Herpes simplex keratitis: Challenges in diagnosis and clinical management

Herpes simplex virus is responsible for numerous ocular diseases, the most common of which is herpetic stromal keratitis. This is a recurrent infection of the cornea that typically begins with a subclinical infection of the cornea that establishes a latent infection of sensory ganglia, most often the trigeminal ganglia. Recurring infections occur when the virus is reactivated from latency and travels back to the cornea, where it restimulates an inflammatory response. This inflammatory response can lead to decreased corneal sensation, scarring, and blindness. The diagnosis of these lesions as the result of a recurrent herpes simplex virus infection can at times be problematic. Currently, herpetic stromal keratitis is diagnosed by its clinical presentation on the slit-lamp examination, but the literature does not always support the accuracy of these clinical findings. Other diagnostic tests such as polymerase chain reaction assay, enzyme-linked immunosorbent assay, immunofluorescent antibody, and viral cultures have provided more definitive diagnosis, but also have some limitations. That said, accurate diagnosis is necessary for proper treatment, in order to prevent serious consequences. Current treatment reduces the severity of lesions and controls further viral spread, but does not provide a cure

The Relative Frequency of Severe Vision Loss from CRAO Versus NAION

Sudden, painless monocular vision loss is a diagnostic challenge in the acute setting. The two most common vascular causes of acute monocular vision loss in the elderly are central retinal artery occlusion (CRAO) and nonarteritic anterior ischemic optic neuropathy (NAION) whose evaluation and treatment greatly differ. There are currently no consensus diagnostic or treatment guidelines for patients presenting with acute monocular vision loss. According to a national survey, up to 53% of US institutions offer intravenous tissue plasminogen activator (tPA) for CRAO, which can sometimes occur without an eye examination in centers that lack access to an on-call ophthalmologist. Therefore, in this study, we aimed to describe the relative frequency of patients with CRAO vs. NAION that presented with acute painless monocular severe vision loss using a population-based cohort

Proceedings of the 43nd Annual Upper Midwest Neuro-Ophthalmology Group Meeting, July 23, 2021 and Second Virtual Upper Midwest Neuro-Ophthalmology Group Meeting.

The 43rd meeting of the Upper Midwest Neuro-Ophthalmology Group (UMNOG) took place on July 23, 2021. For the second sequential year, the meeting was held virtually due to the COVID-19 pandemic. The meeting was held in the honour of the late Ivy Dreizin MD. Ninety people attended virtually marking the highest UMNOG meeting attendance on record. There were 23 podium presentations interspersed with numerous personal testimonials recognising Dr Dreizin and her immense contributions to the UMNOG community

Tachyphylaxis With Sustained Apraclonidine Use in the Treatment of Ptosis Associated With Horner Syndrome

Apraclonidine is an adrenergic agonist with stronger affinity for α2 receptors than α1 receptors. Following sympathetic denervation in Horner syndrome, α receptors are upregulated, and therefore apraclonidine causes both mydriasis, via the effect of α1 stimulation of the dilator pupillae, and lid elevation, via the effect of α2 stimulation on Müller's muscle. In addition to being helpful in confirming Horner syndrome, apraclonidine can be used as a therapeutic agent for ptosis

The Yield of Neuroimaging in Patients Presenting to the Emergency Department with Isolated Neuroophthalmological Complaints

Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. The decision to perform a neuroimaging procedure is currently based on the clinical judgement of the medical team, without defined indications. This study aims to identify presenting symptoms and physical exam findings associated with relative positive findings on neuroimaging studies

Optic Chiasm Involvement Associated with Myelin Oligodendrocyte Glycoprotein and Aquaporin-4 Antibodies (Slides)

To describe and compare the pattern of optic chiasm involvement in patients with myelin oligodendrocyte glycoprotein antibody associated optic neuritis (MOG-ON) with aquaporin-4 antibody associated optic neuritis (AQP4-ON). MOG-IgG associated disease (MOGAD) has been demonstrated to be a distinct entity from AQP4-IgG positive neuromyelitis optica spectrum disorder (NMOSD). Optic neuritis is often the presenting symptom in NMOSD. It has been previously reported that chiasmal involvement is seen in at least 50% of AQP4-ON compared to a minority of patients with MOG-ON