Glare is commonly encountered in patients with corneal disease, uveitis, or retinal problems. Rarely, it may be a presenting manifestation of more sinister conditions such as chiasmal lesions. We present the case of a 42-year-old male who complained of glare for 2-3 months. There was neither headache nor blurring of vision. His neuro-ophthalmological examination was within normal limits except for slight decrease in colour contrast of the upper temporal dots of the red-dot perimetry chart. Automated visual fields showed a central scotoma on the right eye and a temporal-inferior field defect on the left. He underwent neuro-imaging, which revealed a suprasellar cystic mass, most likely a craniopharyngioma. Referral to the neurosurgeon was made who performed supraorbital keyhole surgery. Intraoperative findings showed a cystic mass stuck bilaterally on the optic nerves, carotids, and optic chiasm with the pituitary stalk deviated to the right side. Histopathology report revealed a craniopharyngioma, adamantinomatous variant. One month post excision, the patient showed improvement in his visual functions.
Although nasopharyngeal carcinoma (NPC) is commonly seen in patients from Asia, optic neuropathy is a rare initial presenting symptom of this disease. This is an interventional case report discussing the clinical response of NPC-related optic neuropathy to pulse-steroid therapy. We discuss two patients who initially presented with signs of optic neuropathy. On imaging, a skull-base tumor was noted infiltrating the area of the affected optic nerve. An excision biopsy of the tumor revealed nasopharyngeal carcinoma. Both patients were pulsed with intravenous (IV) methlyprednisolone one gm/day for three days, followed by oral steroids (one mg/kg/BW) with gradual tapering. After two weeks, both showed visual improvement and chemo- and radiation therapy commenced at this time. In these two cases, pulse-steroid therapy did not hinder the chemo- and radiation therapy for nasopharyngeal carcinoma. Steroid therapy brought immediate visual recovery and gradual oral tapering could assist in optimizing visual outcomes for patients with compressive optic neuropathy from nasopharyngeal carcinoma.
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