Charles F. Sydnor

Sarcoidosis and Its Ophthalmic Manifestations

Of 532 cases of sarcoidosis in the southeastern United States, ocular manifestations were a prominent feature of the disease in 202 (38%) of the patients. Approximately one fifth of them sought medical attention because of ocular complaints. This was the second most frequent clinical manifestation, exceeded only by pulmonary symptoms. When ocular segment structures were affected, the anterior segment was involved in 171 (84.7%) of cases. Chronic granulomatous uveitis was the most common abnormality in 106 cases (52.5%). Posterior segment disease occurred in 51 (25.3%) of cases, usually in the form of chorioretinitis or preiphlebitis; it was sometimes the sole manifestation of ocular sarcoidosis, but usually accompanied abnormalities in the anterior part of the eye. The incidence of central nervous system sarcoidosis was increased when posterior segment involvement was observed. Orbital and adnexal structures, primarily lacrimal gland, were affected in 53 (27.7%) of cases.

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.

Traumatic Superior Oblique Palsies

The differences in the clinical and diagnostic characteristics of 33 consecutive traumatic unilateral (21 patients, 62%) and bilateral (12 patients, 38%) superior oblique palsies were studied. The unilateral palsies had a large hypertropia in primary position, more vertical than torsional diplopia, a compensatory head tilt to obtain fusion, and a positive Bielschowsky head tilt test. In contrast, the bilateral palsies had small hypertropias in primary gaze that alternated on right and left gaze, a large V-pattern esotropia with excyclotorsion that was frequently bilateral, and a compensatory head position with fusion in upgaze. The results of the study indicate that a V-pattern in excess of 25 prism diopters, an excyclotorsion of greater than 10 degrees, or head trauma severe enough to cause loss of consciousness should also signal bilateral involvement. Torsional diplopia was present in only 20% of unilateral palsies vs 75% of bilateral palsies. The Bielschowsky head tilt test was diagnostic in 100% of the patients with unilateral palsy and 83% of the patients with bilateral palsy. It was undiagnostic in the supine position in all patients. Spontaneous resolution occurred in 65% of the unilateral palsies but in only 25% of the bilateral palsies. Surgical correction was successful in relieving persistent symptoms.

Abnormal visual pathways in human albinos studied with visually evoked potentials.

Abstract Numerous investigations in albino mammals using neurophysiological and neuroanatomical techniques report an abnormal crossing projection from the temporal retina. Recent studies in human albinos suggest a similar defect. Averaged visually evoked potentials to flashed checkerboard patterns were recorded bilaterally from the scalp overlying the occipital regions in normal and albino human subjects. Square stimulus patterns (10°) were presented to the nasal-temporal retina and hemipatterns to the nasal or temporal retina of each eye. Observations of visual fields, monocular acuities, and stereopsis were recorded. Normal left and right hemispheric responses were symmetrical to monocular nasal-temporal stimulation; in albinos the contralateral early latency responses were larger than the ipsilateral. In monocular nasal stimulation in albinos and in normals, the amplitude of contralateral evoked responses was larger than the ipsilateral; in normals the largest responses to temporal stimulation were ipsilateral. By contrast, temporal retina stimulation of albinos usually produced larger early latency components contralaterally. Temporal stimulation at 5° from the vertical meridian in albinos produced larger contralateral responses. Stimulation beyond 15° gave smaller components contralaterally; new larger amplitude components appeared ipsilaterally. At 30 and 45° eccentricity, ipsilateral responses were reduced. Albino subjects had normal monocular visual fields but failed to fuse stimuli from random dot stereograms. Results of this study provide further evidence for abnormal visual pathways and functional anomalies in human albinos.

A Clinicopathologic Study of a Cartilaginous Hamartoma of the Orbit: A Rare Cause of Proptosis

Abstract The clinical and morphologic features of a unique intraorbital cartilaginous tumor are described. This lesion was excised from the orbit of an 11-year-old girl who was known to have a mild prominence of the right eye since at least age 6 years. This mass was not situated in the vicinity of the trochea or adjacent to the orbital bones, and we speculate that it arose from primitive orbital mesenchyme, which normally only differentiates into cartilage in the trochlea. We have designated this lesion as a cartilaginous hamartoma because it seems to be a tumor-like malformation composed of tissues that are constituents of the normal orbit rather than a true chondroma.

Retinal Vascular Changes in Retrograde Optic Atrophy

Five patients with unilateral optic atrophy of extraocular origin had a normal retinal vasculature. Clinical examination of the patients included color fundus photographs and fluorescein angiography. After comparing the blood vessels in the blind eye with those in the normal fellow eye, we concluded that vascular attenuation is neither invariably associated with optic atrophy, nor solely caused by decreased local oxygen demand in the retina.