Spontaneous cerebrospinal fluid leak and idiopathic intracranial hypertension
Purpose of review
To review the most recent literature on the relationship of spontaneous cerebrospinal fluid (CSF) leak with idiopathic intracranial hypertension (IIH) and considerations in management of these conditions.
Recent findings
A link has been proposed between spontaneous CSF leak and IIH based on similar demographics, radiologic, and clinical findings in these patients, and on a plausible mechanism of skull base erosion in the setting of high CSF pressure over time. IIH patients with CSF leak may not present with classic IIH signs and symptoms as the leak can alleviate excess pressure; however, they may de...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Update: the Miller Fisher variants of Guillain–Barré syndrome
This article will update and review the Miller Fisher variants (MFV) of Guillain–Barré syndrome (GBS) including the clinical presentation, diagnostic testing, and treatment.
Recent findings
Although the diagnosis of GBS and MFV can be made on clinical grounds, cerebrospinal fluid (CSF) analysis, nerve conduction studies, imaging (e.g. ultrasound and MRI), and serologic testing can help to confirm the diagnosis. Some patients may need immunotherapy with either intravenous immunoglobulin (IVIg) or plasma exchange, and recent studies suggest that complement inhibition combined with IVIg could be of benefit, but further ...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Infectious ocular motor neuropathies
Purpose of review
Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the developed world. Provide information on recent developments in diagnostic testing for pathogens that may cause ocular motor neuropathies.
Recent findings
Antigen detection in serum or CSF has improved the diagnosis of cryptococcal disease. Cartridge PCR testing for tuberculosis has increased diagnostic accuracy, though tuberculous meningitis remains difficult to diagnose. Rapid, multiplex PCR and unbiased sequencing allow for diagnosis of a ...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Visual and oculomotor outcomes in children with prenatal opioid exposure
Purpose of review
To summarize the visual and oculomotor outcomes in children with prenatal opioid exposure and review the effects of opioids on the developing central nervous system.
Recent findings
Animal models and imaging studies in children suggest that prenatal opioid exposure may affect neuronal survival and result in delayed maturation of white matter tracts and decreased volumes in certain brain areas. Visual evoked potential testing in children demonstrates delayed maturation of the afferent visual system in opioid-exposed groups compared with controls, though ‘catch-up’ development is seen with longitud...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Ocular motor manifestations of movement disorders
Purpose of review
Impaired eye movements are frequently seen in ophthalmic and neurologic clinical practice, especially in individuals with movement disorders. Identification of the abnormal movement can aid initial diagnosis and improve understanding of the underlying disease pathophysiology. The present article reviews the ocular motor manifestations and recent research on them in common movement disorders.
Recent findings
Ocular motor manifestations and their pathophysiologic correlates are being defined. In particular, study of eye movements can help clarify the changing clinicopathologic spectrum of atypical park...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Neuro-ophthalmic manifestations of the phakomatoses
Purpose of review
The phakomatoses are a group of inherited disorders with variable clinical manifestations that are characterized by brain, cutaneous, ocular and other distinct lesions in multiple organs. Correctly recognizing the neuro-ophthalmic signs and symptoms can lead to early diagnosis and treatment. The group is composed of neurofibromatosis (type 1 and 2), tuberous sclerosis complex, von Hippel–Lindau, ataxia–telangiectasia and Sturge–Weber syndromes. However, more than 60 syndromes have been described in the medical literature. This review provides an update on the diagnosis and management of phakomatos...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Immune checkpoint inhibitors: what neuro-ophthalmologists need to know
Purpose of review
Immune checkpoint inhibitors are currently an exceedingly powerful tool in the management of hitherto incurable malignancies and their use in clinical practice is expected to increase in the near future. The purpose of this review is to discuss the current medical uses of checkpoint inhibitors with a focus on their neuro-ophthalmic side-effects.
Recent findings
Immune checkpoint inhibitors have emerged as a promising breakthrough in the treatment of several tumor types. However, these targeted therapies can induce a wide range of immune-related ophthalmic and neuro-ophthalmic toxicities. It is import...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Update on pediatric optic neuritis
Purpose of review
To summarize recent developments in the classification, investigation and management of pediatric optic neuritis (PON).
