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Optical Coherence Tomography in Neuro-OphthalmologyTony Garcia1, Ghislain Bonnay2, Ayman Tourbah3 and Carl Arndt1[1] Ophtalmologie, Hopital Robert Debre, Reims University Hospital, Reims, France[2] Service d’Ophtalmologie, Troyes General Hospital, Troyes, France[3] Service de Neurologie, Hopital Maison Blanche, Reims University Hospital, Reims, France1. A 54-year-old woman suffered from multiple sclerosis and had already a left demyelinating optic neuritis a few years ago. An 11-year-old girl with no family history of Leber’s disease suddenly presented with severe painless central vision loss in the right eye. A 47-year-old man was admitted for visual field disorders with papulosquamous eruption of the palms and soles within two weeks following a previous asymptomatic general skin eruption.
A Beddiaf, J De Seze, Nevrite optique dans la sclerose en plaques : donnees diagnostiques et pronostiques.
K Kallenbach, J Frederiksen, Optical coherence tomography in optic neuritis and multiple sclerosis: a review. K Gugleta, M Mehling, A Kochkorov, M Grieshaber, R Katamay, J Flammer, et alPattern of macular thickness changes measured by ocular coherence tomography in patients with multiple sclerosis. O Outteryck, H Zephir, S Defoort, M Bouyon, P Debruyne, I Bouacha, et alOptical coherence tomography in clinically isolated syndrome: no evidence of subclinical retinal axonal loss.
M Siger, K Dziegielewski, L Jasek, M Bieniek, A Nicpan, J Nawrocki, et alOptical coherence tomography in multiple sclerosis: thickness of the retinal nerve fiber layer as a potential measure of axonal loss and brain atrophy. V Parisi, G Manni, M Spadaro, G Colacino, R Restuccia, S Marchi, et alCorrelation between morphological and functional retinal impairment in multiple sclerosis patients.
J De Seze, F Blanc, L Jeanjean, H Zephir, P Labauge, M Bouyon, et alOptical coherence tomography in neuromyelitis optica. For a long time now, essential oils have been regarded as being part of traditional and alternative medicine. In the rest of this article, you will know some of the essential oils that are available and how they can be used in order to relieve swelling in the ankles, legs, and feet.
Amongst the anti-inflammatory oils that are available today, one of the most popular would be the chamomile oil. For many years now, tea tree oil has been a preferred choice for the treatment of dandruff and acne, which can be basically attributed to the fact that it is abundant in terms of antibacterial and antiseptic properties. Lavender oil will not only help in being able to reduce swelling, but will also speed up the process by which you recover from various health problems. Those who have been using juniper oil have reported that it is effective for rheumatism, which is why it has been chosen by many as well in the treatment of swelling. Just stir a spoonful into a glass of water in the morning and experience the best health ever! 10 Amazing Benefits of Onions You Didn’t KnowOnion is one of the most used vegetables in the kitchen. Symptoms of peripheral edema include swelling of the affected area(s), which causes the surrounding skin to "tighten." The swelling from peripheral edema is gravity-dependent (it will increase or decrease with changes in body position). In the case of pulmonary edema, there is often no evidence of fluid retention or noticeable swelling on examination of the patient's extremities. Lymphedema is the swelling of one or more of the legs and arms caused by poor function of the lymphatic system.
Read What Your Physician is Reading on Medscape Congestive Heart Failure and Pulmonary Edema »Congestive heart failure (CHF) is an imbalance in pump function in which the heart fails to adequately maintain the circulation of blood.
The dark side of sun exposureSome safe exposure to the summer sun is important to help the body make vitamin D. To provide even greater transparency and choice, we are working on a number of other cookie-related enhancements. IntroductionIn optic nerve disease excluding glaucoma, mainly three ophthalmoscopic presentations of the optic disc can be encountered: an apparently normal optic disc, an atrophic or an edematous optic disc.
