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At least 253 records · Page 14Linked to original sources
PubMed2002

[Full optical correction after cycloplegia in headache].

PURPOSE: To study the advantages of cycloplegia in the accurate assessment of refractive errors and to evaluate the impact of full optical correction in the course of headache. MATERIAL: and methods: A prospective study was carried out in 164 eyes of 82 patients with headache. Corrected visual acuity was 10/10 in all cases. Refraction was measured before and under cycloplegia by cyclopentolate with a CANON R 50 infrared autorefractometer. Full optical cycloplegic correction based on the value of refraction under cycloplegia was prescribed in all cases. Mean follow-up was 10 months. Statistical analyses were used: Student's t test, Pearson coefficient correlation, and Chi2. RESULTS: Under cycloplegia, hypermetropia was significantly the most frequent ametropia (67.1%, p<10(- 9)). The difference between the spherical equivalent, before and during cycloplegia, was highly significant (p<10(- 5)) at 0.79. Optical correction eliminated headaches in 76.5% of the cases. CONCLUSION: The authors conclude on the role of accommodation in headache onset and the need to continue cycloplegia until the age of 45. The importance of optical correction in alleviating headaches is underlined.

Accommodation, Ocular↗
PubMed1992

Delayed filtering bleb encapsulation.

Encapsulated filtering blebs concomitant with increased intraocular pressure (IOP) developed 47 and 6 months, respectively, after surgery in two women, 46 and 60 years old, respectively, who had undergone trabeculectomy operations in one eye. Both blebs were associated with mild anterior uveitis. Following treatment with topical steroids, cyclopentolate, hypotensive medications, and digital massage, the uveitis resolved and the IOP fell. The likely cause of these late-appearing encapsulated blebs was anterior uveitis.

Epinephrine↗
PubMedDate not supplied

[Neurotoxic effects induced by the topical administration of cycloplegics. A case report and review of the literature].

INTRODUCTION: We report a patient who developed an acute confusional state with hallucinations after exposure to cycloplejic eye drops, and review the current literature regarding neurotoxicity due to this type of eye drops. CASE REPORT: A 61 year-old man who developed in two occasions confusion, disorientation and vivid visual hallucinations following exposure to a cyclopejic eye drop containing atropine 2%, scopolamine 0.5% and phenylephrine 4%. We performed a literature search regarding neurological complications of cycloplegic eye drops using the PubMed Database and the services of the Virtual Library 'Agencia Lain Entralgo'. The clinical features of all reports in which the original document was obtained are analyzed and summarized. We have summarized the clinical features of 29 patients with neurotoxicity due to cyclopentolate, 19 to atropine, 18 to scopolamine, 7 to homatropine, and 2 to tropicamide. Our patient should be the fourth reported in Spain, being the offending drug in the four cases the same eye drop. The most commonly reported symptoms are visual hallucinations, behavioral disorders/acute psychosis, alterations of consciousness/confusion, restlessness/hyperactivity, ataxia and speech disorders. Many of the patients reported are children and elder. There have been reported some fatal cases, specially related with atropine. CONCLUSIONS: Neurotoxicity related with anticholinergic effects of cycloplegic agents is not infrequent, although it is not well known in our setting; and can cause death in some cases. Exposure to these drugs should be taken in account in the differential diagnosis of acute confusional syndromes.

Administration, Topical↗
PubMed1991

Muscarinic cholinoceptor regulation of cyclic guanosine monophosphate in human corneal epithelium.

