Medicine › Pathology and Forensic Medicine

Ophthalmology and Eye Disorders

Works Count: 58688

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This cluster of papers focuses on the pathophysiology, management, and associated conditions of Graves' ophthalmopathy, including the role of thyroid-associated ophthalmopathy, orbital fibroblasts, thyrotropin receptor antibodies, teprotumumab treatment, autoimmune mechanisms, thalamus infarction, surgical interventions for strabismus, and the involvement of the IGF-1 receptor. The research covers a wide range of topics related to the understanding and treatment of Graves' ophthalmopathy.

Keywords

Graves' Ophthalmopathy; Thyroid-Associated Ophthalmopathy; Orbital Fibroblasts; Thyrotropin Receptor Antibodies; Teprotumumab; Thyroid Eye Disease; Autoimmunity; Thalamus Infarction; Strabismus Surgery; IGF-1 Receptor

Botulinum toxin injection of eye muscles to correct strabismus.

1981-01-01

Scott Ab

One hundred thirty-two doses of botulinum A toxin were injected into 42 humans. The effect on horizontal strabismus was uniformly beneficial, and effect lasting up to 411 days since the … One hundred thirty-two doses of botulinum A toxin were injected into 42 humans. The effect on horizontal strabismus was uniformly beneficial, and effect lasting up to 411 days since the last injection was documented. The effect in vertical strabismus and lid retraction was beneficial, but less strongly so. No systemic effect or local complications were encountered except for effect on adjacent muscles. The drug appears to be a safe and useful therapy for strabismus.

Pharmacologic weakening of extraocular muscles.

1973-12-01

Alan B. Scott , Arthur L. Rosenbaum , Carter C. Collins

Effect of intraocular pressure on rapid axoplasmic transport in monkey optic nerve.

1974-10-01

Douglas R. Anderson , Anita E. Hendrickson

The Oxford Handbook of Eye Movements

2011-08-18

Simon P. Liversedge , Iain D. Gilchrist , Stefan Everling

THE EYE MOVEMENT REPERTOIRE NEURAL BASIS OF EYE MOVEMENTS VISUAL COGNITION AND EYE MOVEMENTS EYE MOVEMENT PATHOLOGY AND DEVELOPMENT EYE MOVEMENT CONTROL DURING READING LANGUAGE PROCESSING AND EYE MOVEMENTS THE EYE MOVEMENT REPERTOIRE NEURAL BASIS OF EYE MOVEMENTS VISUAL COGNITION AND EYE MOVEMENTS EYE MOVEMENT PATHOLOGY AND DEVELOPMENT EYE MOVEMENT CONTROL DURING READING LANGUAGE PROCESSING AND EYE MOVEMENTS

Gaze control in humans: eye-head coordination during orienting movements to targets within and beyond the oculomotor range

1987-09-01

Daniel Guitton , M. Volle

Gaze, the direction of the visual axis in space, is the sum of the eye position relative to the head (E) plus head position relative to space (H). In the … Gaze, the direction of the visual axis in space, is the sum of the eye position relative to the head (E) plus head position relative to space (H). In the old explanation, which we call the oculocentric motor strategy, of how a rapid orienting gaze shift is controlled, it is assumed that 1) a saccadic eye movement is programmed with an amplitude equal to the target's offset angle, 2) this eye movement is programmed without reference to whether a head movement is planned, 3) if the head turns simultaneously the saccade is reduced in size by an amount equal to the head's contribution, and 4) the saccade is attenuated by the vestibuloocular reflex (VOR) slow phase. Humans have an oculomotor range (OMR) of about +/- 55 degrees. The use of the oculocentric motor strategy to acquire targets lying beyond the OMR requires programming saccades that cannot be made physically. We have studied in normal human subjects rapid horizontal gaze shifts to visible and remembered targets situated within and beyond the OMR at offsets ranging from 30 to 160 degrees. Heads were attached to an apparatus that permitted short unexpected perturbations of the head trajectory. The acceleration and deceleration phases of the head perturbation could be timed to occur at different points in the eye movement. 4. Single-step rapid gaze shifts of all sizes up to at least 160 degrees (the limit studied) could be accomplished with the classic single-eye saccade and an accompanying saccadelike head movement. In gaze shifts less than approximately 45 degrees, when head motion was prevented totally by the brake, the eye attained the target. For larger target eccentricities the gaze shift was interrupted by the brake and the average eye saccade amplitude was approximately 45 degrees, well short of the OMR. Thus saccadic eye movement amplitude was neurally, not mechanically, limited. When the head's motion was not perturbed by the brake, the eye saccade amplitude was a function of head velocity: for a given target offset, the faster the head the smaller the saccade. For gaze shifts to targets beyond the OMR and when head velocity was low, the eye frequently attained the 45 degrees position limit and remained there, immobile, until gaze attained the target.(ABSTRACT TRUNCATED AT 400 WORDS)

The Subcallosal Cingulate Gyrus in the Context of Major Depression

2010-12-09

Clement Hamani , Helen S. Mayberg , Scellig Stone +3 more

Diagnostic Criteria for Graves' Ophthalmopathy

1995-06-01

George B. Bartley , Colum A. Gorman

Tensorial approach to the geometry of brain function: Cerebellar coordination via a metric tensor

1980-07-01

A. Pellionisz , R. Llinás

Geometric relations of eye position and velocity vectors during saccades

1990-01-01

Douglas Tweed , Tutis Vilis

Insula of the old world monkey. Architectonics in the insulo‐orbito‐temporal component of the paralimbic brain

1982-11-20

Marsel Mesulam , Elliott J. Mufson

Abstract The insula of the rhesus monkey has a surface area of approximately 160 mm 2 and can be divided into three architectonic sectors. The agranular sector is coextensive with … Abstract The insula of the rhesus monkey has a surface area of approximately 160 mm 2 and can be divided into three architectonic sectors. The agranular sector is coextensive with prepiriform allocortex and is characterized by three agranular cellular strata, a zonal layer of myelinated fibers, and a high level of intracortical acetylcholinesterase (AChE). The dysgranular sector adjoins the agranular sector and shows first the emergence of a granular L4 and then a gradual differentiation of L2. Cortical myelin is low and mostly within deep layers; the AChE level is less than in the agranular sector. The third and granular sector covers the posterior aspect of the insula and contains granular L4 and L2, incipient sublamination of L3, increased cortical myelin with an emergent outer line of Baillarger, and a very low density of AChE. These observations indicate that AChE histochemistry can be used for the architectonic analysis of cortex. The lateral orbital cortex and the temporal pole can also be subdivided into agranular, dysgranular, and granular regions. In the insula as well as in lateral orbital and temporopolar areas, the agranular sector is directly contiguous with prepiriform cortex. When these three brain regions are considered jointly, they are seen to be organized in the form of increasingly more differentiated agranular, dysgranular, granular, and hypergranular sectors arranged concentrically around prepiriform allocortex. The term paralimbic is suggested as a generic term for all regions where such transitions occur from allocortex to granular isocortex. The insula, lateral orbital surface, and temporal pole are paralimbic areas with an olfactory allocortical focus. The parahippocampal, retrosplenial, cingulate, and subcallosal regions constitute a second group of paralimbic areas with a hippocampal‐induseal focus. In the most general sense, the functional specializations of paralimbic areas are predominantly for behaviors which require an integration between extrapersonal stimuli and the internal milieu. The human insula has a plan of organization virtually identical to that in the rhesus monkey. In the human, the insulo‐orbito‐temporopolar component of the paralimbic brain may become involved in conditions which range from epilepsy to psychosomatic disease.

Mechanisms underlying recovery of eye-head coordination following bilateral labyrinthectomy in monkeys

1973-12-01

J. Dichgans , Emilio Bizzi , Pietro Morasso +1 more

Paramedian thalamic and midbrain infarcts: Clinical and neuropathological study

1981-08-01

P Castaigne , F Lhermitte , A Buge +3 more

The clinical and neuropathological findings in 28 cases of paramedian thalamic and midbrain infarcts are reported. The 4 instances of unilateral paramedian thalamic infarct were characterized by mood and behavioral … The clinical and neuropathological findings in 28 cases of paramedian thalamic and midbrain infarcts are reported. The 4 instances of unilateral paramedian thalamic infarct were characterized by mood and behavioral changes, limitation of the infarct to the center of the anatomical paramedian territory, and symmetrical configuration of the paramedian thalamic arteries. Basilar artery occlusion was found in 1 patient. The 5 cases of bilateral paramedian thalamic infarcts were characterized by disturbances of consciousness and behavior, extension of the infarct (to the mammillothalamic tracts in 4 cases, the red nuclei in 3, and the hypothalamus in 2), and a variable paramedian thalamic arterial pattern. The arterial pattern was symmetrical in 2 cases, asymmetrical in 1, and unilateral in 1. The basilar artery was occluded in 1 case, the basilar communicating and posterior cerebral arteries in 1, and a third patient had occlusion involving an aneurysm of the basilar artery. The 19 patients with paramedian thalamopeduncular infarcts had marked disturbances of consciousness (hypersomnia, deep coma, akinetic mutism) associated with ocular motility changes. Later, abnormal movements--always delayed--and memory disturbances were observed in some. Thalamic changes were restricted to beh paramedian territory in only 3 cases. The arterial pattern was symmetrical in 5. The basilar and posterior cerebral arteries were occluded in 4 patients each. Paramedian infarcts were rarely found as isolated lesions and were always bilateral when there was only one arterial pedicle. The paramedian thalamic pedicle can supply the polar thalamic territory.

Binocular Vision and Ocular Motility Theory and Management of Strabismus

2001-01-01

Jacqueline Frank Shimko

"Binocular Vision and Ocular Motility Theory and Management of Strabismus." American Orthoptic Journal, 51(1), pp. 161–162 "Binocular Vision and Ocular Motility Theory and Management of Strabismus." American Orthoptic Journal, 51(1), pp. 161–162

Basic Mechanisms of Ocular Motility and Their Clinical Implications

1976-04-01

Gunnar Lennerstrand , Paul Bach‐y‐Rita

Relation between Therapy for Hyperthyroidism and the Course of Graves' Ophthalmopathy

1998-01-08

Luigi Bartalena , Claudio Marcocci , Fausto Bogazzi +7 more

The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.We studied 443 patients … The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.We studied 443 patients with Graves' hyperthyroidism and slight or no ophthalmopathy who were randomly assigned to receive radioiodine, radioiodine followed by a 3-month course of prednisone, or methimazole for 18 months. The patients were evaluated for changes in the function and appearance of the thyroid and progression of ophthalmopathy at intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent nyperthyroiaism were promptly corrected.Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15 percent) two to six months after treatment. The change was transient in 15 patients, but it persisted in 8 (5 percent), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at base line had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67 percent) of the 75 with ophthalmopathy at base line had improvement, and no patient had progression. The effects of radioiodine on thyroid function were similar in these two groups. Among the 148 patients treated with methimazole, 3 (2 percent) who had ophthalmopathy at base line improved, 4 (3 percent) had worsening of eye disease, and the remaining 141 had no change.Radioiodine therapy for Graves' hyperthyroidism is followed by the appearance or worsening of ophthalmopathy more often than is therapy with methimazole. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone.

