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[Accumulation of ephedrine, norephedrine, amphetamine and tyramine labeled with carbon 14 in pigmented and non-pigmented eyes in two races of rats].

The pigmented eyes of non albino rats (PVG) accumulated ephedrine, norephedrine and amphetamine. After 15 min accumulation of ephedrine and amphetamine was larger than of norephedrine. Autoradiographic studies showed that accumulation occurred in melanin containing iris and choroid and also in lacrymal glands which lack melanin. Accumulation of tyramine did not occur in eyes containing melanin. The non pigmented eyes of albino rats did not accumulate ephedrine, amphetamine, norephedrine and tyramine. It appeared that in pigmented eyes melanin was a site of loss of ephedrine, amphetamine and norephedrine; hence a smaller amount of drug will be available for interaction with adrenergic neurons and a smaller mydriatic effect will occur. Accumulation is possible only when metabolism is low, as observed with alpha-methylated amines. The four sympathomimetic amines used did not accumulate in the pigmented skin of black and white rats.

Amphetamine↗

Documentation and evaluation of adverse drug reactions (ADR)--contribution from a poison information center.

The Department of Clinical Pharmacology in Jena is a pharmacovigilance center in a study on intensified spontaneous adverse drug reaction reporting. Physicians specialized in clinical pharmacology screen admissions to the Department of Internal Medicine for possible adverse drug reactions. Because of the collaboration between the Pharmacology Department and the nearby Poison Information Center (PIC) in Erfurt the question occurred whether the latter might contribute to adverse drug reaction monitoring. We compared the ADR registered by the intensified spontaneous reporting system in 1999 with those of the PIC during the same period. Each symptom observed was regarded as 1 case. Every suspected drug was also treated separately. The symptoms were classified using adverse reaction terminology. The drugs were classified according to the WHO Anatomical Therapeutic Chemical (ATC) classification index. The causality assessment was based upon bibliographic data and the method of Bégaud et al. [1985]. Only possible, probable or very probable ADR were compared. The PIC registered mainly psychiatric and nervous system disorders sedation and extrapyramidal disorders were the most frequent reactions - unlike the pharmacovigilance study which registered primarily gastrointestinal and heart rate disorders. The PIC registered mainly drugs used in the therapy of disorders of the central nervous system, i.e. mostly psycholeptics and drugs acting on the alimentary tract, mostly anticholinergics. Drugs for the therapy of sensory organs disorders were frequent owing to the systemic and local adverse drug effects of anticholinergic mydriatics. The PIC and pharmacovigilance centers can benefit from co-operation. The PIC provides easy access to qualified drug information and is thus a useful tool in ADR evaluation. Although the number of adverse reactions assessed was small, their evaluation revealed problems in drug usage which would not otherwise be reported. The evaluation has enlarged the pool of ADR data which is the basis for signal detection.

Adverse Drug Reaction Reporting Systems↗

[Encapsulated filtering blebs--incidence and methods of treatment].

