Reversible Bitemporal Hemihypokinetic Pupil Without Hemianopia: A New Chiasmal Sign.

Chiasmal syndromes present mostly with visual problems, such as changes in visual fields, decreased visual acuity, or dyschromatopsia (and classically without pupillary reflex defects). The prototypical bitemporal hemianopia upon visual field testing can easily suggest chiasmal compression due to sellar/suprasellar involvement. However, because of the complexity of the decussation of fibres at the optic chiasm and the presence of anatomical variants, unpredictable visual fields defects can be detected in chiasmal diseases. In some patients, especially in those who have undergone neurosurgical procedures, visual field examination and neuroimaging may not completely reflect the classical pattern of chiasmal visual loss. We describe a novel semiological sign, reporting a patient in which a pupillary bitemporal hemihypokinesia was not accompanied by hemianopia, with the phenomenon being abolished by surgical resection of the causative pituitary macroadenoma. In addition, this finding was an important tool in making the diagnosis.

Efeitos da injeção intraorbitária de carboximetilcelulose 6.0% em coelhos: análise histológica e da mecânica ocular / Effects of intraorbital injection of 6.0% carboxymethylcellulose in rabbits: histological and ocular mechanics evaluation

OBJETIVO: Avaliar se a carboximetilcelulose 6,0% é capaz de atuar como modificadora do sistema oculomotor de coelhos por meio de forças de ação viscoelástica, a durabilidade de seu eventual efeito e reações teciduais à aplicação. MÉTODOS: Foram utilizados 25 coelhos da raça Nova Zelândia, divididos em dois grupos experimentais: um tratado com injeção peribulbar de carboximetilcelulose (CMC) 6,0 por cento e um controle que foi submetido à injeção peribulbar de 3,0 cc de soro fisiológico. No grupo tratado com CMC, variou-se o volume total injetado, obtendo-se, assim, quatro subgrupos (1,0, 1,5, 2,0 e 3,0 cc). Foram realizadas medidas da força necessária para promover movimentos tangenciais de adução, avaliação clínica e medidas da pressão intraocular antes, imediatamente após a injeção da substância e no 7º, 30º e 60º dia pós-operatório. A eutanásia dos animais foi realizada no 60º dia pós-operatório para análise histológica dos tecidos perioculares. RESULTADOS: A força média encontrada, 60 dias após a injeção da CMC 6,0 por cento, foi menor no subgrupo tratado 1,0 e maior nos subgrupos tratados 1,5, 2,0 e 3,0 relativamente à força antes da injeção. Nos subgrupos em que houve aumento da força, a análise histológica revelou processo inflamatório do tipo histiocitário com formação de fibrose e a presença da CMC nos tecidos perioculares. CONCLUSÕES: A carboximetilcelulose 6,0 por cento atuou como modificadora do sistema oculomotor de coelhos, podendo facilitar ou dificultar movimentos. Não foi possível concluir se o aumento da força deveu-se apenas ao processo inflamatório ou à soma de inflamação com um possível atrito viscoso provocado pela CMC.

PURPOSE: To determine the effects of 6.0% carboxymethylcellulose (CMC) in modifying the oculomotor system of rabbits by means of viscoelastic action forces, the durability of this effect and possible inflamatory reaction. METHODS: Twenty-five New Zealand rabbits were divided into two experimental groups: one treated with a peribulbar injection of 6.0 percent CMC and a control group submitted to peribulbar injection of 3.0 cc of physiological saline. The group submitted to peribulbar CMC injection was divided into four subgroups respectively receiving the following volumes: 1.0, 1.5, 2.0 and 3.0 cc. The force needed to promote tangential adduction dislocations, external ophthalmologic signs and intraocular pressure were evaluated. The animals were sacrificed on the 60th day after the injection for histological analysis. RESULTS: The mean force detected 60 days after the injection of 6.0 percent CMC was lower in the 1.0 treated subgroup and higher in the 1.5, 2.0 and 3.0 treated subgroups relative to the force before injection. Histological analysis revealed histiocytic infiltration with fibrosis in the subgroups in which there was an increase in force and the presence of CMC in periocular tissues. CONCLUSIONS: 6.0 percent CMC acted as a modifier of the oculomotor system of rabbits, facilitating or impairing movements. It was not possible to conclude whether the increase in force occurred as a consequence of the inflammatory process alone or of the sum of inflammation and a possible viscous attrition provoked by CMC.