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VISUAL STABILIZATION OF POSTURE

1984-01-01

Walter Paulus , Andreas Straube , Th. Brandt

Visual stabilization of posture is critically dependent on stimulus characteristics as well as on the performance of the visual system. The purpose of the present investigation was to obtain quantitative … Visual stabilization of posture is critically dependent on stimulus characteristics as well as on the performance of the visual system. The purpose of the present investigation was to obtain quantitative data in man by means of posturography of fore-aft and lateral body sway in relation to different visual stimulus characteristics. Visual acuity, when decreased logarithmically, causes a linearly increasing postural instability, twice as prominent for fore-aft than for lateral sway. Any measurable visual contribution for fore-aft sway ceases with an acuity lower than 0.03 and for lateral sway with an acuity lower than 0.01. The central area of the visual field as compared with the peripheral retina dominates postural control. The foveal region exhibts a powerful contribution, in particular for lateral sway. A partial but significant visual stabilization is preserved with a visual input rate between 1 to 4 Hz flicker frequency. As soon as continuous motion perception becomes involved with frequencies higher than 4 Hz, visual stabilization gradually improves with a saturation at frequencies higher than 16 Hz. Lateral body sway activity and eye-object distance are linearly related:body sway decreases with increasing distance corresponding to the linear decrease of net retinal displacement with increasing eye-object distance. Aspects of 'afferent' and 'efferent' visual motion perception, which involve fore-aft and lateral body sway differently, are evaluated. The clinical relevance is demonstrated in patients with oculomotor distrubances. The results are discussed with respect to the variety of related clinical disorders, which involved reduction in visual acuity, field defects, accommodation disturbances and ocular oscillations.

Current Perspective on the Pathogenesis of Graves’ Disease and Ophthalmopathy

2003-12-01

Bellur S. Prabhakar , Rebecca S. Bahn , Terry J. Smith

Graves' disease (GD) is a very common autoimmune disorder of the thyroid in which stimulatory antibodies bind to the thyrotropin receptor and activate glandular function, resulting in hyperthyroidism. In addition, … Graves' disease (GD) is a very common autoimmune disorder of the thyroid in which stimulatory antibodies bind to the thyrotropin receptor and activate glandular function, resulting in hyperthyroidism. In addition, some patients with GD develop localized manifestations including ophthalmopathy (GO) and dermopathy. Since the cloning of the receptor cDNA, significant progress has been made in understanding the structure-function relationship of the receptor, which has been discussed in a number of earlier reviews. In this paper, we have focused our discussion on studies related to the molecular mechanisms of the disease pathogenesis and the development of animal models for GD. It has become apparent that multiple factors contribute to the etiology of GD, including host genetic as well as environmental factors. Studies in experimental animals indicate that GD is a slowly progressing disease that involves activation and recruitment of thyrotropin receptor-specific T and B cells. This activation eventually results in the production of stimulatory antibodies that can cause hyperthyroidism. Similarly, significant new insights have been gained in our understanding of GO that occurs in a subset of patients with GD. As in GD, both environmental and genetic factors play important roles in the development of GO. Although a number of putative ocular autoantigens have been identified, their role in the pathogenesis of GO awaits confirmation. Extensive analyses of orbital tissues obtained from patients with GO have provided a clearer understanding of the roles of T and B cells, cytokines and chemokines, and various ocular tissues including ocular muscles and fibroblasts. Equally impressive is the progress made in understanding why connective tissues of the orbit and the skin in GO are singled out for activation and undergo extensive remodeling. Results to date indicate that fibroblasts can act as sentinel cells and initiate lymphocyte recruitment and tissue remodeling. Moreover, these fibroblasts can be readily activated by Ig in the sera of patients with GD, suggesting a central role for them in the pathogenesis. Collectively, recent studies have led to a better understanding of the pathogenesis of GD and GO and have opened up potential new avenues for developing novel treatments for GD and GO.

Graves' Ophthalmopathy: Current Concepts Regarding Pathogenesis and Management*

1993-12-01

Henry B. Burch , Leonard Wartofsky

RECENT progress in the study of Graves' ophthalmopathy has been anything but stagnant. The past 20 yr have witnessed a rapid expansion in the collective understanding of basic pathophysiology, interdependence … RECENT progress in the study of Graves' ophthalmopathy has been anything but stagnant. The past 20 yr have witnessed a rapid expansion in the collective understanding of basic pathophysiology, interdependence with thyroid pathology, and the effects of ocular or thyroidspecific therapy on disease course that threatens to erode the enigmatic nature of Graves' ophthalmopathy. In the past 5 yr alone, the central autoimmune target responsible for the hyperthyroidism of Graves' disease, the TSH receptor, has been cloned and sequenced (1,2), and an elucidation of exact antigenic epitopes using various techniques has begun (3–6). The availability of highly sensitive TSH assays has vastly simplified the diagnosis of subclinical hyperthyroidism (7), and improvements in TSH receptor autoantibody assays (8) have enhanced the ability of the clinician to identify subtle presentations of autoimmune thyroid disease. Exciting new work has suggested a primary pathogenetic role for the retroorbital fibroblast in the development and progression of Graves' ophthalmopathy (9, 10).

Nigrostriatal bundle damage and the lateral hypothalamic syndrome.

1974-01-01

John F. Marshall , J. Steven Richardson , Philip Teitelbaum

Thyrotropin Receptor Autoantibodies Are Independent Risk Factors for Graves’ Ophthalmopathy and Help to Predict Severity and Outcome of the Disease

2006-07-12

Anja Eckstein , Marco Plicht , Hildegard Lax +6 more

The objective of this study was to examine whether TSH-receptor antibody [TSH binding inhibitory antibodies (TBII)] levels are associated with the severity of Graves' ophthalmopathy (GO) over the entire course … The objective of this study was to examine whether TSH-receptor antibody [TSH binding inhibitory antibodies (TBII)] levels are associated with the severity of Graves' ophthalmopathy (GO) over the entire course of the disease.A total of 159 patients with GO were followed for 12-24 months. One year after the first symptoms of GO, all patients were classified into mild or severe GO according to their clinical manifestations. TBII were measured every 3 months after onset of GO. Receiver operating characteristic plot analysis was performed to assess the power to discriminate both patient groups by TBII (specificity >90%).TBII levels and prevalence at each time point during follow-up were significantly higher in patients with a severe course of GO compared with patients with a mild course of GO. Prognostic statements on the course of the disease were possible for about half of the GO patients at all time points (except the first). If at first presentation and at consecutive time points TBII levels were less than 5.7, 2.6, 1.5, 1.5, 1.5, and 1.5 IU/liter, the patients had a 2.3- to 15.6-fold higher chance of a mild course. If 5-8 months after GO onset and at consecutive time points TBII levels were above 8.8, 5.1, 4.8, 2.8, and 2.8 IU/liter, the patients had a 8.7- to 31.1-fold higher risk of a severe course. This relationship of TBII to the severity was independent from age and smoking.Follow-up measurements of TBII allow, in half of the patients, assessment of the prognosis of GO and, therefore, could be of additional help for the disease management.

Varieties of the locked-in syndrome

1979-08-01

G. Bauer , F Gerstenbrand , E. Rumpl

Botulinum Toxin Injection into Extraocular Muscles as an Alternative to Strabismus Surgery

1980-10-01

Alan B. Scott

Clinical Features of Graves' Ophthalmopathy in an Incidence Cohort

1996-03-01

George B. Bartley , Vahab Fatourechi , Eddie F. Kadrmas +4 more

Thalamic infarcts

1988-06-01

Julien Bogousslavsky , F Régli , A Uské

We studied forty patients with CT-proven thalamic infarcts without involvement of the superficial territory of the posterior cerebral artery. The delineation into four arterial thalamic territories (inferolateral, tuberothalamic, posterior choroidal, … We studied forty patients with CT-proven thalamic infarcts without involvement of the superficial territory of the posterior cerebral artery. The delineation into four arterial thalamic territories (inferolateral, tuberothalamic, posterior choroidal, paramedian) corresponded clinically to four different syndromes. The most common etiologies were lacunar infarction, large artery atherosclerosis with presumed artery-to-artery embolism, cardioembolism, and migrainous stroke. We found no risk factor other than age or oral contraceptive use in six patients. One patient died in the acute phase. During follow-up (45.6 months), the stroke or death rate was 7.4% per year. Delayed pain developed in three patients and abnormal movements in three. Late disability was mainly secondary to persisting neuropsychological dysfunction (thalamic dementia).

Functional Basis of Ocular Motility Disorders

1984-01-01

W. F. Hughes

This book contains the articles and discussions of 84 participants in the international symposium held in Wenner-Gren Center, Stockholm, September, 1981. Although the presentations were organized from a clinical point … This book contains the articles and discussions of 84 participants in the international symposium held in Wenner-Gren Center, Stockholm, September, 1981. Although the presentations were organized from a clinical point of view, most of the material concerns oculomotor research in humans and lesions produced in monkeys trained to fixate and follow targets. The major sections include the following: eye muscle structure and function, eye movement in strabismus and amblyopia, congenital nystagmus, disorders of optokinetic and vestibular nystagmus, eye-head coordination, oculomotor disorders of central and cerebellar origin, and new concepts in the treatment of strabismus including the "Faden" operation. Ragnar Granit stated that future research would probably be directed to the adaptation of the CNS to disease affecting ocular motility. The articles are reproduced in various kinds of typewriter type. There are 37 pages of references. For clinicians interested in strabismus and especially for workers in oculomotor research, this book is

Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach.

1989-08-01

Maarten P. Mourits , Leo Koornneef , Wilmar M. Wiersinga +3 more

Patients with serious inflammatory Graves9 ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. … Patients with serious inflammatory Graves9 ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves9 disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation--pain, redness, swelling, and impaired function. After two consecutive clinical examinations an 9activity score9 can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment.

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Binocular Vision and Ocular Motility: Theory and Management of Strabismus

1986-07-01

Gunter K. von Noorden , Emilio C. Campos

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Ophthalmology HomeNew OnlineCurrent … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Ophthalmology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Ophthalmology journal

Topographic anatomy of the insular region

1999-04-01

Uğur Türe , Dianne C.H. Yaşargil , Ossama Al‐Mefty +1 more

The insula is one of the paralimbic structures and constitutes the invaginated portion of the cerebral cortex, forming the base of the sylvian fissure. The authors provide a detailed anatomical … The insula is one of the paralimbic structures and constitutes the invaginated portion of the cerebral cortex, forming the base of the sylvian fissure. The authors provide a detailed anatomical study of the insular region to assist in the process of conceptualizing a reliable surgical approach to allow for a successful course of surgery.The topographic anatomy of the insular region was studied in 25 formalin-fixed brain specimens (50 hemispheres). The periinsular sulci (anterior, superior, and inferior) define the limits of the frontoorbital, frontoparietal, and temporal opercula, respectively. The opercula cover and enclose the insula. The limen insula is located in the depths of the sylvian fissure and constitutes the anterobasal portion of the insula. A central insular sulcus divides the insula into two portions, the anterior insula (larger) and the posterior insula (smaller). The anterior insula is composed of three principal short insular gyri (anterior, middle, and posterior) as well as the accessory and transverse insular gyri. All five gyri converge at the insular apex, which represents the most superficial aspect of the insula. The posterior insula is composed of the anterior and posterior long insular gyri and the postcentral insular sulcus, which separates them. The anterior insula was found to be connected exclusively to the frontal lobe, whereas the posterior insula was connected to both the parietal and temporal lobes. Opercular gyri and sulci were observed to interdigitate within the opercula and to interdigitate the gyri and sulci of the insula. Using the fiber dissection technique, various unique anatomical features and relationships of the insula were determined.The topographic anatomy of the insular region is described in this article, and a practical terminology for gyral and sulcal patterns of surgical significance is presented. This study clarifies and supplements the information presently available to help develop a more coherent surgical concept.