Encapsulation of the filtering bleb occurs as a complication of glaucoma filtering surgery in 8.3-28% of all eyes filtered, often between 2-4 weeks after surgery. It has a characteristic clinical appearance--highly elevated localized bleb, prominent surface vessels and patent sclerostomies on gonioscopy. This study retrospectively reviewed the results of 100 filtering operations, performed in the Prof. Dr. I. Stankovitsh Eye Department, focused on the incidence, possible risk factors and management of encapsulated filtering blebs. Trabeculectomy was done in all patients with limbus-based conjunctival flap, rectangular scleral flap 4 x 4 mm, and sclerostomy 2 x 2 mm. Two or three interrupted 10-0 nylon sutures were used to tether the flap, the conjunctiva with Tenon's capsule was closed with a running suture. All eyes received topical dexamethasone drops, mydriatics-homatropin or tropicamide and antibiotic ointment for three weeks. Possible risk factors were considered: sex, age, other eye or systemic disease, type of glaucoma, previous ocular procedure and antiglaucoma medical therapy, early postoperative complications, postoperative and final intraocular pressure (IOP). All eycs with encapsulated filtering bleb were given topical beta-blocker initially and carbonic anhydrase inhibitor, and if IOP continued to be uncontrolled incisional surgical management was performed. Success was defined as IOP maintained at less than 22 mmHg, with or without medication. An encapsulated filtering bleb developed in 9% of eyes. Previous argon laser trabeculoplasty was associated with an increased frequency of bleb encapsulation. The mean postoperative IOP was 11.30 +/- 1.90. Encapsulation of filtering bleb was developing at mean time of 19.9 +/- 3.0 after surgery. Six eyes returned to IOP below 21 (mean IOP was 20.17 +/- 0.90) within 4 weeks, and 4 of them continued on a topical beta-blocker. Four eyes required incisional surgery. A week after surgery mean IOP was 18 mmHg. Haemophthalmus occurred after one incision performed in a patient suffering from diabetes mellitus. Late scarring of the filtering bleb was developed in 2 eyes. Seven months and 2 years after filtration surgery mean IOP was 21.30 +/- 4.00 mmHg. The cause of bleb encapsulation is not known. Male patients, surgical glove powder, topical corticosteroids, previous argon laser trabeculoplasty and beta-blockers are some of potential risk factors for the development of encapsulated filtering bleb. This study suggests the association between development of encapsulated bleb and previous argon laser trabeculoplasty--40% in the eyes with encapsulation and 18% in the eyes without encapsulation. The optimal management of bleb encapsulation has not been defined. In this study topical antiglaucoma therapy achieved IOP control and cyst's remodeling in 60% of cases. Forty percent of all cysts required incisional surgical management. Encapsulation of the filtering bleb is not an uncommon complication of glaucoma filtration surgery. It is important to examine postoperative eyes frequently during the first 2 months to detect this complication. Fortunately, most eyes have their IOPs controlled with antiglaucoma therapy.

Adrenergic beta-Antagonists↗

[Drugs and closed-angle glaucoma risk].

Closed-angle glaucomas arise among predisposed patients (narrow iridocorneal angle) in response to various stimuli. Most of the attacks are of iatrogenic origin: all the topical and systemic mydriatic drugs can provoke an angle closure glaucoma attack. Dangerous active ingredients with closed-angle glaucoma are active substances with anticholinergic activity (peripheral action, central action, with anticholinergic side-effects), active ingredients with sympathomimetic alpha activity (alpha 1, alpha and beta with indirect effects), and the active ingredients with parasympathomimetic activity (anticholinesterases). The proprietary medicine, whether or not they are included in the French dictionary Vidal((R)), are classified according to the administration route and their different indications. The closed-angle glaucoma risk after administration of these drugs is noted in the items'contraindications and precautions in the summary of the product characteristics enclosed in the marketing authorization.

Glaucoma, Angle-Closure↗

[The preparation and bioactivities of chiral analogs of baogongteng A].

Eight chiral analogs of baogongteng A were prepared from (+/-)-3 alpha-hydroxy-6 beta-acetoxytropane by chemical resolution. In myotic or mydriatic tests in rabbits, (-)-3 alpha-paramethyl benzenesulfonyloxy-6 beta-acetoxytropane showed cholinergic activities, while (+)-3 alpha-benzoyloxy-6 beta-acetoxytropane and (+)-3 alpha-parachloro benzoyloxy-6 beta-acetoxytropane showed anticholinergic activities.

Animals↗

Alterations in adrenergic sensitivity of the rabbit iris after variation of environmental lighting conditions.

After variation of the environmental lighting conditions, pupillary diameters of albino rabbits in response to progressively increasing doses of the sympathomimetics norepinephrine, epinephrine, and isoproterenol were measured. After maintenance of the rabbits under conditions of constant light for one week, an increased sensitivity of the iris dilator to the mydriatic effects of these adrenergic agents became evident. After maintenance of the rabbits in constant dark for one week, on the other hand, there was no change in the sensitivity of the iris upon administration of the same sympathomimetics. Norepinephrine levels measured in iris and ciliary processes after one week of either constant light of constant dark, moreover, did not differ significantly from those determined under normal lighting conditions. These results indicate that the sensitivity of the iris dilator can be altered by variation of the physiologic stimulus, light. In addition, the chronic interruption of contact between the normal neurotransmitter norepinephrine and its effector cells leading to supersensitivity in the dilator appears to be due to the removal of a trophic influence of norepinephrine, rather than its absolute loss.

Animals↗

Anti-TNF therapy for eye involvement in spondyloarthropathy.

