaluated. The aim of this study is to evaluate the ocular symptoms and signs in CVT and their association with outcome. METHODS: The demographic, clinical, laboratory, radiological, and outcome data were collected and analyzed from patients referred to a tertiary hospital during 6 years. Based on delay from symptom onset to hospital admission, mode of onset was categorized as acute (<2 days), subacute (2-14 days), or chronic (>14 days). RESULTS: Fifty-three patients were identified with a mean age of 33.7 years (17-60 years). Ocular symptoms and signs were the most frequent clinical presentations (77.4%) following headache (83%). Papilledema and diplopia were the main findings in chronic CVTs (P = 0.003 and 0.002, respectively). Proptosis was significantly associated with thrombosis in cavernous sinus (P = 0.00). Otherwise, there was no relationship between any specific ocular findings and the type or number of thrombosed sinus or hemorrhagic infarction. Mortality rate and recurrence in our patients were 3.8% and 5.7%. Absence of proptosis and vision loss was associated with favorable outcome (P = 0.001 and 0.003, respectively). CONCLUSION: Ocular features were among the most common presentation of CVT in every three phases of CVT and could be the sole finding of CVT. Patients who do not have vision loss and proptosis might have a better outcome in CVT.

Effect of Four Horizontal Rectus Muscle Tenotomy and Replacement (TAR) Alone and in Combination with Recessions for Strabismus, on Visual Function and Eye Movements in Patients with Infantile Nystagmus Syndrome (INS) Without Abnormal Head Posture (AHP).

PURPOSE: To evaluate and compare the effect of four horizontal rectus muscle Tenotomy And Replacement (TAR) alone and in combination with recessions for strabismus, on visual function and eye movement records in patients with INS without AHP, and to compare these results. METHODS: This was a prospective interventional case series of 14 patients with INS with no AHP or eccentric null point. Patients underwent 4 horizontal eye muscle tenotomy and replacement (TAR) alone or 2 muscle TAR in combination with conventional bilateral horizontal muscle recession according to the presence and type of strabismus. Outcome measures included best corrected visual acuity and nystagmus intensity from eye movement recordings pre and post operatively. Data were compared between patients with strabismus and those without. RESULTS: Overall nystagmus amplitude and velocity was decreased 28.7% and 21.9% respectively for 4 muscle TAR and 2 muscle TAR with paired strabismus recessions. Visual outcome of combined procedure in patients with INS and strabismus was less comparing with 4 muscle tenotomy. All binocular deviations were surgically corrected and there was no undercorrection or complication. Visual acuity showed improvement in patients who had more impaired pre-operation vision. Most patients were satisfied with cosmetic outcomes. CONCLUSIONS: Tenotomy alone and combined with recession improves both visual function and eye movement records in INS. The procedures show better results in more visually impaired patients. We should consider patients preop VA and their visual potential as prognostic factors for their visual gain. Although visual outcomes are not advanced in all patients, nystagmus dampening effect and cosmetic outcome of these procedures can make them reconstructive options for patients with INS who will not achieve better vision.

Different causes of referral to ophthalmology emergency room.

BACKGROUND: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. AIM: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. SETTINGS AND DESIGN: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. MATERIALS AND METHODS: The patients' demographic data, medical history and final diagnosis were recorded in a questionnaire. RESULTS: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6%) were males. While 299 patients (9.5%) were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%). In patients referred due to trauma (1950 patients), work-related injuries occurred in 955 patients (49%) and occurred accidentally (by chance) in 819 patients (42%). The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%). The most common etiologies of eye trauma (1950 patients) were metal filings (814 patients; 41.8%), blunt trauma (338 patients; 17.3%), fireworks (236 patients; 12.1%) and sharp objects (222 patients; 11.4%). Globe injury was diagnosed in 1865 patients (95.7%) of trauma cases. In patients referred due to non-traumatic reason (1200 patients), eye infection occurred in 482 patients (40.2%) and 299 patients (24.9%) were referred for non-urgent reasons. There was little difference between the frequency of non-trauma-related problems among genders (672 male patients; 56% versus 528 female patients; 44%). CONCLUSIONS: This study identified multiple risk factors whose presence significantly increases severity of an eye injury. Male gender, youth and unprotected eyes during high-risk activities such as sports and certain jobs are risk factors for eye injuries. In patients referred due to non-traumatic reasons, males and females are similar. Considerable proportion of non-trauma-related problems was due to eye infection, that one of the most important reasons may be connected to the increasing use of contact lenses in our target population. Thereupon, we need for further educative and preventive interventions at the level of general population.

Epidemiology and sociodemographic aspects of ocular traumatic injuries in Iran.

Although the incidence of ocular trauma has been clearly described in developed countries, few published data are available on the epidemiology and the effects of parameters that can influence the incidence and severity of ocular injuries in Iran. The present study tried to determine epidemiological aspects of ocular traumatic injuries and evaluate their effects on different types of ocular injury. The case series included 1950 consecutive patients with acute ophthalmic trauma presented to the emergency ward of Farabi Hospital in Tehran. Information was collected by interviewing patients and having them fill in a questionnaire. The final diagnosis was made by a medical resident. If there was a difficulty or doubt in diagnosis or classification, confirmation of diagnosis was made by senior faculty. Ocular injuries were classified into globe and non-globe injuries according to the site of injury. Mechanical globe injuries were classified according to Birmingham Eye Trauma Terminology (BETT) into closed and open injuries. The mean age of patients was 28.8 ± 12.8 years; 87.6% were male. The most common causes of injury were work-related (49.0%) and chance events (42.0%). The most frequent ocular injury was globe injury (95.6%), including mechanical (77.6% closed and 5.9% open), chemical (7.6%), photic (2.3%) and thermal (2.2%) injuries. Non-globe injury also occurred in 10.8% of patients; both globe and non-globe injuries occurred in 6.5% of patients. The hospitalization rate in all patients was 8.8%. Previous history of eye trauma was significantly more common in the group with isolated globe injuries (P < 0.001). History of eye trauma is a risk factor for globe injuries and female gender is a risk factor only for non-globe injuries. These two factors may predict future eye injury and increase its risk by 5.2 and 1.6 times, respectively.