EYE DR CARE CENTER

21/07/2025

Mr M is a 68-year-old gentleman with hypertension and diabetes who presented with blurred vision in his left eye. Patient medical history : heavy craneal trauma with hospitalized for 3 days in parietal’s left lobe and 2 weeks ago Mr M had woken up with OS loss inferior visual field . There were no other symptoms of note. Specifically, there was no fever, weight loss, periorbital pain, headache, scalp sensitivity or jaw claudication. CVF: Examination revealed a left-sided inferior altitudinal VFD with 6/6 corrected visual acuity, a relative afferent pupillary defect and normal eye movements. There was no palpable temporal artery or scalp sensitivity. Fundoscopy revealed hyperaemic papilloedema in the left eye. FBC, ESR and CRP were all within the normal range. A brain MRI revealed some small white matter hyperintensities on T2WI but was otherwise normal. Tonometry revealed normal eye pressure (OD:18mmHg/ OS: 19mm Hg@NCT). Given the broadly normal investigations and patient risk factors, a diagnosis of non-arteritic ION was made.

02/06/2025

CASE ANALYSIS
Two different cases , and 2 different treatment ; when the problem is in the epidermis glands , sometimes better treatment is when exfoliation therapy whiteout mechanical extirpating or laser therapy .
For further therapy :
1. Milias: CO2 Laser
2. Syringoma: Erbium laser o CO2 laser

Never try to do the therapy on your own as it would cause more damage to the aubpuel and, on the contrary, would spread the condition to other areas.

13/05/2025

We design your vision , let’s build it !!!!
Call us : (787) 671-0546

06/02/2025

CASE HISTORY
Male patient 40 y/o , come to the office for diplopia in RIGTH and LEFT look, patient take OCREVUS
( via IV) each six months .
VA:
OD: 20/25 CC
OS: 20/25 CC
CV:
OD: 11/14 @ Ishihara
OS: 10/14 @ Ishihara

EOMS : hyperacc RLR and hypoacc RMR on RIGTH gaze and hyperacc LLR and hypoacc LRM on LEFT gaze.
OPHTALMOSCOPY:
OD : ONH temporal mild atrophy
OS: ONH temporal mild atrophy

DIAGNOSTIC:
MS stage 3 : secundary progressive
BINO , with partial atrophy in ONH ( temporal quadrant).

Types of MS

Multiple sclerosis is a chronic, unpredictable disease of the central nervous system. The brain, spinal cord and optic nerves make up the central nervous system.Scientists think MS is an immune-mediated disorder. This means that the immune system attacks your own healthy tissue in the central nervous system. The immune system is the body’s natural defense against illness. This causes inflammation and damage to the central nervous system. This disrupts the signals to and from the brain and spinal cord and other parts of the body, causing the symptoms of MS.MS is currently divided into 4 different types, or disease courses, as defined by the International Advisory Committee on Clinical Trials of MS in 1996. They are:
Clinically isolated syndrome (CIS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS)
Primary progressive MS (PPMS)
Knowing the type of MS you have may help you know what to expect over the long term. It can also help you and your healthcare provider decide what type of disease-modifying therapy (DMT) might be best for you. Learn more about each disease course below.

Radiologically Isolated Syndrome (RIS)

Radiologically isolated syndrome (RIS) is not considered a course of MS. But it has been used to classify those with:
Lesions on the brain or spinal cord — not explained by another diagnosis — consistent with lesions of MS AND
No past or current neurological symptoms or abnormalities found on a neurological exam

Often these individuals had an MRI because of other symptoms, such as headache. The results showed lesions similar to those seen in MS.A 2020 study found that more than half of those with RIS go on to develop MS within 10 years. There are no specific treatment guidelines for RIS. Doctors need more research results to better understand what factors increase the likelihood that someone with RIS will develop MS. If you have RIS, experts recommend that you monitor your MRIs and neurological symptoms and have regular neurological exams. This way, you can quickly identify changes in the disease course.Several studies are ongoing that could provide more guidance for monitoring and treatment. A 2022 study, for instance, supports the idea that early treatment is protective and that MS can begin well before symptoms emerge.
Treatments for MS

More than 20 disease-modifying therapies have been approved by the U.S. Food and Drug Administration (FDA) to treat the different types of MS. The FDA indicates which type of MS each drug can treat. More treatments are available for relapsing forms of MS than for primary progressive MS. Addressing the challenges of progressive MS is a primary target of the Society’s research strategy.

Bibliography

©️ 2024 The National Multiple Sclerosis Society is a tax exempt 501(c)3 nonprofit organization. Its Identification Number (EIN) is 13-5661935.