[Effects of intraorbital injection of 6.0% carboxymethylcellulose in rabbits: histological and ocular mechanics evaluation]. / Efeitos da injeção intraorbitária de carboximetilcelulose 6,0% em coelhos: análise histológica e da mecânica ocular.

PURPOSE: To determine the effects of 6.0% carboxymethylcellulose (CMC) in modifying the oculomotor system of rabbits by means of viscoelastic action forces, the durability of this effect and possible inflammatory reaction. METHODS: Twenty-five New Zealand rabbits were divided into two experimental groups: one treated with a peribulbar injection of 6.0% CMC and a control group submitted to peribulbar injection of 3.0 cc of physiological saline. The group submitted to peribulbar CMC injection was divided into four subgroups respectively receiving the following volumes: 1.0, 1.5, 2.0 and 3.0 cc. The force needed to promote tangential adduction dislocations, external ophthalmologic signs and intraocular pressure were evaluated. The animals were sacrificed on the 60th day after the injection for histological analysis. RESULTS: The mean force detected 60 days after the injection of 6.0% CMC was lower in the 1.0 treated subgroup and higher in the 1.5, 2.0 and 3.0 treated subgroups relative to the force before injection. Histological analysis revealed histiocytic infiltration with fibrosis in the subgroups in which there was an increase in force and the presence of CMC in periocular tissues. CONCLUSIONS: 6.0% CMC acted as a modifier of the oculomotor system of rabbits, facilitating or impairing movements. It was not possible to conclude whether the increase in force occurred as a consequence of the inflammatory process alone or of the sum of inflammation and a possible viscous attrition provoked by CMC.

Atypical pneumococcal scleritis after pterygium excision: case report and literature review.

PURPOSE: To describe an unusual case of pneumococcal scleritis after pterygium excision and to review the literature on infectious scleritis associated with pterygium excision. METHODS: Case report and literature review. RESULTS: A 58-year-old white man underwent excision of a nasal pterygium of the right eye. Two weeks postoperatively, the patient developed an infectious scleritis caused by Streptococcus pneumoniae. The scleritis was complicated with hypopyon and a scleral necrosis area 6 mm away from the superior limbus with a positive Seidel test. Topical and systemic antibiotics resolved the case without any surgical procedures. CONCLUSION: Streptococcus pneumoniae must be considered as a possible agent in cases of necrotizing scleritis associated with pterygium excision.

[Abnormal head position caused by incorrect prescription for astigmatism: case report]. / Posição viciosa de cabeça por astigmatismo mal corrigido: relato de caso.

Abnormal head position is a compensatory condition which improves patients' vision. It can be caused by ophthalmological problems such as oculomotor imbalances (strabismus, nystagmus) and high astigmatism. However, it results in esthetic impairment, orthopedic trouble and facial asymmetries. We describe a case of a girl, JL, 8 years, with abnormal head position tilted to the left since the last glasses were prescribed. The correction used by the patient was: right eye = +2.00 sph diopter -5.5 cyl 180 degrees and left eye = +2.25 sph diopter -5.75 cyl 180 degrees. In tilted position, the correct visual acuity was: right eye 6/12 and left eye 6/9. No deviations were noted by the cover test and the remaining ophthalmological examination was completely normal. Retinoscopy under cycloplegia and subjective test showed right eye = +3.50 sph diopter -6.00 cyl 10 degrees; and left eye = +3.50 sph diopter -6.00 cyl 170 degrees, with visual acuity 6/6 in both eyes. With adequate prescription, the head position was normalized. Wrong cylindrical positions for correction of high astigmatism may cause abnormal head position. Retinoscopy under cycloplegia and subjective test are essential for precise diagnoses and prescriptions.