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PubMed1998

Ocular medications in children.

Many ocular medications are used by pediatricians or ophthalmologists caring for pediatric patients. Topical antibiotics are commonly prescribed for bacterial conjunctivitis, nasolacrimal duct obstructions, and ophthalmia neonatorum. Many new antiallergy eye drops are now available for the treatment of seasonal (hay fever) conjunctivitis. Dilating eye drops and antiglaucoma medications are generally used or prescribed by ophthalmologists, but pediatricians must be aware of their potentially serious systemic side effects. Before initiating treatment, physicians should evaluate the risks and benefits of ophthalmic medications, establish minimum dosages necessary to achieve a therapeutic benefit, and monitor children for local and systemic side effects.

Anti-Allergic Agents↗
PubMed1990

Humoral and cellular immune reactions against retinal antigens in clinical disease.

Autoimmune reactions against retinal antigens have been suggested to play an important role in clinical uveitis in man. As yet the evidence for this assertion is very weak. Sympathetic Ophthalmia is a disease entity which comes closest to acceptance as an autoimmune disease although the autoantigen involved has not been identified. Both cellular and humoral autoreactivity against retinal antigens have been found both in uveitis patients as well as in healthy controls. Very high levels of retinal antibodies were found in onchocerciasis patients but no relation was observed with the occurrence of chorioretinitis. Differences were observed when testing patient sera against human or bovine retinal antigens (S-antigen or IRBP) emphasizing the need for using human tissue when investigating autoimmune responses. Circumstantial evidence in favor of an autoimmune etiology of uveitis include the morphology of the inflammatory infiltrate, effect of immuno-suppressive therapy and especially the establishment of experimental animal models. The experimental models of S-antigen or IRBP induced uveitis are primarily T cell mediated and also show pineal gland involvement. As yet no "established" human autoimmune disease has been described with a dominant role for T cells. Furthermore there is no evidence for pineal gland involvement in clinical uveitis. Analysis of the specificity of the T cell infiltrate or deposited immunoglobulins obtained from the diseased tissues may provide conclusive evidence for a possible autoimmune character of certain clinical uveitis entities.

Animals↗
PubMed1990

Corneal blindnesses in tropical environment.

Corneal blindnesses make up a main public health problem in numerous developing countries where they constitute a sign of low sanitary level. The main diseases which cause corneal blindnesses are: Trachoma. Xerophthalmia. Measles. Corneal ulcerations and keratitis. Onchocercosis. Neonatorum ophthalmia. Leprosy. Injuries. Some therapeutic practices. Epidemiological analysis leads to the definition of risk groups: Small children. Isolated rural communities. Unhealthy urban communities. Out of place populations. Under-fed populations. Only a joint prevention can be able to fight against this social, economic, a human plague constituted by corneal blindnesses. Simple prevention measures which are often not very expensive, showed their efficiency. They are as follows: Individual and collective hygiene measures. Improvement of alimentary conditions. Earliness and quickness in ocular care. Vaccination against measles. Improvement of the care to mother and child. Sanitary education for prevention. These prevention tasks are supported by the health workers who are spread out inside the population. Their formation, the means they are granted with constitute a main priority which has to be taken into account in the choices and the decisions to be made in order to fight against blindness linked with cornea opacification with efficacy.

Blindness↗
PubMed1977

[Historic notices of Louis braille and the development of dot-writing (author's transl)].

Louis Braille is called by his first biographer to be the "Johannes Gutenberg for the blind". Being blind himself--caused by a sympathetic ophthalmia after a perforating hurt to his eye--he invented at the age of 16 years a simple and ingenious method enabling blind people to read and write. His system consisting of six elevated and palpable dots was rejected by the teachers of these days, claiming there could be a distance between blind and fullsighted men. Despite this opposition the Braille system succeeded because of its advantages for the blind: Nowadays this method is used all over the world.

Blindness↗
PubMed1979

Elemental analysis of melanins from bovine hair, iris, choroid, and retinal pigment epithelium.

