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Biomedical subjects

A S Gurwood

Publications and source records attributed to A S Gurwood.

13 recordsLinked to original sources
PubMed2001

Contact dermatitis.

BACKGROUND: Anatomically, the eyelid can be divided microscopically into (1) skin, which is made up of epidermis and dermis; (2) submucosa (3) muscular layer; (4) submuscular layer (dense connective tissue); (5) fibrous layer; and (6) palpebral conjunctiva. The thin nature of the eyelid makes it susceptible to inflammation resulting from allergy. Minimum levels of irritants contacting the adnexal area can penetrate the skin to initiate the allergic cascade. Allergic reactions that involve the eye may begin via contact to the skin, but often involve the conjunctiva. Eczema is the general term that describes the superficial inflammatory process involving the epidermis. Contact eczema is characterized by varying elements of epidermal erythema, papules, and vesicles. Allergic dermatoconjunctivitis connotes involvement of both the skin and conjunctiva. CASE REPORT: A 24-year-old man came to the clinic with a red, swollen left eye. Based on the history, the constellation of signs and symptoms (lack of diffuse or focal pain, presence of periorbital and conjunctival edema, absence of fever), and failed resolution after treatment with injectable antibiotics, the diagnosis of type IV delayed hypersensitivity reaction secondary to toxic/chemical exposure was made. Speedy resolution was accomplished using a sequenced therapy, which included oral antihistamines, topical cycloplegics, topical antibiotics, topical steroids, and palliative therapies. CONCLUSION: Optometrists should be familiar with the signs and symptoms of contact eczema and allergic dermatoconjunctivitis. Treatment includes management of the skin and adnexae, as well as the ocular manifestations.

Adult↗
PubMed2001

Recurrent phlyctenular keratoconjunctivitis: a forme fruste manifestation of rosacea.

BACKGROUND: Phlyctenular keratoconjunctivitis represents a delayed type hypersensitivity response to a systemic antigen within the body. METHODS: We present a case of symptomatic, recurrent, phlyctenular keratoconjunctivitis in an 8-year-old child. The patient's inflammation responded favorably to topical steroids at each episode, but no specific antigen could be identified. CONCLUSION: After observing the father's erythematous facial lesions, we attributed the child's ocular inflammation to rosacea (as a forme fruste manifestation) and treated her with systemic erythromycin. The symptoms were rapidly relieved and the disease process was arrested.

Child↗
PubMed2001

Congenital retinal macrovessel: a case report.

BACKGROUND: A 24-year-old woman with symptoms of chronic, recurrent headache, presumably secondary to migrainous etiology, came to our clinic and was found to have a congenital retinal macrovessel encircling an area superior to (but not passing through) the macula. CONCLUSIONS: Congenital retinal macrovessels are rare, aberrantly large branches of retinal arteries or veins that typically cross the horizontal raphe to either supply or drain the macular area. These unusual vascular entities must be distinguished from prepapillary vascular loops, racemose hemangiomas, Wyburn-Mason syndrome, or other arteriovenous malformations with potential neuro-ocular sequelae.

Adult↗
PubMed2001

Periocular malignancies and primary eye care.

BACKGROUND: In 1985, an estimated 92,000 new cases of skin malignancies were diagnosed worldwide. Based on reports from the United States Environmental Protection Agency, as the stratospheric ozone layer continues to be depleted, the number of new cases of skin cancer are predicted to climb by as many as 12 million over the next 50 years. Up to 90% of all cases of skin cancer occur in the vicinity of the head or neck and 10% of those involve the eyelids. METHODS: We surveyed the literature regarding the incidence, diagnosis, differential diagnosis, management, prognosis, and prevention of the most common periocular malignancies. The types of malignancies include basal cell carcinoma, squamous cell carcinoma, sebaceous cell carcinoma, and malignant melanoma. RESULTS: The period of greatest risk for the development of skin cancer begins in the fourth decade and increases with advancing age. Up to 20% of periocular skin lesions are malignant. Perhaps the most-significant risk factor is innate skin coloration. Workup for these entities includes biopsy as the first step in diagnosis and management of skin cancers. Punch, incisional, or excisional biopsy may be performed, depending on the size and location of the lesion. Treatment alternatives, used when surgical intervention is unable to be tolerated, include radiation therapy, cryotherapy, chemotherapy, interferons, and recently developed photodynamic therapy. CONCLUSION: The importance of gross observation, examination, and careful slit-lamp biomicroscopy of the ocular adnexa cannot be overstated as a means of detection, diagnosis, and management of beginning, impending, or worsening malignancies.

