Anisocoria

Anisocoria is a term used for unequal size of the pupils and should be evaluated as a pathological sign. In this review, the anatomy and physiology of the pupil, and the causes of pathologic anisocoria are discussed. (Turk J Ophthalmol 2012; 42: Supplement 68-72

Painful ophthalmoplegia manifesting with third nerve palsy in childhood

Çocukluk çağında üçüncü sinir felci ile seyreden ağrılı oftalmopleji yapabilen sebepler arasında, postenfeksiyöz üçüncü sinir felci, bası yapan kitle lezyonları, vasküler anomaliler ve oftalmoplejik migren bulunmaktadır. Oftalmoplejik migren, çocukluk çağında başlayan tekrarlayan baş ağrısı atakları ve oftalmoplejiyle karakterize, literatürde ender rastlanılan bir patolojidir. Oftalmopleji; 3., 4. ya da 6. kraniyal sinirin parezisi ya da paralizine bağlı olarak ortaya çıkar. Ataklar bazen birkaç saat bazen de birkaç hafta sürebilir ve genelde uygun tedaviyle düzelir, ancak bazı olgularda kalıcı sorunlar görülebilir. Bu çalışmada çift görme, tek gözde kapak düşüklüğü, midriyazis ve şiddetli baş ağrısı şikayetleri ile göz polikliniğine başvuran 11 yaşındaki olgu tartışıldı. Hastanın oftalmolojik muayenesinde okülomotor paralizi saptanarak, oftalmoplejik migren tanısı düşünüldü ve buna yönelik ilaç tedavisine başlandı. Migren tedavisi sonrasında hastanın şikayetleri azaldı ve 8 hafta içinde tamamen düzeldi. Bu olgu sunumu ile, çocukluk çağında ağrılı oftalmopleji ve bu tabloya yol açabilecek hastalıklar tartışıldı. (Turk J Ophthalmol 2012; 42: 159-62)The causes of painful ophthalmoplegia that manifests with third nerve palsy in childhood include postinfectious third nerve palsy, compressive lesions, vascular anomalies and ophthalmoplegic migraine. Ophthalmoplegic migraine is a rare pathology in the literature and is characterized by recurrent attacks of headache and ophthalmoplegia that usually begins during childhood. Ophtalmoplegia occurs due to paresis or paralysis of cranial nerves 3, 4 or 6. Attacks may last a few hours to weeks and usually are recovered with appropriate therapy, but some cases may demonstrate permanent defects. in this paper, we discuss the case of an 11-year-old patient, who was admitted to our outpatient clinic with the complaints of right ptosis, mydriasis and severe headache. Ophthalmologic examination revealed oculomotor nerve palsy, the patient was diagnosed as having ophthalmoplegic migraine and medical treatment was started. Her complaints have regressed with medication for migraine and recovered completely in 8 weeks. in this case report, painful ophthalmoplegia during childhood and its possible causes are discussed. (Turk J Ophthalmol 2012; 42: 159-62

The Management of a Patient with Elevated Intraocular Pressure Resistant to Medical Treatment: Anterior Chamber Irrigation

A 7-year-old male patient was medically treated in another center for hyphema which occurred after blunt trauma to his right eye. He was admitted to our clinic when his visual acuity decreased after being discharged. Biomicroscopic examination revealed total hyphema. Intraocular pressure (IOP) was 48 mm Hg in the right eye with Goldmann applanation tonometry. Since IOP could not be managed by medical therapy and there was no regression in hyphema, anterior chamber was irrigated. As in our case, it should not be forgotten that re-hemorrhage may occur in the first week of hyphema during childhood. Moreover, surgical treatment should be considered when hemorrhage does not regress with medical treatment, increased IOP persists, and when there is a risk of corneal endothelial staining (corneal blood staining). (Turk J Ophthalmol 2014; 44: 400-2

