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At least 757 records · Page 42Linked to original sources
PubMed1989

Miotic Adie's pupils.

Two young adults, aged 24 and 31, had a long history of small, poorly reactive pupils. There was no history of large pupils, and a review of old photographs confirmed 10 and 5 years, respectively, of miosis. Both were found to have bilateral tonic pupils that were supersensitive to diluted pilocarpine. Although it is possible that they had an unusually early onset of bilateral Adie's syndrome with dilated pupils that was not noticed, it is suggested that some patients might have primary miotic Adie's pupils without ever passing through a mydriatic phase.

Adie Syndrome↗
PubMed1993

Effect of apraclonidine hydrochloride on the attack of Posner-Schlossman syndrome.

The intraocular pressure (IOP) of glaucomatocyclitic crisis with the attack fell 50.3%, from 37.8 +/- 8.2 mmHg to 18.8 +/- 4.8 mmHg, 4 hours after instillation of 1% apraclonidine. Glaucomatocyclitic crisis showed a more significant hypotensive response to 1% apraclonidine than primary open-angle glaucoma (24.8%, from 43. 1 +/- 8.1 mmHg to 32.4 +/- 7.5 mmHg after 4 hours). The intraocular pressure decrease percentage was similar regardless of the initial level of intraocular pressure. Clinically significant changes in mean systolic and diastolic blood pressures, were not observed, however, a mild decrease in the pulse rate was noted. And the local mydriatic effect on the pupillary diameter was significant. Apraclonidine, 1% might be newly indicated to control the IOP rise of glaucomatocyclitic crisis. Further studies on the possible mechanism of the prostaglandin mediated hypotensive effect of 1% apraclonidine are suggested.

Adolescent↗
PubMedDate not supplied

Abolition of feeding intolerance following ophthalmologic examination of neonates.

Administration of mydriatic medication and ophthalmologic examination have previously been associated with feeding intolerance, characterized by large retained gastric aspirates and abdominal distention. In an attempt to eliminate this problem, we instituted a policy of withholding feedings for four hours following ophthalmologic examination. A prospective series of 50 consecutive patients was then followed to determine the incidence of feeding intolerance 24 hours prior to and 24 hours following the examination. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride prior to the examination. A critical review of the nursing notes revealed no increased incidence in feeding intolerance during the 24-hour period following examination. There were no cases of necrotizing enterocolitis during either period. This study provides evidence that the incidence of feeding intolerance following ophthalmologic examinations might be reduced by withholding feeding for four hours after the examinations.

Cyclopentolate↗
PubMedDate not supplied

Comparison of ultrasonic and ophthalmoscopic evaluation of retinopathy of prematurity.

PURPOSE: Screening for detection of retinopathy of prematurity (ROP) currently is limited to indirect ophthalmoscopy, which requires considerable examiner skill and experience. We investigated whether conventional 10 MHz B-scan ultrasonography could document the clinical stages of ROP as accurately as indirect ophthalmoscopy. METHODS: Thirty-four eyes of 18 neonates were examined by masked, independent observers with indirect ophthalmoscopy and digitally recorded 10-MHz B-scan ultrasonography. After pupil dilation and lid speculum placement, the retinologist recorded the stage of retinopathy with a retinal drawing. The ultrasonographer, without use of papillary mydriatics or lid speculum, determined the presence or absence of a ridge or tractional elements, if present on the ridge. RESULTS: Ultrasound grade correlated with clinical grade (R = .79, P < .001). However, nine eyes were overdiagnosed by one stage, and one eye, in which a peripheral detachment was mistaken for an artifact, was underdiagnosed. CONCLUSIONS: Ten-megahertz ultrasonography offers the potential of imaging and detecting the clinical stages of ROP; the use of higher ultrasound frequencies, now becoming commercially available, is likely to enhance diagnostic accuracy. Care must be taken to distinguish between artifact and true anatomical structures in noncontact ultrasound examinations. Neonates with suspected ROP could be screened with B-scan ultrasonography by neonatal personnel without pupillary dilatation or lid speculum, thus eliminating potential morbidity, and clinically significant cases of ROP then could be referred to the retinologist.

Fundus Oculi↗
PubMed1995

Screening for diabetic retinopathy.

