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Poster 32 - Unilateral Sectoral Swelling of the Optic Disk
POSTERS moxifloxacin O.S. in office. She was instructed to use moxifloxacin q l h for the remainder of the day and q2-3h overnight. Visual acuity was 201400 O.S. the next day, with an epithelial defect 3.0 mm in diameter with dense infiltrate and surrounding edema extending to 5.0 mm. There was pronounced injection of the eye with a severe anterior chamber reaction (plasmoid aqueous) and hypopyon. Noting the increased inflammatory response, 1%prednisolone acetate was added. The patient was followed daily. Complete resolution of the corneal lesion was noted at nine days, with minimal scarring and visual recovery to 20125 + . Conclusions: The management of bacterial corneal ulcers has changed radically in the last few years. Fourth-generation fluoroquinolones are quickly becoming the standard of care. The concurrent use of corticosteroids helps promote the healing process by decreasing the inflammatory response, inhibiting the loss of stromal tissue. and reducing the formation of potentially visually debilitating scar tissue.
POSTER 32 Unilateral Sectoral Swelling of the Optic Disk Lori Ann Kehler, O.D. Vanderbilt University, 8000 Medical Center East, Nashville, Tennessee 37232 Background:The swollen optic disk presents a clinical challenge due to the possibility of vision loss and systemic disease, and the extensive differential diagnosis. In this case, amiodarone-induced optic neuropathy (Ami-ION), non-arteritic anterior ischemic optic neuropathy (nAION), and diabetic papillopathy (DP]are explored. Case Report: A 69-year-oldman came in for treatment of eye strain. His medical history was remarkable for hypertension, A-fib, and diet-controlled diabetes mellitus. He was taking 17 medications, including amiodarone. Best-corrected visual acuity was 20120 O.D., O.S. There was a well-defined area of nerve fiber layer edema, four clock hours in size, on the optic disk O.D. The extensive differential diagnosis was narrowed to: n-AION, DP, and Ami-ION based on history and presentation. Visual-field testing showed an incomplete inferior arcuate defect corresponding to the appearance of the optic nerve swelling. Cardiology was consulted and switched the amiodarone to propafenone. One week later, the swelling increased by 3 clock hours. Treatment with 0.2% brimondine t.i.d. was initiated for possible neuroprotection. Visual-field testing was repeated 3 weeks later, and there was no evidence of the previous defect. Fifteen weeks after initial presentation, there was complete resolution of the swelling. Ami-ION has an insidious onset with slow-progressing visual loss and visual-field defects that improve slowly after discontinuation of drugs. In this case, n-AION was unlikely because the nerve swelling was progressive, slow to resolve, and the associated visual-field defect was reversed. DP could not be ruled out. There is no proven treatment for n-AION or DP. In this case, discontinuation of the amiodarone was the only evidence-based intervention. conclusion: All patients taking amiodarone need regular followup. Patients who use amiodarone and manifest any degree of nerve swelling need an urgent cardiology consult. OPTOMETRY
POSTER 33 Unilateral Serous Retinal Detachment Associated with Preeclampsia John Sharpe, 0 .D. Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Preeclampsia, pregnancy-induced hypertension, is commonly associated with visual disturbances, including scotoma, diplopia, and photopsia. Visual symptoms have been reported in approximately 25% of affected patients. Serous retinal detachment is a much less common clinical finding, being reported in only 1% of cases of severe preeclampsia. Preeclampsia-associated serous retinal detachment is an almost universally bilateral ocular complication. This particular case is one of an atypical, much less common, unilateral presentation. Case Report: A 31-year-old woman came in for an evaluation of acute loss of vision in the left eye. She reported a brownish film over her vision O.S., with a dramatic decrease in visual clarity of approximately one week's duration. She also reported that her symptoms started one day after she had given birth. Medical history was negative, except for severe preeclampsia, which led her medical doctor to induce delivery almost 3 weeks early. Best visual acuity measured 20115 O.D. and 20160 O.S. Biomicroscopy was unremarkable O.D. and O.S. Indirect ophthalmoscopy revealed isolated cotton-wool spot within the posterior pole O.D. and well-delineated, clear elevation within the macula and central posterior pole O.S. Conclusions: A diagnosis of hypertensive retinopathy OU with acute macular serous retinal detachment O.S. was made. The patient was placed on aggressive topical nonsteroidal therapy O.S., advised to closely follow her medical doctor's hypertension treatment, and scheduled to return in two weeks for follow-up evaluation.
