Neurosciences News

KOLOA, Hawaii – When examining a neuro-ophthalmic patient, physicians must check the pupil in the light and the dark, a presenter said here. “If you’re using the abbreviation PERRLA – pupil, equal, round, reactive to light and accommodation – please stop,” Andrew G. Lee, MD, Professor of Ophthalmology in Neurology and Neurological Surgery, Weill Cornell Medical College, said during a mini-symposium on neuro-ophthalmology at the Hawaiian Eye meeting. “Because the pupil can be equal, round and reactive to both light and accommodation and have a whopping relative afferent pupil defect (RAPD).”

As optics and instrumentation have improved for our colleagues in otolaryngology and neurosurgery, we, as ophthalmologists, especially orbital surgeons, have been able to take advantage of these advances and improve our patients’ experiences. We have all become accustomed to endoscopic brow lifts, endoscopic dacryocystorhinostomy and the more recent intraocular endoscopy. But orbital surgeons have been fortunate to enjoy the benefits of collaborations with our colleagues in other fields to minimize our patients’ morbidities and hospital stays.

A 15-year-old African-Asian teenager was referred to our office for 3 days of pain and decreased vision in her left eye. She awoke 3 days earlier with mild pain and blurry vision, which progressed over the following 72 hours to severe pain that was worse with eye movement and profound vision loss. She did not have any prior vision problems and had never had an eye exam in the past. She had no medical issues and was on no medication.

A 78-year-old woman came to the New England Eye Center 2 months after she first began to notice her left upper lid drooping. A few weeks later, she began to have binocular diplopia that was horizontal in nature and seemed to worsen when looking to the left and at distance. These symptoms were variable but did not seem to have progressed. She denied having any recent headaches or head trauma. The clarity of her vision was unchanged.

In part 1 of this column, I discussed the pathophysiology and clinical presentation of thyroid orbitopathy. (See part 1 of this article online at http://www.healio.com/ophthalmology/cornea-external-disease/news/print/ocular-surgery-news/%7B50e32061-7fdc-41d2-a51d-bec5f7feab30%7D/thyroid-orbitopathy-part-1-further-study-of-correlation-needed.) In part 2, I will cover current treatment options and future directions of the disease.

Presently, diagnosis of Alzheimer’s disease begins with symptoms patients exhibit, namely memory loss. Unfortunately, by the time patients become symptomatic, the disease has already progressed to its later stages. Like age-related macular degeneration, treating Alzheimer’s disease at such an advanced stage is difficult, if not altogether impossible. However, recent advances in Alzheimer’s research have yielded the potential for a method of detecting the disease in its developmental stages, possibly decades before patients become symptomatic.

Alzheimer’s disease was first identified by Aloysius Alzheimer, a German psychiatrist, in a published case report in 1915. The pathology includes the loss of neurons and synapses in the cerebral cortex, making it somewhat similar to glaucoma in that once the neurons are lost, they are never replaced. Amyloid plaques and neurofibrillary tangles are visible on histological sections and, along with neuron loss and cerebral atrophy in a patient with typical symptoms, are diagnostic.

A 66-year-old patient first noticed trouble with his right peripheral vision 2 weeks prior to presentation while he was playing golf. He also complained of more trouble with light to dark adaptation and reading.

An 8-year-old girl presented to Tufts Medical Center with complaints of a persistent headache and new-onset binocular diplopia. She was initially seen by her primary care provider 1 week earlier for her headache and ultimately diagnosed with sinusitis and started on oral amoxicillin. However, 2 days after starting oral antibiotics, she developed fevers, intermittent nausea and binocular diplopia. She otherwise felt well and had no history of headaches. She had no significant medical or ocular history.

A 69-year-old woman presented to Tufts Medical Center 2 weeks after developing upper respiratory symptoms. During that time, she also had mild headaches, episodes of nausea and difficulty walking. She later developed acute-onset persistent binocular diplopia.