Cultured human corneal epithelial cells showed high-affinity, specific binding to the muscarinic cholinergic antagonist, 3H-quinuclidinyl benzilate (3H-QNB). The binding sites had a dissociation constant of 3.9 nM and a maximal binding capacity of 880 fmol bound/mg protein. Other muscarinic antagonists (cyclopentolate and atropine) effectively competed for binding with 3H-QNB at low concentrations (IC50 = 10 nM). The muscarinic cholinergic agonist carbachol also competed for binding with 3H-QNB at somewhat higher concentrations (IC50 = 0.5 microM), and the nicotinic cholinergic agonist, nicotine, was at least 400-fold less potent than carbachol. Carbachol stimulated cyclic guanosine monophosphate (GMP) levels in these cells up to threefold over control. This stimulation was sensitive to atropine inhibition, requiring only 2 nM atropine for 50% inhibition and 100 nM of atropine to block the carbachol effect completely. A 90% decrease in specific 3H-QNB binding was observed if cultured cells were homogenized and fractionated before assay. Significant levels of specific 3H-QNB binding could also be observed when intact human corneas were incubated with 3H-QNB and their epithelium subsequently isolated before measurement of bound radioligand. These studies indicate the presence of muscarinic cholinoceptors in human corneal epithelium which are associated with control of cyclic GMP levels in this tissue.

Aged↗
PubMed1987

Cyclotherapy in the treatment of symptomatic latent hyperopia.

Many practitioners have long been frustrated with traditional treatments of symptomatic latent hyperopia (fogging techniques, bifocals, etc.). A technique employing short-acting cycloplegia has been developed which provides rapid relief of symptoms by promoting full correction of latent refractive error. Fifteen symptomatic subjects ages 3-40 were diagnosed as latent hyperopes with the aid of 1% cyclopentolate, and subsequently recyclopleged utilizing full correction in constant wear spectacles. Acuity was maintained via slow diminution of cycloplegia. Short-term and long-term follow-up, with continued use of spectacles or contact lenses, revealed rapid and complete resolution of symptoms and restoration of visual efficiency in each case. Cyclotherapy offers both practitioners and patients an efficient, rapid-acting, and satisfying alternative treatment for this vexing accommodative anomaly.

Accommodation, Ocular↗
PubMed1994

[Pathogenesis and treatment of accommodative disturbance].

Using a computer-assisted infrared optometer with a pupillograph, we tried to obtain basic understanding of accommodative disturbance and its by investigating tonic (dark focus) level of accommodation and quasi-static accommodative response. In normal volunteers in whom either visual fatigue, general fatigue, or drunkeness was loaded intentionally, myopic shift of refraction, increased refractive fluctuation, and miosis were induced in all cases but the effect on amplitude of accommodative response was minimal. Subjects that worked at a computer terminal all day for 2 years, but not controls, developed myopic change at a statistically significant level. The effect on tonic level of accommodation of subject age, sustained near-vision tasks, and topical application of autonomic-related drugs was investigated. In subjects with severe eyestrain, myopic shift of tonic accommodation and prominent pupillary unrest were observed, suggesting increased parasympathetic excitation. One patient who was accidentally exposed to diisopropyl fluorophosphate, a potent cholinesterase inhibitor, showed a phenomenon similar to that mentioned above. Chaos attractors based upon the Shil'nikov phenomenon were introduced for evaluation of microfluctuation and pupillary unrest, as first applied by Sumida et al. Topical application of low-dose cyclopentolate hydrochloride was effective for treating accommodative abnormality in professional computed workers, who sometimes develop abnormal parasympathetic excitation. Based on quasi-static accommodation measurements, accommodative abnormality after head and neck injury, including whiplash injury, was divided into two completely different states: accommodative spasm and palsy. Since quasi-static accommodation was greatly affected by satellite ganglion block, sympathetic innervation from cervical ganglions may strongly influence accommodative response. Hyperthyroidism, which may be accompanied by sympathetic hyper-excitation, showed diminished accommodative response. In patients after refractive surgery by excimer laser, there was no difference in accommodative response before and after surgery, although tonic accommodation was slightly unstable after surgery. These findings suggest that the evaluation of tonic level or a similar state of accommodation and pupillary unrest will yield extremely valuable information in regard to various accommodative disturbances.

Accommodation, Ocular↗
PubMed1993

[The effect of intraocular lens (IOL) length and design on anterior chamber depth under contraction and relaxation of the ciliary muscle].

