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Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing.

Savastano A, Savastano MC, Carlomusto L, Savastano S - Case Rep Ophthalmol (2015)

Bottom Line: Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye.Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations.In fact, our patient strongly rubbed his eyes for more than 10 h per day.

View Article: PubMed Central - PubMed

Affiliation: Western Eye Hospital, Imperial College, London, UK.

ABSTRACT
In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

No MeSH data available.


Related in: MedlinePlus

Photography showing the patient's eye rubbing. The thenar eminence of both hands is vigorously compressed against the eyes. Bottom right: details of exotropia due to severe visual acuity reduction in the left eye.
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Figure 1: Photography showing the patient's eye rubbing. The thenar eminence of both hands is vigorously compressed against the eyes. Bottom right: details of exotropia due to severe visual acuity reduction in the left eye.

Mentions: In a 52-year-old man, severe visual acuity loss in the left eye (LE) and progressive sight reduction in the right eye (RE) were observed. The patient showed no history or presence of systemic diseases, and no optic neuritis or any disease involving the macula, retina or visual pathway were observed. Complete ophthalmologic evaluation was performed. The patient showed exotropia due to extreme visual loss in his LE (fig. 1). Best-corrected visual acuity was 12/20 and counting fingers in the RE and LE, respectively, with no refractive error. IOP by daily curve from 8 a.m. to 6 p.m. every 2 h was measured, resulting in an average value of 12 ± 2 mm Hg (Goldmann applanation tonometry). Central corneal thickness was 554 and 561 µm in the RE and LE, respectively (Orbscan II, Bausch and Lomb). Visual field was measured using the Humphrey program 24-2 (Humphrey-Zeiss, Dublin, Calif., USA). A commercially available GLAID (Lace Elettronica, Pisa, Italy, software version 2.1.14) electrophysiology instrument was used to measure the pattern electroretinogram (PERG) response [10]. Steady-state PERG was performed, and amplitude and phase were evaluated. We used the following stimulation settings: round pattern stimuli, 8.14 Hz, 1.6° horizontal bars, 25° central, skin cup electrodes [11]. Optic nerve head photography was performed (Topcon TRC 50 IX, Topcon Europe Medical, Capelle, The Netherlands) in order to observe the morphological aspect of the optical disc. Retinal tomography (HRTII, Heidelberg Engineering, Heidelberg, Germany) was used after pupil dilation to obtain further objective optic nerve head information. Retinal nerve fiber layer (RNFL) by optical coherence tomography (OCT; Model 3000, Stratus, Carl Zeiss Meditec) was performed under pupil dilatation. According to previous studies, a fast RNFL algorithm was used to obtain RNFL thickness measurements [12, 13]. The patient underwent a complete systemic evaluation by orbit and brain magnetic resonance analysis, electroencephalogram, carotid Doppler and hematological evaluation. All the exams resulted negative for possible systemic disease.


Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing.

Savastano A, Savastano MC, Carlomusto L, Savastano S - Case Rep Ophthalmol (2015)

Photography showing the patient's eye rubbing. The thenar eminence of both hands is vigorously compressed against the eyes. Bottom right: details of exotropia due to severe visual acuity reduction in the left eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608614&req=5

Figure 1: Photography showing the patient's eye rubbing. The thenar eminence of both hands is vigorously compressed against the eyes. Bottom right: details of exotropia due to severe visual acuity reduction in the left eye.
Mentions: In a 52-year-old man, severe visual acuity loss in the left eye (LE) and progressive sight reduction in the right eye (RE) were observed. The patient showed no history or presence of systemic diseases, and no optic neuritis or any disease involving the macula, retina or visual pathway were observed. Complete ophthalmologic evaluation was performed. The patient showed exotropia due to extreme visual loss in his LE (fig. 1). Best-corrected visual acuity was 12/20 and counting fingers in the RE and LE, respectively, with no refractive error. IOP by daily curve from 8 a.m. to 6 p.m. every 2 h was measured, resulting in an average value of 12 ± 2 mm Hg (Goldmann applanation tonometry). Central corneal thickness was 554 and 561 µm in the RE and LE, respectively (Orbscan II, Bausch and Lomb). Visual field was measured using the Humphrey program 24-2 (Humphrey-Zeiss, Dublin, Calif., USA). A commercially available GLAID (Lace Elettronica, Pisa, Italy, software version 2.1.14) electrophysiology instrument was used to measure the pattern electroretinogram (PERG) response [10]. Steady-state PERG was performed, and amplitude and phase were evaluated. We used the following stimulation settings: round pattern stimuli, 8.14 Hz, 1.6° horizontal bars, 25° central, skin cup electrodes [11]. Optic nerve head photography was performed (Topcon TRC 50 IX, Topcon Europe Medical, Capelle, The Netherlands) in order to observe the morphological aspect of the optical disc. Retinal tomography (HRTII, Heidelberg Engineering, Heidelberg, Germany) was used after pupil dilation to obtain further objective optic nerve head information. Retinal nerve fiber layer (RNFL) by optical coherence tomography (OCT; Model 3000, Stratus, Carl Zeiss Meditec) was performed under pupil dilatation. According to previous studies, a fast RNFL algorithm was used to obtain RNFL thickness measurements [12, 13]. The patient underwent a complete systemic evaluation by orbit and brain magnetic resonance analysis, electroencephalogram, carotid Doppler and hematological evaluation. All the exams resulted negative for possible systemic disease.

Bottom Line: Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye.Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations.In fact, our patient strongly rubbed his eyes for more than 10 h per day.

View Article: PubMed Central - PubMed

Affiliation: Western Eye Hospital, Imperial College, London, UK.

ABSTRACT
In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

No MeSH data available.


Related in: MedlinePlus