Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?
Post-surgical (exogenous) endophthalmitis is an uncommon complication. The incidence ranges from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endophthalmi...
How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?
Susac's is a rare disease characterized by an occlusive retinal vasculopathy, eighth nerve disease including hearing loss and balance issues, and CNS disease with a predilection for involvement of the corpus callosum. I am not aware of any randomized controlled data to guide treatment for Susac's, b...
What is your approach to antiviral treatment of HSV acute retinal necrosis?
Acute Retinal Necrosis (ARN) is a rapidly progressive syndrome usually caused by varicella-zoster virus (VZV)and herpes simplex virus 1 or 2 (HSV). The syndrome is rapidly progressive in the absence of antiviral treatment. PCR performed on aqueous or vitreous sampling is highly sensitive and strongl...
How would you approach management of nodular scleritis in the setting of suspected GCA?
Scleritis is probably a rare but real association with GCA. The rarity is such that I would not ignore alternative causes of scleritis. For example, ANCA-associated vasculitis could mimic GCA and syphilis has also been reported as a masquerade. Scleritis is usually divided into 5 forms: nodular, dif...
Can giant cell arteritis present with a partial cranial neuropathy?
Giant cell arteritis (although giant cells on temporal artery biopsy are not a sine qua non) most typically presents to the neuro-ophthalmologist with ischemic optic neuropathy (usually anterior and sometimes posterior).Ophthalmoplegia is uncommon in GCA but has been attributed to oculomotor and abd...
What is your approach to the treatment of visual snow syndrome?
Visual snow is not a syndrome. It's a symptom that consists of static vision. I opine that it's origin is retinal (not brain) and that it relates to ongoing activity. In the past I have referred to it as retinal repolarization disorder. It should not be confused with migraine aura status, which is a...
How do you approach re-operations for vertical strabismus in cases where prior horizontal muscle surgery has affected vertical alignment?
First, you need to know what was done in the previous surgery. Vertical strabismus often accompanies horizontal deviations even after routine surgery. DVD and superior or inferior oblique muscle overaction and the most common deviations. Once you have all of your information, you can plan appropriat...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
What is your approach to the diagnosis and management of optic chiasmitis in systemic lupus erythematosus?
Optic nerve involvement occurs in SLE but not commonly. I am aware of two case reports about 20 years apart describing inflammation of the optic chiasm in lupus. Both appeared the Neuroophthalmology and the most recent was 16:117, 2020. I would be cautious about making the diagnosis of lupus if sero...
How do you approach the planning of oculoplastic surgery for pediatric patients with craniofacial syndromes?
Those are very challenging patients because of the risk of amblyopia, from early keratopathy, and in more severe cases, even permanent corneal scarring. Then there is refractive amblyopia if not addressed early, and difficulty fitting with spectacles. Focus on early intervention, meticulous follow-u...