Anis Mahmoud

Final Diagnosis in Patients Referred with a Diagnosis of Neuroretinitis

Abstract The purpose of this study was to determine final diagnosis of patients referred with a diagnosis of neuroretinitis. A retrospective study of 40 patients with optic disc oedema with macular star (ODOMS) referred with a diagnosis of neuroretinitis was conducted. The final diagnosis was neuroretinitis in 26 patients (65%), with most of these patients (96.1%) having unilateral involvement. Main underlying aetiologies included cat scratch disease (30.8%), rickettsiosis (19.2%), and idiopathic neuroretinitis (23.1%). The remaining 14 patients (35%) had ODOMS that had been mistaken for neuroretinitis. Of these patients, 42.8% were found to have a previously unknown malignant systemic hypertension in association with bilateral ODOMS. Neuroretinitis, usually unilateral, should be differentiated from other causes of unilateral or most often bilateral ODOMS that may masquerade as neuroretinitis, mainly malignant systemic hypertension. This is essential to avoid inappropriate work-up and management and subsequent potential visual or systemic morbidity.

Infectious optic neuropathies: a clinical update

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.

Ocular Manifestations of Rickettsial Disease

Rickettsioses are emergent and resurgent arthropod vector borne diseases due to obligate intracellular small gram-negative bacteria. Most of them are transmitted to humans by the bite of contaminated arthropods, such as ticks. Systemic disease typically consists of high fever, headache and skin rash, with or without «tache noire» (dark spot). Ocular involvement is common including conjunctivitis, keratitis, anterior uveitis, panuveitis, retinitis, retinal vascular changes, and optic nerve involvement. Proper clinical diagnosis of this infectious disease is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular involvement. The diagnosis is usually confirmed by detection of specific antibodies in serum. Ocular involvement associated with rickettsial infection usually has a selflimited course, but it can result in persistent visual impairment. Doxycycline is the treatment of choice for rickettsial diseases but prevention is the mainstay of rickettsial infection control.

Un poil qui pousse dans l’œil : dermoïde du limbe

F c Le dermoïde du limbe (DL) est une dysembryoplasie de l’œil. Sa présentation clinique est le plus souvent typique permettant de porter le diagnostic par le simple examen clinique (Fig. 1). C’est une tumeur cornéo-conjonctivale le plus souvent située au niveau du limbe temporal inférieur [1]. Sur le plan histologique, elle est formée d’un tissu conjonctivoadipeux associé à des glandes lacrymales et des follicules pilo-sébacés sous un revêtement épithélial stratifié kératinisé [2]. Le DL peut être isolé ou associé à un syndrome polymalformatif tel est le cas du syndrome de Goldenhar [2]. Son traitement n’est toujours pas bien codifié [3]. Nous rapportons le cas d’un patient âgé de 32 ans présentant une formation tumorale blanchâtre de l’œil droit, de localisation limbique temporale inférieure avec un poil de 2,5 cm à sa surface évoquant un dermoide du limbe, la réfraction automatique n’a pas montré de vice réfractif, le reste de l’examen ophtalmologique était sans anomalies. La tumeur était isolée sans aucune malformation associée.