Biomedical subjects
Publications and source records attributed to J E Terry.
In a study of 103 eyes, the measurement of intraocular pressure (IOP) was compared between the Perkins hand-held tonometer and the Goldmann slit lamp mounted tonometer. IOP readings from the two instruments were highly correlated (+0.91). Advantages inherent to the Perkins design are also discussed.
Streptococcus pneumoniae is a Gram-positive organism that commonly is the etiologic agent for external ocular infections. The conjunctival response may be relatively mild or quite intense with abundant discharge. Pharmaceutical management with various topical antibiotics is extremely effective in resolving the infection.
The elderly population is particularly susceptible to a number of eye diseases and degenerations. A summary of the more commonly encountered conditions is presented to include eyelid, conjunctival and corneal disorders. In addition, discussions of the retinopathies, macular degenerations, neuropathies, and glaucoma are given.
A case of ocular toxoplasmosis is presented from the initial patient contact to the completion of treatment. A discussion follows which reviews the literature on ocular toxoplasmosis with emphasis on the typical pharmacological management of the disease.
An acute loss of vision accompanied by signs of optic nerve head ischemia in an elderly patient should alert the examiner to suspect the presence of temporal arteritis until it can be proven otherwise. The patient presented here had ischemic optic neuropathy that was initially thought to be due to temporal arteritis, but eventually was proven to be associated with pronounced atherosclerotic aortic arch disease. The diagnosis was complicated by the severe loss of vision and by an elevated erythrocyte sedimentation rate (ESR). A temporal artery biopsy was normal, and other findings implicated the pronounced diffuse atherosclerosis as the cause of the ischemia of the optic nerve head. Therapy was directed toward the vascular occlusive disease, and involved an aortoinnominate bypass graft.
Ocular eyelid infestation of Dermacentor variabilis, the American dog tick, occurred in a 34-year-old man who had been sleeping in an open-floored tent in an Indiana field. The tick was mechanically removed with steady and firm pressure with cilia forceps, with care taken to remove all mouth structures. The involved eyelid area healed rapidly without ocular or systemic complications.
Trauma to the corneal epithelium is frequently encountered in clinical practice. The epithelial defect may range from a mild punctate keratitis to total denuding of the surface. The mechanism of epithelial regeneration and the clinical management of such injuries is herein described.
Since the cornea responds to various toxic stimuli by swelling and ulcerating, these changes may assume a dendriform pattern. A case of herpes simplex dendritic keratitis is presented along with its treatment. In addition, several other etiologic sources of an arborescent keratitis are discussed as to their differentiation and management implication.
Slit lamp biomicroscopy provides invaluable diagnostic information as to the nature of ocular abnormalities and disease processes. As such, the emphasis to be presented in this discourse is biomicroscopic interpretation, as opposed to simple observation, with each major ocular structure discussed in turn.
Using a micro-osmometry technique, 450 nonreflex tear samples were collected hourly from six subjects throughout their waking hours, and on initial opening of the eyes following six to eight hours of sleep. While the waking day mean found for this population agreed closely with current values in the literature, considerable variation did occur among individuals, both in their mean as well as in their hour-to-hour levels. The prolonged lid closure condition resulted in a considerable decrease in tear osmotic pressure and was found to be significantly different from the open-eye condition (P less than .001). No significant differences could be shown however between findings for men and women for either condition, and no consistent impact of food or fluid intake could be demonstrated.
Antepartum fetal evaluation by heart rate monitoring was carried out on a clinical service during a 1-year period utilizing the nonstress test as the primary screening device. Nonreactive nonstress tests were supplemented by the oxytocin contraction stress test. In this study, the use of the nonstress test appropriately led to the identification of all fetuses who were in jeopardy and, in the majority of instances, identified fetuses in good condition who did not require the administration of oxytocin to determine fetal well-being. In our experience, the nonstress test is a reliable, inexpensive, convenient, time-saving screening procedure which can be made available to a greater number of patients than the contraction stress test alone.
Using a precision thermocouple hygrometer, requiring just 5 microliters of sample, the tear osmotic pressures of 6 subjects were monitored throughout their adaptation to rigid contact lenses. Relative to the prefitting baselines established for each previous to this study, these subjects showed a range of hypotonic shifts on initially receiving their lenses, but this imbalance was rectified by the end of the first wearing week and a new relatively hypertonic level of tear osmotic pressure was commonly established. This new baseline was reflected in the pre-insertion samples of several of the subjects as well once adaptation was advanced.
Ocular mydriatics are diagnostic agents that generally facilitate a preferable ophthalmoscopic examination. However, the optometrist should be aware of certain iatrogenic side effects including the precipitation of an acute angle-closure. The purpose of this paper is to summarize the mechanism of mydriatic angle-closure glaucoma. In addition, a shallow anterior chamber is a fundamental ocular variable which should be evaluated before inducing mydriasis and/or cycloplegia. The technical procedures for the oblique illumination shadow test and the van Herick slit lamp test are presented, both of which provide an accurate estimation of the anterior chamber angle. The risk of precipitating an attack after reasonable circumspection by such evaluations approaches zero. However, should an attack occur, the procedures to rapidly lower the intraocular pressure and open the chamber angle are discussed.
Patients were found to differ in their prefitted tear osmotic baselines. Although such differences appeared small, they did represent the "safety margin" (i.e., against osmotic edema) each patient had against a "hypotonic shift" when receiving a hard (PMMA) contact lens.
In a sample of 212 eyes of patients referred to an ocular pathology clinic, measures of intraocular pressure (IOP) using the non-contact tonometer (NCT) and the Mackay-Marg tonometer were highly correlated (+0.91), the NCT MEASURES BEING LOWER BY AN AVERAGE OF 6.5 MM Hg. In a general optometry clinic, the mean IOP as measured with the NCT on 987 eyes of patients, ages 7 to 85 years, was 15.7 mm Hg (S.D.=3.5 mm Hg). Stability of IOP was age, found for this sample, is unexpected if IOP is proportional to systemic blood pressure which rises with age. Several hypotheses propose to explain the apparent inconsistency.
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Morgagnian cataract is a hypermature lens in which the cortex liquifies and the dense nucleus sinks inferiorly. Aside from the total reduction of vision, serious sequelae may result. This report is of a unilateral Morgagnian cataract of unknown etiology for which a dilated pupil facilitated the differential diagnosis between cataract types.
Biomicroscopy is an indispensable part of the ocular health examination performed on every patient. The purpose of this paper is to briefly review the basic illumination technique so that the examiner thoroughly understands their uses and develops for himself a specific investigative procedure. This testing may progress from the lids and lashes to the anterior vitreous in a coordinated manner.