Approximately 40% of patients with ankylosing spondylitis or reactive arthritis will experience the sudden onset of a unilateral anterior uveitis sometime during the course of their spinal disease. In most instances, this inflammation resolves within several weeks and responds to corticosteroid and mydriatic eye drops without the need for additional therapy. A small percentage of patients with either Crohn's disease or psoriatic arthropathy will have a bilateral, chronic, anterior and/or posterior uveitis that is more refractory to therapy. A similar clinical challenge is occasionally encountered in patients with ankylosing spondylitis or reactive arthritis. In this manuscript, we review briefly the clinical manifestations of the uveitis associated with spondyloarthropathy and discuss several potential novel therapeutic approaches, primarily anti-tumor necrosis factor (TNF) therapy.

Animals↗

[Stormorken's syndrome].

In 1985, a new syndrome with the following characteristics was described: thrombopathia, thrombopenia, asplenia, miosis, headache, ichthyosis, dyslexia, muscle defect, and subsequently also hypocalcaemia. Skin and deep bleedings, leg spasms, disturbed dark vision and dyslexia are main worries. This paper describes these patients with a review of the investigations performed. Causes of the bleeding tendency are complex disturbances of the platelet membrane causing insufficient stability of the haemostatic plug, the nature of which is unresolved, but involves membrane scrambling. The muscle defect consists in tubular aggregates and high blood values of creatine kinase. A connection with the hypocalcaemia is possible, because increasing the ionic Ca with calcitriol significantly improves muscle function. Miosis is resistant to mydriatics and causes decreased dark vision, possibly also influencing dyslexia. The asplenia has little influence on immunocompetence, and the patients have survived 300 patient years without critical infections. The gene defect has not yet been unravelled.

Adult↗

[Postoperative endophthalmitis].

PURPOSE: Is to establish the risk factors, the treatment and the prognostic factors at the patients operated for cataract, who developed earl endophtalmitis after the operation. MATERIAL AND METHOD: We studied 14 eyes which were operated for cataract who developed endophtalmitis after the the operation. RESULTS: At all patients the general treatment associated antibiotics (Cefalosporine) with steroids (high doses) and the local one was with mydriatics and steroids. After the treatment, we obtained a visual acuity between 0.7-1 at 11 eyes, visual acuity between 0.400,6 in 3 eyes and 2 eye had a visual acuity under 0.1. CONCLUSIONS: The postoperative endophthalmities is a complication which affect the functional prognosis of the patients operated for cataract.

Adult↗

NTP Toxicology and Carcinogenesis Studies of Phenylephrine Hydrochloride (CAS No. 61-76-7) in F344/N Rats and B6C3F1 Mice (Feed Studies).

