Amaurosis Fugax Secondary to Carotid Artery Atherosclerosis
1
chemosis, and a marked papillary response. Durezol Ò was prescribed at twice a day dosing. Due to extreme swelling, determination of a follicular response was difficult. At the 4-day follow-up, the left eye appeared to have more injec- tion/chemosis and the patient switched from Durezol to Durezol Ò PF. At the 5-day follow-up, a serous discharge was evident, mild tenderness in the left preauricular area, and the right eye showed mild injection. Because of the un- certainty of a possible allergic or toxic response to her prior ocular medications, she was instructed to discontinue phar- maceutical agents and to instill nonpreserved artificial tears. However, her symptoms significantly worsened and she resumed taking Durezol PF. At the 10-day follow-up, both corneas displayed diffuse microcystic edema with punctate staining overlying, trace subepithelial infiltrates, severe lid edema, chemosis, and injection. She began pred- nisolone acetate 1% and at the 11-day follow up, the patient reported better comfort, decreased lid swelling/injection, and microcystic edema with overlying PEK. On Day 13, she showed marked improvement OU. Conclusion: Although viral conjunctivitis is typically a straightforward diagnosis, it was confounded in this case by the use of several drops, in a patient with a known history of allergy. A viral diagnosis was confirmed only after presentation of subepithelial infiltrates and fellow eye involvement. Poster 63 Amaurosis Fugax Secondary to Carotid Artery Atherosclerosis Ruth Smith, Alexandra M. Espejo, O.D., and Julie A. Tyler, O.D., Nova Southeastern University, Fort Lauderdale, Florida Background: Amaurosis fugax, the unilateral transient loss of vision, is caused by a diverse range of etiologies. Arteriolar hypoperfusion is commonly the result of ipsilat- eral carotid artery atherosclerosis. If severely occluded, blood flow through the carotid artery may be dangerously low enough to cause retinal ischemia, leading to acute vision loss. Adding to the complexity of prompt diagnosis, oftentimes symptoms have resolved by the time the patient seeks care, and can’t recall with certainty which portion of the visual field or even which eye was involved. Case Summary: A 63-year-old white female presented with a history of newly diagnosed Stage I hypertension and mildly elevated cholesterol. She complained of transient inferior field loss in the right eye lasting 10 seconds, occurring approximately every 4 weeks. Humphrey visual field testing was normal in the right eye but revealed a nasal arcuate defect in the left eye. Dilated fundus examination of the right eye revealed mild retinal venous tortuosity and dilation. Examination of the left eye revealed a superior temporal nerve fiber layer defect that corresponded to the visual field defect detected on visual field testing. The primary care physician attributed the patient’s vision loss to uncontrolled hypertension. After persistent requests, a carotid artery ultrasound was performed and revealed 80% to 99% occlusion of the right mid-internal carotid artery and 60% to 80% occlusion of the left internal carotid artery. The patient was admitted the following day and underwent successful emergency carotid endarterectomy. In addition, the patient is being monitored for glaucoma suspicion in her left eye and currently has her blood pressure well-controlled. Conclusion: The patient’s vision, and possibly her life, were spared with the prompt diagnosis of carotid artery disease. Challenges may present when co-managing pa- tients with other physicians, but it is imperative to thor- oughly investigate the numerous etiologies of amaurosis fugax. Poster 64 A Unique Presentation of Choroidal Granuloma Secondary to Sarcoidosis Esther Nakagawara, O.D., and Joan Sears, O.D., W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina Background: Sarcoidosis is a non-caseating granulomatous inflammatory disorder with the potential for multisystem involvement, including pulmonary, integumentary, and central nervous system complications. It is a condition that requires coordinated care by several specialists, in- cluding eye care providers. About 40% of sarcoidosis patients have ocular findings, most commonly presenting as granulomatous anterior uveitis, as well as iris or conjunctival granulomas and posterior uveitis. Case Summary: This is the case of a 47-year-old black male with a history of sarcoidosis. He was managed for chronic anterior uveitis and followed for neurosarcoidosis, for which he was taking 20 mg of oral prednisone daily. Upon initial examination, a large elevated hypopigmented choroidal lesion was noted in the posterior pole of the left eye. The lesion had an overlying neurosensory retinal detachment and subsequent cystoid macular edema due to proximity to the lesion. A retinal specialist interpreted a fluorescein angiography and increased the patient’s oral prednisone to 80 mg along with further testing to rule out other etiologies. Differential diagnosis included choroidal granuloma secondary to sarcoidosis, amelanotic choroidal nevus, choroidal hemangioma, and choroidal metastasis. The patient is still under the supervision of both the retinal specialist and his primary care physician to manage his condition and monitor for further changes. Conclusion: A choroidal granuloma is a rare ocular sequela of sarcoidosis and develops in about 5.5% of sarcoidosis patients. Commonly presenting as multiple small lesions with an overlying neurosensory retinal detachment, choroi- dal granulomas often occur without anterior uveitis. In fact, most patients are asymptomatic unless there is optic nerve Poster Presentations 373
-
Upload
ruth-smith -
Category
Documents
-
view
218 -
download
0
Transcript of Amaurosis Fugax Secondary to Carotid Artery Atherosclerosis
Poster Presentations 373
chemosis, and a marked papillary response. Durezol� wasprescribed at twice a day dosing. Due to extreme swelling,determination of a follicular response was difficult. At the4-day follow-up, the left eye appeared to have more injec-tion/chemosis and the patient switched from Durezol toDurezol� PF. At the 5-day follow-up, a serous dischargewas evident, mild tenderness in the left preauricular area,and the right eye showed mild injection. Because of the un-certainty of a possible allergic or toxic response to her priorocular medications, she was instructed to discontinue phar-maceutical agents and to instill nonpreserved artificialtears. However, her symptoms significantly worsened andshe resumed taking Durezol PF. At the 10-day follow-up,both corneas displayed diffuse microcystic edema withpunctate staining overlying, trace subepithelial infiltrates,severe lid edema, chemosis, and injection. She began pred-nisolone acetate 1% and at the 11-day follow up, the patientreported better comfort, decreased lid swelling/injection,and microcystic edema with overlying PEK. On Day 13,she showed marked improvement OU.Conclusion: Although viral conjunctivitis is typically astraightforward diagnosis, it was confounded in this case bythe use of several drops, in a patient with a known historyof allergy. A viral diagnosis was confirmed only afterpresentation of subepithelial infiltrates and fellow eyeinvolvement.
