Epidemiological features of ophthalmic emergencies during the COVID-19 lockdown: Impact of the health crisis in a tertiary care center.

PURPOSE: The goal of this study is to examine changing patterns of ophthalmic visits in an emergency eye care unit of a tertiary referral center in Paris, France, during the Coronavirus disease-19 (COVID-19) pandemic compared to a control period. MATERIALS AND METHODS: This was a single-center, retrospective, observational, epidemiological study. We included all visits in the emergency eye care unit of the Quinze-Vingts National Ophthalmology Center, Paris, France, from March 17, 2020 to April 30, 2020, and a corresponding time period in 2016. We analyzed patients' demographic factors, chief complaints, referral patterns, examination findings, treatment provided, hospitalizations and surgical interventions. RESULTS: During the 6weeks of lockdown, 3547 emergency visits were recorded. The control group contained 2108 patients from June 6-19, 2016. There was a decrease of approximately 50% in the number of average daily visitations. The frequency of serious diagnoses (including severe eye inflammation, serious infections, retinal vascular pathologies, surgical emergencies, and neuro-ophthalmology), increased overall during the period (P=0.03). The proportion of low severity pathologies decreased (P<0.001) between the two periods. In addition, an increased amount of ancillary testing was performed (P<0.001). Finally, the rate of hospitalizations was significantly lower during the lockdown period (P<0.001). CONCLUSION: A significant reduction in total ophthalmic presentations in the emergency eye care unit was observed during the lockdown period. However, the proportion of emergencies requiring specialized treatments (surgical, infectious, inflammatory and neuro-ophthalmological pathologies) increased.

Severe atypical Lemierre syndrome caused by methicillin-sensitive Staphylococcus aureus: Two pediatric case reports.

BACKGROUND: Lemierre syndrome is typically associated with ear, nose, and throat (ENT) infections caused by Fusobacterium necrophorum. Since 2002, cases of atypical Lemierre-like syndrome secondary to Staphylococcus aureus have been reported. CASES: We report two pediatric cases of atypical Lemierre syndrome with a similar presentation: exophthalmia, absence of pharyngitis, metastatic lung infection, and intracranial venous sinus thrombosis. Both patients had a favorable outcome following treatment with antibiotics, anticoagulation, and corticosteroids. CONCLUSION: Regular therapeutic monitoring of antibiotic levels helped to optimize antimicrobial treatment in both cases.

[Chiasmatic syndrome]. / Syndrome chiasmatique.

The optic chiasm is an essential anatomical structure in neuro-ophthalmology. The systematization of the visual pathways results from the arrangement of the retinal ganglion cell fibers. It explains the signs of chiasmal syndrome. A good knowledge of the anatomy permits to correlate visual field defects with imaging results. It is now possible to map the organization of the ganglion cell fibers within the chiasm. Their hemidecussation allows for stereoscopic vision in humans. The causes of chiasmal syndrome are multiple, but tumors and compressive causes predominate. The proximity of the pituitary region to the chiasm accounts for the frequency of chiasmal syndrome, which involves ophthalmologists not only through dysfunction of the visual pathway, which may be the presenting sign, but also through possible complications throughout the course of the disease. This review aims to synthesize the embryology, anatomy and principles of work-up for chiasmal syndrome as well as its many possible causes.

Ophthalmological management in craniosynostosis.

INTRODUCTION: In published series, a large proportion of patients with craniosynostosis show impaired vision. MATERIALS AND METHODS: A literature review was performed, using the PubMed and Google Scholar databases, to identify original and review articles on the consequences of craniosynostosis on the eyes and visual pathways, and on the ophthalmological management of craniosynostosis. RESULTS AND DISCUSSION: Many ophthalmic, potentially sight-threatening, complications, can occur in patients with craniosynostosis, especially when syndromic. Optic neuropathy, mostly resulting from the papilledema-optic atrophy sequence, secondary to raised intracranial pressure (ICP), should be diagnosed early, in order to promptly lower the ICP. Cyclovertical and horizontal strabismus and refractive errors are frequent in unicoronal synostosis (anterior plagiocephaly) and syndromic craniosynostosis. Exorbitism, encountered in some cases of syndromic craniofacial synostosis, leads to exposure keratopathy, which requires aggressive management to avoid severe irremediable corneal complications. Amblyopia can result from optic neuropathy, corneal opacities, strabismus, or refractive errors. If undiagnosed and untreated at a young age, it results in permanent visual impairment. CONCLUSION: Children with craniosynostosis require a multidisciplinary care network including a pediatric ophthalmologist. Systematic ophthalmological follow-up enables papilledema to be diagnosed and amblyopia to be diagnosed and treated, in order to avoid visual impairment.