| OCR Text |
Show Journal of Nemo- Ophthalmology 14( 4): 217- 223, 1994. © 1994 Raven Press, Ltd., New York Literature Abstracts Bilateral Visual Loss and Disc Edema in a 15- Year- Old Girl. Newman NJ. Comments. Sedwick LA, Boghen DR. Surv Ophthalmol 1994; 38: 365- 70 ( Jan- Feb). [ Reprints are not available.] This clinical pathological correlation ( CPC) involves a 15- year- old girl with some URI symptoms, headaches, dizziness, bilateral disc edema, and visual loss. She also has a history of several ventric-uloperitoneal shunt surgeries for hydrocephalus starting at age 6 weeks. Her eventual visual demise was secondary to long- standing papilledema, an unfortunate sequela of delayed diagnosis and treatment for shunt dysfunction. Chiasmal Trauma: Clinical and Imaging Considerations. Tang RA, Kramer LA, Schiffman J, Woon C, Hayman LA, Pardo G. Surv Ophthalmol 1994; 38: 381- 3 ( Jan- Feb). [ Reprint requests to Dr. R. A. Tang, 2476 Bolsover, # 359, Houston, TX 77005.] A 17- year- old boy who was thrown from his speeding motorcycle complained of a bitemporal hemianopia. Initial computerized tomographic scanning demonstrated multiple facial and skull fractures; but, because of his complaint of a bitemporal hemianopsia, magnetic resonance imaging was done, which demonstrated extensive damage in the region of the gyrus recti and chiasm. He soon developed evidence of hypopituitarism. Very nice magnetic resonance imaging photographs are included. Ophthalmologic Features of Thallium Poisoning. Tabandeh H, Crowston JG, Thompson GM. Am J Ophthalmol 1994; 117: 243- 5 ( Feb). [ Reprint requests to Dr. H. Tabandeh, Department of Ophthalmology, St. George's Hospital, London SW 17 OQT, Great Britain.] A 44- year- old man examined a month after hospitalization for acute thallium toxicity was found to have mildly diminished visual acuity in one eye, decreased contrast sensitivity across all spatial fre- Lyn A. Sedwick, MD quencies of both eyes, bilateral abnormal color vision, and bilateral relative cecocentral scotomata. By 2 months posthospitalization, he demonstrated mild optic atrophy. This interesting toxic optic neuropathy is discussed as one other possible neurologic effect of this poison. Orbital Invasion by Pituitary Adenoma. Spiegel PH, Karcioglu ZA. Am J Ophthalmol 1994; 117: 270- 1 ( Feb). [ Inquiries to Dr. Z. A. Karcioglu, Tulane University Medical School, Department of Ophthalmology, 1430 Tulane Ave., New Orleans, LA 70112- 2699.] A 19- year- old woman developed secondary amenorrhea and galactorrhea in 1976, which partially responded to Parlodel. In 1979, a computerized tomographic scan was reportedly normal, although the sella was a little large and prolactin was 361. Craniotomy one year later showed a pituitary adenoma with extensive suprasellar extension, but no orbital invasion. Two years later, she lost vision in her right eye, and a subtotal resection was performed with tumor notably left behind in the right cavernous sinus. Postoperative radiation therapy was given. In 1989, she presented with massive orbital extension of the tumor. This unusual orbital invasion by a " benign" pituitary adenomas is discussed. A Review of 340 Orbital Tumors in Children During a 60- Year Period. Kodsi SR, Shetlar DJ, Campbell RJ, Garrity JA, Bartley GB. Am J Ophthalmol 1994; 117: 177- 82 ( Feb). [ Reprint requests to Dr. R. J. Campbell, Mayo Clinic, 200 First St. S. W., Rochester, MN 55905.] Files of the Department of Pathology at the Mayo Clinic were searched for records from 1932 through 1991 of patients, 18 years or younger, with orbital tumors. Of the 340 cases found, the most common tumors were cysts ( 23.2%) and overall malignancies in almost a fifth ( 18.2%). Details of 227 218 LITERATURE ABSTRACTS specific tumors found and differing trends in the first versus second 30 years of this study are discussed. Salvage of Vision After Hypotension- Induced Ischemic Optic Neuropathy. Connolly SE, Gordon