Iron mydriasis. Pupillary paresis from occult intraocular foreign body.

Two patients presented with unilateral dilated and poorly reactive pupils and were found to have a previously unsuspected intraocular iron foreign body. Both of them had normal vision and one had normal color of the iris so that the condition was missed by several physicians. The pupils reacted normally to pilocarpine 1% and also showed response to dilute (0.

Autoimmune ischemic optic neuropathy associated with positive rheumatoid factor and transient nephrosis.

A young woman had recurrent anterior ischemic optic neuropathy for 18 years. During a recent episode of severe papillopathy in one eye, acute glomerulonephritis, transient low serum complement levels, and a high rheumatoid factor were detected. Despite long and careful follow-up, we could not diagnose systemic lupus erythematosus or any other specific connective tissue or autoimmune disease.

A familial syndrome of dystonia, blepharospasm, and pigmentary retinopathy.

We report the clinical and laboratory findings in 2 siblings with a syndrome of pigmentary retinopathy, blepharospasm, and dystonia. This entity most resembles Hallervorden-Spatz disease, but appears to be a distinct disorder without identifiable neuroimaging or biochemical abnormalities.

Mydriasis in giant-cell arteritis.

A previously healthy 60-year-old woman developed headache, cervical pain, bilateral mydriasis (right greater than left), and bilateral conjunctival injection as the sole manifestations of acute giant-cell arteritis.

Autoimmune endotheliopathy and chronic herpetic conjunctivitis.

A migrating endothelial line of keratic precipitates associated with overlying corneal edema suggests an immune attack on the corneal endothelium. This is seen most commonly in corneal allotransplantation rejection. The etiology of such lines in the absence of this condition is unclear.

Anterior ischemic optic neuropathy in Buerger's disease.

A 77-year-old man with a history of Buerger's disease developed an anterior ischemic optic neuropathy. This disease, while rare in the United States at the present time, is common in other parts of the world. None the less, this appears to be the first reported case of this type of optic neuropathy in a patient with documented Buerger's disease.

Chronic syphilitic meningitis resulting in superior orbital fissure syndrome and posterior fossa gumma. A report of two cases followed for 20 years.

Two case histories, each spanning more than 20 years, demonstrate the complexity and persistence of modern neurosyphilis. Both patients present uncommon manifestations of neurosyphilis that may be easily overlooked today: superior orbital fissure syndrome, posterior fossa gumma, and bilateral deafness. Computed tomographic scans were performed in both patients but were diagnostically nonspecific, and syphilis serology testing in both serum and cerebrospinal fluid was repeatedly misleading.

Optic neuropathy associated with chronic lymphomatous meningitis.

A patient with paranasal sinus lymphoma (recognized retrospectively) developed unilateral, acute, self-limited optic neuritis during the course of chronic lymphocytic meningitis with elevated intracranial pressure and headache. Meningeal symptoms were adequately controlled with analgesics alone for 14 months and corticosteroids alone for a subsequent 11 months without evidence of development of other involvement of organs outside the central nervous system (CNS). Eventually, the visual alteration from optic neuritis prompted a repeat evaluation, which disclosed lymphoma in bone marrow.

Vascular retinopathy in migraine.

After years of episodic monocular visual loss, two migraineurs suffered sudden, persisting loss of vision from retinal vascular occlusion. One was a 34-year-old woman with systemic lupus erythematosus who showed abnormalities of the cilioretinal arterial and retinal venous circulations. The other was a 62-year-old man with hypertension and arteriosclerosis who had a central retinal vein occlusion.

Tonic pupils following oculomotor nerve palsies.

Four patients developed a unilateral tonic pupil following ipsilateral oculomotor nerve palsy. The probable basis for this phenomenon is misdirection of injured oculoparasympathetic fibers in the oculomotor nerve proximal to the ciliary ganglion.

A microangiopathic syndrome of encephalopathy, hearing loss, and retinal arteriolar occlusions.

A syndrome consisting of a subacute encephalopathy, sensorineural hearing loss, and retinal arteriolar occlusions is described in two women. Laboratory investigations did not reveal any systemic vasculitis. CT and cerebral angiography showed no abnormalities, but magnetic resonance imaging revealed small, discrete lesions in the white matter.

Neovascular glaucoma and carotid artery obstructive disease.

Carotid artery obstructive disease, although infrequently diagnosed as a primary or contributing cause of neovascular glaucoma, can produce distinctive characteristics. Decreased perfusion of the ciliary body may decrease aqueous humor production. As a result, such eyes with neovascular glaucoma may occasionally be normotensive or even hypotensive.

Giant-cell arteritis with bilateral uveitic glaucoma.

Bilateral uveitic glaucoma occurred in a patient with giant-cell arteritis. The mechanism appeared to be immunologic, not ischemic.