Wolfram Sendromlu Hastalarda Optik Koherans Tomografi Bulguları

Objectives: To report the optical coherence tomography (OCT) findings in patients with Wolfram syndrome. Materials and Methods: Four patients who fulfilled the criteria for Wolfram syndrome were recruited to the study. In all patients, OCT was performed with Stratus OCT (OCT-3, Carl Zeiss Meditec, Inc. Germany). The fast retinal nerve fiber layer (RNFL) and fast macular thickness protocols were used to measure the RNFL and macular thickness, respectively. The fast optic disc protocol was used to determine the cup-to-disc ratios of the optic disc. All patients were examined with VEP (Retimax, CSO Strumenti Oftalmici, Florence, Italy). Results: In eight eyes of four patients (3 male and 1 female) with a mean age of 18.5±2.08 years (range 16-21 years), RNFL, macular thickness, and cup-to-disc ratios were determined. The mean RNFL was 42.2±5.6 µm (range 34.1-49.5 µm), while the mean macular thickness and cup-to-disc ratios were 145±15 µm (range 125-160 µm) and 0.79±0.07 (range 0.7-0.92), respectively. There was a moderate negative correlation between VEP latencies and macular and RNFL thicknesses (Spearman correlation coefficient was -0.23 and -0.34, respectively). Conclusions: RNFL loss and secondary optical atrophy are severe complications that may affect the visual acuity in patients with Wolfram syndrome. Retinal changes in these patients may be quantified and can be observed using OCT. (Turk J Ophthalmol 2014; 44: 212-5

Kaza ile nd:YAG lazer sonrası gelişen maküler deliğin spontan kapanması

Neodymium:yttrium aluminum garnet (Nd:YAG) lazerin yol açtığı maküler deliklerin seyri, bu tip kazaların ender olmasın- dan dolayı bilinmemektedir. Kaza ile Nd:YAG lazer hasarına bağlı maküler delik tanısı alan 47 yaşında erkek fizik uzmanı takibe alındı. Maküler deliğin boyutu azaldı ve vitre hemorajisi çekildi. Kaza ile yüksek enerjili Nd:YAG lazere maruz kalın- ması, retinada ciddi hasarlara neden olabilir. Ancak, lazere bağlı gelişen bu maküler delikler spontan kapanabilir. Lazere bağlı maküla hasarında, doğal seyri etkileyen en sık bulgular epiretinal membranın varlığı ve maküler deliğin boyutudur.The natural history of Neodymium:yttrium aluminum garnet (Nd:YAG) laser-induced macular holes remains uncertain because this type of injury is uncommon. A 47 years old male physicist with the diagnosis of macular hole induced by ac- cidental Nd:YAG laser injury was followed-up. The size of the macular hole decreased and vitreous hemorrhage resolved spontaneously. Accidental exposure to high-energy Nd:YAG laser may lead to concussive retinal damage and create a macu- lar hole. Laser-induced macular holes can resolve spontaneously. The presence of an epiretinal membrane and the size of the macular hole are the common ocular signs that seem to affect the natural course of laser-induced macular holes

Characteristics of the Anterior Segment Biometry and Corneal Endothelium in Eyes with Pseudoexfoliation Syndrome and Senile Cataract

Objectives: To evaluate the anterior segment biometric features and corneal endothelial changes in eyes with pseudoexfoliation (PEX) syndrome and senile cataract. Materials and Methods: The central corneal thickness, anterior chamber depth (ACD), pupil diameter, lens thickness, endothelial cell density (ECD), and percentages of polymegathism and pleomorphism of 52 subjects with PEX and cataract were compared with 51 age- and gender-matched control subjects with cataract using optical low-coherence reflectometry (OLCR, Lenstar LS 900; Haag Streit AG, Switzerland) and in-vivo confocal microscopy (Confo Scan 4, Nidek Co. Ltd, Osaka, Japan). Nineteen subjects with PEX syndrome had glaucoma and were using anti-glaucoma medications. Only one eye of the subjects was used in statistical analysis and a p value less than 0.05 was considered statistically significant. Results: None of the OLCR parameters reached statistically significant differences among the 3 groups (ANOVA p>0.05). The percentage of eyes with ACD <2.5 mm was 13.7% in the control group, 24.2% in PEX eyes without glaucoma and 21.1% in PEX eyes with glaucoma, with no statistically significant differences (p=0.45). There was a significant difference in mean ECD among the 3 groups (ANOVA p=0.02), whereas no differences could be found in respect to polymegathism and pleomorphism (p>0.05). Mean ECD was significantly lower in the PEX glaucoma group (2,199.5±176.8 cells/mm2) than the control group (2,363±229.3 cells/mm2) (p=0.02), whereas no difference was found in mean ECD of PEX eyes without glaucoma and the control group (p=0.42). ECD was less than 2,000 cells/mm2 in 15.8% of PEX subjects with glaucoma, 9.8% of control subjects and 6.1% of PEX eyes without glaucoma, with no statistically significant difference (p=0.52). Conclusion: As eyes with both PEX glaucoma and cataract seem to be associated with decreased endothelial cell number, specular or confocal microscopy screening should be done for the patients scheduled for intraocular surgery. (Turk J Ophthalmol 2015; 45: 188-192