KB, Horton JC. Am J Ophthalmol 1994; 117: 235- 42 ( Feb). [ Reprint requests to Dr. J. C. Horton, Department of Ophthalmology, UCSF, 10 Kirkham St., San Francisco, CA 94143- 0730.] The authors report three patients with nonar-teritic ischemic optic neuropathy ( two bilateral) temporally immediately related to hypotension and/ or hypovolemia. Vision was improved in all by immediate efforts to increase the blood pressure or restore volume or blood. These interesting cases are presented in detail. Combined Central Retinal Vein Occlusion and Cilioretinal Artery Occlusion Associated With Prolonged Retinal Arterial Filling. Keyser BJ, Duker JS, Brown GC, Sergott RC, Bosley TM. Am J Ophthalmol 1994; 117: 308- 13 ( Mar). [ Reprint requests to Dr. G. C. Brown, 910 E. Willow Grove Ave., Wyndmoor, PA 19118.] The authors describe four men, aged 23 to 47 years, with cilioretinal artery occlusion associated with central retinal vein occlusion without an associated abnormal central retinal artery inflow. Three of the four had recurrent episodes of visual loss, although final visual acuity was 20/ 40 or better in three of four patients. This unusual clinical presentation is discussed. Pseudotumor Cerebri Associated with Corticosteroid Withdrawal in Inflammatory Bowel Disease. Liu GT, Kay MD, Bienfang DC, Schatz NJ. Am J Ophthalmol 1994; 117: 352- 7 ( Mar). [ Reprint requests to Dr. G. T. Liu, Neuro- ophthalmology Unit, Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.] Three patients with inflammatory bowel disease developed pseudotumor cerebri with tapering doses of corticosteroids. These unusual cases are discussed in detail. Aberrant Innervational Pattern in Duane's Syndrome Type II Without Globe Retraction. Gross SA, Tien DR, Breinin GM. Am ] Ophthalmol 1994; 117: 348- 51 ( Mar). [ Reprint requests to Dr. S. A. Gross, University of South Florida College of Medicine, Department of Ophthalmology, 12901 Bruce B. Downs Blvd., MDC- 21, Tampa, FL 33612.] A 17- year- old boy with a history of a head turn and no adduction right eye, which dated to 8 months of age, was studied with electromyography. In fact, the boy demonstrated anomalous firing of both lateral and medial recti in attempted adduction but did not have globe retraction. The authors discuss this lack of retraction and postulate how electromyography can help to plan surgery. Color Doppler Imaging of a Spontaneously Resolved Carotid- Cavernous Sinus Fistula. Okabe H, Takahashi A, Tamai M. Am J Ophthalmol 1994; 117: 410- 1 ( Mar). [ Inquiries to Dr. H. Okabe, Department of Ophthalmology, Tohoku University School of Medicine, 1- 1, Seiryo- machi, Aoba- ku, Sendai 980, Japan.] A 58- year- old woman with clinical signs and symptoms of a low- flow carotid- cavernous fistula was examined with color Doppler. There was no blood and an absent Doppler shift in the dilated superior ophthalmic vein, and conventional arteriography confirmed the spontaneous resolution of the fistula. Neurovisual Findings in the Syndrome of Spontaneous Intracranial Hypotension from Dural Cerebrospinal Fluid Leak. Horton JC, Fishman RA. Ophthalmology 1994; 101: 244- 51 ( Feb). [ Reprint requests to Dr. J. C. Horton, Department of Ophthalmology, K301, 10 Kirkham St, University of California, San Francisco, CA 94143- 0730.] Three patients with spontaneous intracranial hypotension are presented, two with transient obscurations of vision and peripheral automated visual field defects and one with a sixth nerve palsy. In addition, all had headaches that were relieved by lying flat. After treatment, all visual symptoms and signs improved. Magnetic resonance scanning in each patient suggested the diagnosis of flattening of the pons against the clivus, crowding of the / Neuro- Ophthalmol, Vol. 14, No. 4, 1994 LITERATURE ABSTRACTS 219 chiasm between the brain and pituitary fossa, and/ or thickening of the dura with subdural effusions with enhancement postgadolinium. A very