Vascular Syndromes of the Thalamus

2003-08-26

Jeremy D. Schmahmann

This article reviews the anatomy, connections, and functions of the thalamic nuclei, their vascular supply, and the clinical syndromes that result from thalamic infarction.Thalamic nuclei are composed of 5 major … This article reviews the anatomy, connections, and functions of the thalamic nuclei, their vascular supply, and the clinical syndromes that result from thalamic infarction.Thalamic nuclei are composed of 5 major functional classes: reticular and intralaminar nuclei that subserve arousal and nociception; sensory nuclei in all major domains; effector nuclei concerned with motor function and aspects of language; associative nuclei that participate in high-level cognitive functions; and limbic nuclei concerned with mood and motivation. Vascular lesions destroy these nuclei in different combinations and produce sensorimotor and behavioral syndromes depending on which nuclei are involved. Tuberothalamic territory strokes produce impairments of arousal and orientation, learning and memory, personality, and executive function; superimposition of temporally unrelated information; and emotional facial paresis. Paramedian infarcts cause decreased arousal, particularly if the lesion is bilateral, and impaired learning and memory. Autobiographical memory impairment and executive failure result from lesions in either of these vascular territories. Language deficits result from left paramedian lesions and from left tuberothalamic lesions that include the ventrolateral nucleus. Right thalamic lesions in both these vascular territories produce visual-spatial deficits, including hemispatial neglect. Inferolateral territory strokes produce contralateral hemisensory loss, hemiparesis and hemiataxia, and pain syndromes that are more common after right thalamic lesions. Posterior choroidal lesions result in visual field deficits, variable sensory loss, weakness, dystonia, tremors, and occasionally amnesia and language impairment.These vascular syndromes reflect the reciprocal cerebral cortical-thalamic connections that have been interrupted and provide insights into the functional properties of the thalamus.

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Management of Graves’ Ophthalmopathy: Reality and Perspectives*

2000-04-01

Luigi Bartalena , Aldo Pinchera , Claudio Marcocci

Abstract Graves’ ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In … Abstract Graves’ ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3–5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper- and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy

1997-07-01

Maarten P. Mourits , Mark F. Prummel , Wilmar M. Wiersinga +1 more

OBJECTIVE Approximately 35% of patients with Graves' ophthalmopathy do not respond to immunosuppressive treatment. A possible explanation for this finding is that only patients with active ophthalmopathy respond to immunosuppressive … OBJECTIVE Approximately 35% of patients with Graves' ophthalmopathy do not respond to immunosuppressive treatment. A possible explanation for this finding is that only patients with active ophthalmopathy respond to immunosuppressive treatment, whereas patients with fibrotic end stage disease do not. To distinguish between these two groups and to predict the outcome of immunosuppressive treatment, we developed a clinical activity score (CAS) based on four of the five classical signs of inflammation and tested its efficacy in a double‐blind, prospective study. DESIGN, PATIENTS AND MEASUREMENTS The CAS was determined by an ophthalmologist before, on the day of, and after the start of either oral prednisone or retrobulbar irradiation in 43 patients with moderate to severe Graves' ophthalmopathy. The therapeutic outcome was determined by a second ophthalmologist unaware of the CAS stores given. Success of treatment was defined as an improvement in NOSPECS class or grade. RESULTS Responders (22) and non‐responders (21) did not differ in age, sex, duration or severity of their Graves' ophthalmopathy. The pretreatment CAS, however, was significantly higher in responders than in non‐responders. Twelve of 22 responders and three of 21 non‐responders had a CAS ≥ 4 (80% vs 36%; P < 0.01). Using this CAS cut‐off point, the accuracy of CAS in predicting the therapeutic outcome was: specificity 86%, sensitivity 55%, positive predictive value 80%, negative predictive value 64%. Patients with a CAS ≥ 4 had a similar duration of Graves' ophthalmopathy as patients with a CAS < 4. CONCLUSIONS The clinical activity score has a high predictive value for the outcome of immunosuppressive treatment in Graves' ophthalmopathy. Disease activity, and not disease duration, is the prime determinant of therapeutic outcome.

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Mathematics of three-dimensional eye rotations

1995-06-01

Thomas Haslwanter

Cerebellar-dependent adaptive control of primate saccadic system

1980-12-01

Lance M. Optican , David A. Robinson

1. The ability of the central nervous system to compensate for saccadic dysmetria was demonstrated in rhesus monkeys. The behavior of this adaptive mechanism after cerebellar ablations was examined. 2. … 1. The ability of the central nervous system to compensate for saccadic dysmetria was demonstrated in rhesus monkeys. The behavior of this adaptive mechanism after cerebellar ablations was examined. 2. Monkeys were trained to fixate small target lights. Eye movements were monitored while the animals were seated, with their heads fixed, in a rotating magnetic field. The horizontal recti muscles of one eye were weakened by tenectomy. Saccades made by this weakened eye were hypometric and followed by postsaccadic drift. 3. When the patch was switched so that the weak eye was viewing, the hypometric saccades made by the weak eye gradually became larger, until after 3 days they were essentially orthometric. This indicated that the central nervous system could compensate for a peripheral weakness. 4. The tenectomy operation reduced the strength of the muscles, creating hypometria, and upset the ratio of viscosity to elasticity in the orbit, creating postsaccadic drift in the weak eye. The innervation required to make a saccade has both phasic and tonic components, the so-called pulse and step. The sacccadic repair mechanism increased both the pulse and the step to compensate for the hypometria and also adjusted the ratio of the pulse to the step to eliminate postsaccadic drift. 5. Total cerebellectomies were performed on two monkeys, each of which had one tenectomized eye. These ablations created an enduring saccadic hypermetria and postsaccadic drift in the unoperated eye of both animals. The total cerebellectomy abolished all adaptive repair of the saccadic system. 6. Partial cerebellectomies were performed on two monkeys, each of which had one tenectomized eye. Lesions of the vermis and paravermis (lobes IV-IX) and the fastigial nuclei created an enduring saccadic hypermetria without postsaccadic drift in the unoperated eye of both animals. These lesions abolished adaptive control of the pulse of innervation. Adaptive changes in the step of innervation still occurred, so that postsaccadic drift was always eliminated in the experienced, viewing eye. Thus the midline cerebellum (vermis, paravermis, and fastigial nuclei) appears to be important for repair of saccadic dysmetria, but not for repair of postsaccadic drift. Additional evidence that postsaccadic retinal slip cannot be compensated for in flocculectomized monkeys suggest that the adaptive control of the step may depend on the flocculus. 7. After cerebellar lesions the monkeys were able to make saccades of all amplitudes and directions. The principal deficit in these animals seemed to be that the pulse and step of innervation were no longer appropriate to the target displacement. We conclude that the cerebellum's principal contribution to saccadic eye movements is the adjustment of the gains of the pulse- and step-generating mechanisms. Hence this study supports the hypothesis that repair of dysmetria is a general function of the cerebellum.

Modification of the Classification of the Eye Changes of Graves' Disease: Recommendations of the Ad Hoc Committee of The American Thyroid Association

1977-01-01

Sidney C. Werner

Journal Article Modification of the Classification of the Eye Changes of Graves' Disease: Recommendations of the Ad Hoc Committee of The American Thyroid Association Get access Sidney C. Werner Sidney … Journal Article Modification of the Classification of the Eye Changes of Graves' Disease: Recommendations of the Ad Hoc Committee of The American Thyroid Association Get access Sidney C. Werner Sidney C. Werner Professor Emeritus of Clinical Medicine 1Department of Medicine College of Physicians and Surgeons of Columbia University New York, New York 10032 Search for other works by this author on: Oxford Academic Google Scholar The Journal of Clinical Endocrinology & Metabolism, Volume 44, Issue 1, 1 January 1977, Pages 203–204, https://doi.org/10.1210/jcem-44-1-203 Published: 01 January 1977

Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO

2008-02-25

Luigi Bartalena , Lelio Baldeschi , Alison Dickinson +7 more

Summary of consensus a. All patients with GO should (Fig. 1):Be referred to specialist centers;Be encouraged to quit smoking;Receive prompt treatment in order to restore andmaintain euthyroidism.b. Patients with sight-threatening … Summary of consensus a. All patients with GO should (Fig. 1):Be referred to specialist centers;Be encouraged to quit smoking;Receive prompt treatment in order to restore andmaintain euthyroidism.b. Patients with sight-threatening GO should be treatedwith i.v. GCs as the ﬁrst-line treatment; if the responseis poor after 1–2 weeks, they should be submitted tourgent surgical decompression.c. The treatment of choice for moderate-to-severe GO isi.v. GCs (with or without OR) if the orbitopathy isactive;surgery(orbitaldecompression,squintsurgery,and/or eyelid surgery in this order) should beconsidered if the orbitopathy is inactive.d. In patients with mild GO, local measures and anexpectant strategy are sufﬁcient in most cases, buttreatment may be justiﬁed if QoL is affectedsigniﬁcantly. In memoriam This document is dedicated to the memory of MarkPrummel (1956–2005), one of the founders ofEUGOGO, who greatly contributed to expanding ourunderstanding of clinical and therapeutic aspects of GO.

Epidemiology and Prevention of Graves' Ophthalmopathy

2002-10-01

Wilmar M. Wiersinga , Luigi Bartalena

Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%–5% of patients. Two age peaks of incidence are observed in the fifth and … Graves' ophthalmopathy is clinically relevant in approximately 50% of patients with Graves' disease, severe forms affecting 3%–5% of patients. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is more frequent in women than in men, although the female-to-male ratio is only 1:4 in severe forms of eye disease. The natural history of Graves' ophthalmopathy is incompletely defined, but in many instances, especially in mild forms, the disease may remit or improve spontaneously. The onset of the ophthalmopathy is in most cases concomitant with the onset of hyperthyroidism, but eye disease may precede or follow hyperthyroidism. Cigarette smoking plays an important role in the occurrence of the ophthalmopathy, and is also associated with a higher degree of disease severity and a lower effectiveness of its medical treatment. Primary prevention (i.e., avoidance of the occurrence of the ophthalmopathy) is presently not feasible, but smoking withdrawal in relatives of patients with Graves' disease might be important. In terms of secondary prevention (i.e., avoidance of progression of subclinical eye disease into overt and severe ophthalmopathy) in addition to refraining from smoking, early and accurate control of thyroid dysfunction (both hyperthyroidism and hypothyroidism), as well as early diagnosis and treatment of mild eye disease are important. As to the role that management of hyperthyroidism may play in the course of Graves' ophthalmopathy, while antithyroid drugs and thyroidectomy are not disease-modifying treatments, radioiodine therapy causes a progression of the ophthalmopathy in approximately 15% of patients, especially high-risk patients, who smoke, have severe hyperthyroidism or uncontrolled hypothyroidism, high levels of thyrotropin (TSH)-receptor antibody, or preexisting eye disease. However, the risk of radioiodine-associated progression of the opthalmopathy can be eliminated by concomitant treatment with middle-dose glucocorticoids. In terms of tertiary prevention (i.e., avoidance of deterioration and complications of overt disease) early immunosuppressive treatment or orbital decompression, as appropriate, are essential tools. Smoking withdrawal may increase the effectiveness of immunosuppressive treatment.

