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Poster 67
Poster Presentations bedside in a nursing home for bilateral lower lid ectropion and severe blepharitis. He was admitted to the nursing home for treatment of metastatic transitional cell carcinoma of the bladder. He had been followed up closely by dermatology for a longstanding history of multiple basal cell carcinomas (BCCa), SCCa, actinic keratoses (AK), and seborrheic keratoses (SK) of the face and neck. He had undergone excisions of skin lesions on several occasions previously, including Mohs’ procedure. He was found to have multiple periorbital actinic keratoses and skin tags. There were several lesions that were scabbed over, some open and actively bleeding. The lower palpebral conjunctiva O.S. was exposed and was 2⫹ erythematous, and there was 2⫹ mucous buildup in the fornix and on the bulbar conjunctiva. The patient was referred to oculoplastics for surgical intervention, but surgery was repeatedly deferred because of his bladder cancer, and he was unable to obtain medical clearance from cardiology and pulmonary clinics. A shave biopsy of the largest lesion, located at the lateral canthus of the left lower lid, demonstrated SCCa. He was followed over the course of a year with close observation and lid hygeine. Conclusions: SCCa may prove fatal if left untreated. There are risk factors that increase the likelihood of metastasis; thus, further investigation is imperative. As eye care professionals, it is important to recognize suspicious lesions and make the appropriate referrals to oculoplastics and dermatologists. Poster 65 Ocular Manifestations of Sickle Cell Trait Pauline Ilsen, O.D., and Ricardo Fukuzato, O.D., West Los Angeles VA Healthcare Center/Southern California College of Optometry, Bldg. 304, Room 2-111, 11301 Wilshire Blvd, Los Angeles, California 90073 Background: Sea fan neovascularization is a well-established finding in sickle cell retinopathy, but it is usually not associated with sickle cell trait. Under ordinary circumstances, those with sickle cell trait do not develop sickling or anemia and thus do not present with clinical signs or symptoms. However, retinopathy may occur in those individuals with sickle cell trait when there are other precipitating factors present. Under conditions that contribute to hypoxia, patients who have sickle cell trait may develop sickle cell retinopathy and other ocular complications. Case Reports: Two cases in which the individual had what appeared to be sea fan neovascularization are presented. Both were found to have sickle cell trait. Both had other systemic vascular diseases that were believed to have contributed to the development of the sea fan neovascularization. Conclusions: Sea fan neovascularization can occur in patients without sickle cell anemia. In such cases, an investigation for hemoglobinopathies in conjunction with other systemic conditions that may be contributing to hypoxia
297 must be conducted. Those patients who are known to have both sickle cell trait and other systemic vascular disease should undergo regular ophthalmic examination. Poster 66 Diabetic Optic Neuropathy Pauline Ilsen, O.D., and Lindsay Harris, O.D., West Los Angeles VA Healthcare Center/Southern California College of Optometry, Bldg. 304, Room 2-111, 11301 Wilshire Blvd, Los Angeles, California 90073 Background: Diabetes mellitus is the most common endocrine disease in the world, and it proves to have devastating effects on vision when it involves the retina. However, there are numerous other ocular manifestations of this disease. Diabetic optic neuropathy is very controversial because of its unknown pathogenesis. Optic neuropathy associated with diabetes mellitus is considered by some to be a mild variant of nonarteritic anterior ischemic optic neuropathy and by others as a distinctively separate entity involving the disc microvasculature called “diabetic papillopathy.” It is viewed by some as a risk factor for progression of retinopathy. Case Report: A 50-year-old black man with type 2 diabetes mellitus presented for routine examination with bilateral disc edema. Fluorescein angiography demonstrated leakage at the disc without delay in both eyes, indicating diabetic optic neuropathy. A progression of retinopathy to the proliferative stage was observed in the months following the discovery of the disc edema. Conclusions: Given that the prevalence of diabetes mellitus type 2 has increased dramatically in the past decade, eye care providers will increasingly find themselves challenged with unusual ocular manifestations of the disease. This raises the need for increased awareness of uncommon clinical manifestations of diabetes. Ultimately, it is important to be aware of this condition and adjust follow-up accordingly. Poster 67 Aarskog Syndrome: Ocular and Systemic Manifestations Allison Stanton, O.D., Marc