Phenylephrine hydrochloride is a sympathomimetic amine recommended for use as a nasal decongestant and as a mydriatic in ophthalmic applications. In 1977, total U.S. human exposure was estimated at 1.9 x 107 g per year. Phenylephrine hydrochloride was nominated for toxicology and carcinogenesis studies because of a lack of previous long-term studies and because two other sympathomimetic agents (soterenol hydrochloride and mesuprine hydrochloride) produced mesovarial leiomyomas in Sprague-Dawley rats. Toxicology and carcinogenesis studies of USP-grade phenylephrine hydrochloride were conducted by administering diets containing the chemical (99% pure) to F344/N rats and B6C3F1 mice of each sex in studies of 14 days, 12 weeks, and 2 years. In the 14-day studies, no toxic effects were seen in rats or mice fed diets containing up to 2,000 ppm phenylephrine hydrochloride. Doses were increased in the 12-week studies, and deaths of male rats and male mice were observed in groups fed diets containing 10,000 or 20,000 ppm; 1/10 male rats in the 5,000-ppm group died. Other than inflammatory eye lesions (considered secondary to the pharmacologic drying action of the chemical), no specific organ toxicity was noted. Body weights decreased as concentrations of phenylephrine hydrochloride in the diet were increased, and feed consumption was lower in dosed rats. Doses of 0, 620, and 1,250 ppm for rats and 0, 1,250, and 2,500 ppm for mice were selected for the 2-year studies because of the decreased body weight gains in animals given higher doses in the 12-week studies. In the 2-year studies, the approximate amount of phenylephrine hydrochloride consumed per day was 24 mg/kg for low dose rats, 50 mg/kg for high dose rats, 133 mg/kg for low dose mice, and 270 mg/kg for high dose mice. Body weight differences in rats appeared to be dose related, and dosed animals were 3%-15% lighter than controls. Body weights of dosed mice averaged 3%-14% lower than those of controls throughout the 2-year studies. Survival of high dose male rats was greater than that of the controls (control, 30/50; low dose, 33/50; high dose, 42/50); differences in survival were not significant for female rats (42/50; 34/50; 36/50), male mice (35/50; 38/50; 43/50), or female mice (37/50; 34/50; 34/50). Few nonneoplastic lesions were related to phenylephrine hydrochloride dosing in rats or mice. Chronic focal inflammation of the liver was observed at increased incidences in dosed rats (male: 2/50; 13/50; 17/50; female:17/50; 28/50; 35/50). Inflammation of the prostate was seen more frequently in dosed than in control males (10/50; 24/50; 24/50). The incidence of focal cellular change in the liver was increased slightly in high dose male mice (0/50; 2/50; 7/50). In male rats, mononuclear cell leukemia (24/50; 9/50; 5/50) and pheochromocytomas of the adrenal gland (14/49; 11/50; 2/50) occurred with negative trends, and the incidences in the high dose group were lower than those in the controls. No increases in neoplasia were seen in dosed male or female rats or mice. Phenylephrine hydrochloride was not mutagenic in four strains of Salmonella typhimurium (TA100, TA1535, TA1537, and TA98) with or without Aroclor 1254-induced liver S9 from male Sprague-Dawley rats or male Syrian hamsters. The results of mutagenicity studies of phenylephrine hydrochloride were equivocal in the mouse lymphoma L5178Y/TK+/- assay in the absence of S9; it was not tested in the presence of S9. Phenylephrine hydrochloride induced sister-chromatid exchanges (SCEs) but not chromosomal aberrations in Chinese hamster ovary cells. The increase in SCEs was seen only in the absence of metabolic activation with S9. An audit of the experimental data was conducted for the 2-year studies of phenylephrine hydrochloride. No data discrepancies were found that influenced the final interpretations. Under the conditions of these 2-year studies, there was no evidence of carcinogenicity of phenylephrine hydrochloride for male B6C3F1 mice given 1,250 or 2,500 ppm in feed. Survival of high dose male rats was greater than of high dose male rats was greater than that of controls, and the incidences of mononuclear cell leukemia and pheochromocytomas were lower in dosed than in control male rats. Inflammation was observed more frequently in the liver and prostate gland of dosed male rats than in controls. Synonyms: benzene methanol,3-hydroxy-a[(methylamino)methyl]hydrochloride (R)-; (-)-meta-hydroxy-a-[(methylamino)methyl]benzyl alcohol hydrochloride; meta-Synephrine hydrochloride; Neo-synephrinereg.

Journal Article↗

[Diabetic retinopathy in children and adolescents].

Diabetic retinopathy rarely occurs before puberty and is never proliferative in prepubescent children. On the opposite, puberty and adolescence are high-risk periods for diabetic retinopathy progression, and call for strict ophthalmologic monitoring. The period between 16 and 18 years of age is particularly critical. Progression towards florid diabetic retinopathy is to be especially feared and should be prevented in the course of adolescence, as this form can be severe and can lead to blindness. Risk factors are probably many, including diabetes duration, difficulties in achieving glycemic control due to increase in insulin requirements, low compliance to treatment, and hormonal changes related to puberty (abnormalities of the growth hormone (GH)/insulin-like growth factor-I (IGF-1) axis). Systematical diabetic retinopathy screening should be performed in adolescents, notably by non-mydriatic fundus photographs. Furthermore, the anticipation of the switch from pediatric to adult structures, together with the careful information and education of parents and children may improve visual prognosis of young diabetic patients, whose life expectancy is high.

Adolescent↗

Overview of the corneal toxicity of surgical solutions and drugs: and clinical concepts in corneal edema.

