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A study to compare the use of fusidic acid viscous eye drops and chloramphenicol eye ointment in an accident and emergency department.

A total of 300 patients attending an Accident and Emergency department with ophthalmic complaints needing topical antibiotic treatment were treated with fucithalmic or chloramphenicol (chloromycetin). Their compliance and the incidence of side effects were assessed. There was a 70.3% response rate to the questionnaire. Of the patients 51.3% using fucithalmic completed the 5 day course compared with 37.2% of those taking chloramphenicol. However, no patients were found to have suffered as a result of failing to complete the course. The incidence of side effects was similar in both groups.

Chloramphenicol↗

Female reproductive factors and eye disease in a rural South Indian population: the Aravind Comprehensive Eye Survey.

PURPOSE: To determine the potential associations of female reproductive factors with age-related cataract, open-angle glaucoma, macular degeneration, and myopia in an older population of rural south India. METHODS: This was a population-based, cross-sectional study of older adults in rural south India identified through a cluster sampling technique. Histories relating to female reproductive factors were ascertained through a questionnaire administered by trained workers. Detailed ocular examinations including automated perimetry were performed on all participants at a base hospital to arrive at a diagnosis of ocular morbidity. RESULTS: The study achieved a high response rate (93.0%), with examinations performed on 5150 of the eligible 5539 persons aged 40 years or more. Age at menarche was available for 2797 (98.6%) of the women and age at natural menopause for 1841 (98.0%) of 1878 women who were postmenopausal. The mean age at menarche was 14.8 +/- 1.8 years, and the mean age at menopause was 43.4 +/- 3.9 years. The mean duration of endogenous estrogen exposure was 28.4 +/- 4.3 years. The median number of pregnancies was 4 (mean, 4.3 +/- 2.6; range, 0-16). Older age at menarche (>or=14 years) was associated with reduced risk for age-related cataract and myopia, and greater risk for macular degeneration. Neither age at menopause nor duration of endogenous estrogen exposure was associated with any of the ocular diseases studied. Parity was not associated with any of the ocular diseases studied in a multivariate model. CONCLUSIONS: Female reproductive factors do not appear to influence age-related cataract, open-angle glaucoma, macular degeneration or myopia significantly in rural south India.

Adult↗

An eye on inflammatory eye disease.

The purpose of this article is to outline the interaction between ophthalmologists and internists in the management of uveitis. Two issues will be addressed: 1) which strategies should the internist follow when asked to investigate a case of uveitis; and 2) in which systemic diseases should the internist order an ocular examination to rule out intraocular inflammation. The modern approach to the diagnosis of uveitis is based on the naming-meshing system popularized by Smith and Nozik. After a short history (ocular complaints, general health) an ophthalmic examination is carried out to determine the anatomic structures involved. Based on the results a uveitis is classified as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis. Associated factors (eg, unilateral versus bilateral, acute versus chronic, granulomatous versus nongranulomatous, etc.) are also assessed. Based on this information the type of uveitis will be named (eg, acute, nongranulomatous, unilateral, anterior uveitis) and matched (meshing) to a potential list of etiologies (eg, viral iritis, HLA-B 27 associated iritis). Targeted questioning and selected medical and laboratory investigations based on the shortlist will then identify a possible cause for a particular patient's uveitis. In other words the ophthalmologist should never ask the internist to run the full battery of tests in a patient with uveitis. He rather should indicate which type of uveitis is present and what are the most likely diagnoses to be excluded. Many systemic diseases cause diffuse inflammation and are associated with uveitis. These include tuberculosis, spirochaetal diseases such as Lyme disease and syphilis, sarcoidosis, Behçet syndrome, juvenile idiopathic arthritis, and HIV infection amongst many others. Routine ophthalmic examination in patients with systemic disease may be indicated for diverse reasons: to prevent profound damage due to asymptomatic uveitis in JIA; to detect diagnostic clues in patients with febris e causa ignota; or to rule out opportunistic infections in HIV positive patients. It is clear that the information gained from routine examination in systemic disease will be greatly dependent on the prevalence of ocular involvement in a particular disease.

Eye Diseases↗

Nodules in the conjunctiva, bung-eye, and bulge-eye in Africa caused by Mansonella perstans.

Eight patients from Uganda, Sudan, Nigeria, and Zaire presented with swelling of the eyelids, proptosis, or conjunctival granulomas. In 5 patients the cause was Mansonella perstans; in 1, it was a Wuchereria bancrofti-like worm; and in 2, an unidentifiable worm. The morphologic features and histopathologic changes in the conjunctiva and periorbital fat are described and illustrated.

Adolescent↗