The Neurology of Eye Movements

1983-07-01

Henry S Metz

The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy

2016-01-01

Luigi Bartalena , Lelio Baldeschi , Kostas Boboridis +6 more

Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic … Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.

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Occurrence of Ophthalmopathy after Treatment for Graves' Hyperthyroidism

1992-06-25

Leif Tallstedt , G. E. F. Lundell , Ove Törring +4 more

Ophthalmopathy caused by Graves' disease may first appear or worsen during or after treatment for hyperthyroidism. It is not known, however, whether choosing to treat hyperthyroidism with antithyroid drugs, iodine-131, … Ophthalmopathy caused by Graves' disease may first appear or worsen during or after treatment for hyperthyroidism. It is not known, however, whether choosing to treat hyperthyroidism with antithyroid drugs, iodine-131, or surgery affects the development or aggravation of Graves' ophthalmopathy.

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Teprotumumab for Thyroid-Associated Ophthalmopathy

2017-05-03

Terry J. Smith , George J. Kahaly , Daniel G. Ezra +7 more

Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the … Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy.

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"Psychic blindness" and other symptoms following bilateral temporal lobectomy in Rhesus monkeys.

1937-01-01

Heinrich Klüver , Paul C. Bucy

THE NEUROLOGY OF EYE MOVEMENTS

1984-02-01

Richard Leigh , David S. Zee

REVIEWER'S ADDRESS: Kenneth J. Ciuffreda State University of New York State College of Optometry 100 East 24th Street New York, New York 10010 REVIEWER'S ADDRESS: Kenneth J. Ciuffreda State University of New York State College of Optometry 100 East 24th Street New York, New York 10010

Teprotumumab for the Treatment of Active Thyroid Eye Disease

2020-01-22

Raymond S. Douglas , George J. Kahaly , Amy Patel +7 more

Thyroid eye disease is a debilitating, disfiguring, and potentially blinding periocular condition for which no Food and Drug Administration-approved medical therapy is available. Strong evidence has implicated the insulin-like growth … Thyroid eye disease is a debilitating, disfiguring, and potentially blinding periocular condition for which no Food and Drug Administration-approved medical therapy is available. Strong evidence has implicated the insulin-like growth factor I receptor (IGF-IR) in the pathogenesis of this disease.In a randomized, double-masked, placebo-controlled, phase 3 multicenter trial, we assigned patients with active thyroid eye disease in a 1:1 ratio to receive intravenous infusions of the IGF-IR inhibitor teprotumumab (10 mg per kilogram of body weight for the first infusion and 20 mg per kilogram for subsequent infusions) or placebo once every 3 weeks for 21 weeks; the last trial visit for this analysis was at week 24. The primary outcome was a proptosis response (a reduction in proptosis of ≥2 mm) at week 24. Prespecified secondary outcomes at week 24 were an overall response (a reduction of ≥2 points in the Clinical Activity Score plus a reduction in proptosis of ≥2 mm), a Clinical Activity Score of 0 or 1 (indicating no or minimal inflammation), the mean change in proptosis across trial visits (from baseline through week 24), a diplopia response (a reduction in diplopia of ≥1 grade), and the mean change in overall score on the Graves' ophthalmopathy-specific quality-of-life (GO-QOL) questionnaire across trial visits (from baseline through week 24; a mean change of ≥6 points is considered clinically meaningful).A total of 41 patients were assigned to the teprotumumab group and 42 to the placebo group. At week 24, the percentage of patients with a proptosis response was higher with teprotumumab than with placebo (83% [34 patients] vs. 10% [4 patients], P<0.001), with a number needed to treat of 1.36. All secondary outcomes were significantly better with teprotumumab than with placebo, including overall response (78% of patients [32] vs. 7% [3]), Clinical Activity Score of 0 or 1 (59% [24] vs. 21% [9]), the mean change in proptosis (-2.82 mm vs. -0.54 mm), diplopia response (68% [19 of 28] vs. 29% [8 of 28]), and the mean change in GO-QOL overall score (13.79 points vs. 4.43 points) (P≤0.001 for all). Reductions in extraocular muscle, orbital fat volume, or both were observed in 6 patients in the teprotumumab group who underwent orbital imaging. Most adverse events were mild or moderate in severity; two serious events occurred in the teprotumumab group, of which one (an infusion reaction) led to treatment discontinuation.Among patients with active thyroid eye disease, teprotumumab resulted in better outcomes with respect to proptosis, Clinical Activity Score, diplopia, and quality of life than placebo; serious adverse events were uncommon. (Funded by Horizon Therapeutics; OPTIC ClinicalTrials.gov number, NCT03298867, and EudraCT number, 2017-002763-18.).

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Locus coeruleus et sommeil paradoxal

1965-01-01

Michel Jouvet

The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy

2021-07-23

Luigi Bartalena , George J. Kahaly , L. Baldeschi +7 more

Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease (GD). Choice of treatment should be based on the assessment of clinical activity and severity of GO. Early referral … Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease (GD). Choice of treatment should be based on the assessment of clinical activity and severity of GO. Early referral to specialized centers is fundamental for most patients with GO. Risk factors include smoking, thyroid dysfunction, high serum level of thyrotropin receptor antibodies, radioactive iodine (RAI) treatment, and hypercholesterolemia. In mild and active GO, control of risk factors, local treatments, and selenium (selenium-deficient areas) are usually sufficient; if RAI treatment is selected to manage GD, low-dose oral prednisone prophylaxis is needed, especially if risk factors coexist. For both active moderate-to-severe and sight-threatening GO, antithyroid drugs are preferred when managing Graves' hyperthyroidism. In moderate-to-severe and active GO i.v. glucocorticoids are more effective and better tolerated than oral glucocorticoids. Based on current evidence and efficacy/safety profile, costs and reimbursement, drug availability, long-term effectiveness, and patient choice after extensive counseling, a combination of i.v. methylprednisolone and mycophenolate sodium is recommended as first-line treatment. A cumulative dose of 4.5 g of i.v. methylprednisolone in 12 weekly infusions is the optimal regimen. Alternatively, higher cumulative doses not exceeding 8 g can be used as monotherapy in most severe cases and constant/inconstant diplopia. Second-line treatments for moderate-to-severe and active GO include (a) the second course of i.v. methylprednisolone (7.5 g) subsequent to careful ophthalmic and biochemical evaluation, (b) oral prednisone/prednisolone combined with either cyclosporine or azathioprine; (c) orbital radiotherapy combined with oral or i.v. glucocorticoids, (d) teprotumumab; (e) rituximab and (f) tocilizumab. Sight-threatening GO is treated with several high single doses of i.v. methylprednisolone per week and, if unresponsive, with urgent orbital decompression. Rehabilitative surgery (orbital decompression, squint, and eyelid surgery) is indicated for inactive residual GO manifestations.

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Graves' Ophthalmopathy

2010-02-24

Rebecca S. Bahn

This article reviews the mechanisms that lead to the development of Graves' ophthalmopathy. A central feature in its development is autoimmunity that involves not only T cells, B cells, and … This article reviews the mechanisms that lead to the development of Graves' ophthalmopathy. A central feature in its development is autoimmunity that involves not only T cells, B cells, and macrophages but also fibroblasts and adipose tissue within the orbit. Intraorbital cytokine-mediated inflammation also has a prominent role. These recent findings suggest new ways of treating this debilitating disease.

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Graves' Disease

2000-10-26

Anthony P. Weetman

Robert Graves first identified the association of goiter, palpitations, and exophthalmos in 1835, although Caleb Parry had published details of a case 10 years earlier. The discovery of a thyroid-stimulating … Robert Graves first identified the association of goiter, palpitations, and exophthalmos in 1835, although Caleb Parry had published details of a case 10 years earlier. The discovery of a thyroid-stimulating factor that was not thyrotropin in the serum of patients with Graves' hyperthyroidism1 was followed by the identification of this stimulator as an IgG antibody.2 It is now clear that Graves' hyperthyroidism is caused by these thyroid-stimulating antibodies, which bind to and activate the thyrotropin receptor on thyroid cells.3 Graves' disease also affects the eyes (Graves' ophthalmopathy) and the skin (localized dermopathy or myxedema), but the causes of these less . . .

Is Hirschberg enough? — A comparative study of corneal light reflex test and alternate prism cover test in measuring comitant horizontal strabismus

2025-06-25

Insha-e-Qudrat Tirmizi , Sardar Mohammad Ali Ayaz Sadiq | European Journal of Ophthalmology

Objective To determine the mean difference in deviation in prism dioptres as measured by corneal light reflex test and alternate prism cover test in comitant horizontal strabismus to improve practice … Objective To determine the mean difference in deviation in prism dioptres as measured by corneal light reflex test and alternate prism cover test in comitant horizontal strabismus to improve practice patterns. Materials and methods Study setting Institute of Ophthalmology, Mayo Hospital, Lahore, Pakistan; Sardar Trust Eye Hospital, Lahore; The Eye Associates, Lahore, Pakistan. Study design Cross-sectional study. Results The study included a total of 69 patients (36 males, 33 females) aged between 16 to 68 years (mean 23.5 years), of which 48 (70%) had exotropia and 21 (30%) had esotropia. The angle of deviation for exotropia ranged from 12 to 87 prism dioptres (PD) (mean 44.23 ± 19.20 PD), while for esotropia it was from 10 PD to 104 PD (mean 47.19 ± 29.10 PD). The average difference between the angle of deviation as measured by the corneal light reflex test i.e. the Hirschberg test, compared to that by the alternate prism cover test (APCT) for severe deviations was significant ( p -value < 0.05). The difference was also significant for severe exotropia and esotropia, as well as moderate esotropia. Conclusion There is a statistically significant difference between the measurements obtained by the corneal light reflex test and those by the alternate prism cover test, with the corneal light reflex test being substantially less accurate. Moreover, this relationship varies with the angle of the deviation, with overestimations more likely to occur with mild deviations and underestimations with severe deviations.

