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An Unusual Case of Myopic Shift Post Acquired Brain Injury

red-eye-disease

Background

Ocular and visual problems are frequent consequences of an acquired brain injury (ABI). The literature suggests that many patients demonstrate a myopic shift in refractive error after a traumatic brain injury (TBI), a form of an ABI. Three reported courses are suggested. Most commonly the myopia resolves under cycloplegic conditions, secondly the shift is transient, and least commonly the myopia increases over time. This case report, although not due to a TBI, is an example of the least common subgroup.

Case Report

The patient, a 63 year-old male, presented with a history (15 months prior to initial evaluation) of an excised right frontal temporal lobe tumour. The history included dexamethasone 4mg QD pre and post-surgery which caused blood glucose levels to fluctuate between 5.72-22.2 mmol/l; a stroke occurred post surgery causing hemiparesis on his leftside; and shunt surgery to decrease swelling to the area of excision and the optic nerves. Medications included: Cartia, lisinopril, Toprol XL, prednisone, Reglan, and Temodar. The patient was receiving chemotherapy to treat remnants of the tumour. His last eye exam was in 2004 indicated a refractive error of-2.50-1.25X080 in his right eye and -3.00-0.75X080 in his left eye with visual acuity of 6/7.5 in both the right and left eye.He presented to our clinic with an aided visual acuity of 8/100 (6/110) in both the right and left eye and a left homonymous hemianopsia on finger counting fields.Cycloplegic retinoscopy revealed -6.00-3.00X090 in his right eye and -6.00-2.00X090 in his left eye. Dilated fundus exam showed mild swelling of both optic nerves. The patient reported blood glucose levels of 103-140. At a one-month follow-up, his best corrected visual acuity at a distance improved to 6/60 in both the right and left eye through the new prescription. His cycloplegic retinoscopy did not show any change in myopia or astigmatism and the disk edema was resolved.

Conclusion

This case illustrates an unusual presentation of myopic shift post ABI. The patient’s condition continued to deteriorate eventually taking his life. It remains unclear whether the myopia and astigmatism continued to increase or remained stable. Although, the cause of this change is not fully understood and needs further investigation, providing appropriate optical correction did improve the patient’s quality-of-life.Key words: tumours, myopia – treatment,brain injury.

Farrah F. Sunderji, O.D.Resident, Pediatric Optometry and Vision TherapySouthern California Collegeof Optometry 2006-2007 Catherine Heyman, O.D.,F.A.A.O, FCOVD Southern California College of Optometry Faculty Advisor

To read more on this study, click here: Ocular Disease Study.. 

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Deep Cleansing for Healthier Eyelids and Lashes

ZEST (Zocular Eyelid System Treatment) is an in-office eyelid cleaning and debridement treatment developed by Zocular®. It is designed to clean the eyelids and lashes while helping address concerns associated with dry eye, blepharitis, and demodex.

The treatment uses a natural, okra-based gel to remove oil, debris, and residue from the eyelid margins and lashes. By improving eyelid hygiene, ZEST can help reduce the buildup that may contribute to irritation and inflammation around the eyes.

What Is ZEST?

ZEST works like a deep cleansing treatment for the eyelids and lashes. During the procedure, the okra-based gel is applied along the eyelid margins and lashes using a cotton swab. The gel is gently worked into a lather using circular motions before being rinsed away with saline solution.
The gel contains a refined extract of okra, an edible green seed pod. According to the provided product information, okra helps lift and clear oil, debris, and residue while being gentle around the eye area.

How Can ZEST Help?

Keeping the eyelids, eyelid margins, and lashes clean is an important part of eye hygiene. Buildup along the eyelid edges can contribute to symptoms such as itching, burning, gritty sensations, redness, and irritation.

ZEST is designed to address this buildup through thorough cleansing and debridement.

  • Removes Debris: Helps clear dirt, oil, and residue from the eyelid margins and lashes.
  • Supports Eyelid Hygiene: Provides a deeper cleansing treatment than routine eyelid cleaning.
    Addresses Demodex: The treatment is designed to help remove demodex mites and associated debris.
  • Helps Reduce Inflammation: Cleansing the eyelid area may help address buildup associated with irritation and inflammation.
  • Supports Dry Eye Care: ZEST may help relieve symptoms associated with dry eye and poor eyelid hygiene.

ZEST for Dry Eye, Blepharitis, and Demodex

Dry eye and blepharitis can be associated with inadequate eyelid hygiene. Debris along the eyelid margins can enter the tear film with blinking, potentially contributing to redness and irritation.

Demodex mites can also be present in the hair follicles around the eyelashes. According to the provided information, they may contribute to inflammation and dry eye symptoms by blocking the oil glands at the base of the eyelashes.

ZEST provides targeted cleansing of the eyelid margins and lashes to help remove this buildup and address demodex-related concerns.

A Simple In-Office Treatment

The ZEST procedure is performed in the office and involves applying the cleansing gel to the eyelid margins and lashes, working it into a lather, and then rinsing the area with saline solution. The treatment is designed to provide thorough eyelid and lash cleansing without requiring a lengthy procedure.

Is ZEST Right for You?

ZEST may be considered for patients experiencing symptoms associated with dry eye, blepharitis, demodex, or eyelid debris. An eye care professional can assess your symptoms and determine whether ZEST is appropriate for your eye care needs.
587-317-2134