Uploaded byAhmed Alsherbeny
Black & White !
The document provides brief summaries of key points related to various ophthalmic and neurological conditions and treatments. Some of the main topics covered include: identifying intraocular foreign bodies; evaluating optic neuritis and macular dystrophy; investigating non-responders to anti-VEGF treatment for AMD; warning about risks of pigment epithelial tears with anti-VEGF injections; using Amsler grids to evaluate metamorphopsia; avoiding cyst rupture during dermoid cyst removal; investigating sinus infections with orbital cellulitis; needing urgent CT angiography for acute third nerve palsies involving the pupil; testing hearing and corneal sensation for sixth nerve palsies; investigating for thymoma with myasthenia gravis; needing
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- 1. Black & White! By Ahmed Alsherbeny MD, CABOphth, MRCSEd Ophth, FRCS Ophth (Glasg), FICO
- 2. A missed intraocularforeign body with a ferrous component can result in late visual loss secondary to siderosis.
- 3. In optic neuritissecondary to multiple sclerosis the vision usually improves without treatment over a period of several months.
- 4. Stargardt disease isthe most commonly inherited macular dystrophy and is usually associated with mutations in the ABCA4 gene.
- 5. In a patientwith AMD who has not responded to anti-VEGF treatment after 3 months, undertake ICG angiography to check for polypoidal choroidal vasculopathy
- 6. Patients with alarge pigment epithelial detachment should be warned that there is a risk of inducing a pigment epithelial tear with anti-VEGF injection
- 7. Metamorphopsia is acommon early symptom of macular disease and can be evaluated with an Amsler grid.
- 8. When removing anorbital dermoid cyst take care not to rupture the wall of the cyst, as this can cause a granulomatous inflammation in the surrounding tissue
- 9. In thyroid eyedisease, compression of the optic nerve secondary to enlarged and congested rectus muscles may occur in the absence of proptosis
- 10. The most commontumour associated with opticociliary shunt vessels on the disc is an optic nerve sheath meningioma
- 11. Because orbital cellulitisoften occurs as a consequence of a sinus infection, urgent radiological investigation of the sinuses is mandatory.
- 12. Urgent CT angiographyis needed in a patient who presents with an acute third nerve palsy that involves the pupil, to exclude an expanding intracranial aneurysm.
- 13. Hearing and cornealsensation should be tested in patients with a sixth nerve palsy, to exclude a vestibular schwannoma (acoustic neuroma).
- 14. Patients with myastheniagravis should undergo thoracic imaging to exclude a thymoma
- 15. All patients withpapilloedema should undergo urgent neuroradiological investigation to exclude intracranial pathology.
- 16. Neurological lesions causingoptic nerve or chiasmal compression can produce visual field defects that may be misinterpreted as glaucomatous, and neuroimaging should be performed if there is any suspicion; some practitioners routinely perform a cranial MRI in all cases of NTG.
- 17. MRI should neverbe performed if a metallic foreign body is suspected
- 18. In pleomorphic lacrimalgland adenoma , it is wise to avoid prior biopsy, to avoid tumour seeding into adjacent orbital tissue, with recurrences which may later turn malignant
- 19. Glaucoma with deepA.C: 1- Plateau iris syndrome 2- pigment dispersion syndrome 3- Buphthalmos
- 20. In Sturge-Weber syndrome, Ipsilateral parietal or occipital leptomeningeal haemangioma may cause contralateral or generalized focal or generalized seizers, hemiparesis or hemianopia
- 21. In acoustic neuroma,the first symptom is hearing loss and the first sign is diminished corneal sensitivity
- 22. In Kerns-Sayer syndrome,ECG demonstratescardiac conduction defects and should be performed periodically; pacemaker implantation may be required.
- 23. Malignancies with calcificationsrelated to the eye : 1- lacrimal gland carcinoma 2-retinoblastoma 3- optic nerve sheath meningioma 4- osseous choristoma
- 24. A small childwith characteristic ophthalmic features of abusive head trauma (especially unexplained retinal haemorrhages) should be examined in conjunction with a specialist paediatrician.
- 25.