Medial wall orbital decompression surgery for the treatment of Graves’ ophthalmopathy: follow-up results in a single medical center

2025-06-25

Meydan Ben Ishai , Daniel Yagoda , Judith Dadon +3 more | International Ophthalmology

Abstract Purpose To examine the success rate of endoscopic decompression surgery in Graves’ ophthalmopathy. Methods This is a retrospective cohort study of all patients who underwent endoscopic decompression surgery at … Abstract Purpose To examine the success rate of endoscopic decompression surgery in Graves’ ophthalmopathy. Methods This is a retrospective cohort study of all patients who underwent endoscopic decompression surgery at the Rabin Medical Center, Israel, between 2010 and 2022. The data includes post-surgery follow-up time, visual acuity, proptosis outcomes, and post-surgical complications. Results Thirty patients underwent unilateral or bilateral decompression surgery at our medical centre during the study period, a total of 42 eyes. The mean age at the time of decompression was 49 ± 15.82 years. The reason for surgery was proptosis in twenty-eight patients (93.3%), while only two patients (6.67%) were referred to surgery due to compressive optic neuropathy. The medial wall was decompressed in all of our patients either as a single procedure or in combination with other procedures. Thirteen patients (43.33%) underwent medial wall-only surgery, thirteen patients (43.33%) had medial and lateral wall surgery, and four patients (13.33%) had medial, lateral, and inferior wall decompression. The mean difference between pre-and post-op of the operated eye, measured by Hertel exophthalmometer, was 3.39 ± 2.45 mm ( P < 0.001). The mean difference between the operated eye’s visual acuity between pre and post-op was 0.04 ± 0.21LogMAR ( P = 0.19). The mean follow-up time for the Hertel measurement was 460.10 days (SD = 585.36). We do not report long-term surgical complications. Conclusion In the TED (thyroid eye disease) patient, endoscopic medial wall decompression can ensure sufficient orbital decompression while minimising complications. The size of the proptosis should be a factor when planning the surgery.

The Pathogenesis of Papilledema: Review of the Literature and a New Hypothesis

2025-06-25

David N. Levine , Ari I Rapalino | Bulletin of Mathematical Biology

Abstract Since the first description of swelling of the optic nerve head in patients with increased intracranial pressure, our understanding of its pathogenesis has undergone significant changes. Early theories postulated … Abstract Since the first description of swelling of the optic nerve head in patients with increased intracranial pressure, our understanding of its pathogenesis has undergone significant changes. Early theories postulated that the swelling was caused by excessive extracellular fluid, but these views were disproved when electron microscopy showed that the swelling arose from dilated optic nerve axons, and autoradiography demonstrated blocked axonal transport at the posterior lamina cribrosa. This led to the currently prevailing view that the axonal swelling is caused by the damming back of axoplasm. However, this theory cannot account for the extent of swelling, its rate of development, and the variety of morphological changes in papilledema. It also cannot explain the differing patterns of swelling in papilledema and acute glaucoma despite identically located blockages of axonal transport. We conducted a biomechanical analysis, in which we calculated the stresses induced in a cylindrical nerve by external compression and the effect of these stresses on the nerve’s axons and the axoplasm within them. We propose a new theory in which the axial gradient of tissue pressure causes displacement of axoplasm from the extraocular to the intraocular segment of the nerve, accounting for the intraocular axonal swelling. In addition, a sharply localized axial shear stress disrupts the axonal cytoskeleton to block axonal transport. Although the pressure gradient and the shear stress are both caused by the external compression of the nerve, they differ in their relative magnitudes across the nerve cross-section. The proposed hypothesis resolves the difficulties with the damming back hypothesis.

Dynamic Navigation Third Eye in Implantology

2025-06-24

Morankar Rahul | International Journal of Oral and Maxillofacial Surgery

Ataxia with Oculomotor Apraxia Type 1 Presenting in a 5-Year Old Child: Diagnostic and Clinical Considerations

2025-06-24

Noura Agarrab , Azzeddine Laaraje , Radi Abdelilah +3 more | Asian Journal of Pediatric Research

Ataxia with oculomotor apraxia type 1 (AOA1) is a rare neurodegenerative disease with autosomal recessive inheritance, caused by mutations in the APTX gene encoding aprataxin, a protein involved in DNA … Ataxia with oculomotor apraxia type 1 (AOA1) is a rare neurodegenerative disease with autosomal recessive inheritance, caused by mutations in the APTX gene encoding aprataxin, a protein involved in DNA repair. We report the case of a 5-year-old child born to consanguineous parents, presenting with ataxic gait, speech difficulties, and strabismus since age 3. Examination revealed postural instability, areflexia, peripheral hypotonia, and asynchrony between eye and head movements. Three café-au-lait spots and telangiectasia were noted on skin examination. Brain MRI showed early cerebellar atrophy, and electromyography demonstrated decreased sensory amplitudes in the upper limbs. Alpha-fetoprotein, albumin, and lipid profile were normal, unlike some AOA1 cases. High-throughput DNA sequencing identified the homozygous c.875-1G>A variant in the APTX gene, confirming the AOA1 diagnosis. Treatment remains symptomatic, with stem cell transplantation being considered for our patient.

Three-Dimensional Culture of Orbital Fibroblasts From Thyroid Eye Disease Induce In Vivo-Like Tissue Remodeling and Fibrosis

2025-06-23

Xiaoli Bao , Zhihui Xu , Xi Wang +3 more | Investigative Ophthalmology & Visual Science

This study aimed to investigate the characteristics and molecular mechanisms of orbital fibroblasts under three-dimensional (3D)-culture conditions. Orbital connective tissue was collected from patients with thyroid eye disease (TED) and … This study aimed to investigate the characteristics and molecular mechanisms of orbital fibroblasts under three-dimensional (3D)-culture conditions. Orbital connective tissue was collected from patients with thyroid eye disease (TED) and normal controls. Primary fibroblasts were cultured and used to generate 3D microspheres via the hanging drop. These spheroids were cultured for nine days, followed by biomechanical testing, transmission electron microscopy (TEM), and RNA sequencing for transcriptomic analysis. Multiplex immunofluorescence staining was used to assess fibrosis markers, and quantitative PCR validated gene expression changes. TED and normal control (NC) tissues, as well as primary cultured fibroblasts, were also subjected to transcriptomic sequencing. TED-3D microspheres exhibited enhanced contractility, denser fiber deposition, and a characteristic fibrous ring at the periphery. TEM revealed more extracellular matrix (ECM) deposition and stronger tissue remodeling in TED-3D. Fibrosis markers (α-SMA, COL1A1, FN1) increased significantly in TED-3D. Biomechanical testing showed higher stiffness in TED-3D compared to NC-3D. Transcriptomic analysis revealed significant differences, with genes involved in ECM remodeling and fibrosis pathways enriched in TED-3D. Transcriptomic comparison of TED-tissue, TED-2D, and TED-3D revealed that TED-3D is closer to tissue than TED-2D. The 3D culture of orbital fibroblasts from TED induces in vivo-like tissue remodeling and fibrosis features. Compared to traditional two-dimensional culture, the expression pattern of TED-3D is closer to tissue, making it a more effective model for studying the mechanisms of TED-related fibrosis.

An Atypical Presentation of Thyroid Eye Disease in a Patient With a Remote History of Graves’ Disease

2025-06-23

Nancy L. Van Buren , Cui-Hua Yu , Elizabeth A. Bradley | Cureus

A pediatric case of clinically isolated syndrome presenting with one-and-a-half syndrome

2025-06-23

Shonosuke Tagashira , Nobuko Katayama , Atsushi Kato +1 more | Brain and Development Case Reports

Integrating ocular and clinical features to enhance intravenous glucocorticoid response prediction in thyroid eye disease: a machine learning approach

2025-06-23

Chen Zhao , Chaoyu Lei , Sen Pei +6 more | Endocrine

A Case of Horizontal Gaze Palsy With Progressive Scoliosis and G6PD Deficiency in a Child

2025-06-22

Parmeet Kaur , Sangita Yadav | Cureus

The Management of Thyroid Eye Disease: From Current Practice to Future Perspectives

2025-06-21

Navneet Dhaliwal , Lubna Razzaq | Cureus

Abducens-nerve palsy with ipsilateral herpes zoster ophthalmicus and skin rash: a case report

2025-06-20

Jae‐Weon Kim , Donghun Lee | International Journal of Ophthalmology

Isolated oculomotor nerve palsy caused by midbrain infarct: A case report

2025-06-20

Qinke He , Fangshuai Song , Yujie Wang +3 more | Advanced Neurology

A 70-year-old man with hypertension and diabetes mellitus was admitted to the hospital two days after the onset of acute diplopia. His neurological examination revealed a disconjugate gaze at rest … A 70-year-old man with hypertension and diabetes mellitus was admitted to the hospital two days after the onset of acute diplopia. His neurological examination revealed a disconjugate gaze at rest and limited inward gaze in the left eye, as well as an impaired convergence test. There was no ptosis of the upper eyelid, and the rest of the eye movements were normal. The pupils on both sides were equal in size and round, with normal light reflexes. The rest of the neurological examination was normal. High-resolution magnetic resonance imaging showed restricted diffusion in the periaqueductal gray matter of the lower midbrain. Acute stroke patients with visual symptoms may be misdiagnosed and do not receive the appropriate treatment. This is particularly important because potential acute stroke treatments such as intravenous thrombolysis or thrombectomy should be timely administered. We reported an isolated oculomotor nerve palsy caused by central cerebral infarction, which is seldom reported previously.

Combining biomarkers to predict the disease activity of graves’ ophthalmopathy: a combinatory model of the NLR, TRAb and FT4

2025-06-20

Ting Niu , Lujue Wang , Jing Deng +6 more | Frontiers in Endocrinology

Purpose The aim of this study was to identify potential biomarkers associated with active Graves’ ophthalmopathy (GO) and develop a model for predicting the occurrence and progression of active GO. … Purpose The aim of this study was to identify potential biomarkers associated with active Graves’ ophthalmopathy (GO) and develop a model for predicting the occurrence and progression of active GO. Methods A retrospective study was conducted on 220 GO patients (n=120 in the active phase, n=100 in the stable phase) and 70 healthy controls. Laboratory and other clinical indicators were compared in GO patients at different stages and healthy controls. A multivariate regression analysis model was used to analyze the clinical risk factors affecting the occurrence and progression of active GO, and a predictive model based on risk factors was established. Results Higher WBC, NEU, NLR, TRAb and FT4 levels (all p&lt;0.005) were detected in patients with active GO than those in inactive GO. The CAS score of the GO patients was positively correlated with the WBC (r = 0.155, p = 0.003), NEU (r = 0.165, p = 0.002), NLR (r = 0.134, p = 0.010), FT3 (r = 0.117, p = 0.031), FT4 (r = 0.139, p = 0.011), and TRAb (r = 0.160, p = 0.004) counts and negatively correlated with the TSH level (r = - 0.114, p = 0.043). Multivariate regression analysis revealed that the NLR, TRAb, and FT4 were significant risk factors for GO progression (all p &lt; 0.05). The cut-off levels for predicting active GO were 8.71 IU/L for TRAb (AUC=0.643, sensitivity 0.58, specificity 0.74), 19.82 ng/dL for FT4 (AUC=0.606, sensitivity 0.41, specificity 0.75), and 2.405 for the NLR (AUC=0.597, sensitivity 0.50, specificity 0.75). A predictive model including these risk factors was built (the cutoff value was 0.6, the AUC was 0.716, the sensitivity was 0.533, and the specificity was 0.808). Conclusion The laboratory biomarkers for the occurrence and progression of active GO include the NLR, FT4, and TRAb. We have developed a predictive combined model that may assist in timely assessment of GO activity and progression, and provide clues for future development of facile tools to predict GO activity.

