Ophthalmology Research: An International Journal

Ocular Manifestations of Endocrine Disorders in Children and Adolescents: A Critical Narrative Review with Quantitative Appraisal and Comparison with Adult Disease

Ahmed Kassem, Ashraf Soliman — Tue, 25 Aug 2026 00:00:00 +0000

Background and Significance: The eye is a target organ for almost every hormonal axis, and endocrine disease in childhood therefore carries ophthalmic consequences that are not simply earlier versions of adult disease. Ocular tissue in the growing child is still undergoing axial elongation, photoreceptor maturation, myelination of the anterior visual pathway and synaptic refinement, so identical endocrine insults produce different phenotypes, different reversibility and different functional costs before and after skeletal maturity.

Purpose and Scope: This critical narrative review evaluates the strength, consistency and methodological quality of evidence on ocular manifestations of endocrine disorders in people aged under 20 years, and compares that evidence directly with the corresponding adult literature. Coverage spans diabetes mellitus, thyroid disease, hypothalamic-pituitary disorders, disorders of calcium and glucocorticoid regulation, gonadal and sex-chromosome conditions, and monogenic endocrine-ocular syndromes.

Approach: Indexed scholarly sources were searched for literature published between January 2000 and 19 June 2026, supplemented by citation searching. Selection prioritised population-based cohorts, quantitative syntheses, multicentre series and consensus guidance. Quantitative appraisal was confined to critical comparison of published pooled estimates, because ascertainment heterogeneity precludes defensible de novo pooling.

Principal Findings: Published pooled estimates of retinopathy prevalence in paediatric diabetes diverge substantially and in opposing directions, and the dominant explanatory variable is the retinal imaging method rather than the underlying biology; the same body of studies yields a near-thirty-fold difference in measured prevalence between direct fundoscopy and stereoscopic fundus photography. Orbitopathy in paediatric Graves disease is consistently milder and less often sight-threatening than in adults, yet the paediatric evidence base consists almost entirely of single-centre series and contains no randomised treatment data. Compressive and developmental optic neuropathies associated with sellar tumours and midline malformations account for a disproportionate share of irreversible childhood visual loss and correlate with the severity of accompanying pituitary hormone deficiency.

Unresolved Questions and Implications: Screening thresholds derived from adult microvascular models remain unvalidated for prepubertal exposure, retinal neurodegeneration has not been shown to predict clinically meaningful outcomes, and no paediatric-specific outcome instrument exists. Harmonised ascertainment and prospective paediatric cohorts with functional endpoints are required before current practice can be considered soundly grounded.

Acute, Highly Asymmetric Thyroid Eye Disease Mimicking Orbital Cellulitis: A Case Report

Lotfi Chaabani, Ines Bouallegui, Hazem Aloui, Imane Souiri, Leila Rizki — Fri, 24 Jul 2026 00:00:00 +0000

Background: Thyroid eye disease is an immune-mediated orbital disorder that may cause proptosis, eyelid oedema, chemosis, and restricted ocular motility. Acute, markedly asymmetric presentations can closely resemble orbital cellulitis, making prompt clinical assessment and orbital imaging essential for accurate diagnosis.

Aims: The study aims to describe an acute, highly asymmetric presentation of thyroid eye disease (TED) in an elderly woman with treated hyperthyroidism and to emphasise the role of emergency orbital imaging in differentiating TED from orbital cellulitis.

Presentation of Case: A woman in her late seventies who was receiving thiamazole 10 mg twice daily and propranolol 20 mg daily for hyperthyroidism presented with painful bilateral proptosis that was markedly more pronounced in the left eye. The left eye showed eyelid oedema, conjunctival hyperaemia, chemosis, and limited ocular motility. The anterior segment was quiet, and fundus examination was normal. No fever was documented in the emergency record, and the complete blood count and C-reactive protein level were normal. Urgent orbito-cerebral computed tomography demonstrated bilateral grade 1 proptosis and bilateral enlargement of the extraocular muscle bellies, with relative sparing of the anterior tendinous insertions and no reported orbital collection. These findings supported active, left-predominant TED rather than infectious orbital cellulitis. Antithyroid therapy was continued, and systemic corticosteroids were administered, resulting in improvement in pain, chemosis, conjunctival inflammation, and eyelid oedema.