Diagnosis, Differential↗
PubMed2000

Duane's retraction syndrome: literature review.

BACKGROUND: Duane's retraction syndrome (DRS), also known as Stilling-Turk-Duane syndrome, is defined as a congenital miswiring of the lateral and medial recti muscles, resulting in an impaired ocular motility syndrome that includes palpebral fissure narrowing. The incidence of DRS is approximately 1% of the total cases of strabismus. Eighty percent of cases are unilateral and characterized by either limited abduction, limited adduction, or both. CASE REPORT: A 21-year-old man came to the clinic for a routine ocular examination without symptoms. A review of the history uncovered the presence of congenital, type I Duane's retraction syndrome. The examination demonstrated orthophoria in primary gaze, an abduction deficit O.S., and left globe retraction with palpebral fissure narrowing on right gaze O.S. MANAGEMENT: In most cases of DRS the eyes are straight in primary position and there is no amblyopia. Amblyopia, when present, is usually the result of anisometropia and not strabismus. Because our patient had no symptoms of diplopia in primary gaze (orthophoria) or in attempted right gaze (due to suppression of the left eye with abduction), prismatic and/or surgical management were not indicated, since the patient was free from binocular and cosmetic abnormalities. CONCLUSION: DRS is characterized by abnormal development of the cells in the abducens nucleus (CN VI), resulting in restricted or absent abduction and erroneous innervation of the lateral rectus by branches emanating from oculomotor nuclei (CN III). Management may include orthoptics, surgery, or monitoring.

Adult↗
PubMed2000

Understanding nystagmus.

BACKGROUND: Nystagmus is one of the more-common, yet least-understood, neuro-ophthalmic findings in the clinical setting, affecting one in every 5,000 to 10,000 individuals. Several electrodiagnostic techniques are available for characterizing congenital nystagmus, as well as for differentiating it from pathological forms. Ruling out central nervous system involvement is critical. A variety of treatments--including contact lenses, optical aids, vision therapy, biofeedback, pharmaceuticals, surgery, and low-vision rehabilitation--are available to nystagmus patients to improve visual functioning. Eye care practitioners should be familiar with this condition, its differential diagnoses, and strategies for management. METHOD: A comprehensive guide for clinical management of nystagmus is presented. Concerns such as differentiating congenital nystagmus from acquired nystagmus and management techniques for both forms of nystagmus are described. Myths of congenital nystagmus are dispelled, while newer theories are reinforced by the presentation of current research. CONCLUSION: Although nystagmus is a complicated entity, the optometric practitioner can successfully manage cases by using principles of diagnosis and being aware of the unique problems associated with nystagmus.

Humans↗
PubMed1998

Retinal arterial macroaneurysm: a case report.

BACKGROUND: Retinal arterial macroaneurysms are an acquired retinal vascular abnormality. These isolated dilatations of the major retinal arterial branches are found within the posterior pole and are associated with systemic hypertension, arteriosclerosis, retinal emboli and cardiovascular disease. RESULTS: Although many patients are asymptomatic, vision loss is the most commonly manifested symptom. Vision loss may occur as a result of hemorrhage (subretinal, intraretinal, preretinal or vitreous) or macular edema with associated lipoprotein exudation. Most lesions spontaneously involute without causing any visual consequence. If central vision is reduced or threatened, laser photocoagulation may be applied directly to the macroaneurysm itself or to affected retinal capillary beds. While retinal arterial macroaneurysms frequently manifest as isolated phenomena with few symptoms (loss of visual acuity if bleeding or exudation encroaches on the macula), their differential diagnosis includes retinal and systemic diseases that require thorough investigation. CONCLUSION: Optometrists should be familiar with the signs and symptoms of retinal arterial macroaneurysms, their differential diagnosis, workup, and management.

Aged↗
PubMed1998

The enigma of giant cell arteritis: multidisciplinary management of two cases.