Bilateral Persistent Pupillary Membranes in Adulthood: A case report

2025-06-20

Sara Ennaki , Ghizlane Daghouj , Zyad Laftimi +3 more | World Journal of Advanced Research and Reviews

We report the case of a 43-year-old woman with bilateral persistent pupillary membranes (PPM) obstructing the visual axis, leading to chronic visual impairment since childhood. Best corrected visual acuity was … We report the case of a 43-year-old woman with bilateral persistent pupillary membranes (PPM) obstructing the visual axis, leading to chronic visual impairment since childhood. Best corrected visual acuity was 1/10 in both eyes, with slit-lamp examination revealing dense PPM and high myopia on cycloplegic refraction. No prior treatment had been attempted, and the patient declined surgical intervention. While PPM is typically asymptomatic and regresses in infancy, this case illustrates a rare adult presentation with significant visual consequences. Early detection and appropriate management are essential, especially in cases with central obstruction.

<i>ABCB1</i>GENE POLYMORPHISMS ARE ASSOCIATED WITH CLINICAL RESPONSE TO NABIXIMOLS IN PATIENTS WITH MULTIPLE SCLEROSIS-RELATED SPASTICITY

2025-06-20

Alessandra Gemma , M. Mauri , Paola Banfi +6 more | medRxiv (Cold Spring Harbor Laboratory)

Abstract Background Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system causing severe symptoms, including spasticity-related pain. Nabiximols (NBX), a drug combining Tetrahydrocannabinol and Cannabidiol, is approved … Abstract Background Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system causing severe symptoms, including spasticity-related pain. Nabiximols (NBX), a drug combining Tetrahydrocannabinol and Cannabidiol, is approved for MS-associated spasticity. Despite NBX efficacy, only 60-70% of patients respond to treatment. This study explores whether genetic polymorphisms in key genes involved in NBX pharmacology influence response to drug. Materials & Methods This is a genetic, exploratory study in which MS patients, treated with NBX, were retrospectively enrolled. Polymorphisms in genes related to NBX metabolism ( CYP2C9 , CYP2C19 ), efflux (ATP Binding Cassette subfamily B member 1 - ABCB1 ), and cannabinoid receptors ( CNR1 , CNR2 ) were analyzed using Real-Time PCR. Results Among 45 enrolled patients, 29 responded to NBX and 16 did not. Of responders, 38% were homozygous for the T allele in ABCB1 1236C>T (rs1128503), and 48% for the T allele in ABCB1 3435A>T (rs1045642). None of the non-responders carried T allele. The odds ratios for response to NBX of TT homozygotes was 20.5 (95% CI:1.1-376.1, P=0.0039) for rs1128503 and 30.9 (95% CI:1.7-563.2, P=0.0006) for rs1045642. Discussion This study suggests a link between genetic profiles and NBX response. If validated in larger studies, these findings could pave the way for personalized therapy for MS-related spasticity.

Eight-and-a-Half Syndrome: An Uncommon but Potentially Life-Threatening Disease Secondary to Acute Brainstem Infarction

2025-06-19

Nicholsan Jesiah , Mayurathan Pakkiyaretnam | Cureus

Outcomes of inferior rectus muscle recession surgery using absorbable versus non-absorbable sutures

2025-06-19

Dhruvil Shah , Victoria Tang , Saurabh Jain | Strabismus

Inferior rectus (IR) recession surgery is commonly performed for vertical strabismus, yet overcorrection risk remains high (21-50%) due to factors like lower lid retractors, suture dissolution, and muscle tension in … Inferior rectus (IR) recession surgery is commonly performed for vertical strabismus, yet overcorrection risk remains high (21-50%) due to factors like lower lid retractors, suture dissolution, and muscle tension in thyroid eye disease (TED). This study aims to contribute novel insights by comparing clinical outcomes of IR recession using absorbable and non-absorbable sutures. A retrospective study (01/12/20-31/01/23) was conducted at a tertiary referral center on patients undergoing IR recession with absorbable or non-absorbable sutures. The following data were collected: absorbable vs non-absorbable suture use, age at operation, sex, date of operation, surgical indication, presence of TED, adjustable vs non-adjustable suture technique, surgeon training level, number of muscles recessed, IR distance recessed, and time from surgery to final follow-up. Thirty-two IR recession procedures were evaluated (26 absorbable, 6 non-absorbable cases) with a mean follow-up of 3.6 months. Both groups achieved similar success in vertical deviation control with no significant difference in success rates for distance (p = .48) or near fixation (p = .21). Overcorrection occurred in 23.1% (absorbable) and 16.7% (non-absorbable) cases, with no statistical difference (p = .61). Logistic regression analysis was performed, which showed that TED (p = .99), surgeon training level (p = .20), adjustable sutures (p = .89) and number of muscles operated on (p = .28) did not significantly impact success for absorbable sutures. This study demonstrates that IR recession surgeries using absorbable sutures yield outcomes comparable to those using non-absorbable sutures, with no significant difference in success rates and overcorrection rates consistent with existing literature. These findings suggest that absorbable sutures are equally viable in use for IR recession surgeries.

Analysis of Strabismus Surgical Outcomes: A Retrospective Study of 2269 Cases from a Single Center

2025-06-19

Hao Wu , Hu Liu | Medical Science Monitor

A Case of Adult-Onset Spastic Paraparesis: A Treatable Presentation of MTHFR Deficiency

2025-06-19

Navyasri | International Journal of Contemporary Medicine

IntroductionSpastic paraparesis in young adults often raises suspicion for neurodegenerative, demyelinating, or structural spinal cord disorders. However, metabolic causes such as methylenetetrahydrofolate reductase (MTHFR) deficiency are frequently overlooked despite being … IntroductionSpastic paraparesis in young adults often raises suspicion for neurodegenerative, demyelinating, or structural spinal cord disorders. However, metabolic causes such as methylenetetrahydrofolate reductase (MTHFR) deficiency are frequently overlooked despite being potentially treatable.This case presents a 21-year-old male with progressive spastic paraparesis due to late-onset MTHFR deficiency and hyperhomocysteinemia, emphasizing the importance of early metabolic screening in unexplained motor syndromes. It contributes to literature by reinforcing that early intervention can halt or reverse neurological deterioration in a rare but manageable condition.Patient Concerns and Key Clinical FindingsDemographics:21-year-old male from TripuranthakamWell-built, tall; noted to have gynecomastiaChief Complaints:Progressive stiffness in both lower limbs for 1 yearWeakness in both lower limbs for 5 monthsHistory of Present Illness:Onset in left leg, followed by rightDifficulty in:Walking without supportClimbing stairsRising from squatting positionWearing footwear due to dragging of feetPseudobulbar affect reported (sudden inappropriate laughter/crying)Recent swelling, pain, and discoloration in left legExamination Findings:Neurological:Conscious, oriented, MMSE: 30/30No cranial nerve or sensory deficitsSpastic gait with grade 3 spasticity bilaterallyBilateral extensor plantar responsesExaggerated deep tendon reflexes (DTRs)General:Left leg: Tender and warmGynecomastia noted Diagnosis, Interventions, and OutcomesFinal Diagnosis:Late-adolescent onset MTHFR deficiencySpastic paraparesis associated with hyperhomocysteinemiaDiagnostic Clues:Progressive bilateral spasticity without sensory lossPseudobulbar affectElevated serum homocysteine levelsConfirmed MTHFR mutation (via genetic testing, if done)Treatment Initiated:Betaine – to support alternative remethylation of homocysteinePyridoxine (Vitamin B6) – cofactor for homocysteine metabolismFolate and Vitamin B12 supplementation (if applicable)Supportive care – physiotherapy for spasticity management Outcome:At follow-up, the patient showed improvement in lower limb strength, reduction in spasticity, and improved gait stability with continued betaine and vitamin therapy.Conclusion and Key TakeawaysMTHFR deficiency, though rare, is a treatable cause of adult-onset spastic paraparesis.Early detection and management can prevent irreversible neurological damage.Routine homocysteine screening in cases of unexplained spasticity can aid in timely diagnosis.This case underscores the importance of metabolic workups in young patients with upper motor neuron signs, particularly in settings where degenerative and inflammatory causes have been excluded.

Microstructural alterations of the trigeminal ganglion in chronic ocular surface pain patients: A diffusion MRI study

2025-06-18

Alpen Ortuğ , Nicholas Reyes , Anat Galor +7 more | NeuroImage

Corrigendum to “A randomised, double-masked, placebo-controlled trial evaluating the efficacy and safety of teprotumumab for active thyroid eye disease in Japanese patients” The Lancet Regional Health—Western Pacific, Volume 55 (2025), 101464

2025-06-18

Yuji Hiromatsu , Eri Ishikawa , Ai Kozaki +7 more | The Lancet Regional Health - Western Pacific

Paroxysmal Eye Movements in Treatment-Resistant Schizophrenia

2025-06-18

Carol S. Lim , Rachel Conrad , Saad Rahmat +2 more | The Primary Care Companion For CNS Disorders

Особенности клинической картины при остром нарушении мозгового кровообращения в бассейне артерии Першерона: клинический случай

2025-06-17

Е.Ю. Шураева , В.И. Курман | Неврология и нейрохирургия Восточная Европа

Артерия Першерона – это анатомический вариант строения сосудов головного мозга, при котором одна артерия, отходящая от проксимального отдела одной из задних мозговых артерий, кровоснабжает парамедиальные отделы таламусов и ростральную часть … Артерия Першерона – это анатомический вариант строения сосудов головного мозга, при котором одна артерия, отходящая от проксимального отдела одной из задних мозговых артерий, кровоснабжает парамедиальные отделы таламусов и ростральную часть среднего мозга. Окклюзия артерии Першерона является причиной двусторонних инфарктов таламуса, иногда с вовлечением структур среднего мозга. Клиническая картина инфаркта головного мозга в бассейне артерии Першерона наиболее часто проявляется нарушением сознания, глазодвигательными расстройствами и нейропсихологическими проявлениями. В статье описан клинический случай острого нарушения мозгового кровообращения в бассейне артерии Першерона. Трудности распознавания причины ишемического инсульта у пациентки были связаны с полиморфизмом психических расстройств, а также угнетением сознания. Приводятся клинические особенности заболевания, позволяющие в совокупности с использованием методов нейровизуализации (в том числе различных режимов магнитно-резонансной томографии) провести правильную и своевременную диагностику. The artery of Percheron is an anatomical variant of the cerebral vascular structure in which one artery, branching off from the proximal part of one of the posterior cerebral arteries, supplies the paramedian parts of the thalami and the rostral part of the midbrain. The occlusion of the artery of Percheron causes bilateral thalamic infarctions, sometimes with involvement of the midbrain structures. The clinical picture of cerebral infarction in the basin of the artery of Percheron is most often manifested as impaired consciousness, oculomotor disorders and neuropsychological manifestations. The article describes a clinical case of acute cerebrovascular accident in the basin of the artery of Percheron. Difficulties in recognizing the cause of ischemic stroke in the patient were associated with polymorphism of mental disorders, as well as depression of consciousness. The clinical features of the disease are presented, enabling, in combination with the use of neuroimaging methods (including various modes of magnetic resonance imaging), a correct and timely diagnostics.

