Baird S. Grimson

Eleven Cases of Sarcoidosis of the Optic Nerve

Of 11 patients (eight women and three men, ranging in age from 16 to 48 years) who had sarcoidosis of the optic nerve that caused decreased visual acuity and visual field abnormalities, only two were known to have sarcoidosis at the time the visual impairment developed. Four patients had granulomas involving the optic nerve head, four had granulomatous inflammation of the orbital or intracranial optic nerve or chiasm, and three had retrobulbar neuritis. All 11 patients had histologically confirmed idiopathic noncaseating granulomatous inflammation and eight of the 11 had abnormalities compatible with sarcoidosis in chest roentgenograms. In the three patients in whom the serum level of angiotensin-converting enzyme was determined, it was increased in one and normal in the other two. Computed tomography of the anterior visual pathways was the single most useful neurodiagnostic study. Treatment with corticosteroids was beneficial in six of the 11 cases. These cases demonstrated that sarcoidosis should be included in the differential diagnosis of any inflammatory or compressive lesion involving the anterior visual pathways.

Scanning electron microscopy of vascular casts of the human scleral lamina cribrosa

Vascular casts of the human lamina cribrosa region were studied in three autopsy specimens utilizing scanning electron microscopy (S.E.M.) in own modified technique. The lamina cribrosa is supplied from two major sources, the short posterior ciliary artery within the sclera and the distal optic nerve sheath pial vasculature. Recurrent choroidal arteries supplied a small number of centripetal branches to the lamina cribrosa. The central retinal artery did not give off centrifugal branches as it coursed through the lamina. The findings in these three human cases in three-dimensial visualization support other recent studies using serial histologic sectioning techniques. The photomicrographs are presented as a first successful images in S.E.M. for additional appreciation of the topographic morphology of radial arterioles.

Magnetic Resonance Imaging of Optic Gliomas

We compared magnetic resonance imaging of the optic nerves and chiasm with computed tomography in four patients (a 17-year-old girl, a 14-year-old boy, a 13-year-old girl, and a 22-year-old woman) with biopsy-proven or suspected optic gliomas. Orbital abnormalities were effectively viewed by both techniques. Gliomatous and normal optic nerves had similar spin-echo magnetic resonance imaging characteristics. Magnetic resonance was superior to contrast-enhanced computed tomography for identification of the intracranial optic nerves, chiasm, and optic tracts, but computed tomography delineated orbital anatomic and spatial relationships better.

Clinicopathological Correlation of a Solitary Choroidal Tuberculoma

In a 34-year-old black man with pulmonary tuberculosis, a rapidly enlarging choroidal tuberculoma progressed to larger size, despite appropriate systemic anti-tuberculous therapy. The eye harboring the tuberculoma became blind and painful, and was subsequently enucleated. Conventional staining of tissue sections revealed a choroidal granuloma without evidence of organisms, but tubercle bacilli were demonstrated by fluorescence microscopy.

Enlargement Of the Optic Disk in Childhood Optic Nerve Tumors

Two children, a 9-year-old girl and an 8-month-old girl, were first examined because of unilateral proptosis. Both children were found to have unilateral optic nerve glioma, accompanied in the second case by neurofibromatosis. Two years after Patient 1 was first examined, the initial findings of thin vertical retinal striae and a gray opacification of the peripapillary retina had resolved. The enlarged left optic disk had an average diameter of 2 mm while that of the normal right optic disk was 1.6 mm. The disk-arteriolar ratio was R.E.:16:1 and L.E.: 20:1. Four years later, the patients visual acuity was still 20/20 in both eyes and the only visual field abnormality was an enlarged blind spot corresponding to the enlarged left optic nerve head. Fundus photographs, orbital echography, and computed tomography showed no change in the size or location of the optic nerve glioma during the six-year follow-up period. In Case 2, the initial intraocular pressure was higher in the proptotic right eye than in the left eye (25 vs 19 mm Hg), but subsequent intraocular pressures were within normal limits and approximately equal in the two eyes. The disk-arteriolar ratio was R.E.:21:1 and L.E.: 18:1 and the cup-disk ratio was R.E.: 0.7 and L.E.: 0.3. Computed tomography disclosed an enlarged right retrobulbar optic nerve, a superior orbital fissure that was much larger on the right than on the left, and a larger cavernous sinus on the right. The right sphenoid bone was partially absent. Despite mild developmental delay, the patients visual acuity apparently remained normal and the ophthalmologic findings did not change significantly during the 18-month follow-up period.

Case report concomitant ocular and orbital neoplasms

The simultaneous presence of ocular and orbital space occupying lesions should suggest orbital extension of ocular tumors (choroidal melanoma, retinoblastoma), metastatic tumor to the eye and orbit, or simultaneous involvement of the ocular and periocular structures by lymphoma or leukemia. The complementary use of computed tomography and ultrasonography was helpful in managing our case of choroidal melanoma with orbital extension.

Sixth nerve palsy complicating percutaneous thermal ablation of the trigeminal nerve rootlet.

Two patients, an 81-year-old man and a 77-year-old woman, developed sixth nerve palsies after radiofrequency trigeminal gangliolysis for trigeminal neuralgia. Both sixth nerve palsies resolved spontaneously within four to seven months. The combination of postoperative trigeminal nerve deficits and transient oculomotor nerve palsies can mimic parasellar mass lesions and lead to unnecessary neuroradiologic investigation in the early postoperative period.

Isolated, Bilateral Orbital Mass Lesions During Childhood

A 9-year-old female developed bilateral orbital masses over four months without associated orbital inflammation or systemic disease. Orbital biopsy documented an unusual presentation of childhood pseudotumor. Nine days following surgery orbital inflammatory signs appeared suddenly and involved both the unoperated and biopsied orbits equally. These orbital lesions resolved completely after three months of systemic corticosteroid therapy. The sudden and progressive development of palpable bilateral orbital mass lesions rarely occurs in children without readily identifiable systemic disease. The 9-year-old girl described herein acquired bilateral orbital space-occupying lesions without evidence of ocular, orbital, or systemic abnormalities.

Chiasmal syndrome caused by pituitary-sellar disproportion

A patient with pituitary-sellar disproportion, a perichiasmal visual field defect, and no clinically demonstrable endocrinopathy is presented. Radiographic and pathologic studies suggested that the pituitary-sellar disproportion was secondary to sellar hypoplasia, a previously unrecognized cause of the chiasmal syndrome. It remains to be seen whether hormonal manipulation aimed at suppression of gonadotropin- and/or prolactin-secreting cells might obviate the need for exploration in patients similar to ours.

Intravenous digital subtraction angiography of orbital and ocular circulation

In serial experiments on cats, intravenous digital subtraction angiography (DSA) was utilized to observe orbital and ocular circulation. Images of the orbital arterial system as well as normal ocular vasculature were obtained, utilizing dosage of contrast material acceptable for human study. Images obtained after intraarterial DSA had no advantage over those obtained with intravenous DSA. After retrobulbar injection of 3 ml of saline, intravenous DSA demonstrated straightening of the external ophthalmic arteries showing the potential of this method for identifying orbital vascular pathology.