interesting disorder. Orbital Decompression for Disfiguring Exophthalmos in Thyroid Orbitopathy. Lyons CJ, Root-man J. Ophthalmology 1994; 101: 223- 30 ( Feb). [ Reprint requests to Dr. J. Rootman, Department of Ophthalmology, 2550 Willow St, Vancouver, British Columbia, V5Z 3N9 Canada.] The authors report their experience with orbital decompression for a disfiguring exophthalmos in 34 patients ( 65 orbits). They used several surgical approaches but usually a medial canthal incision or subciliary incision with decompression into the maxillary antrum and ethmoidal air cells. The results were generally good, although five patients developed diplopia, which was successfully treated, compensated, or resolved. The mean ret-roplacement was 4 mm ( range: 1- 10 mm). Impressive pre- and postoperative full- face photographs are included. Cortical Visual Impairment in Children. Good WV, Jan JE, DeSa L, Barkovich AJ, Groenveld M, Hoyt CS. Surv Ophthalmol 1994; 38: 351- 64 ( Jan- Feb). [ Reprint requests to Dr. W. V. Good, A704, 400 Parnassus Avenue, University of California, San Francisco, San Francisco, CA 94143.] This is an eminently readable " major review" of the topic, which includes, among others, interesting sections on ophthalmic evaluation, neurobe-havioral adaptations, use of imaging techniques, causes, differential diagnosis, and rehabilitation of these youngsters. Orbital Lymphoma Associated with Acquired Immune Deficiency Syndrome ( AIDS). Reifler DM, Warzynski MJ, Blount WR, Graham DM, Mills KA. Surv Ophthalmol 1994; 38: 371- 80 ( Jan- Feb). [ Reprint requests to Dr. D. M. Reifler, East Paris Medical Building, Suite 221, 1000 East Paris Ave., S. E., Grand Rapids, MI 49546.] A 35- year- old HIV- positive man presented with a 3- week history of left orbital swelling, a biopsy of which disclosed small, noncleaved cell ( Burkitt's type) lymphoma. Other similar reported cases are catalogued in Table 1 and discussed at length. Fluorescein Angiography in Acute Nonarteritic Anterior Ischemic Optic Neuropathy. Arnold AC, Hepler RS. Am J Ophthalmol 1994; 117: 222- 30 ( Feb). [ Reprint requests to Dr. A. C. Arnold, Jules Stein Eye Institute, 100 Stein Plaza, UCLA, Los Angeles, CA 99024- 7005.] Intravenous fluorescein angiography from 41 patients with nonarteritic ischemic optic neuropathy of less than 3 weeks duration were compared with those of 43 age- matched control patients. There was a significant delay in onset and time to completion of prelaminar optic disc filling in patients with nonarteritic ischemic optic neuropathy, but both onset and completion of peripapillary choroidal filling were not delayed. These data suggest that nonarteritic ischemic optic neuropathy results from " reduced perfusion within the territory of the paraoptic branches of the short posterior ciliary arteries" but not from short posterior ciliary occlusion or hypoperfusion of peripapillary choroid. Temporal Artery Biopsy After One Month of Corticosteroid Therapy. To KW, Enzer YR, Tsiaras WG. Am } Ophthalmol 1994; 117: 265- 7 ( Feb). [ Inquiries to Dr. K. W. To, Rhode Island Hospital, Department of Ophthalmology, 593 Eddy St. APC- 744, Providence, RI 02903.] An 80- year- old lady with a 3- week history of headaches presented with a pupil- sparing third nerve palsy. Westergren sedimentation rate was 71 mm/ h, and corticosteroids ( prednisone 60 mg a day) was started. The patient refused biopsy initially but 4 weeks later did consent, at which point her third nerve palsy had resolved and her sedimentation rate was 14. The biopsy was unequivocally positive, bringing into doubt conventional wisdom about how quickly such biopsies must be done after initiating corticosteroid therapy. Primitive Neuroectodermal Tumor of the Orbit. Singh AD, Husson M, Shields CL, De Potter P, Shields JA. Arch Ophthalmol 1994; 112: 217- 21 ( Feb). / Neuro- Ophthalmol, Vol. 14, No. 4, 1994 220 LITERATURE ABSTRACTS [ Reprint requests to