13/01/2025

CASE ANALYSIS
Male patient 70 y/o come to office by blur vision OD and long standing data Orbital tumor ; patient was examined by ophtalmology MD , who he’s not recommended orbital surgery by compromise orbital structures .
VA:
OD: SC: 20/40
OS: SC : NPPL
EOMs: over acc LLR, hypo acc LMR
DIAGNOSIS : LEFT ORBITAL LYMPHOMA PROLIFERATIVE

Orbital lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the conjunctiva, lacrimal gland, soft tissues of the eyelid, or extraocular muscles; it is most commonly extraconal in location. Orbital lymphoma is said to be primary when it arises spontaneously from one of these locations, and secondary when it is associated with metastatic spread from an extraorbital site.

Epidemiology
While lymphoma constitutes more than half of all orbital malignancies (55 percent),1 the incidence of orbital lymphoma has been reported to account for between 1 and 10 percent of NHL cases.2

Orbital lymphoma may be unilateral or bilateral. Although it has been known to present in patients between 15 and 70 years of age, most cases cluster around the seventh decade. Historically, a female preponderance has been noted,3 but there have been several conflicting reports regarding gender predominance. Geographically, the disease is most common in Asia and Europe.

Pathophysiology
Immunosuppression due to any cause—including AIDS, immunosuppressive drugs, or increasing age—has long been established as the main factor contributing to the pathophysiology of orbital lymphoma.

More recently, however, the role of various pathogens has entered into the debate. These include associations with Chlamydia psittaci and Helicobacter pylori, as well as some viruses.

Histology
Almost 80 percent of orbital and adnexal lymphomas are of low-grade variety, with B-cell lymphomas and extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue type (MALT lymphoma) being the most common histological diagnoses.4 MALT lymphomas comprise a distinct set of tumors that exhibit the unique property of “homing,” which permits lymphoma cells to adhere to other epithelial and mucosal sites, thus enabling bilateral involvement.

Other subtypes have also been reported, including follicular lymphomas, diffuse large B-cell lymphomas, and mantle cell lymphomas.

Clinical Presentation
The clinical presentation is generally nonspecific and depends on the location of the lymphoma. Vision is usually preserved, as infiltration of the globe or optic nerve is rare.

Conjunctiva. Patients typically demonstrate a pink or red “salmon patch” of swollen conjunctiva or conjunctival hyperemia.

Orbit. Orbital presentation is most commonly observed as a painless palpable mass in the superolateral quadrant. It may lead to proptosis, ptosis, diplopia, or abnormal ocular movement.

Lacrimal gland. The enlarged gland displaces the eyeball inferomedially.

Eyelids. Swelling and prolapse may occur in the eyelid.

Diagnosis
The differential diagnosis of orbital lymphoma includes the following:

Pseudotumor
Orbital metastases
Diffuse lymphangioma
Lacrimal adenoma
Cavernous hemangioma
Lymphoid lesions of the orbit (benign reactive lymphoid hyperplasia, atypical lymphoid hyperplasia)
Diagnostic workup. The following evaluations form the basis of a good diagnostic workup, undertaken in conjunction with the patient’s internist:

History and physical examination
Dilated fundus examination
Thorough examination of opposite orbit as well as the oral cavity and oropharynx
Complete blood count, biochemistry profile
Fine-needle aspiration and biopsy
Liver function tests, renal function tests
Chest x-ray
Computed tomography (CT) and magnetic resonance imaging (MRI) of orbit, abdomen, thorax, and pelvis
Bone marrow aspiration
Imaging
Computed tomography. The typical finding on CT scanning is a moderately well-defined orbital mass, which molds to the adjacent ocular structures without bony destruction. It is usually homogeneous in density, either isodense or slightly hyperdense when compared with the density of the extraocular muscles. It may exhibit any of the following four patterns: retroocular, anterior preseptal, lacrimal gland involvement, or extension of an adnexal lesion.

Lesions that are heterogeneous, with bony destruction, are indicative of high-grade lymphomas, which are usually accompanied by pain.

Magnetic resonance imaging. Compared with the extraocular muscles, the orbital mass appears isointense or hypointense on a T1-weighted MRI scan, but it appears isointense to hyperintense on a T2-weighted scan. Hypointense T2-weighted images are suggestive of high-grade lymphomas.

Contrast-enhanced imaging techniques. Contrast-enhanced CT/MRI scans reveal mild to moderate enhancement of the lesion, and when this is seen in T1-weighted images, high cellularity of the lymphoma can be expected. High cellularity in lymphoma produces a lower apparent diffusion coefficient (ADC) of

08/10/2024