Optic tract lesions (OTL) are often difficult to diagnose. We suggest an algorithm to simplify the often-challenging diagnosis of OTL. Clinical and imaging data were retrospectively collected from the electronic files of 6 patients diagnosed with OTL at a tertiary medical center in 2016–2020. The series included 4 children and 2 adults with an OTL caused by a glioma (n = 5) or motor vehicle accident (n = 1). Magnetic resonance imaging (MRI) revealed a suprasellar glioma involving the chiasm and tract alone (n = 1) and the ipsilateral optic nerve (n = 2) and only optic tract (3). Perimetry showed incongruent homonymous hemianopia in 3 patients. In two patients, perimetry could only be performed in one eye, and demonstrated hemianopia. In one patient perimetry was unreliable. Fundus examination revealed bow-tie atrophy in all patients. On optical coherence tomography (OCT) of the peripapillary retinal nerve fiber layer (RNFL) horizontal thinning was observed in the contralateral eye (n = 6). By presenting the information in a predefined order—visual field damage, OCT RNFL thickness, and MRI—the diagnosis could be easily reached even in children, and when other structures like the chiasm were involved. Fundus photographs easily detect bow tie atrophy in children. Systematic presentation of the data in a predefined order can ease the diagnostic process of OTLs.

Background: Tuberous sclerosis is characterized by hamartomas in multiple organs including retinal hamartomas. Everolimus is a novel treatment for tuberous sclerosisrelated lesions. We present a case where everolimus led to lesion shrinkage, the skin tuberomas, as well as the retinal hamartomas, indicating that its effect can be detected, measured, and monitored with an ocular examination. Case Report: We describe a 24-year-old female diagnosed with tuberous sclerosis since birth, with multiorgan involvement. The patients had multiorgan involvement, with angiolipomas of the kidney resistant to treatment. She also underwent subependymal giant cell astrocytoma brain tumor resection. The patient was treated with everolimus after recurrent embolization failed to shrink the renal angiolipomas. The tumors responded well to treatment. Conclusions: Skin lesions disappeared, and fundus photos and repeat retinal optical coherence tomography measurements documented shrinkage of the retinal hamartomas during the 24 months of treatment. We conclude that a simple eye examination can monitor treatment effectiveness.

Dental implants are often used in maxillofacial surgery. Extraocular muscle (EOM) laceration is a rare complication of the mandibular-zygomatic drilling accidentally penetrating the orbital space. In a single previous report of a lost lacerated lateral rectus muscle post-dental implantation, the muscle was not found, and transposition of the vertical muscles was performed to restore ocular motility partially. Here we present a case of traumatic laceration of the lateral rectus muscle and a successful reconstruction six weeks after injury. Our case demonstrates the EOM laceration was missed on initial radiological assessment, which led to a delayed surgical exploration. Fortunately, the lacerated muscle was re-attached. Botulinum toxin was injected to the antagonist medial rectus muscle in order to improve surgical outcome. Radiological assessment may not be sufficiently sensitive to detect EOM cut. Therefore, surgical exploration should be performed according to clinical suspicion. Even if the surgical procedure is delayed due to hematoma or edema, there is a potential for complete functional recovery.

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