The Effects of Smoking on Anterior Segment Parameters, Retinal Nerve Fiber Layer, and Pupillary Functions

Objectives: To evaluate the alterations in the anterior segment parameters, retinal nerve fiber layer, and pupillary functions in smokers. Materials and Methods: In this case-control study, 45 eyes of 45 smokers and 45 eyes of 45 non-smoker control subjects were evaluated. All patients underwent measurement of anterior segment parameters with optical low coherence reflectometry (OLCR), mesopic and photopic pupillary diameter with an aberrometer device, retinal nerve fiber layer thickness with optical coherence tomography, and dry-eye assessment with Schirmer’s test. The results were compared with independent t-test by SPSS 16.0 Inc., and a p-value lower than 0.05 was determined as significant. Results: There was a significant difference between both groups in terms of mesopic pupil diameters that were measured with both OLCR and aberrometer device (p=0.03 and 0.02, respectively). Schirmer scores were also significantly decreased in smokers (p=0.001). The other measured parameters demonstrated no difference between smokers and non-smokers (p>0.05 for all). Conclusion: Smoking may affect pupillary functions, especially the mesopic pupillary diameter, and may cause a deficiency in pupil response under dark circumstances. (Turk J Ophthalmol 2014; 44: 11-4

Eyelid Molluscum Contagiosum Lesions in Two Patients with Unilateral Chronic Conjunctivitis

Molluscum contagiosum (MC) is a viral infection of the skin and mucosal tissues characterized by skin-colored or transparent round nodules with a dimple or pit in the center. The infection is caused by a DNA poxvirus called the MC virus. Although MC generally occurs in children, it has also been reported in immunocompromised and atopic patients. The virus is transmitted by skin contact or sexual intercourse. The lesions disappear spontaneously within several months in most cases. However, excision, cryotherapy, cauterization, topical chemical and antiviral agents, and/or oral cimetidine are used in refractory cases or to accelerate the healing process. Herein, we discussed the clinical findings and our treatment of two patients with unilateral chronic conjunctivitis associated with eyelid MC lesions in light of the literature

Bilateral Adie’s Tonic Pupil

A 37-year-old male patient applied with the complaint of photophobia and having difficulties in reading. Both pupils were found to be dilated and unreactive to light but responsive to accommodation. The case was diagnosed with bilateral tonic pupil following neurological, radiological and laboratory evaluations. Tonic pupil should be kept in mind in eyes with light-near dissociation. In this case report, bilateral tonic pupils and the possible mechanism which may cause this disorder were discussed. (Turk J Ophthalmol 2013; 43: 64-6

Topikal proparakain suistimaline bağlı gelişen toksik keratopati

Gözde ağrı, yanma, batma ve yaşarma şikayetleri ile başvuran kırk iki yaşındaki erkek olguda kornea santralinde epitel defekti, stromal ülserasyon ve korneal ödem saptandı. Sanayide kaynak işi yapan ve şikayetlerinin 40 gündür mevcut olduğunu ifade eden olgunun ısrarlı sorgulanması sonucunda proparakainin topikal formunu kullandığı öğrenildi. Özellikle sanayi, inşaat gibi kornea yaralanması oranı yüksek olan meslek gruplarında proparakain suistimali daha sık görülmektedir. Bu nedenle, kornea epitel defekti, epitel iyileşmesinde gecikme, stromal erime, şiddetli ağrı ve görme keskinliğinde azalma görülen özellikle bu meslek gruplarındaki hastalarda propakain suistimali akla getirilmelidi