Ophthalmic Diseases

All Items

• Lacrimal sac diffuse large B-cell lymphoma presenting as sudden-onset binocular diplopia Antoine Jeri-Yabar, Liliana Vittini-Hernandez, Bharati Dev, Marissa Patel, Meihuan Lin Views: 0 HTML: 0 PDF: 0

  Introduction: Diffuse large B-cell lymphoma (DLBCL) is a prevalent subtype of non-Hodgkin lymphoma (NHL) affecting predominantly elderly individuals.
  Case description: A 68-year-old man with a history of hypertension, hyperlipidaemia and a small pituitary gland tumour presented with sudden-onset binocular diplopia and right-eye blurry vision. A magnetic resonance imaging (MRI) of the brain revealed enhancing soft tissue in the right superolateral orbit inseparable from the lacrimal gland, extending medially to the right superior rectus muscle and soft tissue. Further scanning showed widespread metastasis to the bilateral retroperitoneal lymph nodes, adrenal gland, spine and lymph nodes in the neck. A biopsy of the lacrimal gland confirmed DLBCL.
  Conclusion: Primary lacrimal gland DLBCL is a rare and delayed diagnosis that often stems from the resemblance of its clinical manifestations to more benign conditions such as dacryocystitis, dacryostenosis or mucocele. Timely recognition and accurate diagnosis are essential for initiating appropriate treatment and improving patient outcomes.

• Sudden visual loss due to arteritic anterior ischaemic optic neuropathy: A rare manifestation of eosinophilic granulomatosis with polyangiitis Antonio Faraone, Alberto Fortini, Vanni Borgioli, Chiara Cappugi, Aldo Lo Forte, Valeria Maria Bottaro, Augusto Vaglio Views: 188 HTML: 41 PDF: 143

  Background: eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multisystem inflammatory disease characterized by asthma, eosinophilia and granulomatous or vasculitic involvement of various organs. While the eye is uncommonly affected in patients with EGPA, multiple ophthalmic manifestations have been reported, which can result in serious visual impairment without timely treatment.
  Case report: we report the case of a 79-year-old woman with a history of asthma and nasal polyps who presented with low-grade fever, mild alteration of mental status, and fatigue. Chest X-ray revealed bilateral interstitial infiltrates. Lab tests showed elevated C-reactive protein level and eosinophilia (eosinophil count, 4.6 x10⁹ cells/l); blood cultures and parasitological examination of stools tested negative. Four days after presentation, the patient reported sudden and severe blurring of vision in her left eye. Ophthalmological examination revealed bilateral swollen optic disc and visual field loss, more severe in the left eye. A diagnosis of EGPA complicated by arteritic anterior ischaemic optic neuropathy (A-AION) was proposed, while an alternative or concurrent diagnosis of giant cell arteritis was ruled out based on clinical picture.
  Immunosuppressive treatment with high-dose intravenous glucocorticoids was promptly started. The patient’s visual defect did not improve; however, two months later, no worsening was registered on ophthalmic reassessment.
  Conclusions: A-AION is an infrequent but severe manifestation of EGPA, requiring prompt diagnosis and emergency-level glucocorticoid therapy to prevent any further vision loss. Disease awareness and a multidisciplinary approach are crucial to expedite diagnostic work-up and effective management of EGPA-related ocular complications.

• Hyperglycaemia-related visual seizure Win Myat Thu, Hein Htet Zaw Views: 292 HTML: 49 PDF: 286

  Introduction: Visual seizure is one of the rare complications of poorly controlled chronic hyperglycaemia. This condition can be debilitating for patients. Early recognition and careful control of hyperglycaemia is vital.
  Case description: A middle-aged female was found collapsed at her home after missing insulin for several days. She was found to have diabetes ketoacidosis (DKA) and she was started on treatment for DKA. She reported visual hallucinations in the right side of her visual field for a week. Further assessment with EEG and brain MRI suggested an occipital seizure consistent with metabolic disturbances. She was initially started on antiepileptic medication. After strict diabetes control, her symptoms resolved, and she no longer needed antiepileptic treatment.
  Conclusion: Experiencing diabetes-related seizures can be terrifying both for patients and their family. Early recognition and quick control of hyperglycaemia is important in treating these patients.