We compared the effect of intraocular lens (IOL) length and its design on the anterior chamber depth (ACD) change during contraction and relaxation of the ciliary muscle. We performed phacoemulsification or extra capsular cataract extraction using continuous circular capsulorhexis on 100 eyes, and implanted in 23 eyes a short one-piece IOL, in 22 eyes a short three-piece IOL, in 25 eyes a long one-piece IOL, and in 30 eyes a long three-piece IOL. All IOLs were fixed in the capsular bag. ACD changes after administration of 2% pilocarpine and 1% cyclopentolate were measured with a pachymeter between 3 and 6 months postoperatively. The compatibility of the IOLs with ciliary muscle contraction and relaxation was, in descending order, the short one-piece IOL, the short three-piece IOL, the long one-piece IOL, and the long three-piece IOL. The results indicated that short IOLs are more physiologically fixed in the capsular bag, with less stress on the zonules of Zinn.

Aged↗
PubMed1996

[Sleep modifies anticholinergic mydriasis].

In sleep, the eyelids are closed and the pupils narrow. The pupil width indicates alertness and, if it is narrow, sleepiness. The deeper the sleep, the narrower the pupil: miosis during drowsiness, sleep, sedation and general anesthesia relies on reduced inhibition of the oculomotor nucleus and, even more, on reduced sympathetic tone (it is as sympatholysis that accounts for the miosis exerted by the famous "cocktail lytique" onto an iris whose sphincter is weakened from briskly elevated IOP in angle-closure glaucoma). For whatever reason a lack of sympathetic tone occurs, a poor response to anticholinergic mydriatics will be the consequence. This communication is concerned with children who received tropicamide, cyclopentolate or atropine for diagnostic pupil dilation and cycloplegia but, during subsequent sleep, exhibited an unsatisfactory mydriatic response that could be overcome by additional administration of phenylephrine. Thus, parasympatholytic mydriasis can be proven to be a function of the sympathetic tone. The pupil shrinks during deep sleep even after atropine. If the conditions of deep sleep, sedation or general anesthesia are present and mydriasis needs to be maintained, an additional administration of a sympathomimetic compound is mandatory.

Anesthesia, General↗
PubMed2000

The spectrum of ocular inflammation caused by euphorbia plant sap.

OBJECTIVE: To report the spectrum of clinical findings in patients with ocular inflammation caused by plant sap from Euphorbia species. DESIGN: Clinical case series. SETTING: Ophthalmology emergency referrals in the United Kingdom. PATIENTS: We examined 7 patients, all of whom gave a history of recent ocular exposure to the sap of Euphorbia species. INTERVENTIONS: All patients were treated with antibiotic drops or ointment (chloramphenicol). Cycloplegic and steroid drops were also used for some patients. Patients were observed until all signs and symptoms had resolved. MAIN OUTCOME MEASURES: Symptoms, visual acuity, and clinical signs of inflammation. All patients provided a specimen of the plant for formal identification. RESULTS: Initial symptoms were generally burning or stinging pain with blurred vision. In most cases, visual acuity was reduced between 1 and 2 Snellen lines. In 1 patient with age-related maculopathy, acuity dropped from 20/80 to hand motions before recovering. Clinical findings varied from a mild epithelial keratoconjunctivitis to a severe keratitis with stromal edema, epithelial sloughing, and anterior uveitis. All signs and symptoms had resolved by 1 to 2 weeks. CONCLUSIONS: These cases illustrate the range of severity of Euphorbia sap keratouveitis. The condition seems to be self-limiting when managed supportively. People who work with Euphorbia plant species should wear eye protection. Clinicians managing keratopathy caused by Euphorbia species should be aware of the danger of sight-threatening infection and uveitis, particularly during the first few days.

Adult↗
PubMed2001

Cycloplegic refractions in healthy children aged 1 through 48 months.

