Adil Hussein

Ocular burns and related injuries due to fireworks during the Aidil Fitri celebration on the East Coast of the Peninsular Malaysia

This study aims to describe the epidemiology of ocular burns and related injuries due to fireworks during the Aidil Fitri celebration on the East Coast of the Peninsular Malaysia. A prospective analysis of all patients with ocular burns and related injuries due to fireworks attended three tertiary hospitals in East Coast of Peninsular Malaysia during Aidil Fitri, which was from 10 September to 17 October 2008. We observed the demographic and injury characteristics, extent of the injuries and presenting visual symptoms. Thirty patients with 34 eyes with ocular burns and related injuries were identified. Patients ranged between 2 and 43 years of age. 70.00% of the patients were 12 years old and below. Of the 30 patients, 29 (96.67%) were male and the left eye was affected in 14 (46.70%). Thermal injuries accounted for 60.0% of the injuries whereas 40.0% were due to exploding firework. Burns to the eyelid and cornea (35.29%) were the most common injuries noted. Fifteen patients (50%) were bystanders whilst a majority of patients (96.67%) had no eye protection. At presentation, 15 (44.12%) eyes had a visual acuity of 6/6 to 6/9 in the injured eyes, while 3 out of 34 eyes (8.82%) had vision acuity 6/60 or worse. In conclusion, fireworks cause serious preventable ocular burns and related injuries especially in children who are the most affected age group. It affects mainly eyelid and anterior segment structures which result in moderate visual loss on presentation. Health education, public awareness and tighter legislation are essential preventive measures to limit the effect of fireworks to the public.

Orbital apex syndrome after tooth extraction in an immunocompromised patient.

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

Visual acuity and visual skills in Malaysian children with learning disabilities

Background: There is limited data in the literature concerning the visual status and skills in children with learning disabilities, particularly within the Asian population. This study is aimed to determine visual acuity and visual skills in children with learning disabilities in primary schools within the suburban Kota Bharu district in Malaysia. Methods: We examined 1010 children with learning disabilities aged between 8–12 years from 40 primary schools in the Kota Bharu district, Malaysia from January 2009 to March 2010. These children were identified based on their performance in a screening test known as the Early Intervention Class for Reading and Writing Screening Test conducted by the Ministry of Education, Malaysia. Complete ocular examinations and visual skills assessment included near point of convergence, amplitude of accommodation, accommodative facility, convergence break and recovery, divergence break and recovery, and developmental eye movement tests for all subjects. Results: A total of 4.8% of students had visual acuity worse than 6/12 (20/40), 14.0% had convergence insufficiency, 28.3% displayed poor accommodative amplitude, and 26.0% showed signs of accommodative infacility. A total of 12.1% of the students had poor convergence break, 45.7% displayed poor convergence recovery, 37.4% showed poor divergence break, and 66.3% were noted to have poor divergence recovery. The mean horizontal developmental eye movement was significantly prolonged. Conclusion: Although their visual acuity was satisfactory, nearly 30% of the children displayed accommodation problems including convergence insufficiency, poor accommodation, and accommodative infacility. Convergence and divergence recovery are the most affected visual skills in children with learning disabilities in Malaysia.

Follicular thyroid carcinoma mimicking meningioma: A case report

Abstract Follicular thyroid carcinoma (FTC) is a well-differentiated tumor which resembles the normal microscopic pattern of the thyroid. Although intracranial metastasis to the brain is frequent in adults, metastasis from FTC is very rare. Dural metastases mimicking meningioma have been documented in the literature now and then. However, cases arising from a FTC are again very rare. We report the case of a middle-aged lady who presented with progressive, painless left eye proptosis. She was noted to have a non-axial proptosis with dystopia, compressive optic neuropathy and exposure keratitis. She also had a painless swelling over the occipital region. She was initially misdiagnosed to have multiple foci of meningioma based on magnetic resonance imaging findings. Subsequent histopathological examination revealed presence of FTC. She was euthyroid but was found to have multiple small thyroid nodules by ultrasonography. Hence, the definite diagnosis of all dural masses must be histological wherever possible and thyroid carcinoma should be considered as a potential primary tumour in such presentations.

Non-arteritic anterior ischaemic optic neuropathy in Malaysia: a 5 years review.

AIM To evaluate the clinical presentations and visual outcomes of non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS A retrospective study was conducted involving 18 consecutive patients (20 eyes) with NAION attending Hospital Universiti Sains Malaysia from January 2005 until December 2009. RESULTS Most patients were Malay (94.4%), and followed by Chinese (5.6 %). The female-to-male ratio was 3.5:1. The age of patients ranged from 36 to 85 years (mean, 57.1 years). The main risk factors in systemic diseases were hypertension (55.5%), diabetes mellitus (44.4%), and ischaemic heart disease (11.1%). Most patients (77.8%) presented with acute loss of vision while gradual onset was in 22.3% of cases. Majority had visual acuity worse than 1/60 (80%). The most common fundoscopic findings were peripapillary splinter haemorrhage (90%), sectorial swollen optic disc (60%) and hyperemic disc (60%). During follow up, 20% of the patients showed stabilization in visual acuity, and 80% showed worsening of vision. CONCLUSION Majority of patients with NAION presented with acute poor vision involving middle-aged and elderly individuals. Hypertension and diabetes mellitus were among the main risk factors involved. NAION can lead to permanent visual loss despite treatment.

