Ocular penetration by anesthetic injection.
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Biomedical subjects
Publications and source records attributed to R M Feibel.
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We studied four patients with anisocoria and the pigmentary dispersion syndrome. In all patients, the larger pupil was on the side of the greater iris transillumination. The amount of anisocoria was between 0.5 and 1.5 mm and was the same in both the light and dark. There was no blepharoptosis, and all pupils dilated normally with cocaine. All of the patients were young men with myopia, and one patient had increased intraocular pressure.
Air at 75 lbs/sq in from an air compressor hose struck a 19-year-old man in his right eye. Injected through a superior conjunctival laceration, the air entered subcutaneous, mediastinal, and bilateral orbital and intracranial spaces. High-resolution computed tomography scanning of the head and orbits revealed air adjacent to the right optic nerve throughout the orbit. We hypothesize that air was injected intracranially, but extradurally, through the superior orbital fissure. The patient suffered no visual loss.
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A simple modification of the bent needle cystitome allows a more precise and regular anterior capsulotomy in extracapsular cataract surgery.
Ultrasonography and the more recently developed technique of computerized tomography (see the preceding chapter) should be used concurrently in the evaluation and diagnosis of suspected orbital pathology. Ultrasonography is easily performed and safe; it has no known complications or contraindications. Unique information concerning the position and acoustical quality of tumors can be obtained. However, the interpretation of the ultrasonogram can be quite difficult; highly sophisticated equipment is needed to obtain the finer resolution required to make tissue diagnosis.
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During the Napoleonic Wars from 1798-1815, severe epidemics of keratoconjunctivitis affected the military and civilian populations of Western Europe. This disease was known as the Egyptian ophthalmia because it was first described in troops stationed in Egypt. Most physicians believed this condition was not infectious, but caused by various climatological factors. John Vetch, a British physician, emphasized that this disease was spread by direct conveyance of pus from the diseased to the healthy eye. His insistence that the ophthalmia was contagious, and his suggestions for prevention and treatment were milestones in the history of ophthalmology.
Recently there have been major advances in the field of retrobulbar anesthesia. New agents which allow prolonged anesthesia and akinesia have been introduced. Several new techniques to administer retrobulbar anesthesia have been developed. The toxicity of local anesthetics and the complications arising from such injections have been studied, and ways to avoid and manage them have been expanded.
The name of Auguste Van Lint is linked with the development of facial nerve akinesia for ophthalmic surgery. Less well known is Robert Ernest Wright (1884-1977) who described techniques to block the facial nerve in the same manner as later published by Atkinson and Nadbath. This paper reviews Wright's life as an ophthalmologist and ophthalmic bacteriologist and pathologist in British India, and his role in the evolution of facial nerve akinesia.
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