Noa Hadar

Orbital apex syndrome (OAS) is characterized by optic neuropathy and ophthalmoplegia and is generally associated with poor visual prognosis. The aim of this study was to describe patients with acute OAS who demonstrated substantial recovery of visual function and ocular motility. We retrospectively reviewed the medical records of patients treated for OAS at a tertiary medical center between 2019 and 2024 whose condition ultimately proved reversible. Data on demographics, clinical findings, imaging, management, and follow-up were collected. Six patients (three female, three male; age range 14–87 years) were included and followed for a median follow-up of 7 months (range 2–31). All presented with reduced vision and ophthalmoplegia of varying severity. Underlying etiologies included inflammatory disease (n = 2), lymphoma, infection, blunt trauma, and post-surgical OAS of undetermined etiology (n = 1 each). Treatment was directed at the underlying cause. Visual acuity ranged from 20/30 to hand motion (HM) at presentation and 20/15 to 20/60 at the final visit. Improvement in vision and ocular motility occurred after a median time to clinical improvement of 2.37 months (range 0.25–5 months). Near-complete recovery of ocular motility was observed in all patients, with only one retaining mild abduction limitation. These findings highlight a subset of OAS cases with favorable outcomes and emphasize the importance of early diagnosis and etiology-directed management.

Ocular tilt reaction (OTR) and trochlear nerve palsy (TNP) can induce cyclotorsion. We aimed to assess the utility of fundus photography in distinguishing between these disorders. The database of a neuro-ophthalmology hospital-based clinic was retrospectively searched for patients referred for new-onset vertical diplopia between 2020 and 2023. Medical data were collected, and the angle between the optic disc and fovea was measured using ImageJ software to quantify torsion. Distinct torsional patterns were identified between the groups. OTR was characterized by variable, often conjugate torsion, whereas TNP demonstrated consistent disconjugate extorsion. Analysis of interocular torsional relationships, rather than magnitude alone, provided useful diagnostic discrimination. Fundus photography may be useful for differentiating OTR from TNP in complicated neurological cases, particularly in patients who are difficult to examine. This study emphasizes the practical clinical value of fundus photography as a simple, accessible, and objective tool for differentiating OTR from TNP, by contributing the torsional component of OTR triad, particularly in emergency or diagnostically challenging settings where standard examination may be limited.

Background/Objectives: To simplify diagnosing congenital and acquired nystagmus using fundus photographs. Methods: A retrospective study included patients with congenital or childhood-acquired nystagmus examined at a hospital-based ophthalmology clinic (September 2020–September 2023) with fundus photos taken. Exclusions were for incomplete data or low-quality images. Demographics, aetiology, orthoptic measurements, and ophthalmologic and neurological exams were reviewed. Two independent physicians graded fundus photos based on amplitude (distance between “ghost” images), the number of images visible, and the direction of nystagmus. Severity was rated on a 0–3 scale using qualitative and quantitative methods. Photographic findings were compared to clinical data, and statistical analysis used Mann-Whitney tests. Results: A total of 53 eyes from 29 patients (16 females, 13 males; mean age 12.5 years, range 3–65) were studied: 25 with binocular nystagmus and 3 with monocular nystagmus. Diagnoses included congenital (n = 15), latent-manifest (n = 3), neurologically associated (n = 2), and idiopathic (n = 9). Types observed were vertical (n = 5), horizontal (n = 23), rotatory (n = 10), and multidirectional (n = 15). Visual acuity ranged from 20/20 to no light perception. Fundus photos correlated with clinical diagnoses, aiding qualitative assessment of direction and amplitude and mitigating eye movement effects for clearer retinal detail visualization. Conclusions: Fundus photography effectively captures nystagmus characteristics and retinal details, even in young children, despite continuous eye movements. Integrating fundus cameras into routine practice may enhance nystagmus diagnosis and management, improving patient outcomes.