Compressive disease (case 4)Compression of visual pathways caused by a pituitary adenoma induces axonal loss responsible for RNFL loss on time domain OCT.
Other hereditary optic neuropathiesIn the authors' clinical experience, OCT is also useful in the morphological evaluation of optic neuropathies encountered in other hereditary diseases such as recessive optic neuropathy and Wolfram's disease. Gradual RNFL reduction following initial increase of RNFL thicknessIn optic disc swelling, an increase in the RNFL thickness can be quantified by OCT.
Dilated capillaries in the retina adjacent to the optic nerve head were found in both eyes. J Fernandez, Progressive changes in the retinal nerve fiber layer in patients with multiple sclerosis. I Pan, M Freedman, C Demeulemeester, Differences in retinal nerve fiber layer atrophy between multiple sclerosis subtypes. C Gundogan, S Demirkaya, G Sobaci, Is optical coherence tomography really a new biomarker candidate in multiple sclerosis?
J Munoz-negrete, Optical coherence tomography versus automated perimetry for follow-up of optic neuritis.
J Munoz-negrete, Follow-up of nonarteritic anterior ischemic optic neuropathy with optical coherence tomography. This means that you should use it together with a carrier oil in order to avoid problems that can possibly worsen the condition that is being treated rather than having it resolved. In this case, you will generally have two choices: German chamomile oil and Roman chamomile oil. The oil has a spicy aroma and is also considered to be one of the oils that can help in detoxification. Not only can this ingredient make dishes more delicious, but it can actually boost the nutritional value of recipes. For example, if a person is lying on their back (supine), the swelling will not appear in the legs, but will appear in the area around the sacrum.
However, the cumulative effects of sun exposure put us at higher risk of cellular damage, early wrinkling, age spots, actinic keratoses and skin cancer -- including malignant melanoma, the most serious type. It is intended for general information purposes only and does not address individual circumstances. The importance of this axonal loss predicts visual acuity changes and visual field recovery after surgery for pituitary adenoma [23]. Depending on the underlying disease, the condition will either resolve with normalization or shift to optic atrophy with axonal loss. H Kardon, Tracking retinal nerve fiber layer loss after optic neuritis: a prospective study using optical coherence tomography. I Pan, et alQuantifying axonal loss after optic neuritis with optical coherence tomography.
J Munoz-negrete, Optic disc cupping after optic neuritis evaluated with optic coherence tomography. C Frohman, R Zivadinov, E Eggenberger, P Calabresi, et alRetinal architecture predicts pupillary reflex metrics in MS.
A Cree, Distinctive retinal nerve fibre layer and vascular changes in neuromyelitis optica following optic neuritis.
R Eggenberger, Optical coherence tomography: another useful tool in a neuro-ophthalmologist’s armamentarium.
If the oil is going to be used for swelling, the best option would be the German chamomile oil. One of the good things about this oil is that it can be applied directly on the surface of the skin that swells and there will be no need for you to have it mixed with a carrier oil.
More so, it has also gained solid reputation for swelling that is caused by lack of water retention and premenstrual symptoms.


The skin over the swollen area appears tight and shiny, and often when pressure is applied to the area with a finger, an indentation appears. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health.
This retinal layer is composed of non myelinated axons (myelination is generally posterior to the cribriform lamina).
The postoperative recovery is significantly better if the preoperative thickness is greater than 85.00 ?m [24]. A bilateral papilloedema, venous engorgement, white exudates and superficial retinal folds was found (Figure 22). M Liebmann, R Ritch, S Zafar, D Lefton, et alImaging of the optic disc and retinal nerve fiber layer in acute optic neuritis. C Frohman, A Conger, et alMacular volume determined by optical coherence tomography as a measure of neuronal loss in multiple sclerosis.
C Klawiter, J Shepherd, K Trinkaus, et alOptical coherence tomography differs in neuromyelitis optica compared with multiple sclerosis.