Surgical solutions and drugs are important in ocular surgery. These include irrigating solutions, viscoelastic substances, mydriatics and miotics, and a growing number of other agents designed to enhance intraocular surgery and its outcome. Potential for damage to the corneal endothelium and other tissues is related to the chemical composition, pH, and osmolality of the irrigating solutions that bathe tissues. Quality balanced salt solutions (BSS) are usually safe for use as an intraocular solution in patients with normal corneal endothelium. If prolonged irrigation times are expected, or the patient already has decompensated endothelium, i.e., primary or secondary endotheliopathy, the use of a "complete" BSS solution is indicated to minimize damage. Intraocular sulfite-containing epinephrine may cause severe corneal edema and should be avoided, or if used, be well diluted. Sulfite-free epinephrine solution is now available and does not cause the endothelial toxicity that one may see with sulfite-containing epinephrine solutions. Current formulations of acetylcholine and carbachol used as miotics in surgery have been evaluated in humans and caution is recommended in using acetylcholine solutions intracamerally in patients with already decompensated endothelium. Chondroitin sulfate, hydroxypropyl methylcellulose, and sodium hyaluronate are non-toxic to animal endothelial cells under conditions analogous to cataract extraction in humans but can be toxic to endothelium if there is continued contact with endothelium for hours. Chondroitin sulfate has been shown to have more of a protective effect in mechanical pseudophakos trauma probably because of its cohesiveness and tendency to coat the endothelium. Viscoelastics cause a significant rise in intraocular pressure of > 30 mm Hg in 3-10% of patients. Very high intraocular pressures are often seen postoperatively after viscoelastic use surgically in patients who preoperatively have a history of ocular hypertension or glaucoma.

Cell Count↗

Hyperthyroidism, ophthalmoplegia and unilateral mydriasis.

Clinical description of a 33 years-old woman, with hyperthyroidism, admitted to the emergency unit with external bilateral ophthalmoplegia and left mydriasis, unreactive to light. The external ophthalmoplegia is proven to be due to myasthenia. The left mydriatic pupil demonstrates features typical for Adie's tonic pupil. The association of a tonic pupil with an auto-immune disease is infrequent. The axiom that internal ophthalmoplegia in a patient with external ophthalmoplegia excludes myasthenia gravis should be reevaluated.

Adult↗

Myasthenia gravis-like syndrome induced by topical ophthalmic preparations. A case report.

This case study reports on a 64-year-old female who presented for cataract surgery. She relayed a history of allergic responses to local anesthetics such as xylocaine, but was otherwise in good health. Upon instilling ophthalmic preparations into her eyes during routine ocular examination, she developed general muscular weakness but not other allergic-like symptoms. Further investigation established her myasthenic-like syndrome to be precipitated by an ophthalmic mydriatic preparation. She was able to undergo uneventful cataract surgery and enjoy 20/20 vision postoperatively, with proper management.

Cataract Extraction↗

[Predictive factors of mortality in severe craniocerebral trauma].

BACKGROUND: The prediction of mortality in severe head injury is of interest for the evaluation of patient prognosis and to also permit therapeutic measures to be considered and improve knowledge of this problem. METHODS: A multiple logistic regression model was developed and validated from the data obtained from a series of 231 patients hospitalized for the above mentioned condition. Seventy-five percent of the patients were used to define the model with the remaining 25% validating the same. RESULTS: The variables included in the model were: intraventricular hemorrhage, odds ratio = 20.4 (confidence interval 95%: 3.56-116); compression of basal cistern and/or of the III ventricle, odds ratio = 11.5 (4.43-29.8); mydriatic pupils in both eyes, odds ratio = 5.71 (1.32-24.6); age, odds ratio = 1.03 (1.01-1.05) and Glasgow scale upon admission, odds ratio = 0.57 (0.43-0.75). The maximum global value of the model (84.9%) corresponded to a sensitivity of 84.5% and specificity of 85.2%. The cut-off point of probability of death was found to be 0.475. In the validation of the model the highest global value (84.2%) was also observed at the cut-off point of 0.475 with a sensitivity of 84.2% and specificity of 84.4%. CONCLUSIONS: The predictive factors of mortality in severe head injury are the evidence of hemorrhage in the cerebral ventricles, mydriasis and a low score on the Glasgow scale. The model presented is useful and valid for carrying out the prediction of mortality at the time of admission and is also easy to apply since the variables used are obtained in the initial examination of the patients with severe head injury.

Adult↗

[21st century management of glaucoma].