According to recent theory on the structure of melanin, the sulfur content of melanin is a reflection of the amount of cysteine used in its manufacture. We compared the sulfur contents of melanins from hair, choroid, iris, and retinal pigment epithelium from black-haired cattle and separately from red-haired cattle. In black-haired cattle, sulfur contents of hair and ocular melanins were all between 0.60% and 0.94%, however, in red-haired cattle, hair melanin had a sulfur content (8.66%) different from those of choroid (0.94%) or RPE (1.72%) MELANIN. One may conclude that in an individual animal, ocular melanins can have different chemical structures from hair melanins. The clinical importance of this finding is discussed with regard to sympathetic ophthalmia.

Animals↗
PubMed1984

Silver nitrate prophylaxis.

In many countries the statutory use of silver nitrate prophylaxis as soon as possible after birth has recently been reviewed from both a human rights and a medical standpoint. It has been argued that silver nitrate does not prevent all cases of gonococcal ophthalmia neonatorum (GON) and that it causes chemical conjunctivitis, pain and visual impairment, which may interfere with parent-infant bonding. Furthermore, the low incidence of GON, better methods of prenatal diagnosis, and the availability of suitable alternative prophylactic medication and of effective methods of treatment of GON have prompted recommendations that alternative prophylaxis be legally allowed or that mandatory prophylaxis be eliminated altogether. This paper reviews the situation and provides updated recommendations.

Conjunctivitis↗
PubMed1984

Sympathetic orchidopathia.

Subfertility has recently been shown to follow unilateral torsion of the spermatic cord in more than half the patients studied. Since the anatomical anomaly that predisposes to torsion (a high investment of the tunica vaginalis) is commonly bilateral, there could be an associated congenital defect in spermatogenesis on each side. Alternatively, autoantigens escaping from the ischaemic or 'exciting' testis could trigger an immunological response which damages the contralateral or 'sympathising' testis. Demonstration of an autoallergic (sympathetic) orchidopathia, analogous to sympathetic ophthalmia, would fundamentally alter the management of testicular torsion.

Animals↗
PubMed1981

[Sexually transmissible disease in tropical Africa].

Sexually transmitted diseases in tropical Africa are a severe problem. The facilities for diagnosis and treatment in general are pour. Reliable informations on epidemiology are rare. Gonorrhea and non-gonorrheal urethritis are probably the commonest in tropical Africa, frequently giving rise to epididymitis, urethral strictures and salpingitis as well as pelvic inflammatory diseases, important factors of infertility. Evidence available suggests that the incidence of infectious syphilis is high. Some authors however are of the opinion that there is a steady decline of the condition. Among young children gonococcal vulvovaginitis and ophthalmia neonatorum as well as congenital syphilis are still very common. The management of sexually transmitted diseases has been briefly reviewed as well as the role of socio-cultural attitudes.

Adult↗
PubMed1975

Silver nitrate ophthalmic solution and chemical conjunctivities.

The current status of nursery routines of prophylaxis against ophthalmia neonatorum were surveyed by mail questionnaire to 100 leading maternity hospitals. More than 20% of the respondents were not using silver nitrate, mainly because of chemical conjunctivitis. The clinical significance and incidence of chemical conjunctivitis were studied in 1,000 newborns whose eyes were handled differently. Rinsing after instillation of silver nitrate does not reduce the conjunctival irritation. Although 90% of the infants had conjunctivitis in the first hours of life, the majority cleared within 24 hours. Chemical conjunctivitis did not increase secondary infection, neither did it mask bacterial infection. Silver nitrate is effective in vitro against Neisseria gonorrhoeae and Staphylococcus aureus in a concentration of 0.1% and against Escherichia coli in a concentration of 0.01%.

Conjunctivitis↗
PubMed1977

Gonorrhea in preadolescent children: an inquiry into source of infection and mode of transmission.