Discussion: Asymmetric, painful proptosis may mimic infectious orbital disease. In this case, the thyroid history, bilateral CT involvement, tendon-sparing myopathy, normal inflammatory markers, and absence of an orbital collection were decisive diagnostic clues.

Conclusion: TED should be considered in patients with thyroid dysfunction who present with painful or asymmetric proptosis. Prompt imaging and multidisciplinary care are essential to exclude vision-threatening and infectious conditions.

Cytomegalovirus Retinitis with Optic Neuritis in Non-Hodgkin's Lymphoma: Favorable Visual Outcome with Combined Antiviral Therapy

Wed, 29 Jul 2026 00:00:00 +0000

Purpose: The study aims to describe the clinical presentation, diagnostic evaluation, treatment, and visual outcome of cytomegalovirus retinitis with optic neuritis and retinal vasculitis in a patient with non-Hodgkin’s lymphoma receiving chemotherapy.

Case Presentation: A 54-year-old man with treated stage IV follicular non-Hodgkin’s lymphoma, who was receiving cycle 3 of ICE chemotherapy for recurrence, presented with sudden, painless visual loss in the left eye of two days’ duration. Best-corrected visual acuity was counting fingers at 2 metres, with a grade 3 relative afferent pupillary defect. Fundus examination showed optic disc oedema, extensive yellowish-white peripapillary retinitis with superficial haemorrhages, cystoid macular oedema, a subretinal haemorrhage, and perivascular sheathing suggestive of retinal vasculitis. Optical coherence tomography and fundus fluorescein angiography supported the clinical findings. Blood polymerase chain reaction was positive for cytomegalovirus, and vitreous qualitative polymerase chain reaction confirmed the diagnosis.

Management and Outcome: The patient received combined antiviral treatment with repeated intravitreal ganciclovir and systemic valganciclovir. Following treatment, the retinitis regressed, the haemorrhages resolved, macular and optic disc oedema subsided, and visual acuity improved to 6/24. Central macular thickness decreased from 711 µm to 230 µm.

Conclusion: This case demonstrates favourable anatomical and visual recovery following early molecular confirmation and prompt combined antiviral therapy in severe cytomegalovirus retinitis involving the optic nerve and retinal vasculature.

Acute Compressive Optic Neuropathy Secondary to an Onodi Cell Mucocele: A Case Report

Mon, 31 Aug 2026 00:00:00 +0000

Aims: To report a rare case of compressive optic neuropathy secondary to an Onodi cell mucocele and to emphasise the importance of early recognition of rhinogenic causes of acute vision loss.

Case Presentation: A 51-year-old woman with aspirin-exacerbated respiratory disease and previous endonasal surgery for recurrent nasal polyposis presented with acute, rapidly progressive unilateral visual loss. Examination showed counting-fingers vision that deteriorated to light perception, a relative afferent pupillary defect, painful eye movements, and a normal optic fundus. Magnetic resonance imaging demonstrated a posterior ethmoid/Onodi cell mucocele compressing the intracanalicular optic nerve without optic nerve enhancement. Intravenous corticosteroids and ceftriaxone were administered while transfer for definitive surgery was arranged. Endoscopic posterior ethmoidectomy, sphenoidotomy, and decompression were performed 5 days after presentation. No visual improvement was observed during the one-year follow-up.

Discussion: Onodi cell mucoceles are uncommon but vision-threatening lesions because of the close anatomical relationship between the posterior ethmoid sinus and the optic nerve. Published outcomes are heterogeneous: severe preoperative visual impairment is associated with poorer recovery in observational series, whereas the effect of the interval to decompression is less consistent. Adjunctive corticosteroid and antibiotic therapy has not been established as a substitute for surgical relief of compression.