Dr. J. A. Shields, Oncology Service, Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107.] A 10- year- old girl developed a lump in the lateral aspect of the right eyebrow over a 3- week period, which, on computerized tomographic scanning, extended into the upper outer anterior half of the orbit. Incisional biopsy revealed a primitive neuroectodermal tumor, a malignancy that has been reported in this location only twice previously. Temporal Artery Biopsy and Sarcoidosis. Levy MH, Margo CE. Am J Ophthalmol 1994; 117: 409- 10 ( Mar). [ Inquiries to Dr. M. H. Levy, 3400 Bee Ridge Rd., Sarasota, FL 34239.] A 51- year- old patient with new bifrontal headaches had a temporal artery biopsy performed, which showed focal noncaseating granulomatous inflammation just outside the wall of the artery, the significance of which was unknown. Several months later, the patient had an abnormal chest radiograph, which led to mediastinal lymph node biopsy, showing similar inflammatory changes. A diagnosis of sarcoidosis was made. [CFoculartrauma] Variable Diplopia and Blepharoptosis After Orbital Floor Fracture Repair. Vaughn GL, Hass AN, Bosley TM, Flanagan JC. Am ] Ophthalmol 1994; 117: 407- 9 ( Mar). [ Inquiries to Dr. J. C. Flanagan, Director, Oculoplastics Department, Wills Eye Hospital, 900 Walnut St., Philadelphia, PA 19107.] A 23- year- old patient with an orbital floor fracture from a soccer injury acutely demonstrated 2 mm of blepharoptosis of the right upper lid and 2 mm of enophthalmos with a marked, deficit of su-praduction. Surgical repair gave a good initial result; however, diplopia and ptosis recurred and responded favorably to a short course of oral corticosteroids only to recur upon withdrawal of the drug. Acetylcholine receptor antibody assay was negative, but Tensilon testing was positive. The Eye in Bone Marrow Transplantation. VI. Retinal Complications. Coskuncan NM, Jabs DA, Dunn JP, Haller JA, Green WR, Vogelsang GB, Santos GW. Arch Ophthalmol 1994; 112: 372- 9 ( Mar). [ Reprint requests to Dr. D. A. Jabs, The Wilmer Ophthalmological Institute, 550 N. Broadway, Suite 700, Baltimore, MD 21205.] Of 397 patients undergoing bone marrow transplantation during 1979- 1980 and 1984- 1992 at Johns Hopkins University Oncology Center, 51 ( 12.8%) developed posterior segment complications, including 11 ( 2.8%) with bilateral disc edema. Of these 11 cases, 8 were believed to be secondary to a toxic effect of cyclosporin and the remaining 3 cases resulted from intracranial hemorrhage, meningitis, and relapse of leukemia, respectively. Pattern Visual Evoked Potentials in Treatment Trials for Optic Neuropathy. Brigell M. Reply. Beck RW, Kaufman DI. Arch Ophthalmol 1994; 112: 299- 300 ( Mar). [ No reprint information given.] In his letter to the editor, Dr. Brigell laments the lack of visual evoked response data in the study design of the Optic Neuritis Treatment Trial, as this may have provided different and potentially useful information regarding the efficacy of treatment. Dr. Beck and Dr. Kaufman reply that standardization of visual evoked response instrumentation and data from multiple centers was an insurmountable problem, as the cost involved could not be justified in relation to the primary objectives of this study. Recurrent Neuroretinitis. Purvin VA, Chioran G. Arch Ophthalmol 1994; 112: 365- 71 ( Mar). [ Reprint requests to Dr. V. A. Purvin, Midwest Eye Institute, 1800 N. Capital Ave., Indianapolis, IN 46202.] The authors describe seven patients who experienced two to seven attacks of neuroretinitis at intervals ranging from 1 to 10 years. These unusual patients had extensive testing not revealing of a specific, or treatable, disease process, and corticosteroid therapy seemed to have little or no effect on final visual outcome. The authors speculate that these patients have a form of a recurrent optic disc vasculitis. Idiopathic Sclerosing Inflammation of the Orbit. A Distinct Clinicopathologic