OBJECTIVES: To identify factors associated with a high risk of diabetic retinopathy in order to rank patients for urgency of examination by fundal photography. DESIGN: Retrospective case survey. PATIENTS: Eight hundred and eighty-eight consecutive diabetic patients who were routinely referred for mydriatic fundal photography to the Queen Elizabeth Hospital, Adelaide, between August 1987 and May 1992. OUTCOME MEASURES: The prevalence of non-proliferative and proliferative diabetic retinopathy and patient biochemical and demographic characteristics and urinary albumin excretion rate. RESULTS: The prevalences of nonproliferative and proliferative diabetic retinopathy were 18.1% and 2.4%, respectively. Multiple logistic regression analysis established that treatment with insulin or oral hypoglycaemic drugs was associated with the highest risk of diabetic retinopathy (odds ratio [OR], 14.7; 95% confidence interval [CI], 3.4-63.2), while duration of diabetes > or = 7 years (OR, 3.6; CI, 1.9-6.8), age 50-66 years (OR, 2.1; 95% CI, 1.1-4.0) and albumin excretion rate > or = 21 micrograms/min (OR, 2.2; 95% CI, 1.1-4.5) were also significant risk factors. Non-significant variables were hypertension, obesity and sex. CONCLUSIONS: Diabetic patients may be ranked for urgency of retinal photographic screening based on mode of treatment and duration of diabetes, thereby facilitating examination of patients at highest risk of asymptomatic diabetic retinopathy and increasing the efficiency of the screening program.

Adult↗
PubMed2005

Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership.

OBJECTIVE: To describe how a novel program of diabetic retinopathy screening was conceived, refined and sustained in a remote region over 10 years, and to evaluate its activities and outcomes. DESIGN: Program description; analysis of regional screening database; audit of electronic client registers of Aboriginal community controlled health services (ACCHSs). SETTING AND PARTICIPANTS: 1318 Aboriginal and 271 non-Aboriginal individuals who underwent retinal screening in the 5 years to September 2004 in the Kimberley region of north-west Australia; 11 758 regular local Aboriginal clients of Kimberley ACCHSs as at January 2005. MAIN OUTCOME MEASURES: Characteristics of clients and camera operators, prevalence of retinopathy, photograph quality, screening intervals and coverage. RESULTS: Among Aboriginal clients, 21% had diabetic retinopathy: 19% with non-proliferative retinopathy, 1.2% with proliferative retinopathy, and 2.8% with maculopathy. Corresponding figures for non-Aboriginal clients were 11%, 11%, 0 and 0.4%, respectively. Photograph quality was generally high, and better for non-Aboriginal clients, younger Aboriginal clients and from 2002 (when mydriatic use became universal). Quality was not related to operator qualifications, certification or experience. Of 718 regular Aboriginal clients with diabetes on local ACCHS databases, 48% had a record of retinal screening within the previous 18 months, and 65% within the previous 30 months. CONCLUSIONS: Screening for diabetic retinopathy performed locally by Aboriginal health workers and nurses with fundus cameras can be successfully sustained with regional support. Formal certification appears unnecessary. Data sharing across services, client recall and point-of-care prompts generated by electronic information systems, together with policies making primary care providers responsible for care coordination, support appropriate timely screening.

Aged↗
PubMedDate not supplied

Mobile retinal screening--a Waikato Area Health Board initiative.

In conclusion the Waikato Area Health Board has shown that regular eye review can be offered to all patients with diabetes by means of a register of people with diabetes, and the provision of a mobile retinal screening service. The use of a mydriatic camera is a practical and cost-effective way of providing this service, and with suitably designed carrying systems it can be provided at almost any venue, ensuring access even for people in remote rural areas. Demands for our service have meant that we are now offering retinal screening to other Waikato communities which do not have access to a visiting ophthalmologist.

Diabetic Retinopathy↗
PubMed1999

Severe symptoms following a massive intentional L-thyroxine ingestion.

L-Thyroxine (T4) is commonly prescribed medication for hypothyroidism in humans and animals. Overdose has generally resulted in limited symptomatology managed with sedatives and beta-adrenergic receptor antagonists. We describe the largest acute T4 ingestion ever reported, which resulted in a profound thyrotoxicosis, resistant to treatment. A 34-y-old man ingested 900 (0.8 mg) tablets of veterinary T4 (720 mg) and was given 60 g of activated charcoal. He became lethargic on post-ingestion days 2 and 3; had vomiting, diaphoresis and insomnia on day 4; on day 5 he "looked like he had too much coffee", began "using a lot of words" and became agitated, assaultive and stopped speaking intelligibly; and on day 6 returned to the hospital combative and confused. He was diaphoretic, mydriatic, hyperreflexic, tremulous, with clear lungs and active bowel sounds, and received activated charcoal, haloperidol, diazepam, and phenobarbital, and was tracheally intubated. During hospitalization he was rehydrated, treated with propranolol and diazepam, but remained continuously tachycardic. On day 12 he became afebrile and his tachycardia resolved. Free T4 levels ranged from > 13 mcg/dL on day 6 to 1.2 mcg/dL on day 12. By discharge (day 15) he had lost 20 kilograms of body weight, but was clinically euthyroid 2 w later. This case suggests that large intentional T4 ingestions should be managed differently than current T4 overdose protocol.

