Introduction: To evaluate the effectiveness of methylprednisolone (MP) and surgical treatment in achieving complete reversal of dysthyroid optic neuropathy (DON) and predictive factors of this therapy. Material and methods: The group consisted of 10 patients (18 eyes) with DON. The diagnosis of DON was based on at least two criteria from the following: (i) deterioration of visual acuity (VA < 1.0), (ii) loss of colour vision, (iii) optic disc swelling, and/or (iv) signs of DON in magnetic resonance imaging (presence of apical crowding and/or optic nerve stretching). A complete recovery of DON was defined as the normalisation of VA (VA = 1.0), normal colour vision, and reversal of optic disc swelling. A significant improvement was defined as improvement of VA of at least 0.2. The consecutive steps of treatment of DON consisted of: (i) first-line treatment -intravenous MP pulse therapy (3 × 1 g); (ii) second-line treatment -endoscopic intranasal orbital decompression of medial wall; (iii) additional treatment -additional MP therapy and/or surgical decompression. Results: A significant improvement in VA could be achieved in the majority of patients; a complete recovery was noted in 22.2%, 33.3%, and 66.7% of eyes after first-line, second-line, and additional treatment, respectively. Positive predictive factors were: younger age (p = 0.049), shorter duration of DON (p = 0.035), and a higher Graves' orbitopathy clinical activity score (p = 0.035). Conclusions: By using combination therapy (intravenous MP pulse therapy and surgical decompression), a complete recovery can be achieved in the majority of patients with DON. (Endokrynol Pol 2016; 67 (2): 166-173)

BackgroundThe aim of this study was to assess the clinical course and distinctive features of different white dot syndromes (WDS) in patients attending the Ophthalmology Department, Medical University of Warsaw in the years 1995–2015.Material/MethodsSixty-two (62) patients (43 females and 19 males), aged 18 to 77 years, referred with a WDS were included in this prospective study, with observation period ranging from 5 months to 16 years. All patients underwent a complete ophthalmological examination and multimodal imaging studies.ResultsIn this cohort of 62 patients, the following WDS entities were identified: multifocal choroiditis with panuveitis (MFCPU), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), birdshot, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), subretinal fibrosis and uveitis, multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, and single cases of acute annular outer retinopathy (AAOR).ConclusionsThe study was performed at a Polish referral center and may to some extent reflect the varied geographical distribution of white dot syndromes, as none of the subjects was found to suffer from acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), or diffuse unilateral subacute neuroretinitis (DUSN). Long-term follow-up is warranted by the evolution of lesions in the eye fundus, while management depends on correct diagnosis of WDS. When the posterior pole is involved in some cases of the WDS an immunosuppressive treatment, the use of the PDT or anti-VEGF injections were necessary.

Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of persistent lacrimation with secretion in the eye, in children. Symptoms appear in approx. 5% of neonates and infants. Most often it is caused by presence of an abnormal membrane in the distal segment of the nasolacrimal duct (Hasner' s valve), hence usually we are dealing with congenital obstruction of the nasolacrimal duct. Much less often, difficulties in the outflow of tears in children is caused by stenosis of the nasolacrimal duct or, for example, absence of lacrimal points and ducts. An increased risk of tear duct obstruction occurs in children with Down syndrome, hemifacial hypoplasia, midfacial anomalies, craniosynostoses, Goldenhar syndrome, and cleft syndromes. Obstruction of the lacrimal duct and the associated blockage in the outflow of tears causes several symptoms, including retention of tears, wet and clustered eyelashes, presence of secretion in the conjunctival sac (initially mucous, then mucopurulent or purulent) accumulating on the edges of eyelids and on eyelashes, and retention of pathological content in the lacrimal sac. Those symptoms develop in the first month of life. In 30% of children with congenital nasolacrimal duct obstruction, problems with outflow of tears occur bilaterally. In these cases, complex obstruction in the upper part of the nasolacrimal ducts (lacrimal ducts, lacrimal sac, upper part of the nasolacrimal duct) is more common, rather than obstruction at Hasner's valve level. Main complications of CNLDO are: dacryocystitis, inflammation of orbital soft tissue, upper respiratory tract infection, more frequent anisometropia and amblyopia on the side of obstructed lacrimal ducts. The diagnosis of CNLDO is based mostly on characteristic clinical symptoms.

Swelling of the optic disc may result from inflammation, infiltration, optic nerve compression or ischaemia, as well as increased intracranial pressure. It can be imitated by local structural features of the optic disc leading to pseudopapilloedema. Disease entities leading to optic disc swelling can take different courses in the paediatric population compared to the adult population. Investigations used to confirm diagnosis include optical coherence tomography (OCT), ocular ultrasound, fluorescein angiography, visual evoked potentials (VEP), and imaging studies of head and orbits.

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