Entity. Rootman J, McCarthy M, White V, Harris G, Kennerdell J. / Neuro- Ophthalmol, Vol. 14, No. 4, 2994 LITERATURE ABSTRACTS 221 Ophthalmology 1994; 101: 570- 84 ( Mar). [ Reprint requests to Dr. J. Rootman, Department of Ophthalmology, 2550 Willow Street, Vancouver, British Columbia, Canada, V5Z 3N9.] The authors review and catalogue findings in the management of 16 patients from three institutions, who were seen between 1979 and 1991 with the unusual disorder that is refractory to easy treatment, although, fortunately, usually unilateral. Computerized tomographic scans included with the article most resemble cases of pseudotumor of the orbit. The authors agree that " early recognition and diagnosis and aggressive immunosuppressive therapy is the most rational, currently available treatment" for this recently recognized clinicopathologic entity. Optic Canal Decompression in Indirect Optic Nerve Trauma. Levin LA, Joseph MP, Rizzo III JF, Lessell S. Ophthalmology 1994; 101: 566- 9 ( Mar). [ Reprint requests to Dr. L. A. Levin, F4/ 340 CSC, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792- 3220.] At Massachusetts Eye and Ear Infirmary 31 consecutive alert patients were seen within 6 days of head trauma with unilateral traumatic optic neuropathy and treated with transethmoidal decompression of the optic canal as well as perioperative, high- dose intravenous corticosteroids. The only variable that negatively influenced outcome in a statistically significant way was age- patients over 40 had less chance of improved vision than those under 40- and, interestingly, the level of the visual impairment preoperatively did not affect the outcome. Thus, even an eye with no light perception may benefit as much as one starting with better visual acuity. Because of the study design, no conclusions can be reached about whether this therapy is superior to corticosteroids alone or to no treatment, and again the call is made for a multi-center, randomized study. The Retinal Venous Pulse. Its Relation to Optic Disc Characteristics and Choroidal Pulse. Hedges Jr. TR, Baron EM, Hedges III TR, Sinclair SH. Ophthalmology 1994; 101: 542- 7 ( Mar). [ Reprint requests to Dr. T. R. Hedges, Jr., The Pennsylvania Hospital, 700 Spruce, Suite 507, Philadelphia, PA 19106.] The authors examined 97 patients for presence and strength of spontaneous venous pulsations in the optic nerve head and performed pneumoto-nometry to obtain an intraocular pulse pressure in the same patients as well as measuring brachial pulse pressure. Certain optic nerve vasculature and anatomic configurations were correlated with lesser or greater ability to detect spontaneous venous pulsations, and the configuration correlated better to venous pulsation than did intraocular pulse pressure amplitude. An interesting study with some clinical pearls. Wegener's Granulomatosis. Eyelid and Conjunctival Manifestations as the Presenting Feature in Two Individuals. Jordan DR, Addison DJ. Ophthalmology 1994; 101: 602- 7 ( Mar). [ Reprint requests to Dr. D. R. Jordan, 267 O'Connor Street # 611, Ottawa, Ontario, K2P 1V3, Canada.] This report describes two patients with unusual ocular lesions as the presenting sign of what was eventually diagnosed as Wegener's granulomatosis: one with inferior fornix conjunctival ulcer and one with recurrent eyelid masses suggestive of chalazia. Both patients had biopsy of the periocular lesion, which retrospectively was consistent with Wegener's disease, although diagnosis in neither was made until pulmonary symptoms ensued. Anterior Segment Ischemia After Strabismus Surgery. Saunders RA, Bluestein EC, Wilson ME, Ber-land JE. Surv Ophthalmol 1994; 38: 456- 66 ( Mar- Apr). [ Reprint requests to Dr. R. A. Saunders, Storm Eye Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425- 2236.] This is a nice short reference on an uncommon but potentially blinding complication of strabismus surgery and includes nice color