J Balcer, et alOptical coherence tomography helps differentiate neuromyelitis optica and MS optic neuropathies. D Gamble, In vivo retinal nerve fiber layer thickness measured by optical coherence tomography predicts visual recovery after surgery for parachiasmal tumors. In order to use it for swelling, combine 2 drops of lavender oil with a drop of lemon oil and a drop of geranium oil. If you have swollen feet, one of the things that you can do is to look for a large open container with more than enough depth where you can soak your feet.
SuntanTanned skin may be revered as beautiful, but that golden colour you see is the result of injury to the epidermis, the top layer of skin.
Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. OCT can quantify a decrease in thickness due to the atrophy by axonal loss or increase in thickness related to edema. On the OCT, there is a slight RNFL swelling in its nasal superior part, however the mean thickness remains within normal limits (figure 2). Figure 5.Visual field (case 2)On ophthalmoscopy, a left temporal disc pallor indicative of previous optic neuritis was noted (figure 6). Toxic optic neuropathy OCT can be useful for the follow-up of visual loss in patients with toxic optic neuropathy due to smoking, alcohol consumption or treatment for tuberculosis.
Papilledema (case 7)Optic disc swelling due to idiopathic intracranial hypertension is referred to as papilledema [26].
Secondary intracranial hypertension Many different diseases can be responsible for increased intracranial pressure such as infectious meningitis (case 9). Figure 29.Visual fields (case 9)Serological tests on blood and cerebrospinal fluid confirmed a syphilitic infection.
While there are many choices that are available, it is apparent that not all of them are the same. It is the azulene in this chamomile that allows it to treat swelling and inflammation, which also makes it effective for treating wounds and insect bites. It is not recommended to use warm water is the weather is hot as it can only cause the affected area to be stiff.
Exposure to the sun’s ultraviolet (UV) rays accelerates the effects of ageing and increases your risk of developing skin cancer. This review aims to illustrate the usefulness of this RNFL quantification in the exploration of optic nerve and anterior visual pathway diseases.2. In the early stages of toxic optic neuropathy, RNFL edema may be detected in some patients before permanent visual loss occurs. It may be responsible for the deterioration of visual function and progression to optic atrophy. Figure 23.Visual fields (case 7)After spinal puncture and acetazolamide medication, she recovered normal visual acuity. As in other diseases with initial optic disc swelling, OCT enables to monitor RNFL thickness reduction after causal treatment.
K Song, et alOptical coherence tomography is less sensitive than visual evoked potentials in optic neuritis. You should choose which one is the best depending on the application at which it will be needed. Dip your feet for about 20 minutes and you can instantly notice that the swelling will stop. To prevent sun damage, use a sunscreen of SPF 15 or higher when outdoors and re-apply it regularly.
Materials and methodsAn extensive review of the literature on applications of OCT in optic neuropathy was performed. Dominant Optic Atrophy (DOA) or Kjer's disease (Case 5)In dominant optic atrophy (DOA), there is bilateral symmetric optic nerve pallor (Case 5) related to retinal ganglion cell death. If in case the swelling is caused by burn, sting, or insect bites, you can put a drop of lavender oil directly on the area that is affected and it will soon work on its way towards giving it the cure that it needs. Also, cover-up with clothing, sunglasses and a wide-brimmed hat and seek the shade during the middle of the day. The PubMed search engine was applied to the keywords "optic neuropathy", "optical coherence tomography" and "retinal nerve fiber layer".
Thus, axonal loss is often present in both eyes even if symptomatic optic neuritis affects one eye only. This is not the case for RNFL thickness changes which only enable to monitor the progression of the disease.
Anterior Ischemic Optic Neuropathy (AION) At the initial stage of an anterior ischemic optic neuropathy, there is most often a progressive optic disc swelling.