Conclusion: Acute unilateral optic neuropathy with a normal fundus should prompt urgent neuroimaging and consideration of sinonasal disease, particularly in patients with chronic rhinosinusitis, nasal polyposis, or previous sinus surgery. Expedited multidisciplinary assessment and surgical decompression are warranted when optic nerve compression is identified, although profound initial visual loss may limit recovery.

Electronic Devices Overuse and Vision Problems among Medical Students in Thamar University, Thamar Governorate, Yemen

Thu, 09 Jul 2026 00:00:00 +0000

Background: Electronic device use has become common among university students and may contribute to Computer Vision Syndrome (CVS), particularly in settings where screen exposure is prolonged and preventive practices are limited.

Aim: This study assessed awareness of electronic device use and associated vision-related problems among undergraduate medical students at Thamar University, Thamar Governorate, Yemen.

Methods: A descriptive cross-sectional study was conducted in December 2024 using a structured, self-administered questionnaire. Although 263 students participated, statistical analysis was performed for 208 respondents with complete data. Information was collected on sociodemographic characteristics, ocular history, patterns of digital device use, CVS-related symptoms and awareness. Data were analysed descriptively using SPSS version 22.

Results: Most participants were aged 20–24 years (73.6%), male (63.5%) and single (93.3%). Daily screen exposure was high, with 66.0% using devices for more than 5 hours. The most frequent symptoms were neck or shoulder pain (61.1%), eye strain (54.8%), headache (48.1%), light sensitivity (45.2%), blurred vision (33.2%), dry eyes (28.4%) and double vision (20.7%). Symptoms commonly began after more than 60 minutes of device use (57.7%) and improved with breaks (82.7%), while 38.0% reported interference with daily activities. Awareness was limited: 16.8% had heard of CVS, 2.4% had received preventive training and 17.8% knew the 20–20–20 rule.

Conclusion: CVS-related symptoms were common, while awareness and preventive practices remained insufficient. Structured awareness and ergonomic education are needed for medical students.

Anti-Vascular Endothelial Growth Factor Treatment Outcomes in Patients with Visual Impairment in Ahmadu Bello University Teaching Hospital, Zaria: A Retrospective Analysis

Aishah Ukashat, Kehinde Oladigbolu, Kashetu Suleiman Bello, Mubarak Bello — Tue, 01 Sep 2026 00:00:00 +0000

Aim: To assess treatment outcomes in eyes that received an anti-VEGF injection in the medical retina unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria, in terms of visual acuity and central macular thickness.

Study Design: A retrospective descriptive study.

Place and duration of study: Medical Retina Record Unit, Department of Ophthalmology, ABUTH, Zaria, from January to April 2025.

Methodology: We reviewed the records of patients who received intravitreal anti-VEGF injections for retinal diseases at ABUTH, Zaria. Approximately 30 patients had received about 90 anti-VEGF injections, primarily bevacizumab, as of October 2024. Total population sampling was adopted, and all eligible patients with retrievable case files were included. Demographic, clinical, treatment, visual acuity, and OCT data were extracted. Visual acuity was converted to logMAR, and outcomes were assessed using a gain of ≥15 ETDRS letters at two months. Data were analysed using descriptive statistics, the Mann–Whitney U test, chi-square test, and logistic regression in SPSS version 23. A total of 14 patient case files were reviewed between January and April 2025.

Results: The median age was 59.0 years. Retinal vein occlusion (RVO) (57.1%) and diabetic macular oedema (DMO) (35.7%) were the most common indications. All patients received bevacizumab. Most patients presented with moderate to severe visual impairment. Statistically significant improvements in visual acuity and reductions in central macular thickness were noted (p = 0.006 and p = 0.012, respectively). Minor complications included subconjunctival haemorrhage and raised intraocular pressure (7.1% each). Diagnosis, presenting visual acuity, and systemic disease status were associated with treatment outcome, although no independent predictors were identified.

Conclusion: Bevacizumab significantly improved visual and anatomical outcomes in patients with retinal diseases. Early presentation, systemic disease control, and adherence to follow-up are important for optimising outcomes in resource-constrained settings.