Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach the management of amblyopia in children with developmental delays or cognitive impairments?
I agree with Dr. @Dr. First Last! We never want to not offer the best therapies to children due to a perceived developmental delay or cognitive impairment. Many times, families and patients will surprise us and do wonderfully. That being said, trying to understand the emotions of the family can be ...
What is your surgical approach for optic disc pit retinal detachments if laser treatment is unsuccessful?
Vitrectomy with ILM peeling, creation of a pedunculated ILM flap that I attempt to insert into the pit to serve as a plug, peripapillary laser barricade, gas tamponade, and face-down positioning. If that fails, I will also consider using tissue glue to try to plug the pit further along with repeatin...
What is your approach to duration of systemic antibiotics for treatment of isolated bacterial endophthalmitis in the absence of bacteremia or other deep-seated metastatic foci of infection?
Post-surgical (exogenous) endophthalmitis is an uncommon complication. The incidence ranges from 0.04%-0.3%, 0.019%- 0.54%, and 0.11% - 0.03% following cataract surgery, intravitreal injection, and vitrectomy, respectively (Soliman et al., PMID 32467482). Initial management of exogenous endophthalmi...
How do you approach tapering immunosuppression in a patient with a history of Susac Syndrome who has stabilized on MMF and IVIG?
Susac's is a rare disease characterized by an occlusive retinal vasculopathy, eighth nerve disease including hearing loss and balance issues, and CNS disease with a predilection for involvement of the corpus callosum. I am not aware of any randomized controlled data to guide treatment for Susac's, b...
How would you approach management of nodular scleritis in the setting of suspected GCA?
Scleritis is probably a rare but real association with GCA. The rarity is such that I would not ignore alternative causes of scleritis. For example, ANCA-associated vasculitis could mimic GCA and syphilis has also been reported as a masquerade. Scleritis is usually divided into 5 forms: nodular, dif...
Can giant cell arteritis present with a partial cranial neuropathy?
Giant cell arteritis (although giant cells on temporal artery biopsy are not a sine qua non) most typically presents to the neuro-ophthalmologist with ischemic optic neuropathy (usually anterior and sometimes posterior).Ophthalmoplegia is uncommon in GCA but has been attributed to oculomotor and abd...
What is your approach to the treatment of visual snow syndrome?
Visual snow is not a syndrome. It's a symptom that consists of static vision. I opine that it's origin is retinal (not brain) and that it relates to ongoing activity. In the past I have referred to it as retinal repolarization disorder. It should not be confused with migraine aura status, which is a...
How do you approach re-operations for vertical strabismus in cases where prior horizontal muscle surgery has affected vertical alignment?
First, you need to know what was done in the previous surgery. Vertical strabismus often accompanies horizontal deviations even after routine surgery. DVD and superior or inferior oblique muscle overaction and the most common deviations. Once you have all of your information, you can plan appropriat...
How often and in what way do you monitor patients who are receiving teprotumumab (Tepezza) for thyroid eye disease?
A week or two after completion unless having an issue.
What is your approach to the diagnosis and management of optic chiasmitis in systemic lupus erythematosus?
Optic nerve involvement occurs in SLE but not commonly. I am aware of two case reports about 20 years apart describing inflammation of the optic chiasm in lupus. Both appeared the Neuroophthalmology and the most recent was 16:117, 2020. I would be cautious about making the diagnosis of lupus if sero...