An alternative would be soaking a clean cloth in a mixture of hot water and drops of chamomile. Studies exploring the various diseases of the optic nerve were classified according to the OCT results obtained at the initial visit. This RNFL loss predominates in the temporal quadrant [3] [7], a clinical model demonstrating the coexistence of axonal loss and demyelinating lesions in MS.Other parameters have been evaluated with OCT in MS, especially a decrease in macular volume which is correlated with axonal loss [8] [9]. Most sunburns result in redness, warmth to the touch, and mild pain, affecting only the outer layer of skin (first degree burns).
The relationship between central and peripheral macular thickness is an indicator of the evolution of the disease [10].
Leber’s Hereditary Optic Neuropathy (LHON) (case 8)At the acute phase, Leber’s hereditary optic neuropathy associates peripapillary telangiectasia, tortuosity of retinal vessels and a peripapillary RNFL swelling with apparent optic disc swelling (figure 25-27). Sunburn usually appears within hours after sun exposure and may take several days to weeks to fade.
In addition, in MS, RNFL loss is considered to be a fairly accurate indicator of overall axonal loss, both ocular and extraocular. Within a few months (generally less than six months), diffuse optic atrophy occurs without excavation [29,30]. Painkillers such as paracetamol or ibuprofen, cold compresses and aloe, hydrocortisone or moisturising creams may help reduce pain and discomfort. ResultsThe average RNFL thickness is the most common parameter encountered in all publications. In the early course of the disease, there is a correlation between the decrease in RNFL thickness and neurological disability assessed by the Expanded Disability Status Scale (EDSS) [11] which represents the global axonal loss in MS.


Refractive media disordersUltra-red light has to pass through the transparent media of the eye to reach the retina. Sunburn (second degree burns)A second degree burn - damaging deeper skin layers and nerve endings - is usually more painful and takes longer to heal. It represents the average of all measured thickness values in a predefined annular zone adjacent to the optic disc. In case of corneal dystrophy, cataract, vitreous opacity, there is a signal decrease and RNFL thickness measurements become less reliable.
Thus, at the early stages of MS, OCT is less sensitive than VEP for detecting clinical and subclinical optic neuropathy [13].At distance of the initial attack of optic neuritisthere is no correlation between RNFL thickness (a marker of axonal loss) and P100 latency (a marker of demyelination) [14].
DiscussionAs in macular disease, OCT has become a precious tool that contributes to improve management of optic nerve disease.
Inflammatory diseases: Multiple sclerosis (case reports 1 et 2)Multiple sclerosis (MS) is the most common cause of optic neuropathy, therefore the evaluation of RNFL thickness in MS was the subject of numerous publications [1,2] At the initial stage of optic neuritis, RNFL thickness is within normal limits, after 2 months it decreases and stabilizes between 6 and 12 months [3,4] as highlighted in case report 1. This review illustrates the many indications in neuro-ophthalmology, although there are limitations to its use.
Degenerative diseases: Neuromyelitis Optica (NMO) or Devic's disease (case report 3)In Devic's syndrome, unlike MS, optic neuropathy is severe and is associated with spinal cord lesions without brain damage (figure 10).
In OCT, the significant decrease in the thickness of the layer of ganglion fibers reflects an atrophy more severe and diffuse than that observed in MS, mainly in the upper and lower quadrants [19,20]. Axonal loss may be masked in cases with optic nerve head swelling due to the inhibition of orthograde axoplasmic transport at the initial stage of the disease.Despite the high utility of OCT in neuro-ophthalmology, exclusive RNFL thickness analysis is not sufficient for assessing optic nerve disease. More than 80% of the signs of skin ageing in adults are the result of the tans they had as teenagers before the age of 18.
As in MS, there is a correlation between the retinal nerve fiber layer thickness and the overall neurological disability assessed by the EDSS [21].
OCT results should always be interpreted in the light of clinical ophthalmoloscopy and visual function (visual acuity, perimetry, visual evoked potentials).8.