clinical photographs of the anterior segment. The authors stress that old ideas regarding which patients are at risk for anterior segment ischemia ( more than two muscles moved in one operation) may not be accurate. Patients who are at risk need to be identified preoperatively for specific informed consent and thoughtful surgical approach. Disk Edema and Peripheral Neuropathy. Breen LA. Comments. Hedges III TR, Katz B. Surv Ophthalmol 1994; 38: 467- 74 ( Mar- Apr). [ Reprints are not available.] J Neuro- Ophthalmol, Vol. 14, No. 4, 1994 222 LITERATURE ABSTRACTS In this CPC, a 55- year- old woman with a " walking problem," diplopia, and papilledema is discussed. The discussants nicely try to reconcile all her clinical problems. Her spinal fluid demonstrated increased protein ( 208 mg/ dl), and a spinal cord tumor was suspected and imaged before her cerebrospinal fluid examination. A very nice case demonstrating the unusual and not fully understood relationship between a " pseudotumor cerebri"- like presentation in a setting of a spinal cord tumor. Gliomas of the Anterior Visual Pathway. Dutton JJ. Surv Ophthalmol 1994; 38: 427- 52 ( Mar- Apr). [ Reprint requests to Dr. J. J. Dutton, Duke University Eye Center, Box 3802, Durham, NC 27710.] Dr. Dutton has written a comprehensive " major review" of gliomas involving optic nerve and chiasm. Particularly good is the section concerning the controversial aspects of management, although the entire article is an excellent reference on the subject. Intraorbital Glomus Cell Tumor. Neufeld M, Pe'er J, Rosenman E, Lazar M. Am J Ophthalmol 1994; 117: 539- 41 ( Apr). [ Inquiries to Dr. J. Pe'er, Department of Ophthalmology, Hadassah University Hospital, P. O. Box 12000, 91120 Jerusalem, Israel.] A 35- year- old woman with progressive propto-sis for 1 year was found to have a well-circumscribed superior orbital mass, which was removed and found to be a glomus tumor, a benign entity rarely found in this location. Ocular Amyloidosis. Gorevic PD, Rodrigues MM. Am} Ophthalmol 1994; 117: 529- 32 ( Apr). [ Reprint requests to Dr. P. D. Gorevic, State University of New York, Health Sciences Center, T16- 040, Stony Brook, NY 11794- 8161.] The authors offer a classification of ocular amyloid based on currently known heredity and amyloid subunit protein involved. The two types of most interest to neuro- ophthalmologists involve the pupils ( dominant inheritance) and extraocular muscles ( sporadic inheritance), both associated with systemic amyloidosis. Septic Cavernous Sinus Thrombosis After Head Trauma. Coll GE, Boxrud CA, Steinsapir KD, Goldberg RA. Am J Ophthalmol 1994; 117: 538- 9 ( Apr). [ Inquiries to Dr. R. A. Goldberg, 100 Stein Plaza, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA 90024- 7006.] A 77- year- old man with idiopathic neutropenia fell off his bicycle, injuring the left side of his face. Within hours, he developed left ptosis, decreased vision, and headaches and a traumatic orbital apex syndrome was diagnosed with computed tomography scan showing opacification of left posterior ethmoid and sphenoid sinuses. On corticosteroid therapy, his vision, headaches, and eyelid edema worsened. Computed tomography scans then showed an enlarged left superior ophthalmic vein and enhancement of the left cavernous sinus felt to be consistent with septic cavernous sinus thrombosis. Despite aggressive IV antibiotic therapy and sinus surgery, his left eye remained blind. The authors point out that the differential diagnosis of traumatic orbital apex syndrome should include an infectious process involving the cavernous sinus. Bilateral Extraocular Muscle Metastases in Zollinger- Ellison Syndrome. Liu GT, Schatz NJ, Curtin VT, Tse DT. Arch Ophthalmol 1994; 112: 451- 2 ( Apr). [ No reprint information given.] A 40- year- old woman experienced 2 months of right retro- orbital pain and then developed acute diplopia and right eyelid edema. Three years