From November 1974 through December 1975 a study was made of all reported cases of gonorrhea in children under 10 years of age in Tennessee. Clinical manifestations of the 73 subjects identified included vaginal infection (48), urethritis (11), conjunctivitis (8), and ophthalmia neonatorum (6). A total of 203 relatives and associates of 54 subjects was cultured. Fifty-four (27%) had gonorrhea; 43 of these were relatives. A history of sexual contact was found in 18 children, including seven where the contact had a positive culture for Neisseria gonorrhoeae. Sexual transmission was common in children with vaginitis or urethritis. In nine cases, sexual abuse or child neglect was suspected. The recognition of a child with gonococcal infection identifies a cluster of family members and associates who are at increased risk of having gonorrhea.

Child↗
PubMed1976

Causes for removal of the eye: a study of 890 eyes.

This study is a review of 890 cases of eye enucleations performed over a period of 22 years. The major cause for enucleations was trauma, accounting for 39.7% of the eyes enucleated. Chronic inflammatory diseases accounted for 22.1%, glaucoma for 11.5% and tumours for 9.2% in this group. Retinal diseases were responsible for 5.5% of the eyes; vascular occlusion for 5%; and miscellaneous causes for the remaining 7%. Injuries were everyday tools and small flying missiles caused most of the trauma. Previously planned surgical operations accounted for 15% of the enucleations. Forty-eight of these eyes had epithelial or fibrous downgrowths resulting from inflammation, secondary glaucoma, and phthisis bulbi. A more careful selection of cases and better surgical techniques might significantly lower these statistics. Also, vascular occlusion should be given a high level of suspicion in all intractable cases of glaucoma of unexplained etiology. As a general rule, enucleations should not be performed because of the suspected presence of sympathetic ophthalmia.

Adolescent↗
PubMed2001

Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma.

OBJECTIVES: To evaluate the feasibility of diode laser transscleral cyclophotocoagulation (TSCPC) as a primary surgical treatment for primary open-angle glaucoma and to compare 2 laser energy settings used for treatment. METHODS: In a prospective clinical trial in Cape Coast and Accra, Ghana, 1 eye of each of 92 patients with primary open-angle glaucoma was treated by diode laser TSCPC as a primary surgical treatment. Eyes were randomly assigned to receive treatment by 20 applications of either 1.5 W applied for 1.5 seconds or 1.25 W applied for 2.5 seconds. RESULTS: Seventy-nine (86%) of 92 patients completed 3 months of follow-up; follow-up was 13.2 +/- 6.0 months (mean +/- SD). Intraocular pressure decreased in 53 (67%) of the 79 eyes. The drop in intraocular pressure was 20% or more in 37 eyes (47%) and final intraocular pressure was 22 mm Hg or less in 38 eyes (48%). An atonic pupil was a previously unreported complication that arose in 27 (28%) of 92 eyes. There were no serious complications of hypotony, phthisis bulbi, or sympathetic ophthalmia. Visual acuity decreased in 18 (23%) of 79 eyes treated by TSCPC and in 10 (23%) of 47 fellow eyes treated only with glaucoma medications. There was no difference in outcomes between the 2 laser energy settings. CONCLUSIONS: Diode laser TSCPC is a practical, rapid, well-tolerated procedure that may provide a modest and variable lowering of intraocular pressure. The treatment, used with conservative energy levels applied to the eye, seems to have few serious complications, although a previously unrecognized complication of atonic pupil needs further evaluation. A moderate variation in laser energy settings does not influence the results of treatment.

Adult↗
PubMed2005

The eyes of Johann Sebastian Bach.

Johann Sebastian Bach's only physical problem seems to have been his vision. Myopia seems most likely, and it is probable that he developed cataracts at an older age. In addition to the cataracts, his worsening vision may have been due in part to some other eye problem. During the last year of his life, Bach's vision became so poor that he decided to have his eyes operated on. Two operations were performed in 1750 by the traveling English eye surgeon John Taylor. Most likely the first operation was Taylor's standard couching procedure. About 1 week after the first operation, Bach had to be operated on again because of a reappearance of the cataract. Many painful and/or vision-reducing complications could have been induced by these intraocular operations: uveitis or endophthalmitis, secondary glaucoma, hemorrhage, retinal detachment, and even sympathetic ophthalmia. Bach was "completely blind" after the operations, and he died less than 4 months after the final operation.

Eye Diseases↗
PubMed1979

Experimental allergic uveitis: clinicopathologic features associated with varying doses of S antigen.