POSTER 34 The Evolving Cover Test: Diagnosing Multiple Sclerosis Traci Goldstein, 0 .D. and Cynthia Zara, 0.D. Metropolitan Vision Correction, 22 West 13th Street, New York, New York 10011 Background: In young adults, sixth nerve palsies are idiopathic 25% of the time. Other causes include severe trauma, Lyme disease, meningitis, syphilis, and multiple sclerosis. While a CNVI palsy is not commonly considered a presenting sign of multiple sclerosis (MS),it should not be overlooked, and magnetic resonance imaging (MRI]should be obtained in all cases. Case Report: A 32-year-old woman came to us initially for routine examination. She had no symptoms. Her BCVA was 20120 O.D., O.S., OU, and her cover test was 4pd XP'. One year later, the patient returned, slp gastric bypass surgery, reporting eye fatigue and dizziness. All testing was unremarkable, with the exception of significant convergence insufficiency. There was no vertical component found. Full-field HVF-120 was within normal limits OU. The patient returned for followup of earlier symptoms one week later, with additional reports of horizontal diplopia at distance. Distance cover test VOLUME 76lNUMBER 6IlUNE 2005
POSTER 32 Unilateral Sectoral Swelling of the Optic Disk Lori Ann Kehler, O.D. Vanderbilt University, 8000 Medical Center East, Nashville, Tennessee 37232 Background:The swollen optic disk presents a clinical challenge due to the possibility of vision loss and systemic disease, and the extensive differential diagnosis. In this case, amiodarone-induced optic neuropathy (Ami-ION), non-arteritic anterior ischemic optic neuropathy (nAION), and diabetic papillopathy (DP]are explored. Case Report: A 69-year-oldman came in for treatment of eye strain. His medical history was remarkable for hypertension, A-fib, and diet-controlled diabetes mellitus. He was taking 17 medications, including amiodarone. Best-corrected visual acuity was 20120 O.D., O.S. There was a well-defined area of nerve fiber layer edema, four clock hours in size, on the optic disk O.D. The extensive differential diagnosis was narrowed to: n-AION, DP, and Ami-ION based on history and presentation. Visual-field testing showed an incomplete inferior arcuate defect corresponding to the appearance of the optic nerve swelling. Cardiology was consulted and switched the amiodarone to propafenone. One week later, the swelling increased by 3 clock hours. Treatment with 0.2% brimondine t.i.d. was initiated for possible neuroprotection. Visual-field testing was repeated 3 weeks later, and there was no evidence of the previous defect. Fifteen weeks after initial presentation, there was complete resolution of the swelling. Ami-ION has an insidious onset with slow-progressing visual loss and visual-field defects that improve slowly after discontinuation of drugs. In this case, n-AION was unlikely because the nerve swelling was progressive, slow to resolve, and the associated visual-field defect was reversed. DP could not be ruled out. There is no proven treatment for n-AION or DP. In this case, discontinuation of the amiodarone was the only evidence-based intervention. conclusion: All patients taking amiodarone need regular followup. Patients who use amiodarone and manifest any degree of nerve swelling need an urgent cardiology consult. OPTOMETRY
POSTER 33 Unilateral Serous Retinal Detachment Associated with Preeclampsia John Sharpe, 0 .D. Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Preeclampsia, pregnancy-induced hypertension, is commonly associated with visual disturbances, including scotoma, diplopia, and photopsia. Visual symptoms have been reported in approximately 25% of affected patients. Serous retinal detachment is a much less common clinical finding, being reported in only 1% of cases of severe preeclampsia. Preeclampsia-associated serous retinal detachment is an almost universally bilateral ocular complication. This particular case is one of an atypical, much less common, unilateral presentation. Case Report: A 31-year-old woman came in for an evaluation of acute loss of vision in the left eye. She reported a brownish film over her vision O.S., with a dramatic decrease in visual clarity of approximately one week's duration. She also reported that her symptoms started one day after she had given birth. Medical history was negative, except for severe preeclampsia, which led her medical doctor to induce delivery almost 3 weeks early. Best visual acuity measured 20115 O.D. and 20160 O.S. Biomicroscopy was unremarkable O.D. and O.S. Indirect ophthalmoscopy revealed isolated cotton-wool spot within the posterior pole O.D. and well-delineated, clear elevation within the macula and central posterior pole O.S. Conclusions: A diagnosis of hypertensive retinopathy OU with acute macular serous retinal detachment O.S. was made. The patient was placed on aggressive topical nonsteroidal therapy O.S., advised to closely follow her medical doctor's hypertension treatment, and scheduled to return in two weeks for follow-up evaluation.
POSTER 34 The Evolving Cover Test: Diagnosing Multiple Sclerosis Traci Goldstein, 0 .D. and Cynthia Zara, 0.D. Metropolitan Vision Correction, 22 West 13th Street, New York, New York 10011 Background: In young adults, sixth nerve palsies are idiopathic 25% of the time. Other causes include severe trauma, Lyme disease, meningitis, syphilis, and multiple sclerosis. While a CNVI palsy is not commonly considered a presenting sign of multiple sclerosis (MS),it should not be overlooked, and magnetic resonance imaging (MRI]should be obtained in all cases. Case Report: A 32-year-old woman came to us initially for routine examination. She had no symptoms. Her BCVA was 20120 O.D., O.S., OU, and her cover test was 4pd XP'. One year later, the patient returned, slp gastric bypass surgery, reporting eye fatigue and dizziness. All testing was unremarkable, with the exception of significant convergence insufficiency. There was no vertical component found. Full-field HVF-120 was within normal limits OU. The patient returned for followup of earlier symptoms one week later, with additional reports of horizontal diplopia at distance. Distance cover test VOLUME 76lNUMBER 6IlUNE 2005