previously, neuroendocrine cancer of the pancreas and duodenum with regional metastases ( Zollinger- Ellison syndrome) was biopsied. Computed tomographic scanning of the orbits showed bilateral, variably enlarged, extraocular muscles. Biopsy showed tissue consistent with Zollinger- Ellison metastasis. This may be the first reported case of Zollinger- Ellison metastatic to extraocular muscles. Orbital Myositis as a Paraneoplastic Syndrome. Harris GJ, Murphy ML, Schmidt EW, Hanson GA, / Neuro- Ophthalmol, Vol. 14, No. 4, 1994 LITERATURE ABSTRACTS 223 Dotson RM. Arch Ophthalmol 1994; 112: 380- 6 ( Mar). [ Reprint requests to Dr. G. J. Harris, Eye Institute, 8700 W. Wisconsin Ave., Milwaukee, WI 53226.] A 43- year- old man developed a left seventh nerve palsy and right- sided proptosis, chemosis, and diplopia with enlargement of the extraocular muscles on computerized tomographic scanning. He was treated for presumed Graves' disease but worsened. After numerous peripheral neuropathies developed, he was ultimately found to have a systemic lymphoma. The striking similarities between this case and idiopathic orbital myositis and thyroid eye disease should remind us all for the need to reevaluate thoroughly any patient who does not respond to the usual therapy for these disorders. Orbital Dermoid Cysts Located within the Lateral Rectus Muscle. Howard GR, Nerad JA, Bonavo-lonta G, Tranfa F. Ophthalmology 1994; 101: 767- 71 ( Apr). [ Reprint requests to Dr. G. R. Howard, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425.] A 13- year- old girl with a 2- week history of diplopia and a 31- year- old man with a 6- month history of proptosis are presented. Each had a lesion in the lateral rectus muscle found on surgical removal to be a dermoid. The authors believe these to be the first reported cases of this location of an orbital dermoid. Nonarteritic Ischemic Optic Neuropathy. The Impact of Tobacco Use. Chung SM, Gay CA, Mc- Crary III JA. Ophthalmology 1994; 101: 779- 82 ( Apr). [ Reprint requests to Dr. S. M. Chang, The Anheuser- Busch Eye Institute, St. Louis University Health Sciences Center, 1755 South Grand, St. Louis, MO 63104.] The authors review 137 patients from 1980 through 1990 with anterior ischemic optic neuropathy and found those who smoked were younger ( mean: 51 years) than nonsmokers ( mean: 64 years). The patients who stopped smoking assumed the risk level of nonsmokers. Another good reason to stop smoking. The Silent Sinus Syndrome. A Cause of Spontaneous Enophthalmos. Soparkar CNS, Patrinely JR, Cuaycong MJ, Dailey RA, Kersten RC, Rubin PAD, Linberg JV, Howard GR, Donovan DT, Ma-toba AY, Holds JB. Ophthalmology 1994; 101: 772- 8 ( Apr). [ Reprint requests to Dr. J. R. Patrinely, Cullen Eye Institute, 6501 Fannin, NC- 200, Houston, Texas 77030.] Four cases of this syndrome are presented, gleaned from several medical centers, and five cases reviewed from the literature. All had otherwise asymptomatic, unilateral spontaneous enophthalmos in association with unilateral maxillary sinus hypoplasia. Possible etiologies of this sinus disorder are discussed. The Use of Botulinum Toxin for Treatment of Acquired Nystagmus and Oscillopsia. Ruben ST, Lee JP, O'Neil D, Dunlop I, Elston JS. Ophthalmology 1994; 101: 783- 7 ( Apr). [ Reprint requests to Dr. S. T. Ruben, FRCS, FRCOphth, Moorfields Eye Hospital, City Rd., London EC1V 2PD, England.] Twelve patients with acquired nystagmus from a variety of disorders were treated with botulinum A toxin, usually with retrobulbar injection, but some with medial rectus and lateral rectus injection. Eight of these patients had measurable increase in visual acuity, although ptosis was a complication in over half the patients. Some patients chose to have ongoing injections to maintain better visual acuity. This seems a nice alternative for patients who receive no benefit from drug therapy for disabling nystagmus. / Neuro- Ophthalmol, Vol. 14, No. 4, 1994 |