OBJECTIVES: To provide a description of refractive errors in healthy, term-born children, aged 1 through 48 months, and to test the hypotheses that spherical equivalent becomes significantly less hyperopic and less variable with increasing age. METHODS: Following a prospective, cross-sectional design, cycloplegic retinoscopy was used to measure the refractive error in both eyes of 514 healthy, term-born children in 12 age groups. Three hundred were aged 12 months or younger. Spherical equivalent and cylindrical power and axis were analyzed as a function of age. Prediction limits for spherical equivalent were calculated. RESULTS: Spherical equivalents of right and left eyes did not differ at any age. Hyperopia declined significantly with increasing age. The variability in spherical equivalent also decreased significantly with age. Cylindrical error of 1 diopter or more was found in 25% of the children; the proportion with astigmatism was highest in infancy and then waned. Myopia and anisometropia were rare, occurring in 3% and 1% of the sample, respectively. CONCLUSIONS: Significant declines in hyperopia and variability of spherical equivalent appear to be features of emmetropization. The normal prediction limits provide guidelines against which data from individual patients can be compared.

Age Distribution↗
PubMed1979

Paradoxical intraocular pressure response to pilocarpine. A proposed mechanism and treatment.

A patient with unilateral angle-recession glaucoma had an ipsilateral increased intraocular pressure (IOP) with miotics despite open angles, and decreased IOP with cycloplegics. The following mechanism is proposed to explain these findings: Pilocarpine hydrochloride has been demonstrated experimentally to increase trabecular outflow and decrease uveoscleral outflow. In this eye with a severely compromised and unresponsive trabecular outflow, miotics served to impair uveoscleral outflow and cause a net rise in IOP. Similarly, an increase in uveoscleral outflow with cycloplegics served to decrease IOP. The use of atrophine sulfate in these rate cases may be of therapeutic value in lieu of systemic or surgical therapy.

Atropine↗
PubMed1988

Holes in clear lenses demonstrate a pinhole effect.

This study describes a new variant of the pinhole principle. Holes drilled in clear plastic lenses held in combination with a blurring lens can overcome the blurring effect much as a traditional pinhole. Specifically, this study shows how holes of different diameter placed in lenses of different spherical power can improve visual acuity that has been degraded by a series of blurring spherical lenses. In general, the hole in the clear lens improves visual acuity for progressively stronger blurring lenses.

Cyclopentolate↗
PubMed1992

The effect of topical corticosteroids on refractive outcome and corneal haze after photorefractive keratectomy. A prospective, randomized, double-blind trial.

In this study, we report the results of a prospective, double-blind trial to determine whether high-dose topical corticosteroids have an effect on refractive outcome or anterior stromal haze after photorefractive keratectomy. A total of 113 patients were allocated randomly to either placebo- or steroid-treated groups (0.1% dexamethasone metasulphobenzoate for 3 months) and underwent either -3.00-diopter (D) or -6.00-D procedures. At 6 weeks, the mean change in refraction was significantly greater in the steroid-treated group than in the placebo-treated group (-3.00-D group, P = .0015; -6.00-D group, P = .0011). However, when corticosteroids were discontinued at 3 months, this difference became statistically insignificant. There was no statistically significant effect on anterior stromal haze at any stage. Since long-term use of corticosteroids to maintain the initial beneficial effect on refraction would be unacceptable, we conclude that these agents should not be used after photorefractive keratectomy.

Administration, Topical↗
PubMed1979

Endophthalmitis associated with Haemophilus influenzae type b bacteremia and meningitis.

The unusual occurrence of endophthalmitis associated with Haemophilus influenzae type b bacteremia and meningitis was confirmed in three young children during a five-year period. In contrast to bacterial endophthalmitis attributed to other microorganisms, these three infections resolved completely within a few days with conventional antimicrobial therapy. Endophthalmitis is but one of the apparently increasing number of unsuual complications that may be observed as a result of H influenzae type b bacteremia.

Administration, Topical↗
PubMed1981

[Retinoscopy under cycloplegic and non-cycloplegic conditions in children comparison of measurements of three examiners (author's transl)].

