Bilateral Amaurosis Caused by Salmonella enteritidis Infection

The aim of this paper was to show the potential of Salmonella enteritidis infection to eventually result in visual impairment. A case of salmonellosis in a 6-year-old boy, caused by intake of a cake made from eggs infected with Salmonella enteritidis, is presented. Prolonged duration of the disease was followed by complete remission of neurologic complications and persistent amaurosis with bilateral optic nerve atrophy. A severe form of Salmonella enterocolitis with neurologic involvement can lead to optic nerve lesion with consequential loss of vision

Inapparent Visual Field Defects in Multiple Sclerosis Patients

To assess inapparent visual field defects in patients with multiple sclerosis free from optic neuritis. During 5 years period 120 patients with multiple sclerosis were examined at the University Department of Ophthalmology, Zagreb University Hospital Center. They were divided into three groups with 40 patients each: patients with acute unilateral optic neuritis, referred to ophthalmologist and treated with pulsed steroid therapy; patients with subjective feeling of blurred vision, normal visual acuity and no signs of acute optic neuritis; and patients free from subjective signs of visual impairment. Study patients underwent standard ophthalmologic examination and visual field testing in photopia by use of quantitative kinetic Goldmann perimetry. The initial and control examination by visual field testing were performed at least 6 months apart. Study results showed 65% of multiple sclerosis patients to have visual field defects without subjective signs of impaired vision. The most common defects were mild to moderate visual field narrowing with blind spot enlargement and depression from above. The following results were recorded: acute optic neuritis group: normal in 13/40 (32.5%) for the affected eyes and 27/40 (67.5%) for fellow eyes; mild visual field narrowing in 4/40 (10%) for the affected eyes and 10/40 (25%) for fellow eyes; moderate visual field narrowing with blind spot enlargement in 14/40 (35%) for the affected eyes and 1/40 (2.5%) for fellow eyes; and paracentral and arcuate scotomata in 9/40 (22.5%) for the affected eyes and 2/40 (5%) for fellow eyes; subjective symptom group: normal in 8/40 (20%) for the affected eyes and 11/40 (27.5%) for fellow eyes; mild visual field narrowing in 11/40 (27.5%) for the affected eyes and 16/40 (40%) for fellow eyes; moderate visual field narrowing with blind spot enlargement in 18/40 (45%) for the affected eyes and 10/40 (25%); and paracentral and arcuate scotomata in 3/40 (7.5%) for both affected and fellow eyes; and subjective symptom-free group: normal in 24/80 (30%), mild visual field narrowing in 22/80 (27.5%) moderate visual field narrowing with blind spot enlargement in 24/80 (30%); and paracentral and arcuate scotomata in 10/80 (12.5%). The presence of subclinical form of optic nerve involvement could be demonstrated in a very early stage of multiple sclerosis by the introduction of visual field testing in the standard examination protocol

Therapeutic Efficacy of 5% NaCl Hypertonic Solution in Patients with Bullous Keratopathy

A clinical trial was undertaken to evaluate the efficacy of hypertonic solution (5% NaCl) in patients who have bullous keratopathy (BK). The aim of the study was to define the stage of the disease and the thickness of cornea in micrometers, which would be the threshold for therapeutic approach. This was a prospective study on 70 eyes of 55 patients. Patients were divided in two groups at the beginning of the study.The first group (n=33 eyes) included patients with initial stage of BK: only stromal component of corneal oedema was present. The second group (n=37 eyes) included patients with advanced stage of BK: the epithelial component of the disease with bullae on the corneal surface had already developed. Visual acuity, central and peripheral thickness of cornea and morphology of the disease was recorded before therapy, 7 days and 4 weeks after administration of hypertonic solution. Our results shown that the efficacy of hypertonic solution correlates with the severity of clinical picture in patients with BK. When 5% NaCl hypertonic solution was applied in the early stage of the disease, when only stromal component of corneal oedema was presented, visual acuity and pachymetry readings were significantly improved. The threshold pachymerty measurement of corneal thickness justifying the application of hypertonic solution was 613–694 _m(in the central corneal area), and 633–728 _m(at corneal periphery). It seems reasonable to apply hypertonic solution to the patients who have BK and whose pachymetric values are below mentioned range. In terminal stages of BK, when superficial bullae (epithelial component) had already developed, treatment with NaCl was not effective and patients had to be submitted to penetrating keratoplasty

Multiple Sclerosis and Neuro-Ophthalmologic Manifestations

The authors report clinical features of ocular manifestations in patients with multiple sclerosis (MS), those that affect the visual sensory system and those that affect the ocular motor system. Disturbances of visual sensory function may precede, manifest coincidentally or follow the neurologic manifestations. Visual disturbances are common in MS and often a result of acute demyelinating optic neuropathy. Careful examination of MS patients, who have never suffered optic neuritis, may also reveal asymptomatic visual loss. Asymptomatic visual loss seems to be a universal feature of MS. Patients with multiple sclerosis may develop disorders of fixation, ocular motility and ocular alignment. Disorders of ocular motor system are frequently the initial sign of multiple sclerosis and occur as its presenting sign weeks, month, or years before other neurologic symptoms and signs develop

Minor head trauma and isolated unilateral internuclear ophthalmoplegia

Internuclear ophthalmoplegia is a syndrome that develops due to a lesion of the medial longitudinal fasciculus. This lesion is mostly caused by multiple sclerosis (usually bilaterally), and only rarely by head injury. A case is presented of unilateral internuclear ophthalmoplegia as an isolated sequel of minor head trauma, which eventually resolved. A 40-year-old woman with isolated internuclear ophthalmoplegia secondary to closed head trauma with anatomical lesions of the mesencephalon in the region of medial longitudinal fasciculus is described. A minor contusion was detected by magnetic resonance imaging. Diplopia resolved in 5 months. In conclusion, internuclear ophthalmoplegia should be considered in the differential diagnosis in patients with recent head injuries showing adduction impairment. The connection between the clinical picture and anatomical lesions is visualized by magnetic resonance imaging