Adult↗
PubMed1999

[Ocular complications in ulcerative colitis].

Ocular complications in ulcerative colitis has been reviewed. Ocular complications usually occur in 1% of patients with ulcerative colitis(UC) and include anterior uveitis, episcleritis and conjunctivitis in the order of increasing frequency. Anterior uveitis represents most common ocular complications encountered in UC and most belongs to a nongranulomatous variety, accompanied by a hypopyon in 50% of UC. Although occasionally compromised first by an intensive hypopyon, outcomes in visual acuity, in the majority of cases, are favorable. The anterior uveitis usually is able to be treated with topical or sub-Tenon injections of corticosteroids combined with short-acting mydriatics. Uveitis occurs after UC in 82% of cases and in 18%, contemporary with. Preceded by arthritis, uveitis arise in 44% of UC patients in Japan.

Anti-Inflammatory Agents↗
PubMed1999

[Life-saving hemicraniectomy in acute massive brain infarction].

Acute occlusion of the middle cerebral artery is an important cause of ischemic stroke. The resulting brain infarction is often very large, leading to massive brain oedema and intracranial hypertension. Despite intensive medical treatment, the mortality rate due to herniation and cerebral circulatory arrest remains very high. A Norwegian left-handed male, 28 years of age, developed signs of impending herniation following an acute right-side middle cerebral artery occlusion. When admitted to neurosurgical care 54 hours after the stroke, he was soporous, had a left-side hemiparalysis, conjugated deviation of the gaze and a mydriatic pupil on the right side. The intracranial pressure level was between 30 and 40 mm Hg. Following a right-side hemicraniectomy, the intracranial pressure fell to levels around 20 mm Hg. The bone flap was replaced four months later. One year after the stroke, the patient is fully independent of others, despite a left-side hemianopia and hemiparesis. Hemicraniectomy may be indicated in selected patients with impending herniation due to brain infarction. Intracranial pressure recordings are useful as an adjunct in the management of these patients. Our report seems to be the first account of decompressive hemicraniectomy performed in Norway for acute massive brain infarction.

Acute Disease↗
PubMed2000

Vascular network changes in the retina during ageing in normal subjects: a computerized quantitative analysis.

BACKGROUND: Direct ophthalmoscopic examination of fundus oculi is widely used for the qualitative evaluation of target organ damage in several pathological conditions. At present, there are no reliable techniques available to quantify retinal vascular damage. The aim of this study was to develop a computerized technique for the quantitative analysis of fundus oculi. METHODS: We studied 68 non-smoking, normotensive normal subjects, with a visual acuity > 8/10. From each subject retinal images were taken using a non-mydriatic ophthalmoscope and digitized onto a personal computer. In each image the area of analysis was set to a circular selection, corresponding to 25% of the whole fundus oculi, concentric with the optic disc. From each selection arterial and venous area and mean arteriolar bifurcation angle were obtained. Measurements were taken in a blinded way by two operators and, by the same operator, twice at different times. Parameters were correlated with age and body surface area. RESULTS: Retinal arterial density (arteries 7.44 +/- 1.25%; bifurcation angle 75 +/- 16 degrees) was significantly correlated with age, but not with body surface area. Intra- and interobserver coefficient of variation resulted 2.5 and 3.2%, respectively. CONCLUSIONS: Computerized analysis of the fundus oculi with the evaluation of vascular density indexes represents a simple and reproducible technique that could be useful in identifying changes in retinal vascular network during ageing.

Adolescent↗
PubMed1999

[The efficacy of acyclovir treatment in the therapy of herpetic keratitis].

There were investigated 51 patients, 19 female and 32 male, with ages between 12 and 80 years, hospitalized in the Dept. Ophthalm. of the City Hospital of Arad, during 1995-1997. From these, 21 had the clinical diagnosis of superficial keratitis, typical form of dendritic ulcer, 7 had non-typical forms, and 4 had stromal keratitis; 19 patients recurred. The diagnosis of herpetic keratitis was established correlating the clinical aspect with the cytologic examination, made on conjunctivo-corneane smears. A number of 32 patients received a specific treatment with Acyclovir, in an ointment form in local applications and on general route orally; there were also associated mydriatics and epitelizants of the cornea. The evolution of the disease was evaluated by comparing results obtained in different groups of patients.

Acyclovir↗
PubMed2000

Recruitment methods for community-based screening for diabetic retinopathy.