The refractive status of 100 eyes were measured by three ophthalmologists utilizing retinoscopy under non-cycloplegic and cycloplegic conditions. The statistical analysis of the results was done by multiple regression. The retinoscopic measurements of sphere and cylinder of the three examiners show smaller differences under cycloplegic than under non-cycloplegic conditions. The largest differences in the measurements of axis were found in cases of small cylinder power. Especially in children and in patients with strabismus, the authors feel that measurements of the refractive state have to be carried out under cycloplegia.

Accommodation, Ocular↗
PubMed2002

Efficiency of a video-autorefractometer used as a screening device for amblyogenic factors.

BACKGROUND: High ametropia is known as a risk factor in developing amblyopia. The aim of the study was to evaluate the efficiency of a commercially available infrared videorefractometer (PowerRefractor) in examining children, and to evaluate its effectiveness in detecting amblyogenic factors of the refraction. The influence of cycloplegia was of interest. METHODS: A total of 255 eyes (-28.25 D to +7.88 D spherical equivalent) of 128 patients (1-81 years) were examined by cycloplegic retinoscopy. All of them were measured with the PowerRefractor under cycloplegia. Fifty-four of these patients (108 eyes) were additionally measured without cycloplegia. The technique of the device is based on the eccentric photorefraction method. Both eyes can be measured simultaneously from a distance of 1 m. A video-analysis of each eye is computed in three meridians. The subject can be observed in real time on a screen, and the refraction is immediately available. RESULTS: Measurement of refraction was possible at all ages. More effort was required with young children who could not cooperate well with the procedure of conventional table-top autorefractometers. The mean sensitivity in detection of any amblyogenic ametropia was 80% with and without cycloplegia. The specificity was 61% with cycloplegia and 84% without. The rate of false-negative results in the detection of anisometropia, hyperopia and astigmatism ranged from 10% to 24%. In particular, high astigmatism and hyperopia remained undiscovered. CONCLUSIONS: The reliability of the photorefractor which was the subject of the evaluation in detecting amblyogenic ametropia was comparable to that of other devices described previously in the literature. The method is suitable for use in children, but anisometropia, high astigmatic and hyperopic ametropia remained undiscovered in several cases. Commercial interest: none.

Adolescent↗
PubMed2005

Accuracy of a new photo-refractometer in young and adult patients.

BACKGROUND: Photorefraction can be carried out in both eyes simultaneously from a distance and is therefore suitable for examination of children. This study evaluated the accuracy of a commercially available photo-refractometer (Power Refractor, Plusoptix, Erlangen, Germany) and investigated whether the working distance relaxes the accommodation sufficiently without cycloplegia. METHODS: Photo-refractometer readings were compared to cycloplegic retinoscopy. Because of the limited working range the group of patients consisted of low and moderate ametropic eyes within a spherical power of -7.0 to +5.0 D. One hundred and ninety-two eyes from 104 patients (2-81 years) were photo-refracted under cycloplegia. A subgroup of 83 eyes from 46 patients was additionally refracted without cycloplegia. RESULTS: Under cycloplegia, the Power Refractor measured the spherical equivalent slightly below that of cycloplegic retinoscopy (too much minus). The mean difference in spherical equivalent was -0.12+/-0.91 D (SD). The mean difference of cylindrical power was -0.17+/-0.73 D. The mean weighted axis difference was 0.61+/-0.71 D which is comparable to an axis deviation of 18 degrees at a cylinder power of 1.00 D. Without cycloplegia, the mean difference of the spherical equivalent was -0.73+/-1.25 D. The mean difference of cylindrical power was -0.20+/-0.65 D. The mean weighted axis difference was 0.44+/-0.58 D which is comparable to an axis deviation of 13 degrees at a cylinder power of 1.00 D. CONCLUSIONS: Without cycloplegia, the spherical equivalent of the Power Refractor tends to be underestimated due to uncontrolled accommodation, especially in children. Cycloplegia improves the accuracy in evaluating the spherical equivalent, but decreases the accuracy of cylinder power and axis.

Accommodation, Ocular↗