Clinical profiles of patients with optic neuritis and papillitis: A prospective study

To analyse the demographics and presenting features of patients presenting with optic neuritis and papillitis. Clinical profiles of 40 patients presenting with optic neuritis and papillitis at a tertiary care center were collected retrospectively and prospectively. Detailed medical and ophthalmic history was taken especially about mode, duration and course of the disease, drug intake, alcoholism, smoking, pregnancy, lactation, convulsions, pyrexia, history suggestive of TB, syphilis, neurological deficit. A comprehensive ophthalmological and neurological evaluation was done for each patient along with radiological work up. Patients were prospectively followed up for an average of three months. Females in the reproductive age group constituted largest number of the patients (61.8%) in the present series. Maximum patients (70%) were between 20-50 years of age. Vision was found to be affected in all the patients at presentation and most of them presented with vision CF or HM (35.4% and 29.25% respectively) while 4 patients had complete loss of vision. Two third (66.7%) of patients reported eye pain at presentation. Abnormal pupillary reaction was found in most patients with the most common being RAPD on swinging flash light which was seen in 85.4%. Equal percentage (39.5%) of patients presented with Blurred Hyperemic (BH) disc and ophthalmoscopically normal appearing disc. Onset and progression of disease was found to be rapid in most cases ranging from few hours to days. Visual recovery post treatment was found to be good with most eyes achieving vision 6/24 or better. Optic neuritis has varied clinical presentations. Most of our patients were young to middle aged females. The most common presenting features were decrease in vision ranging from slight to profound, eye pain and abnormal pupillary reaction. Morphological abnormalities in appearance of optic disc were also found in two third of cases.Rapid progression was noted in almost all cases. Most of the cases achieved a good outcome at the end of follow up period.

Conjunctivitis: A Systematic Review

Conjunctivitis is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of conjunctivitis, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered. Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral conjunctivitis remains to be the most common overall cause of conjunctivitis. Bacterial conjunctivitis is encountered less frequently and it is the second most common cause of infectious conjunctivitis. Allergic conjunctivitis is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic conjunctivitis as the underlying etiology. Effective management of conjunctivitis includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment.

Objective Measurement of Sustained Pupillary Constriction: A Pilot Study Using an App-Based Pupilometer

Background: The pupillary reaction is controlled by the two main branches of the autonomic nervous system, namely the parasympathetic and sympathetic nervous systems. New discoveries in pupil research has identified that intrinsically photosensitive retinal ganglion cells have an impact on pupillary constriction, particularly sustained pupillary constriction. In the current paper, an objective measurement of sustained pupillary constriction versus the inability to maintain sustained pupillary constriction are observed. The variability in the sustained pupillary constriction, i.e. Alpha Omega pupil, can be objectively identified with the use of modern technology. Case Examples: Two female subjects were adapted to dim illumination, and then two objective pupil measurements of the right eye using Reflex – PLR Analyzer by BrightLamp© (Indianapolis, IN, USA) with sustained illumination were obtained. Subject 1, a 25 year-old-female, demonstrated normal ability of the pupil to constrict and sustain constriction for 10 seconds. She was used as a control for subject 2. Subject 2, a 27 year-old-female, demonstrated the inability to sustain pupillary constriction. She reported being under great psychological stress. Her pupil began to re-dilate between 2 and 3 seconds after the initial constriction. Conclusion: Objective pupillometry can be used to assist in many diagnoses and provides the clinician invaluable information on the state of the individual, and qualifications of sustained pupillary constriction can now be assessed in an objective manner.

VISUAL SCREENING OF SCHOOL CHILDREN IN THE MUNICIPALITY OF SAPAREVA BANYA IN SOUTHWESTERN BULGARIA

Within 3-days-program almost 200 children and 50 adults had their vision checked by an international qualified team of eye specialists in the local school in Sapareva Banya. Visual acuity, objective and subjective refraction, color perception, binocular vision, cover test, pupillary reaction and other tests were performed. Apart from the ophthalmic examination, all the patients’ parents also filled in questionnaire regarding visual strain regimen, previous eye doctor visits and other details. The aim was to promote visual health, establish and possibly treat refractive errors and amblyopia, to facilitate access to specialized medical care, optical and optometrist’s service for children’s population of remote municipalities with population under 10 000 people. The visual screening of Sapareva Banya school children was of great value because only 38% of children had been examined before. There were no major deviations, severe anisometropia and ametropia values or very low visual acuity patients not wearing optical correction. A surprisingly high incidence of color vision deficiency was found 9, 2% males and 4, 3 % females.

Google Trends Analyses and Case Report: A Persistently Dilated Pupil in Psychedelics’ User

An eighteen years old female patient of the Caucasian ethnicity from New Zealand, she presented with a persistently dilated pupil causing her discomfort and occasional burning sensation when outdoor due to an oversensitivity to sunlight. However, her pupillary reaction to light (pupillary light reflex) was intact. The patient is a known user of psychedelic substances (entheogens) including LSD, NBOMe, psilocybin, and DMT. The condition affects both eyes to the same extent. A thorough medical, neurological, and radiological examination, including an EEG and an MRI of the head and neck region, were completely normal. All these tests failed to detect any pathophysiological or anatomical abnormalities. The patient is a known case of chronic endogenous depression in association with attention deficit hyperactivity disorder, for which she is medicating with citalopram and Ritalin respectively. There was neither a family history nor a similar congenital condition in her family. Collateral inferential statistical analyses were implemented in relation to Google Trends database to seek out relevant data in relation to psychedelic substances and their corresponding geographic mapping.

Could Hallucinogens Induce Permanent Pupillary Changes in (Ab)users? A Case Report from New Zealand

An eighteen-year-old female patient of the Caucasian ethnicity from Australasia presented with a persistently dilated pupil causing her discomfort and occasional burning sensation when she is outdoors due to oversensitivity to sunlight. However, her pupillary reaction to light (pupillary light reflex) was intact. The patient is a known user of psychedelic substances (entheogens) including LSD, NBOMe, psilocybin, and DMT. The condition affects both eyes to the same extent. Thorough medical, neurological, and radiological examinations, including an EEG and an MRI of the head and neck region, were completely normal. All these tests failed to detect any pathophysiological or anatomical abnormalities. The patient is a known case of chronic endogenous depression in association with attention deficit hyperactivity disorder, for which she is taking citalopram and Ritalin, respectively. There was neither a family history nor a similar congenital condition in her family.

Paediatric Orbital Fractures: The Importance of Regular Thorough Eye Assessment and Appropriate Referral

The paediatric orbital fracture should always raise alarm bells to all clinicians working in an emergency department. A delay or failure in diagnosis and appropriate referral can result in rapidly developing and profound complications. We present a boy of childhood age who sustained trauma to his eye during a bicycle injury. Acceptance of the referral was based on no eye signs; however, on examination in our unit the eye had reduction in visual acuity, no pupillary reaction, and ophthalmoplegia. CT scan suggested bone impinging on the globe and the child was rushed to theatre for removal of the bony fragment. Postoperatively no improvement was noted and a diagnosis of traumatic optic neuropathy was made. An overview of factors complicating paediatric orbital injuries, their associated “red flags”, and appropriate referral are discussed in this short paper.