Taub, O.D., and Marjorie L. McLin, B.S., Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Aarskog syndrome (facial-digital-genital syndrome) is an X-linked inherited disorder that causes multiple limb and genital abnormalities. Cardinal features consist of short stature, short hands with mild syndactyly, and a shawl scrotum. Ocular associations most commonly include hypertelorism, blepharoptosis, and strabismus, while ophthalmoplegia, optic nerve head hypoplasia, and retinal vessel tortuosity are rarer findings. Case Report: An 8-year-old white male with Aarskog syndrome presented with concerns of letter reversals, letter additions, and an occasional “crooked” eye when the patient became frustrated. The parents had noticed an eye turn for
298 the previous 3 to 4 years but were unsure which eye was affected. The patient was having trouble with academics, especially math and reading. The entering visual acuities were 20/70 O.D., 20/50 O.S., 20/60 OU at distance and 20/125 O.D., 20/40 O.S., 20/40 OU at near. The patient was not using a spectacle correction, as this was his first examination. Near point of convergence was up to 3 cm, with a recovery of 8 cm. The cover test was orthophoric at distance and 6 exophoria at near. Local stereo was positive with the “Stereo Fly.” Pupils, color vision, and confrontation fields were unremarkable. Extra-ocular muscle testing revealed a restriction in elevation in all superior gazes (primary, temporal, and nasal) O.D., full range of motion O.S. Forced ductions were attempted but not obtained due to poor patient cooperation. Dry and cycloplegic retinoscopy revealed a high hyperopic astigmatic correction. The anterior segment was remarkable for hypertelorism and a downward slanting of the palpebral fissures. The posterior segment revealed tortuosity of the retinal vessels, with normal optic nerve head, macula, and peripheral retina. The patient was diagnosed with bilateral anisometropic amblyopia secondary to high hyperopic astigmatism, hypertelorism, a unilateral superior ophthalmoplegia, and retinal vessel tortuosity. A full-time prescription was issued and follow-up exam was scheduled. Conclusion: While this syndrome may be rare, it is important that eye care professionals remain aware of Aarskog syndrome and its ocular/systemic associations. Poster 68 Two Cases of Torsional Nystagmus in the Absence of Neurological Pathology Nadine Girgis, O.D., and Geoffrey Goodfellow, O.D., Private Practice, 4970 N. Harlem, Harwood Heights, Illinois 60706 Background: Nystagmus is a biphasic ocular oscillation that can be classified in nearly 50 different categories. Torsional or rotary nystagmus is generally a sign of vestibular, cerebellar, or brainstem disease; rarely, it is a congenital, benign, or isolated condition. There are published cases of congenital torsional nystagmus as a subtype of manifest latent nystagmus (MLN). MLN is an early-onset, generally horizontal nystagmus, which is apparent with both eyes open while viewing an object though only one eye is fixating. Frequently strabismus and dissociated vertical deviation (DVD) are also present. Two case reports with eye movement video recordings will demonstrate adult patients exhibiting longstanding torsional nystagmus in the absence of any known neurological pathology. Case Reports: Patient TL, a 43-year-old white male, presented for a comprehensive eye examination with no ocular/ visual complaints and no remarkable medical history. TL had been diagnosed with congenital nystagmus 4 years
Optometry, Vol 78, No 6, June 2007 prior, and his ocular history also included an infantile constant exotropia for which glasses were prescribed at age 18 months. Examination revealed bilateral mixed astigmatism, constant alternating exotropia, DVD, and a bilateral manifest latent torsional nystagmus of small frequency and amplitude. All other examination findings were unremarkable. Patient LH, a 50-year-old white male, presented for a comprehensive eye examination with no ocular/visual complaints and no remarkable medical history. LH reported having had eye muscle surgery when he was younger to treat infantile esotropia. Examination revealed compound hyperopic astigmatism O.D., compound myopic astigmatism O.S., constant right exotropia, DVD, and a bilateral manifest latent torsional nystagmus of small amplitude and frequency. All other examination findings were unremarkable. Conclusion: Most cases of torsional nystagmus are caused by neurological pathology and result in oscillopsia and other patient complaints. These cases are a cause for concern, and patients should undergo neuroimaging. The cases presented above illustrate 2 adults with a rare, longstanding torsional nystagmus that appears to have a congenital etiology. The waveform, absence of symptoms, and presence of a latent component can aid clinicians in differentiating