Recent findings
A recent surge in interest surrounding antibodies to myelin oligodendrocyte glycoprotein antibody (MOG-Ab) has instigated a paradigm shift in our assessment of children with PON. This serological marker is associated with a broad spectrum of demyelinating syndromes that are clinically and radiologically distinct from multiple sclerosis (MS) and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). Optic neuritis is the most common present...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Clinical and radiologic approach to ‘typical’ versus antibody-related optic neuritis
Purpose of review
Optic neuritis is an autoimmune optic neuropathy that has been associated with multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and more recently antimyelin oligodendrocyte glycoprotein (anti-MOG)-positive disorder. At initial presentation, it is often difficult to differentiate these entities given their significant overlap in clinical presentation and MRI findings. This review summarizes the distinguishing clinical and radiological features of MS, NMOSD, and anti-MOG disorders to help clinicians accurately diagnose and manage patients affected by these conditions.
Recent findi...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Advances in the diagnosis of giant cell arteritis
Purpose of review
To summarize recent advances in the diagnosis of giant cell arteritis (GCA).
Recent findings
Less common manifestations of GCA include corneal edema, proptosis from lacrimal gland ischemia and sensorineuronal hearing loss. Histology studies have suggested that temporal artery biopsies (TAB) with fixed specimen lengths of 15 mm may be adequate to prevent false negative biopsies. In centers with appropriate radiologic expertise, a European rheumatology consensus guideline has proposed Doppler ultrasound as a first-line confirmatory test for GCA in lieu of temporal artery biopsy. Finding extracranial ...
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Ophthalmology)
Source: Current Opinion in Ophthalmology - October 4, 2019 Category: Opthalmology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Update on the clinical assessment and management of thyroid eye disease
Purpose of review
To offer an update on advances and controversies in the assessment, investigation and treatment of thyroid eye disease (TED), a disfiguring orbital autoimmune disease, which can manifest with diplopia and threaten not only sight – but also life.
Recent findings
Developments in biomarkers and imaging are helping to tailor the management of patients. Emerging therapies target different pathways in the disease and are informed by studies into TED pathogenesis: the last 2 years has, for example, seen the culmination of a two-decade long bench-to-bedside story in which an original focus on the IGF1 rece...
Source: Current Opinion in Ophthalmology - August 9, 2019 Category: Opthalmology Tags: OCULOPLASTIC AND ORBITAL SURGERY: Edited by Richard C. Allen Source Type: research
Periocular hyaluronic acid fillers: applications, implications, complications
This article reviews current understanding of the principal complications in the periocular area and their management.
Recent findings
Hyaluronic acid is a ubiquitous, biodegradable, nonspecies-specific molecular substrate with limited potential for immunogenic reactions. However, in the periocular area, such products can migrate and last significantly longer than the expected filler lifespan. Contamination or subsequent immune stimulation can trigger delayed-onset inflammatory reactions. Though minor vascular occlusions are not uncommon, cases of blindness secondary to facial filler injections are thought to be rare. T...
Source: Current Opinion in Ophthalmology - August 9, 2019 Category: Opthalmology Tags: OCULOPLASTIC AND ORBITAL SURGERY: Edited by Richard C. Allen Source Type: research
Neurostimulation for tear production
Purpose of review
Dry eye disease (DED) is a chronic multifactorial disease that affects millions of people worldwide. Despite ongoing research, treatment for DED remains a challenge. Neurostimulation for tear production is a rapidly evolving field that culminated in the development of the intranasal tear neurostimulator (ITN). In this article, we review the neuroanatomy and pathophysiology of tear production and the evolution of neurostimulation for the treatment of DED.
Recent findings
The ITN was approved for commercial use in April 2017. This innovation stemmed from the success of lacrimal nerve and anterior ethmo...
Source: Current Opinion in Ophthalmology - August 9, 2019 Category: Opthalmology Tags: OCULOPLASTIC AND ORBITAL SURGERY: Edited by Richard C. Allen Source Type: research
Medical and sclerosing agents in the treatment of orbital lymphatic malformations: what's new?
Purpose of review
Currently, there is no ideal management for orbital lymphatic malformations. Significant advances have been made since the discovery of new agents in the treatment. The purpose of this manuscript is to review the recent evidence on new sclerotherapy agents and systemic medications.
Recent findings
Traditional sclerosants are OK-432, sodium tetradecyl sulphate and ethanol. More recent developments are the use of doxycycline, bleomycin, and pingyangmycin. Sirolimus as a systemic medication has revolutionized the medical management of lymphatic malformations. Other oral drugs such as propranolol and sil...
Source: Current Opinion in Ophthalmology - August 9, 2019 Category: Opthalmology Tags: OCULOPLASTIC AND ORBITAL SURGERY: Edited by Richard C. Allen Source Type: research