Poster 63
Amaurosis Fugax Secondary to Carotid ArteryAtherosclerosis
Ruth Smith, Alexandra M. Espejo, O.D., and Julie A. Tyler,O.D., Nova Southeastern University, Fort Lauderdale,Florida
Background: Amaurosis fugax, the unilateral transient lossof vision, is caused by a diverse range of etiologies.Arteriolar hypoperfusion is commonly the result of ipsilat-eral carotid artery atherosclerosis. If severely occluded,blood flow through the carotid artery may be dangerouslylow enough to cause retinal ischemia, leading to acutevision loss. Adding to the complexity of prompt diagnosis,oftentimes symptoms have resolved by the time the patientseeks care, and can’t recall with certainty which portion ofthe visual field or even which eye was involved.Case Summary: A 63-year-old white female presented witha history of newly diagnosed Stage I hypertension andmildly elevated cholesterol. She complained of transientinferior field loss in the right eye lasting 10 seconds,occurring approximately every 4 weeks. Humphrey visualfield testing was normal in the right eye but revealed anasal arcuate defect in the left eye. Dilated fundusexamination of the right eye revealed mild retinal venoustortuosity and dilation. Examination of the left eye revealeda superior temporal nerve fiber layer defect thatcorresponded to the visual field defect detected on visualfield testing.
The primary care physician attributed the patient’s visionloss to uncontrolled hypertension. After persistent requests,a carotid artery ultrasound was performed and revealed80% to 99% occlusion of the right mid-internal carotidartery and 60% to 80% occlusion of the left internal carotidartery. The patient was admitted the following day andunderwent successful emergency carotid endarterectomy.In addition, the patient is being monitored for glaucomasuspicion in her left eye and currently has her bloodpressure well-controlled.Conclusion: The patient’s vision, and possibly her life,were spared with the prompt diagnosis of carotid arterydisease. Challenges may present when co-managing pa-tients with other physicians, but it is imperative to thor-oughly investigate the numerous etiologies of amaurosisfugax.
Poster 64
A Unique Presentation of Choroidal GranulomaSecondary to Sarcoidosis
Esther Nakagawara, O.D., and Joan Sears, O.D., W.G.(Bill) Hefner Veterans Affairs Medical Center, Salisbury,North Carolina
Background: Sarcoidosis is a non-caseating granulomatousinflammatory disorder with the potential for multisysteminvolvement, including pulmonary, integumentary, andcentral nervous system complications. It is a conditionthat requires coordinated care by several specialists, in-cluding eye care providers. About 40% of sarcoidosispatients have ocular findings, most commonly presentingas granulomatous anterior uveitis, as well as iris orconjunctival granulomas and posterior uveitis.Case Summary: This is the case of a 47-year-old black malewith a history of sarcoidosis. He was managed for chronicanterior uveitis and followed for neurosarcoidosis, forwhich he was taking 20 mg of oral prednisone daily.Upon initial examination, a large elevated hypopigmentedchoroidal lesion was noted in the posterior pole of the lefteye. The lesion had an overlying neurosensory retinaldetachment and subsequent cystoid macular edema due toproximity to the lesion. A retinal specialist interpreted afluorescein angiography and increased the patient’s oralprednisone to 80 mg along with further testing to rule outother etiologies. Differential diagnosis included choroidalgranuloma secondary to sarcoidosis, amelanotic choroidalnevus, choroidal hemangioma, and choroidal metastasis.The patient is still under the supervision of both the retinalspecialist and his primary care physician to manage hiscondition and monitor for further changes.Conclusion: A choroidal granuloma is a rare ocular sequelaof sarcoidosis and develops in about 5.5% of sarcoidosispatients. Commonly presenting as multiple small lesionswith an overlying neurosensory retinal detachment, choroi-dal granulomas often occur without anterior uveitis. In fact,most patients are asymptomatic unless there is optic nerve