between congenital torsional versus pathological torsional nystagmus. Poster 69 Initial Signs of Acute Myelogenous Leukemia: Roth Spots Adrienne Ari, O.D., M.P.H., U.S. Army, 301 Andrews Avenue, Fort Rucker, Alabama 36362 Background: A 30-year-old white female had been treated for a sinus infection for a week. She and her family had recently vacationed in the Bahamas, and, upon return, she became ill. Her symptoms included a fever, coughing, and sneezing. In addition to her illness, she noted blurry vision after a few days of treatment with Entex PSE (guaifenesin/ pseudoephedrine), worse in the left eye. Case Summary: The patient was referred by her PCM because of the change in her visual status and complaint of “seeing spots.” She had no previous history of spectacle wear. Unaided visual acuity was 20/25 O.D. and 20/30 O.S., which did not improve with refraction. Pupils were equal and responsive to light. No abnormal anterior segment findings were noted. After dilation, Roth spots were noted O.S.⬎⬎O.D. Labs were obtained to determine the cause: complete blood count with differential, comprehensive metabolic panel, and an erythrocyte sedimentation rate. Results showed low values for white blood count, red blood count, hemoglobin, and hematocrit and high values for lymphocytes, platelets, and ESR. The patient was immediately referred to the local emergency room for a blood transfusion and further workup for a definitive diagnosis. She received
297 must be conducted. Those patients who are known to have both sickle cell trait and other systemic vascular disease should undergo regular ophthalmic examination. Poster 66 Diabetic Optic Neuropathy Pauline Ilsen, O.D., and Lindsay Harris, O.D., West Los Angeles VA Healthcare Center/Southern California College of Optometry, Bldg. 304, Room 2-111, 11301 Wilshire Blvd, Los Angeles, California 90073 Background: Diabetes mellitus is the most common endocrine disease in the world, and it proves to have devastating effects on vision when it involves the retina. However, there are numerous other ocular manifestations of this disease. Diabetic optic neuropathy is very controversial because of its unknown pathogenesis. Optic neuropathy associated with diabetes mellitus is considered by some to be a mild variant of nonarteritic anterior ischemic optic neuropathy and by others as a distinctively separate entity involving the disc microvasculature called “diabetic papillopathy.” It is viewed by some as a risk factor for progression of retinopathy. Case Report: A 50-year-old black man with type 2 diabetes mellitus presented for routine examination with bilateral disc edema. Fluorescein angiography demonstrated leakage at the disc without delay in both eyes, indicating diabetic optic neuropathy. A progression of retinopathy to the proliferative stage was observed in the months following the discovery of the disc edema. Conclusions: Given that the prevalence of diabetes mellitus type 2 has increased dramatically in the past decade, eye care providers will increasingly find themselves challenged with unusual ocular manifestations of the disease. This raises the need for increased awareness of uncommon clinical manifestations of diabetes. Ultimately, it is important to be aware of this condition and adjust follow-up accordingly. Poster 67 Aarskog Syndrome: Ocular and Systemic Manifestations Allison Stanton, O.D., Marc Taub, O.D., and Marjorie L. McLin, B.S., Southern College of Optometry, 1245 Madison Avenue, Memphis, Tennessee 38104 Background: Aarskog syndrome (facial-digital-genital syndrome) is an X-linked inherited disorder that causes multiple limb and genital abnormalities. Cardinal features consist of short stature, short hands with mild syndactyly, and a shawl scrotum. Ocular associations most commonly include hypertelorism, blepharoptosis, and strabismus, while ophthalmoplegia, optic nerve head hypoplasia, and retinal vessel tortuosity are rarer findings. Case Report: An 8-year-old white male with Aarskog syndrome presented with concerns of letter reversals, letter additions, and an occasional “crooked” eye when the patient became frustrated. The parents had noticed an eye turn for
