ceRGC and Vision Loss From Traumatic Optic Neuropathy Indud by Repetitive Closed Head Trauma Is Dependent on Timing and Force of Impact.

Purpose: Traumatic optic neuropathy (TON) is often caused by blunt head trauma and has no currently effective treatment. Common animal models of TON induced by surgical crush injury are plagued by variability and do not mimic typical mechanisms of TON injury. Traumatic head impact models have recently shown evidence of TON, but the degree of head impact necessary to consistently induce TON is not well characterized, and it is examined here. Methods: Traumatic skull impacts to C57BL/6J mice were induced using an electromagnetic controlled impact device. One impact performed at two depths (mild and severe), as well as three and five repetitive impacts with an interconcussion interval of 48 hours, were tested. Optokinetic responses (OKRs) and retinal ganglion cell (RGC) loss were measured. Results: Five repetitive mild impacts significantly decreased OKR scores and RGC numbers compared with control mice 10 weeks after initial impact, with maximal pathology observed by 6 weeks and partial but significant loss present by 3 weeks. One severe impact induced similar TON. Three mild impacts also induced early OKR and RGC loss, but one mild impact did not. Equivalent degrees of TON were induced bilaterally, and a significant correlation was observed between OKR scores and RGC numbers. Conclusions: Repetitive, mild closed head trauma in mice induces progressive RGC and vision loss that worsens with increasing impacts. Translational Relevance: Results detail a reproducible model of TON that provides a reliable platform for studying potential treatments over a 3- to 6-week time course

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A 71 year old Caucasian man with a past medical history of hypertension, hyperlipidemia, Type 2 DM, ESRD status post renal transplant, facial melanoma, currently on ASA for a stable left sided putaminal hemorrhage presented with new right sided ptosis and lower extremity weakness. Brain MRI obtained on admission showed small cortical hemorrhages consistent with prior stroke, without evidence of acute pathologic changes. Repeat fine cut MRI of the brain and orbits with and without contrast showed an enhancing lesion in the right parietal bone, clinoid process, and associated abnormal soft tissue changes extending into the right orbital apex, adjacent superior right sphenoid sinus, and the right anterolateral cavernous sinus

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History & ExamA 71 year old Caucasian man with a past medical history of hypertension, hyperlipidemia, Type 2 DM,ESRD status post renal transplant, facial melanoma, currently on ASA for a stable left sided putaminalhemorrhage presented with new right sided ptosis and lower extremity weakness. Brain MRI obtainedon admission showed small cortical hemorrhages consistent with prior stroke, without evidence of acutepathologic changes. Repeat fine cut MRI of the brain and orbits with and without contrast showed anenhancing lesion in the right parietal bone, clinoid process, and associated abnormal soft tissue changesextending into the right orbital apex, adjacent superior right sphenoid sinus, and the right anterolateralcavernous sinus.EMG showed no evidence of a neuromuscular disorder. Lung and parietal bone biopsy revealed CD10positive atypical lymphoid cells. On laboratory evaluation, a CBC revealed a low red blood cellcount. A lumbar puncture revealed an opening pressure of 12.5 mmHg with an Epstein Barr Virus loadof 115 with normal cell counts otherwise. Lymphoma panel showed no abnormal lymphaticcells. Additional CT of the chest, abdomen, and pelvis revealed multiple well-circumscribed pulmonarynodules suspicious for pan-lobar metastatic disease involving both the right and left lungs in addition toprofound mesenteric lymphadenopathy. Bone scan showed evidence of multiple areas of involvement inthe skull, right humerus and left tibia.Vital signs were normal. Visual acuity was 20/60 OD and 20/30 OS, color vision was intact, visualfields were normal and pupils were anisocoric (R 4mm, L 3mm both reactive) with near complete ptosison the right with severely depressed levator function. His right eye was unable to adduct past themidline while the left eye had normal range of motion. There was an associated right-sided facial droop.Motor testing showed normal bulk and tone with normal reflexes. There were no sensory deficits

Benign (May Be Malignant) Episodic Unilateral Mydriasis In A Patient With Hodgkin's Disease!

Benign episodic unilateral mydriasis (BEUM) is an isolated benign cause of intermittent anisocoria. The underlying physiopathology is not clear and may involve either parasympathetic paralysis or sympathetic hyperactivity affecting the iris musculature. Other life threatening causes of anisocoria should be ruled out

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Capillary hemangiomas of the optic disc are endophytic or exophytic vascular hamartomas that may arise from the optic nerve. These congenital hereditary lesions may be associated with central nervous system diseases such as von HippelLindau disease (VHL)

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A 71 year old Caucasian man with a past medical history of hypertension, hyperlipidemia, Type 2 DM, ESRD status post renal transplant, facial melanoma, currently on ASA for a stable left sided putaminal hemorrhage presented with new right sided ptosis and lower extremity weakness. Brain MRI obtained on admission showed small cortical hemorrhages consistent with prior stroke, without evidence of acute pathologic changes. Repeat fine cut MRI of the brain and orbits with and without contrast showed an enhancing lesion in the right parietal bone, clinoid process, and associated abnormal soft tissue changes extending into the right orbital apex, adjacent superior right sphenoid sinus, and the right anterolateral cavernous sinus

Visual Outcomes After Treatment of Venous Sinus Stenosis with Dural Venous Sinus Stenting

"Dural venous sinus stenting (DVSS) has been utilized for years to treat Idiopathic Intracranial Hypertension (IIH), but the literature is scant illustrating its utility in venous sinus stenosis. In most clinical studies that involve this technique, there is an overwhelming group of patients with IIH with few that have known venous sinus abnormalities causing visual symptoms at the time of diagnosis. Although DVSS has been found to be safe and effective at lowering intracranial pressure, this study reviews the effect on the visual system after DVSS with or without addition of acetazolamide.

Multifactorial Optic Neuropathy - When it isn't always glaucoma

We present a case of a rare HLA-B27 associated optic neuropathy masquerading as glaucomatous progression

The Importance of Health Literacy in Addressing Eye Health and Eye Care Disparities

Disparities in eye health and eye care frequently result from a lack of understanding of ocular diseases and limited use of ophthalmic health services by various populations. The purpose of this article is to describe the principle of health literacy and its central role in enhancing health, and how its absence can result in poorer health outcomes. The article evaluates the current status of health literacy in visual health and disparities that exist among populations. It also explores ways to improve health literacy as a means of reducing disparities in visual health and eye care. Advancing dissemination of health information and enhancing health literacy may help not only to reduce healthcare barriers in the underserved populations but also to lessen visual health disparities