Bitemporal hemianopia is a rare presentation following severe head injury, which causes a delay in detection of the visual symptoms. This is a case of traumatic bitemporal hemianopia in a 20-year-old gentleman after an alleged motorbike accident. He was intubated following a severe head injury. The ophthalmologic assessment was performed after he regained consciousness and complained of acute blurring of vision in bilateral eyes. The visual acuity was 2/60 on the right eye and 4/60 on the left eye. Bilateral eyes anterior and posterior segments examination were unremarkable. Confrontation visual field testing discovered bitemporal hemianopia. Plain computed tomography (CT) scan of the brain showed right frontal bone fracture extending to the right orbital roof, superomedial wall of the right orbit, bilateral lamina papyracea, ethmoidal air cells, roof and bilateral walls of sphenoid sinus. He was treated conservatively by the ophthalmology team. Subsequent follow-ups showed improvement of visual acuity which were 6/6 on the right eye and 6/6 on the left eye. Humphrey visual field test confirmed the persistence of bitemporal hemianopia. His good visual acuity does not correlate with the severity of the field defect. Therefore, surveillance for bitemporal scotoma is necessary for all head injuries with severe midline facial bone fractures.
OBJECTIVE: To compare the clinical presentation, severity and progression of primary angle closure between Chinese and Malays residing in Malaysia.
METHODS: A comparative retrospective record review study was conducted involving one hundred (200 eyes) Malay and fifty eight (116 eyes) Chinese patients. They were selected from medical records of Hospital Universiti Sains Malaysia, Kelantan and Hospital Pulau Pinang, Penang, Malaysia. The selected patients were re-diagnosed based on the International Society of Geographical and Epidemiological classification. The clinical data on presentation including the presence of systemic diseases were documented. Progression of the disease was based on available reliable visual fields and optic disc changes of patients who have been on follow-up for at least five years.
RESULTS: Malay patients presented at older age (61.4 years SD 8.4) compared to Chinese (60.6 years SD 8.3). There was significant higher baseline Intraocular Pressure (IOP) among Malays (34.7 SD 18.5mmHg) compared to Chinese (30.3 SD 16.7mmHg) (p=0.032). The Chinese patients presented with significantly better visual acuity (p<0.001) and less advanced cup to disc changes (p=0.001) compared to Malays. Malay patients progressed faster than the Chinese. Majority progressed within 1 year of diagnosis. Malays without laser peripheral iridotomy (LPI) have a 4 fold (95% CI 1.4, 10.9) risk of progression. Higher baseline IOP, more advanced visual field defect and absence of LPI was identified as significant predictors associated with progression.
CONCLUSION: The Malays presented with more advanced angle closure glaucoma as compared to the Chinese in Malaysia. Aggressive disease progression was observed in Malays with the onset of optic neuropathy. Effective public awareness and aggressive management is important to prevent blindness in the Malaysian population.
In human, sporotrichosis infection commonly manifests as skin lesions through direct inoculation. It is rarely associated with ocular manifestation via a zoonotic transmission. We describe a young lady who presented with acute left eye granulomatous conjunctivitis who had a history of exposure to her sick cat diagnosed with sporotrichosis infection. Sporothrix schenckii was isolated from the culture of the excised conjunctival tissue. The patient recovered fully after six months of oral anti-fungal treatment. Clinicians should be aware of this new zoonotic infection transmitted by infected felines as it is reversible with timely diagnosis and initiation of anti-fungal therapy.