298 the previous 3 to 4 years but were unsure which eye was affected. The patient was having trouble with academics, especially math and reading. The entering visual acuities were 20/70 O.D., 20/50 O.S., 20/60 OU at distance and 20/125 O.D., 20/40 O.S., 20/40 OU at near. The patient was not using a spectacle correction, as this was his first examination. Near point of convergence was up to 3 cm, with a recovery of 8 cm. The cover test was orthophoric at distance and 6 exophoria at near. Local stereo was positive with the “Stereo Fly.” Pupils, color vision, and confrontation fields were unremarkable. Extra-ocular muscle testing revealed a restriction in elevation in all superior gazes (primary, temporal, and nasal) O.D., full range of motion O.S. Forced ductions were attempted but not obtained due to poor patient cooperation. Dry and cycloplegic retinoscopy revealed a high hyperopic astigmatic correction. The anterior segment was remarkable for hypertelorism and a downward slanting of the palpebral fissures. The posterior segment revealed tortuosity of the retinal vessels, with normal optic nerve head, macula, and peripheral retina. The patient was diagnosed with bilateral anisometropic amblyopia secondary to high hyperopic astigmatism, hypertelorism, a unilateral superior ophthalmoplegia, and retinal vessel tortuosity. A full-time prescription was issued and follow-up exam was scheduled. Conclusion: While this syndrome may be rare, it is important that eye care professionals remain aware of Aarskog syndrome and its ocular/systemic associations. Poster 68 Two Cases of Torsional Nystagmus in the Absence of Neurological Pathology Nadine Girgis, O.D., and Geoffrey Goodfellow, O.D., Private Practice, 4970 N. Harlem, Harwood Heights, Illinois 60706 Background: Nystagmus is a biphasic ocular oscillation that can be classified in nearly 50 different categories. Torsional or rotary nystagmus is generally a sign of vestibular, cerebellar, or brainstem disease; rarely, it is a congenital, benign, or isolated condition. There are published cases of congenital torsional nystagmus as a subtype of manifest latent nystagmus (MLN). MLN is an early-onset, generally horizontal nystagmus, which is apparent with both eyes open while viewing an object though only one eye is fixating. Frequently strabismus and dissociated vertical deviation (DVD) are also present. Two case reports with eye movement video recordings will demonstrate adult patients exhibiting longstanding torsional nystagmus in the absence of any known neurological pathology. Case Reports: Patient TL, a 43-year-old white male, presented for a comprehensive eye examination with no ocular/ visual complaints and no remarkable medical history. TL had been diagnosed with congenital nystagmus 4 years
Optometry, Vol 78, No 6, June 2007 prior, and his ocular history also included an infantile constant exotropia for which glasses were prescribed at age 18 months. Examination revealed bilateral mixed astigmatism, constant alternating exotropia, DVD, and a bilateral manifest latent torsional nystagmus of small frequency and amplitude. All other examination findings were unremarkable. Patient LH, a 50-year-old white male, presented for a comprehensive eye examination with no ocular/visual complaints and no remarkable medical history. LH reported having had eye muscle surgery when he was younger to treat infantile esotropia. Examination revealed compound hyperopic astigmatism O.D., compound myopic astigmatism O.S., constant right exotropia, DVD, and a bilateral manifest latent torsional nystagmus of small amplitude and frequency. All other examination findings were unremarkable. Conclusion: Most cases of torsional nystagmus are caused by neurological pathology and result in oscillopsia and other patient complaints. These cases are a cause for concern, and patients should undergo neuroimaging. The cases presented above illustrate 2 adults with a rare, longstanding torsional nystagmus that appears to have a congenital etiology. The waveform, absence of symptoms, and presence of a latent component can aid clinicians in differentiating between congenital torsional versus pathological torsional nystagmus. Poster 69 Initial Signs of Acute Myelogenous Leukemia: Roth Spots Adrienne Ari, O.D., M.P.H., U.S. Army, 301 Andrews Avenue, Fort Rucker, Alabama 36362 Background: A 30-year-old white female had been treated for a sinus infection for a week. She and her family had recently vacationed in the Bahamas, and, upon return, she became ill. Her symptoms included a fever, coughing, and sneezing. In addition to her illness, she noted blurry vision after a few days of treatment with Entex PSE (guaifenesin/ pseudoephedrine), worse in the left eye. Case Summary: The patient was referred by her PCM because of the change in her visual status and complaint of “seeing spots.” She had no previous history of spectacle wear. Unaided visual acuity was 20/25 O.D. and 20/30 O.S., which did not improve with refraction. Pupils were equal and responsive to light. No abnormal anterior segment findings were noted. After dilation, Roth spots were noted O.S.⬎⬎O.D. Labs were obtained to determine the cause: complete blood count with differential, comprehensive metabolic panel, and an erythrocyte sedimentation rate. Results showed low values for white blood count, red blood count, hemoglobin, and hematocrit and high values for lymphocytes, platelets, and ESR. The patient was immediately referred to the local emergency room for a blood transfusion and further workup for a definitive diagnosis. She received