Normative Measurement of Ocular Muscle Using Computed Tomography

2025-06-17

Unnati Pant , R.M. Pandey | Journal of Neonatal Surgery

Accurate assessment of extraocular muscle dimensions is crucial for diagnosing orbital and systemic pathologies. Computed Tomography (CT) offers high-resolution imaging for precise measurement of orbital structures. This study aims to … Accurate assessment of extraocular muscle dimensions is crucial for diagnosing orbital and systemic pathologies. Computed Tomography (CT) offers high-resolution imaging for precise measurement of orbital structures. This study aims to establish normative values for the diameters of extraocular muscles in a healthy population using CT imaging and to evaluate variations based on age, gender, and laterality. A prospective analysis was conducted on CT head scans of 118 individuals without orbital pathology. Measurements included diameters of the medial, lateral, inferior rectus, and superior muscle groups for both eyes. The study establishes normative CT-based ocular muscle dimensions, providing a reference for clinical assessment in the Indian population.

Approach to Oculomotor Apraxia: A Syndromic Approach to Genetic Causes

2025-06-17

Mehri Salari , Kamran Rezaei , Mahsa Haghighatzadeh +2 more | The Cerebellum

Pseudo oculomotor palsy associated with Parry-Romberg syndrome

2025-06-17

Alejandra Antacle , Macarena Nougues , Graciela Espada +2 more | Archivos Argentinos de Pediatria

Parry-Romberg syndrome is a rare form of localized scleroderma that can affect deep tissues, including muscles and the central nervous system. Early and appropriate treatment during the inflammatory phase is … Parry-Romberg syndrome is a rare form of localized scleroderma that can affect deep tissues, including muscles and the central nervous system. Early and appropriate treatment during the inflammatory phase is essential to prevent serious sequelae. We present the case of an 11-year-old patient whose first manifestation was a palpebral hypochromia, followed by pseudo paralysis of the third cranial nerve with ptosis and hypotropia, whose late diagnosis delayed the start of treatment and conditioned an unfavorable evolution. This work emphasizes the significance of early diagnosis in enhancing prognosis and preventing permanent sequelae.

Tendon Elongation with Fascia Lata Grafts in Strabismus Surgery – Multiple Indications Apart from Gravesʼ Orbitopathy

2025-06-16

J. C. Prinz , Kathi Hartmann , Peter Walter +3 more | Klinische Monatsblätter für Augenheilkunde

Abstract Background To investigate the use of fascia lata (FL) grafts for eye muscle tendon elongation in patients with complex and residual strabismus types apart from Gravesʼ orbitopathy. Methods and … Abstract Background To investigate the use of fascia lata (FL) grafts for eye muscle tendon elongation in patients with complex and residual strabismus types apart from Gravesʼ orbitopathy. Methods and Materials In this retrospective study, a heterogeneous group of 27 eyes of 21 patients with complex and residual strabismus types who underwent elongation of the eye muscle tendon with FL were included. Orthoptic and ophthalmological examinations including measurement of the head posture, the extent of deviation in primary position (PP), and monocular excursion were conducted preoperatively and after a mean postoperative time of 12.2 (6.0 – 37.0, median 7.0) months in all patients. Results Eight patients (12 eyes) with residual exotropia, 4 patients (4 eyes) with residual esotropia, 4 patients (6 eyes) with partial abducens nerve palsy, 4 patients (4 eyes) with vertical deviation, and 1 patient (1 eye) with Duaneʼs retraction syndrome (DRS) type I were included. A residual squint angle of 10Δ or less was achieved in 57.1% of the patients at the last follow-up. The head posture was significantly reduced at the last follow-up compared to preoperatively in patients with residual exotropia (p = 0.002), esotropia (p = 0.040), abducens nerve palsy (p = 0.005), and vertical deviation (p = 0.005). At the last follow-up, a significant reduction in the squint angle occurred in patients with residual exotropia (p = 0.001), abducens nerve palsy (p = 0.046), and vertical deviation (p = 0.033). Conclusion FL grafts may offer safe and effective surgical options for complex and residual strabismus types. No significant reduction in the excursion into the fields of action of the affected muscles was witnessed.

Deep learning system for the auxiliary diagnosis of thyroid eye disease: evaluation of ocular inflammation, eyelid retraction, and eye movement disorder

2025-06-16

Yu Han , Jun Xie , Xiaoyu Li +4 more | Frontiers in Cell and Developmental Biology

Objective This study aims to construct a semantic segmentation-based auxiliary diagnostic model for thyroid eye disease (TED) focusing on eyelid retraction, eye movement disorders, ocular inflammation related to Clinical Activity … Objective This study aims to construct a semantic segmentation-based auxiliary diagnostic model for thyroid eye disease (TED) focusing on eyelid retraction, eye movement disorders, ocular inflammation related to Clinical Activity Score (CAS), facilitating rapid and non-invasive diagnosis for suspected TED patients and enhancing the efficiency of treatment and diagnosis. Methods Data were collected from 153 subjects exhibiting symptoms of eyelid retraction, eye movement disorders, and ocular inflammation related to CAS. After quality screening, datasets for the primary position (303 eyes), gaze positions (1,199 eyes), and a multi-label inflammatory classification dataset (272 eyes) were constructed. The constructed TBRM-Net adopts a dual-branch feature extraction and fusion strategy to extract inflammation features for multi-label classification and recognition; the constructed DSR-Net performs segmentation of ocular structures and has designed a quantitative diagnostic algorithm. Results The semantic segmentation-based auxiliary diagnostic model for TED demonstrated a mean pixel accuracy (MPA) of 94.1% in the primary position dataset and 95.0% in the gaze positions dataset. The accuracy for diagnosing eye movement disorders, upper eyelid retraction, and lower eyelid retraction reached 85.4%, 95.1%, and 87.0%, respectively. The accuracy for Redness of Eyelids, Swelling of Eyelids, Redness of Conjunctiva, Swelling of Conjunctiva, and Swelling of Caruncle or Plica reaches 81.8%, 78.8%, 90.6%, 73.5%, and 83.9%, respectively, with an average accuracy of 81.7%. Segmenting and classifying images of structures affected by ocular inflammation can effectively exclude interfering features. The designed quantitative algorithm provides greater interpretability than existing studies, thereby validating the effectiveness of the diagnostic system. Conclusion The deep learning-based auxiliary diagnostic model for TED established in this study exhibits high accuracy and interpretability in the diagnosis of ocular inflammation related to CAS, eyelid retraction, and eye movement disorders. It holds significant medical value in assisting doctors in formulating treatment plans and evaluating therapeutic effects.

Effectiveness of treatment modalities for childhood esotropia: a systematic review

2025-06-16

Saif Hassan Alrasheed , Naveen Kumar Challa , Saeed Aljohani +2 more | PeerJ

Background Esotropia has several types that commonly manifest in early childhood, with numerous treatment options described in the literature. The aim of this systematic review is to synthesize recent research … Background Esotropia has several types that commonly manifest in early childhood, with numerous treatment options described in the literature. The aim of this systematic review is to synthesize recent research findings on the management of childhood esotropia (ET) to clarify the relative success rates and specific indications for each treatment option, providing guidance for eye care professionals in selecting the most effective interventions. Methodology A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, ProQuest, Scopus, Google Scholar, EBSCO, and Medline, following PRISMA 2020 guidelines. The search was restricted to articles published between 1990 and 2023 that examined various treatment modalities for different types of childhood esotropia (ET). In this study, success was defined as a post-treatment deviation of less than 10 prism dioptres (PD). The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024589042. Results The final systematic review included 34 studies from 14 countries, encompassing 3,877 children with a mean age of 4.72 ± 2.08 years. The reviewed studies indicated that optical correction had the highest effectiveness rate at 79.31% after an average follow-up of 5.57 years. Extraocular muscle surgery demonstrated an effectiveness rate of 71.4% with a follow-up period of 2.89 years, while botulinum toxin (BT) injections showed a lower effectiveness rate of 61.24% after a follow-up of 3.15 years. Conclusions The review concluded that substantial evidence supports full cycloplegic hyperopic correction as the most effective first-line treatment for childhood accommodative esotropia (AET). However, surgery may be required for some children with AET if their deviation remains over 15 PD after full cycloplegic hyperopic correction. Prismatic correction was highly successful in managing residual deviation in partial AET. Bilateral BT injections proved effective as a first-line treatment for acute-onset ET and infantile ET without a vertical component. Timely surgical intervention enhances sensory outcomes in infantile ET; however, no surgical technique has demonstrated a distinct advantage.

Jeavons syndrome - clinical spectrum, diagnostic challenges and innovative treatment strategies

2025-06-16

Martyna Borowska-Łygan , Patrycja Grzech , Lena Maria Kreczyńska +5 more | Journal of Education Health and Sport

Introduction:Jeavons syndrome (JS), also known as epilepsy with eyelid myoclonus (EEM), is a rare form of genetically generalized epilepsy (GGE) characterized by light-triggered seizures, eyelid myoclonus, and often concurrent absence … Introduction:Jeavons syndrome (JS), also known as epilepsy with eyelid myoclonus (EEM), is a rare form of genetically generalized epilepsy (GGE) characterized by light-triggered seizures, eyelid myoclonus, and often concurrent absence seizures and GTCS. The condition is sometimes misdiagnosed as neural tics, leading to significant diagnostic delays. In recent years, there has been growing interest in new treatments for JS, including alternative approaches in cases of treatment resistance.Objective:The purpose of this study is to provide an update on Jeavons syndrome, including clinical presentation, genetic factors, diagnostic methods and the latest therapeutic strategies.Methods:A non-systematic review of the scientific literature from 2020-2025 was performed using PubMed, Google Scholar, Web of Science and Scopus databases. Publications describing JS, treatment of drug-resistant epilepsy, eyelid myoclonus, dietary therapy and modern brain stimulation methods were included.Results: The most commonly used first-line drugs are valproic acid, levetiracetam and lamotrigine. In refractory cases, lacosamide, zonisamide, and VNS and RNS have also shown efficacy. The potential of diet therapy (ketogenic, Atkins, low-GI diets) and lentiviral therapy in patients with photosensitivity was identified. The study emphasized the role of genetic diagnosis in personalizing treatment. Conclusions: Jeavons syndrome requires a comprehensive therapeutic approach. Standard pharmacotherapy is sometimes insufficient, so adjunctive therapies are playing an increasingly important role. Early diagnosis, consideration of genetic factors and implementation of individualized treatment strategies can significantly improve seizure control and quality of life for patients.

