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Show Poster 9 A Unique Case of Transient Vision Loss Caused by Forceful Eye Rubbing During Sleep Michael Thorne1, Lysa Biosse-Lomax2, Bo Li3, Seyed Mirsattari3, J. Alexander Fraser3 1 Dalhousie University, Halifax, Canada, 2Queen's University, Kingston, Ontario, Canada, 3Western University, London, Ontario, Canada Introduction: Transient monocular vision loss upon awakening is thought to represent a benign phenomenon. We present a case that provides exception to this rule. Description of Case(s): A 23 year old woman was referred to neuro-ophthalmology for evaluation of recurrent episodes of complete monocular visual loss strictly occurring upon awakening at night. Family had witnessed extremely forceful eye rubbing during her sleep, to the point that she was burying her knuckles deep in her globes, with twisting movements that were audible across the room. She had tried various measures such as wearing mittens and goggles at night, with no effect. Her vision during the day remained normal. Past medical history included episodic migraine, restless legs syndrome, and somnambulism as a child. Best corrected visual acuity was 20/20 OU. Ophthalmological and neurological examination was normal. Humphrey automated perimetry was normal. Investigations that were completed and normal included a CT head, MRI head, routine EEG, and OCT. Overnight polysomnography was normal and did not reveal any abnormal movements. Corneal topography studies were negative for secondary keratoconus. Conclusions, including unique features of the case(s): The patient underwent three admissions to the epilepsy monitoring unit (EMU) for continuous (including nocturnal) videoelectroencephalogram (EEG) recording. During her third EMU admission several examples of her stereotyped eye rubbing were finally captured on video-EEG, occurring on different sides, and all definitively originating out of stage-2 non-REM sleep. The diagnosis of non-REM parasomnia was made. In the two months since starting prescription oral cannibidiol (CBD) oil 30mg three times daily, however, she has not had any further episodes, and she has woken up in the morning with makeup on her knuckles only twice, instead of nearly every day. References: Ifran M, Schenck CH, Howell MJ. (2017) Non-Rapid Eye Movement Sleep and Overlap Parasomnias. Continuum 23(4):1035-50. Turner DC, Girkin GA, Downs JC. (2019). The magnitude of intraocular pressure elevation associated with eye rubbing. Ben-Eli H, Erdinest N, Solomon A. (2019) Pathogenesis and complications of chronic eye rubbing in ocular allergy. Curr. Opin. Allergy Clin. Immunology Oct;19(5):526-534. Bouffard MA, Cornblath WT, et.al. (2017). Transient Monocular Vision Loss on Awakening: A Benign Amaurotic Phenomenon. J Neurophthal. 37:122-5. Savastano A, Savastano MC, Carlomusto L, Savastano S. (2015) Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing. Case Rep Ophthalmol. 2015 Sep 2;6(3):279-83. Pecora L, Carrasco MA. (2002) Eye-rubbing Optic Neuropathy. American Journal of Ophthalmology 134 (3):460-2. Ioannidis AS, Speedwell L, Nischal KK. (2005) Unilateral keratoconus in a child with chronic and persistent eye rubbing. American Journal of Ophthalmology 139(2):356-7. Jafri B, Lichter H, Stulting RD. (2004) Asymmetric keratoconus attributed to eye rubbing. Cornea 23(6):560-4. Keywords: Optic neuropathy, Orbit/ocular pathology Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: None provided. 2020 Annual Meeting Syllabus | 67 |