BACKGROUND: Giant cell arteritis is an enigmatic disease that is characterized by chronic granulomatous inflammation of the walls of large and medium-sized arteries. The process has a predilection for the extradural cranial arteries, which include the ophthalmic and the posterior ciliary arteries. A multisymptom disease of older individuals, giant cell arteritis often manifests challenging issues and diagnostic dilemmas. CASE REPORTS: We illustrate two cases with initial symptoms of intermittent headache, malaise, and decreased visual acuity that were incorrectly diagnosed or ultimately misdiagnosed. The first case represents a patient who was diagnosed as having migraine headache and an erythrocyte sedimentation rate (ESR) that was interpreted by the attending physician as too low to warrant temporal artery biopsy. The second case is that of a patient who had a history of headaches, jaw claudication, and numerous medical evaluations. CONCLUSION: Giant cell arteries is an enigmatic disease with multiple manifestations. The differential diagnoses can range from temporal mandibular joint dysfunction to tension headache. Imminent vision loss as a sequelae of this condition warrants careful review of ocular and constitutional history and prompt treatment.

Aged↗
PubMed1997

Understanding angioid streaks.

BACKGROUND: Angioid streaks are defined as a series of linear, cracked-line dehiscences of Bruch's membrane, with secondary changes in the retinal pigment epithelium and choriocapillaris. They may be progressive or degenerative, with varied presentation, color, distribution, and retinal involvement. METHODS: The epidemiology, pathophysiology, diagnosis, and management of angioid streaks are described. In addition, the systemic diseases most commonly associated with the disease are reviewed. RESULTS: Optometrists need to be able to differentially diagnose angioid streaks and to refer for evaluation of underlying systemic disease. CONCLUSIONS: Angioid streaks are considered a rare disorder, associated with pseudoxanthoma elasticum, Paget's disease of the bone, sickle hemoglobinopathies. Marfan syndrome, and Ehlers-Danlos syndrome. Ocular complications include subretinal choroidal neovascular membrane formation. Clinicians should be aware of the disease's subtle ocular appearance, its association with systemic diseases, its potential for producing subretinal ocular complications, and correct management protocols and treatments.

Angioid Streaks↗
PubMed1995

Idiosyncratic ocular symptoms associated with the estradiol transdermal estrogen replacement patch system.

The Estradiol Transdermal Estrogen Replacement Patch System (Estraderm) is designed to provide continuous estrogen replacement therapy through a rate-limiting membrane applied to the skin. The relative advantage of the patch over the more commonly prescribed oral medication, Premarin, is that the drug is absorbed directly into the bloodstream without extended metabolism by the digestive system and the liver. Ocular side effects associated with Estraderm, reported in the literature, include fluctuation in corneal curvature and variations of keratitis sicca. Here, a case is presented in which a 50-year-old Caucasian female, without previous ocular sequelae status after hysterectomy and oophorectomy, experienced what appears to be atypical ocular symptoms associated with the Estraderm. To the best of our knowledge, this information has not been reported in the literature. Clinicians should be aware of the unusual symptoms that could accompany the use of the Estradiol Estrogen Replacement Patch and include them among the differential diagnoses. The condition, its associated symptoms, and summary of the literature are discussed.

Delayed-Action Preparations↗
PubMed1992

Literature review of hepatitis B: should eye care practitioners receive a hepatitis B vaccine?

The incidence of Hepatitis B infection has been steadily increasing over the last 5 years. The current literature has established that eye care practitioners are in the high risk category for contracting and transmitting this serious viral infection. Hepatitis B Virus (HBV) is present in all bodily fluids including tears and is considered to be more easily transmitted with a higher degree of infectiousness than Human Immunodeficiency Virus (HIV). Fortunately, unlike Acquired Immune Deficiency Syndrome (AIDS), hepatitis can be prevented with a vaccine. Recent improvements in the hepatitis vaccine have made it safer and more effective. As optometrists expand their scope of practice, it becomes essential to increase the knowledge base and awareness of this clinical entity so informed decisions can be made regarding vaccination by eye care practitioners, teaching faculty, and students.

Hepatitis Antibodies↗
PubMed1991

Low vision rehabilitation of the albino patient.

From the eye care professional's point of view, the three most common types of albinism are tyrosinase-negative oculocutaneous albinism, tyrosinase-positive oculocutaneous albinism and ocular albinism. Skin and uveal hypopigmentation is variable in this condition depending on the type of albinism. However, all types of albinism lack the necessary uveal pigmentation have subnormal visual acuity. Using low vision rehabilitation techniques such as modifying lighting and providing telescopic optical devices, these patients can experience dramatic improvements in functional visual acuity. This manuscript examines strategic approaches to visual rehabilitation as well as provides a clinical review of the condition.

Albinism, Oculocutaneous↗