A mannequin resembling a young woman with Graves' disease

2025-06-16

Fabio Trimarchi , Enrica Antonia Martino , Luigi Bartalena | Journal of Endocrinological Investigation

The temporal dynamics and clinical relevance of choroid plexus measures in multiple sclerosis

2025-06-14

Ermelinda De Meo , Sarmad Al-Araji , Baris Kanber +7 more | Brain Communications

Abstract Choroid plexus (ChP) enlargement is a promising biomarker of disease activity in multiple sclerosis (MS). However, longitudinal changes in ChP volume and microstructural integrity remain unclear. This study investigated … Abstract Choroid plexus (ChP) enlargement is a promising biomarker of disease activity in multiple sclerosis (MS). However, longitudinal changes in ChP volume and microstructural integrity remain unclear. This study investigated temporal changes in ChP measures and their correlations with clinical disability and brain volume changes over 18 months and the entire disease duration. We recruited consecutive relapsing-remitting (RR) MS patients at treatment initiation who were then invited to come back for clinical, neuropsychological and brain MRI assessments at 6 and 18 months. ChP volume was measured using FreeSurfer and Gaussian Mixture Models on 3D-T1-weighted scans, and ChP T1/T2 ratio was calculated from conventional 3D-T1- and T2-weighted images. Brain lesion, whole brain, grey matter, and white matter volumes were measured. Alternating Conditional Expectation algorithm was used to estimate trajectories of changes in ChP measures over the entire disease course. Multiple linear regression and mixed effects models were used to investigate associations of ChP measures with clinical and MRI measures. False discovery rate (FDR) correction was applied. 422 RRMS patients were recruited [mean age: 40.8 years (SD 10.9), mean disease duration: 9.5 years (SD 17.4), median Expanded Disability Status Scale: 2.0 (IQR: 1.5-3.5); mean Symbol Digit Modalities Test score: 50.6 (SD 14.7), mean Brief Visuospatial Memory Test-Revised (BVMT-R) score: 25 (SD7.6)]; 276 participants were studied at 6-months follow-up and 80 at 18-months. During the entire disease course, an initial increase in normalized ChP volume was observed, followed by a plateau; T1/T2 ratio decreased initially, but then increased once the volume had stabilized. When examining changes in ChP volumes over a median follow-up of 8.6 months, significant increases in both ChP volumes [β=0.45, standard error (SE)=0.11, FDR-corrected p&lt;0.001)] and T1/T2 ratios (β=0.29, SE=0.14, FDR-corrected p=0.05) were observed. A higher baseline ChP T1/T2 ratio was linked to a faster rate of decrease in normalized brain volume (β=-0.21, SE=0.08, FDR-corrected p=0.01) and deep grey matter volume (β=-0.25, SE=0.10, FDR-corrected p=0.03) over time. Higher baseline ChP T1/T2 values were associated with worsening performance on BVMT-R over time (β=-0.23, SE=0.10, FDR-corrected p=0.04). Changes in ChP measures over time appear non-linear, with volumes increasing earlier in the disease course and T1/T2 ratios rising later. After a mean disease duration of 9.5 years, higher ChP T1/T2 ratios, but not volume, predicted faster memory decline and whole brain and deep grey matter volume loss, underscoring the value of assessing ChP microstructure, alongside volumes, in predicting clinical and MRI outcomes.

Abnormal functional lateralization and functional connectivity in thyroid-associated ophthalmopathy: mechanistic links to transcriptomic signatures and neurotransmitter systems

2025-06-13

Rui-Yang Hu , Xin Huang | Neuroreport

Background Thyroid-associated ophthalmopathy (TAO), characterized by eyelid retraction, proptosis, extraocular muscle hypertrophy, and pathological elevation of intraorbital pressure, represents a potentially devastating autoimmune disorder affecting both ocular structure and visual … Background Thyroid-associated ophthalmopathy (TAO), characterized by eyelid retraction, proptosis, extraocular muscle hypertrophy, and pathological elevation of intraorbital pressure, represents a potentially devastating autoimmune disorder affecting both ocular structure and visual function. Emerging evidence demonstrates significant neurophysiological correlations in TAO pathogenesis, manifesting cerebral hemispheric specialization and cooperation; however, conventional methodologies failed to account for inherent anatomical asymmetries between cerebral hemispheres. Therefore, the present study used a new data analysis method to systematically interrogate hemispheric specialization and cooperation in TAO, while concurrently exploring its multi-omics correlations with transcriptomic signatures and neuromodulatory receptors/transporters. Methods A total of 32 patients with TAO and demographically matched healthy controls underwent high-resolution resting-state functional MRI. Whole-brain connectome matrices profiling autonomy index-functional homotope (CFH) interactions were generated to quantitatively characterize lateralized functional decoupling and transhemispheric coordination deficits in TAO. Voxel-wise aberrations in autonomy index/CFH metrics underwent multimodal correlation mapping with whole-transcriptome expression profiles and neurotransmitter receptor/transporter density atlases. Results Patients with TAO had higher abnormal autonomy index expression in the left inferior temporal gyrus; CFH values were reduced in the left cuneus, right cuneus, left precuneus, right precuneus, and left superior parietal. Enrichment analysis of genes associated with abnormal autonomy index and CFH values, respectively, revealed that these genes were mainly involved in synaptic development and regulation. Finally, in the density correlation analysis of abnormal CFH values with neurotransmitter receptors/transporters, significant correlations were found for 5-hydroxytryptamine (5-HT) 1A R, 5-HT 2A R, CB 1 R, GABA A R, M 1 R, and mGlu 5 R. Conclusion This multimodal investigation yields novel neurobiological insights into hemispheric dysregulation patterns in TAO, while elucidating the pathophysiological continuum of this complex disorder.

Refractive Profile and Angle of Deviation in Patients with Congenital Esotropia and Congenital Exotropia

2025-06-13

Masoud Khorrami‐Nejad , Mohamad Reza Akbari , Ali Hassan Khaleel +3 more | Journal of Ophthalmic and Vision Research

Purpose: To compare refractive error and angle of deviation in patients with congenital esotropia (CET) and congenital exotropia (CXT). Methods: This retrospective study reviewed the medical documents of 246 patients … Purpose: To compare refractive error and angle of deviation in patients with congenital esotropia (CET) and congenital exotropia (CXT). Methods: This retrospective study reviewed the medical documents of 246 patients with CET (n = 206) and CXT (n = 40) admitted to Farabi Eye Hospital, Iran, from 2012 to 2022. All patients were between 6 and 12 months old at the time of admission. Refractive error components and angles of deviation in these patients were recorded and analyzed. Results: In patients with CET, the mean sphere, cylinder, and spherical equivalent (SE) were 2.59 ± 2.28 diopters (D), –0.42 ± 0.57 D, and 2.38 ± 2.28 D, respectively. Also, the mean horizontal deviation at near was 45.5 ± 12.3 prism diopters (Δ) (range, 20–98 Δ). The most common range was 44–55 Δ (40%), followed by 33–44 Δ (28%) and 55–65 Δ (12%). On the other hand, the mean sphere, cylinder, and SE in patients with CXT were 1.88 ± 1.84 D, –0.39 ± 0.69 D, and 1.69 ± 1.74 D, respectively. Also, the mean horizontal deviation at near was 45.0 ± 17.1 Δ (range, 20–105 Δ). For the CXT group, deviation ranges of 33–44 Δ (37%), 44–55 Δ (32%), and 22–33 Δ (15%) were most prevalent. The mean sphere and SE were significantly higher in the CET group than in the CXT group (P = 0.010). Conclusion: This study found a distinct refractive profile and distribution of the angle of deviation in patients with CET versus CXT. Patients with CET demonstrated significantly greater hyperopia than those with CXT.

Cigarette Smoking Drives Thyroid Eye Disease Progression via RAGE Signaling Activation

2025-06-12

Jin Liu , Tianyi Zhu , Yang Li +7 more | Thyroid

Background: Thyroid eye disease (TED) is a sight-threatening autoimmune disease with cigarette smoking as one of the key risk factors. Cigarette smoking affects both the severity of TED and the … Background: Thyroid eye disease (TED) is a sight-threatening autoimmune disease with cigarette smoking as one of the key risk factors. Cigarette smoking affects both the severity of TED and the patient's response to medication. However, the underlying pathogenic mechanisms of smoking in TED remain unclear. Methods: Orbital fibroblasts (OFs) were extracted from patients with TED and non-TED controls, and treated with cigarette smoking extract (CSE). Luminex assays and Western blots were employed to examine inflammatory status and pathological phenotypes of OFs. A specific reactive oxygen species (ROS) probe was used to evaluate oxidative stress levels. RNA-sequencing of CSE-treated OFs was used to analyze differentially expressed genes. Immunofluorescence and RNA-sequencing were used to examine the expression of receptor for advanced glycation end products (RAGE) signaling molecules in patients. Small interfering RNA sequences and a RAGE-specific inhibitor were employed to investigate the effects of RAGE blockade on cigarette smoking-related pathological phenotypes. To validate our findings in vivo, we generated an adenovirus-induced TED mouse model with exposure to cigarette smoke. Results: Exposure to CSE resulted in an inflammatory phenotype of OFs together with higher levels of oxidative stress. OFs exposed to CSE presented susceptibility to transforming growth factor-β-induced myofibroblast differentiation, and 15-D-PGJ2-induced adipocyte differentiation, indicating pro-fibrotic and pro-adipogenic phenotypes. RNA-sequencing of CSE-treated OFs revealed upregulation of RAGE signaling molecules. TED patients with smoking history also exhibited higher levels of RAGE signaling, both in the orbit and peripheral blood, compared with non-smoking patients. Enhancement of inflammatory status was associated with activation of the ROS-nuclear factor-kappa B pathway downstream of RAGE. RAGE gene interference or administration of RAGE inhibitor effectively mitigated cigarette smoking-related pathological changes in OFs. Disrupting RAGE signaling in TED mice efficiently ameliorated smoking-induced disease progression in vivo. Conclusions: Cigarette smoking-relevant TED progression was linked with RAGE signaling activation, leading to the exacerbation of orbital inflammation and tissue-remodeling, including fibrosis and adipogenesis. Our findings demonstrate that cigarette smoke exposure affects the biological characteristics of TED-derived OFs and supports RAGE as a promising therapeutic target for the management of patients with TED and smoking habits.

A Rare Case of Eight-and-a-Half Syndrome Due to a Pontine Ischemic Stroke

2025-06-12

Pedro L. Almeida , Tiago Félix , Rafaela Evangelista +2 more | Cureus

Re: “Blepharotomy Versus Levator Recession With Adjustable Sutures for Correction of Upper Eyelid Retraction in Thyroid Eye Disease”

2025-06-11

Holalu Shankaralingegowda Ravikumar , Dayakar Yadalla , Jayagayathri Rajagopalan | Ophthalmic Plastic and Reconstructive Surgery

Reply Re: “Blepharotomy Versus Levator Recession With Adjustable Sutures for Correction of Upper Eyelid Retraction in Thyroid Eye Disease”

2025-06-11

Hans Olav Ueland , Kathrine Halsøy , Eyvind Rødahl | Ophthalmic Plastic and Reconstructive Surgery

Ptosis correction with frontalis sling surgery in a patient with bilateral chronic progressive external ophthalmoplegia: A case report

2025-06-09

Yashi Bansal | Indian Journal of Clinical and Experimental Ophthalmology