According to a recent epidemiological study done in Japan, 2 or 3 million Japanese people are thought to be suffering from glaucoma, and 70-80% of them have not been examined or diagnosed by ophthalmologists. Therefore, the problem is how to find these untreated and undiagnosed people. At present, treatment of glaucoma continues to be directed at lowering intraocular pressure to prevent progression of glaucomatous optic neuropathy. However, theoretically, there are three stages in the prevention of progression of glaucoma. In the first stage, diagnosis of glaucoma can be done by genetic examination, before occurrence of glaucoma. The MYOCILIN/trabecular meshwork-inducible glucocorticoid response gene and the optineurin gene were identified as the genes that cause open angle glaucoma. Although some Japanese patients have sequence changes in the myocilin gene, there are no apparent specific mutations in Japanese glaucoma patients, in the MYOCILIN/TIGR and optineurin genes. Secondary glaucoma such as steroid glaucoma, induced by allergic diseases, and neovascular glaucoma, induced by retinal circulatory insufficiency, are preventable by improving the causal diseases, diabetes and hypertension. The education of doctors and laymen is important to reduce the occurrence of diabetes, and hypertension to prevent diabetic retinopathy, and retinal vessel occlusion. The second stage in preventing progression of glaucoma is to find the disease as early as possible. In Japan, a physical examination system is in place for everybody over 40 years old, in companies and local districts. Therefore, ocular examination, specially non-mydriatic fundus photographs should be taken in these examinations, and the film should be evaluated by an ophthalmologist, to search for retinal and optic disc abnormalities. Primary open angle glaucoma can be detected through this system in early stages. In primary angle closure glaucoma, instruments for estimating anterior chamber rapidly and accurately are necessary for the diagnosis. There is a special machine which can be handled easily, safely, and economically for detecting angle closure glaucoma, has been developed by Yamanashi University. This machine might help to reduce the number of angle closure glaucoma patients in the world. In the near future, a glaucoma network system should be put in place all over Japan. This organization consists of central headquarter and local central office. Most hospitals and private offices will belong to a local central office, and several glaucoma specialists will work in central and local offices. All glaucoma patients will be registered in local glaucoma office. The information on glaucoma patients will be communicated in the system the through light fiber cables or a satellite system. The patients can ask about their own disease through this glaucoma center system. In the third stage of glaucoma prevention, progression of glaucomatous optic neuropathy is retarded by conventional IOP lowering treatment or neuroprotective drugs. This stage compromises rehabilitation of visual function, implant of artificial visual systems, and regeneration of retinal ganglion cells(RGC). The disturbances of axonal flow in guinea pig optic nerve fibers was demonstrated electromicroscopically by quick-freeze, deep-etching method and, the decrease in numbers of motor proteins like "Kinesin" "Dynein" and "MAP-1" was shown in guinea pig eyes with elevated intraocular pressure by immunohistochemistry. Retinal glanglion cells have been isolated and new findings have been reported using this RGC culture system. Therefore, new neuroprotective drugs will be developed through this culture system.

Animals↗

[The clinical picture of Fuch's heterochromic cyclitis].

The authors are presenting their experience with the diagnosis and treatment of Fuchs' heterochromic cyclitis. They followed-up 13 patients with this disease for 0.5-3 years. Most often the patients were sent to the clinic with the diagnosis of recurrent anterior uveitis not responding to the treatment with corticosteroids and mydriatics. Patients underwent numerous investigations including neurological, internal and rheumatological examinations. Antibodies against EBV, HSV and CMV were detected. The examination of humoral immunity and HLA was done. The authors describe the ophthalmological findings, the course of the disease and the treatment. They did not find any correlation in the laboratory investigations and the course of the disease, the diagnosis is based on the clinical picture. They point out the advantage of the small incision in the extracapsular extraction of cataract in these patients.

Adult↗

[Effect of environmental temperature on the course of spontaneous postmortem pupillary changes (studies of the rabbit eye)].

The diameter of the pupils was measured in the bodies of rabbits under different ambient temperatures (2-4 degrees C, 10-12 degrees C, 18-20 degrees C, 28-30 degrees C). It was found that the pupils changed in three phases: Initial miosis, which set in within minutes after death, was followed by a mydriatic phase, which lasted several hours and was approximately synchronous with the post-mortem rigidity of the skeletal muscles. In the third phase the pupils slowly contracted in the course of several days. The higher the ambient temperature, the more marked was the dilatation of the pupils in the second phase. In contrast to this the reaction of the pupils was characterized by less pronounced changes in size and a longer duration of secondary mydriasis, when temperatures were low.

Animals↗