Richard E. Appen

Amaurosis and blood loss.

A 57-year-old alcoholic man sustained permanent bilateral blindness and optic atrophy as a complication of hemorrhage from peptic ulcer disease. Post-hemorrhagic visual loss occurs in middle-aged, debilitated persons a short time after repeated episodes of hemorrhage from any site.

Ocular and Cerebral Involvement in Familial Lymphohistiocytosis

A 5-month-old infant girl died of familial lymphohistiocytosis. The central nervous system showed widespread perivascular infiltration of the cerebral pia and arachnoid, the cerebral white matter and deep gray matter, the cerebellum, and brain stem by lymphocytes, benign appearing histiocytes, and macrophages with erythro-and lymphophagocytosis. The eyes had mild infiltration of the anterior uveal tract, moderate involvement of the inner retina, and marked infiltration of the optic nerves by identical cells.

BILATERAL HOMONYMOUS HEMIANOPIA

Bilateral homonymous hemianopia occurred in 15 patients seen during a four-year period. Persons with this visual deficit had similarly shaped visual field defects on corresponding sides of the vertical midline for each eye, equal visual acuity which is generally normal, and normal pupil and fundus examinations. The most common causes of the bilateral posterior cerebral artery insufficency were arteriosclerosis (40%), uncalherniation (20%), and migraine (13%).

Meningeal carcinomatosis with blindness.

A 53-year-old man had bilateral blindness secondary to meningeal carcinomatosis from pulmonary adenocarcinoma. Histopathologic examination of the visual system showed extensive infiltration of the arachnoid of the proximal optic nerves and chiasm, with minimal invasion of the optic nerves themselves. The visual pathways within the cerebral cortex were not affected.

Optic Disk Vasculitis

A 44-year-old woman developed progressive loss of vision associated initially with a swollen optic disk, and later with optic atrophy and a diffuse retinal vasculopathy, which caused extensive retinal hemorrhagagic. Histopathologic examination showed hemorrhagagic infarction of the retina, as well as infarction of the anterior optic nerve. In the optic nerve, the central retinal vessels showed extensive phlebitis and occlusion of many small arterioles.

Bilateral loss of vision following radiation therapy

Following radiation therapy tor unilateral paranasal sinus malignancies. three patients (one of whom also received chemotherapy) sustained loss of vision in the ipsilateral eye two to three years later due to chorioretinal dysfunction, and in the contralateral eye three to four vears later secondary to optic nerve compromise. There was no evidence of persistent tumor. The occurrence of this delayed post-irradiation complication appears to be mediated by impairment of the arterial perfusion of the eye or of the optic nerve, and may be potentiated by simultaneous chemotherapy.

Traumatic injuries: office treatment of eye injury. 1. Injury due to foreign materials.

Eye injury caused by foreign materials may be inconsequential or severe. The primary physician must rapidly assess the nature and extent of injury in relation to the causative agent to determine whether general office treatment will suffice or if the patient must be referred to an ophthalmologist.

Traumatic injuries: OFFICE TREATMENT OF EYE INJURY 2. Injury From Sharp Instruments or Blunt Trauma

Eye injuries caused by sharp instruments range from superficial scratches of the corneal epithelium to serious lacerations of the globe of the eye. Scratches, conjunctival lacerations, and some eyelid lacerations can be dealth with by the primary physician in the office, but damage to the globe requires immediate referral to an ophthalmologist. Among possible results of blunt trauma to the area of the eye are ecchymosis, hyphema, blow-out fracture, subluxation or dislocation of the lens, or retinal detachment. Most of thes require thoroguh ophthalmologic examination and specialized treatment. The primary physician may be the first to examine a patient with serious head injury. For future reference the status of each eye should be carefully documented as soon as possible after injury.