A week in neuro-ophthalmology: the Singapore scene

Objective
To report the frequency of neuro-ophthalmologic cases seen over one working week by a senior neuro-ophthalmologist in Singapore and to determine a pattern in the incidence of neuro-ophthalmic diseases.

Methods
A retrospective review of 57 consecutive neuro-ophthalmologic cases seen by one senior neuro-ophthalmologist from June 14 to 18, 2010 was done. All patients underwent a complete neuro-ophthalmologic examination. Demographic data and clinical diagnoses were gathered.

Results
A total of 57 patients were seen. Thirty-one percent (18) of these patients were new consultations while the remaining 61% (39) were follow-up visits. Fifty-two percent were females (30) with a mean age of 53 years while 47% were males (27) with a mean age of 49 years. Nineteen cases involved disorders of the optic nerve followed by disorders of ocular motility (11), optic chiasm, visual pathways, and/or visual cortex (14). Among the cases involving the optic nerve, 5 were ischemic optic neuropathy. In respect to disorders of ocular motility, ocular myasthenia gravis (n=5) was the most common condition seen. Pituitary adenomas comprised the bulk of the disorders of the optic chiasm (4). The remaining neuro-ophthalmic cases were almost evenly distributed. A very rare case of Froin’s syndrome was also seen.

Conclusion
Overall, during the five-day neuro-ophthalmologic clinic, majority of cases were ischemic in nature, reminding readers that systemic diseases, such as hypertension, diabetes mellitus, hyperlipidemia, commonly manifest in the eye. Hence, better systemic control of these diseases is necessary.

Keywords: Neuro-ophthalmic diseases, Optic neuropathy, Disorders of ocular motility, Disorders of the optic chiasm, Visual pathway, Visual cortex