Microbiological aetiology of acute dacryocystitis in hospital Universiti Sains Malaysia, Kelantan Malaysia

Abstract Objective To determine the microbiological aetiology of acute dacryocystitis presented to the Hospital University Sains Malaysia, Kubang Kerian, Kelantan in 5 years duration from 2005 until 2010. Methods This is a retrospective analysis of patients who were clinically diagnosed as acute dacryocystitis from 2005 until 2010 to determine the regional microbiological pattern. The age, gender, predisposing factors, intravenous antibiotics and their microbiological results of discharge from punctal expression were collected. The laboratory procedures were in accordance with the Clinical and Laboratory Standards Institute guidelines. Results There were 23 patients admitted to the eye ward during study period. Females (n=17) outnumbered males (n=6). Majority of isolates were Gram-positive bacteria (n=10, 43.4%) followed by Gram-negative isolates (n=2, 12.9%). The most predominant isolates were Streptococcus pneumonia (S. pneumonia) (21.7%) followed by Staphylococcus epidermidis (S. epidermidis) (13.0%). Conclusions S. pneumoniae was the commonest gram positive organism identified in our study. 47.8% patients showed resistant to initial empirical treatment.

Recurrent bilateral orbital myositis: case report and review of the literature

Abstract Orbital myositis in children is uncommon. Recurrence is a major challenge in management. An 11-year-old Malay girl who presented with bilateral orbital myositis with recurrent attacks of diplopia is reported.

Saka, an ancestral possession: Malaysia

This report illustrates a culture‐bound disorder known as “saka” in the local population of Kelantan, as well as other states in Malaysia. It is a form of possession by the spirit of a deceased ancestor who was once a traditional healer or shaman. While in a dissociative state, the patient introduced a 7 × 3–4 cm wooden stick precisely into his inferior rectus muscle, in an attempt to identify with a blind ancestor who showed his presence momentarily and specifically to the patient. The stick remained hidden to ophthalmologists for 17 days and during this period the patient developed right orbital cellulitis, bilateral cavernous sinus thrombosis and sepsis. The stick was identified after the family took the patient home for cultural healing rites to be performed. The patients altered behavior resolved with the removal of the stick and he returned to his premorbid personality and functioning without psychotropic medication. To date, saka has not been reported in any peer‐reviewed medical journal.

Clinical profile of ocular toxoplasmosis in the Universiti Sains Malaysia Hospital – 7-year review

Background. toxoplasmosis is caused by infection from a ubiquitous obligate intracellular parasite known as Toxoplasma gondii, which can infect both human and warm-blooded animals. this infection is commonly prevalent in developing country. Objectives. the purpose of this study is to report on a 7-year review of ocular toxoplasmosis patients that presented to the Universiti Sains malaysia hospital. Material and methods. this is a retrospective review of cases. the demographic data, ocular manifestations, clinical and laboratory profiles, treatment and disease outcome were collected from the patients’ medical records from January 2010 to December 2016. Results. a total of 16 patients with a diagnosis of ocular toxoplasmosis were identified. the mean age was 43.2, with standard deviation ± 15.4 years old. the percentage was 62.5% (10 patients) females and 37.5% (6 patients) male. the majority of patients were malay (93.4%, 15 patients). the most common classification of uveitis was panuveitis (56.3%, 9 patients), followed by posterior uveitis (25%, 4 patients), anterior uveitis (12.5%, 2 patients) and intermediate uveitis (6.2%, 1 patient). Keratic precipitate (75%, 12 patients) and vitritis (75%, 12 patients) were the most common ocular manifestation of ocular toxoplasmosis. a serological test for toxoplasmosis found only 1 patient with positive serum immunoglobulin m, while all patients displayed non-reactive serum immunoglobulin G (except 1 missing data). all ocular toxoplasmosis patients were treated with oral azithromycin 500 mg daily for 6 weeks, 81.3% (13 patients) were given an instillation of a steroid eye drop, while 25% (4 patients) required administration of an oral steroid. all of the patients responded well to treatment, but 25% (4 patients) suffered from recurrence, which required a second course of treatment. Conclusions. Ocular toxoplasmosis is a serious and depilating disease that can cause serious ocular morbidities. this review shows a diverse presentation of ocular toxoplasmosis as a result of toxoplasmosis infection.

Simultaneous Bilateral Optic Neuritis Following Human Papillomavirus Vaccination in a Young Child

Vaccination-induced optic neuritis is not common. The development of optic neuritis following various vaccinations have been reported, suggesting a possible association between optic neuritis and vaccination. Of those reported cases, influenza vaccines have been the most common. Although rare, those patients who developed optic neuritis following HPV vaccination also presented with other central nervous system (CNS) demyelinating syndromes, especially following a booster dose. We present a rare case of simultaneous isolated bilateral optic neuritis following the first dose of an HPV vaccination in a young child. She received treatment with a systemic corticosteroid that resulted in a good clinical outcome without developing any demyelinating disease.