The patients with periorbital edema and/or redness, and normal eye movements were diagnosed with preseptal cellulitis, whereas at least one of following findings of limited eye movement, inflammation signs in the conjunctiva, orbital pain, decreased VA (for at least 2 lines on the Snellen chart), afferent pupillary defect
signs or radiological imaging detecting inflammation in the orbital region, were accepted for a diagnosis of orbital cellulitis (1-3).
The OTS is calculated using six parameters, including the initial visual acuity, occurrence of globe rupture, endophthalmitis, perforating injury, retinal detachment, and afferent pupillary defects
Macular scarring/hole, optic neuropathy, RD, choroidal haemorrhage, globe perforation, central corneal opacity, endophthalmitis and the presence of afferent pupillary defect
have been identified as poor prognostic factors in ocular war injuries.5-7
Pupil (relative afferent pupillary defect
) was negative in all the patients (100%) with open globe injury.
15 cases with relative afferent pupillary defect
were noted, 9 with closed globe injuries & 6 with open globe injuries.
* Neuro-opthalmic signs include afferent pupillary defect
, dyschromatopsia, and in some cases changes in visual acuity.
His pupils were reactive and a 1+ relative afferent pupillary defect
was present on the right.
Examination revealed significant left periocular swelling, relative afferent pupillary defect
, chemosis, extraocular movement limitation, and no light perception in the left globe.
At our clinic, we noted that her color vision was normal, there was no relative afferent pupillary defect
(RAPD), and she had a full visual field after confrontation visual field testing.
During hospitalization he developed neurological impairments including visual anosognosia (Anton-Babinski syndrome), afferent pupillary defect
, apraxia (of gait, dressing, and eating), right hemiparesis, generalized tonic-clonic seizures, and cognitive deterioration.
Visual acuity (VA) in the left eye was counting fingers with no afferent pupillary defect
It is based upon visual acuity on presentation and vision-threatening injuries such as globe rupture, endophthalmitis, perforating injury, retinal detachment and afferent pupillary defect
. Higher scores tend to indicate a better prognosis6-8.
The Ocular Trauma Score (OTS) (4) was first published in 2002 and it estimates visual function six months after the trauma by assigning a score according to the initial visual acuity and then subtracting another score according to the presence of eyeball rupture, endophthalmitis, ocular perforation, retinal detachment and afferent pupillary defect
. Patients are classified into five categories, with category 1 and 2 having the worst visual prognosis.
On physical examination, the visual acuity was 20/20 in both eyes and there was no relative afferent pupillary defect
. Hertel measurements showed 6 mm of left exophthalmos.
Pupils were equally round and reactive to light with a relative afferent pupillary defect
in her left eye.