That’s because over time, the sun's ultraviolet light damages the fibres in the skin called elastin. OCT can thus provide morphological arguments in the differential diagnosis of Devic’s syndrome and MS. When these fibres break down, the skin begins to sag, stretch and lose its ability to go back into place after stretching. The average RNFL loss is 15 ?m in a patient suffering from MS, whereas it is 39.00 ?m in the case of Devic's syndrome [22].
However, for a long time now, honey is being kept in many household for more than such purpose. The sun can also cause a permanent stretching of small blood vessels, giving your skin a reddish appearance. FrecklesFlat, pigmented spots on the skin, freckles are usually found on sun-exposed areas of the body. They’re more noticeable in the summer, especially among fair-skinned people and those with light-coloured or red hair. Seek medical advice if the size, shape or colour of a spot changes or if it becomes painful, itchy, or bleeds.
Melasma (pregnancy mask)Melasma (or chloasma) is characterised by brown or tan coloured patches on the cheeks, nose, forehead and chin.
If it persists, melasma can be treated with prescription creams and over-the-counter products.
Age spots (solar lentigines)These brown or grey spots are not really caused by ageing, though they do multiply as you get older.
Age spots are the result of sun exposure, which is why they tend to appear on areas that get a lot of sun, such as the face, hands and chest.
Solar lentigines are harmless, but to rule out serious skin conditions such as melanoma, seek medical advice to confirm the diagnosis.
Actinic keratosis (solar keratosis)The small, scaly red, brown or skin-coloured patches caused by too much sun exposure commonly occur on the head, neck or hands, but can be found elsewhere on the body.
Actinic keratosis usually appears on people after the age of 40, but they can appear in much younger people. Early treatment is advised to stop the possible progression to squamous cell carcinoma, a type of skin cancer. Actinic cheilitis (farmer's lip)Related to actinic keratosis, actinic cheilitis is a precancerous condition that usually appears on the lower lips.
Less common symptoms include swelling of the lip, loss of the sharp border between the lip and skin, and prominent lip lines. Actinic cheilitis may eventually evolve into invasive squamous cell carcinoma if not treated. Squamous cell carcinomaThis non-melanoma skin cancer may appear as a firm red nodule, a scaly growth that bleeds or develops a crust, or a sore that doesn’t heal. It most often occurs on the nose, forehead, ears, lower lip, hands and other sun-exposed areas of the body. Bowen's diseaseBowen's disease is also called squamous cell carcinoma "in situ." It is a type of skin cancer that spreads outward on the surface of the skin. By contrast, "invasive" squamous cell carcinomas can grow inward and spread to the interior of the body. Basal cell carcinomaThe most common form of skin cancer, basal cell carcinoma is the most easily treatable and least likely to spread, though it can damage surrounding tissue. Basal cell carcinomas can take many forms, including a pearly white or waxy bump, often with visible blood vessels, on the ears, neck or face.
The carcinoma can also appear as a flat, scaly, flesh-coloured or brown patch on the back or chest, or more rarely, a white, waxy scar.
Malignant melanomaMalignant melanoma is not as common as other types of skin cancer, but it's the most serious and potentially deadly. Possible signs of malignant melanoma include a change in the appearance of a mole or pigmented area.
Seek medical advice if a mole changes in size, shape or colour, has irregular edges, is more than one colour, is asymmetrical, or itches, oozes or bleeds. Malignant melanoma can affect the skin only, or it may spread to internal organs and bones.
CataractA cataract is a cloudy area in the lens of the eye that blocks the passage of light to the retina.
Cataracts are painless but may cause vision problems, including foggy vision, glare from light and double vision in one eye.
Shun the sunThe best way to prevent sunburn, premature wrinkles, skin cancer and other damaging effects from the sun is to stay out of it, especially between 11am and 3pm in the UK, when the sun’s rays are strongest. Apply sunscreen liberally (don’t forget the lips and ears!), wear a hat and sunglasses and cover up with clothing when outdoors. If you notice changes to your skin such as a mole changing appearance, a new growth, or a sore that won't heal, seek medical advice promptly.



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