Regular screening of all people with diabetes is the most efficient and cost-effective way to detect early stages of diabetic retinopathy so that laser treatment can be performed at the optimal time. A major aim of the Program for the Early Detection of Diabetic Retinopathy was to increase compliance with guidelines for screening for diabetic retinopathy. This community-based screening program used non-mydriatic retinal photography and was initiated in four areas of Victoria, Australia from 1996-1998. Recruitment strategies included targeted mail-outs, provision of the program brochure in English and the main languages spoken in the areas and media promotion in ethnic newspapers and on ethnic radio stations. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. This program was able to increase compliance with guidelines to 70% among people with diabetes that had not had a recent eye examination. A total of 1,197 people with diabetes were screened for diabetic retinopathy. Of the 1,197 people who were screened, 620 (15% of the estimated number of people with diabetes) had not had their eyes examined in the past two years. This pilot study identified strategies to encourage people with diabetes to have their eyes examined at the recommended intervals.

Age Distribution↗
PubMedDate not supplied

[Episodic benign unilateral mydriasis. Clinical case in a girl].

INTRODUCTION: Pupil asymmetry is an alarm signal which should lead to investigation to rule out severe underlying neurological disorders. Among its causes are tumors, aneurysms and hernia of the uncus. The differential diagnosis should also include other conditions such as Adie's tonic pupil, the Pourfour de Petit syndrome and local disorders such as closed angle glaucoma or segmental spasm of the iris dilator muscle. In practice however, exposure to mydriatic substance is one of the commonest causes. Another cause of this sign is benign episodic unilateral mydriasis. This uncommon condition has been defined as an isolated benign cause of pupil asymmetry. The underlying physiopathology is not always clear and may involve either parasympathetic deficiency or sympathetic hyperactivity affecting the iris. Usually related to migraine, some authors classify it as a limited form of ophthalmoplegic migraine, although some cases have been described with no accompanying headache. CLINICAL CASE: We describe a case of benign episodic unilateral mydriasis in a six-year-old girl who presented with intermittent episodes of pupil asymmetry with no other neurological symptoms. CONCLUSION: We underline the rarity of this condition in children with no simultaneous headache.

Child, Preschool↗
PubMed1975

Fine structure and mechanics of the anterior border of the primate iris: a scanning and transmission electron microscope study.

The morphology of the anterior border of the primate iris has been examined by transmission and scanning electron microscopy. The results confirm that the anterior iris is composed of heavily pigmented melanocytes, fibroblasts, and a loosely arranged network of collagen fibres. The melanocytes are slender, elongate structures, which show some branching in the peripheral iris. They run parallel to the surface and are filled with spindle-shaped pigment granules which are oriented in the long axis of the cell. In the miotic state, the peripheral iris melanocytes form a dense, interlacing network. As the pupillary margin is approached, the angles between intersecting melanocytes diminish; the melanocytes appear to be parallel and in close contact with one another.During mydriasis, the peripheral iris melanocytes are compressed and pupillary components are found to intersect at angles greater than 90%. The superficial fibroblasts are flattened cells, closely applied to the underlying melanocyte processes and in the mydriatic iris form a resonably continous monolayer over the anterior iris surface. Iris pores are present, exposing the underlying melanocytes and stromal collagen. During miosis, the surface fibroblasts become attenuated and the pores increase in size and number. This paper demonstrates the value of the scanning electron microscope in presenting an accurate three dimensional model of the iris.

Animals↗
PubMed2001

[Urrets-Zavalia syndrome].

We report four cases of Urrets-Zavalia Syndrome (fixed dilated pupil with iris atrophy) observed after penetrating keratoplasty. The precise etiology of the syndrome is uncertain and different mechanisms are reviewed. Care should be taken to avoid the use of mydriatic eye drops after penetrating keratoplasty.

Adult↗
PubMed2001

[Diclof 0.1% eyedrops in pediatric ophthalmology].

The authors analyze their two years experience with 208 patients hospitalized at the Clinic of Pediatric Ophthalmology treated by the locally administered antiprostaglandin diclophenac, 0.1% eye drops. The spectrum of the disease was wide and comprised different conditions after intraocular surgery, in particular of cataract, glaucoma and perforation injuries, Yag laser capsulotomy, and conservatively treated conditions, in particular inflammatory processes, uveitis and keratoconjunctivitis. Diclophenac was not combined with other non-steroid antiphlogistics but frequently it was adjuvant treatment of corticosteroids, antibiotics and mydriatics. The authors did not observe any side-effects of the preparation, even after long-term administration or after short-term administration to neonates. As to the intensity of effect, diclophenac was comparable with other prostaglandin inhibitors and in pediatric ophthalmology it is an effective and safe antiphlogistic agent.

Adolescent↗