Considerable differences were observed in the experimental autoimmune disease elicited by retinal S antigen, depending on the immunizing dose. An inoculum of 50 microgram produced a massive panophthalmitis containing many polymorphonuclear leukocytes, eosinophils, and mononuclear cells. A less severe endophthalmitis was seen in animals receiving 25 microgram of antigen. Animals receiving between 5 and 10 microgram of antigen developed a disease characterized by a granulomatous uveitis. The inflammatory infiltrate consisted primarily of mononuclear and epithelioid elements and appeared virtually identical to that seen in sympathetic ophthalmia. One microgram of S antigen produced primarily a nongranulomatous posterior uveitis composed chiefly of mononuclear cells. The principal change in the character of the disease occurred at dose levels between 10 and 25 microgram. This change consisted of the disappearance of polymorphonuclear leukocytes and eosinophils at the lower dose levels. These histopathologic changes suggest that at higher dose levels an immune complex disease may be superimposed on or replace a presumably cell-mediated hypersensitivity response.

Animals↗
PubMed1986

HLA-DR antigens on retinal pigment epithelial cells from patients with uveitis.

The pathogenic mechanisms involved in immunologically associated ocular diseases are not clearly understood. To further evaluate these types of disorders, we examined the expression of HLA-DR antigen on eye sections from normal individuals and five patients (six eyes) with ocular inflammation (sympathetic ophthalmia and chronic uveitis). Using immunoperoxidase staining technique and the complement-mediated cytotoxicity assay, we detected the presence of HLA-DR antigens on retinal pigment epithelial (RPE) cells from uveitic eyes. In contrast, HLA-DR antigen was not detected on RPE cells from normal ocular tissue. Our study shows that during the course of human ocular inflammatory disorders, the RPE cell is activated to express HLA-DR antigens. This antigen expression may be important in the initiation and/or perpetuation of immune reactivity in the eye.

Adolescent↗
PubMed1986

Uveitis induced in primates by interphotoreceptor retinoid-binding protein.

Interphotoreceptor retinoid-binding protein was found to be highly uveitogenic in primates. All six monkeys immunized with bovine interphotoreceptor retinoid-binding protein developed ocular inflammation. The main clinical changes were sheathing of retinal vessels and deep well-circumscribed yellow-white lesions. Histologic changes in the retina included shortening of the outer segments and foci of inflammation, which extended through all retinal layers. Particularly profound were the choroidal changes, such as severe inflammatory infiltration, which often formed focal granulomas with epithelioid and giant cells. Some granulomas had the structure of Dalen-Fuchs nodules. These structures and other histologic changes in the monkeys closely resemble those in uveitic conditions in humans, such as sympathetic ophthalmia or Vogt-Koyanagi-Harada syndrome. These findings show that antigen that localizes specifically in the retina may initiate an immunopathogenic process affecting mainly the choroid.

Animals↗
PubMed1995

Clinically successful contact transscleral krypton laser cyclophotocoagulation. Long-term histopathologic and immunohistochemical autopsy findings.

OBJECTIVE: To report long-term histopathologic findings 10 months after contact transscleral krypton cyclophotocoagulation. METHODS: The tissue response in a successfully treated eye was analyzed by light microscopy and a panel of 11 antibodies to epithelial, mesenchymal, and inflammatory cells. RESULTS: A 75-year-old man with uncontrolled angle recession glaucoma was treated with transscleral contact krypton cyclophotocoagulation (17 burns, 3.5 J each) 10 months before his death. The intraocular pressure fell from 28 to 17 mm Hg 6 months after therapy. Confluent scars straddled the posterior pars plicata and the anterior pars plana. The ciliary processes were destroyed, but the sclera and zonules were intact. Vimentin and cytokeratin 8 and 18 persisted in the degenerated ciliary epithelium. The inner connective-tissue layer and the ciliary muscle had atrophied, as shown with antibodies to the HNK-1 epitope, desmin, and alpha-smooth-muscle actin. Macrophages with phagocytized pigment and single T cells were present instead. No unusual inflammatory infiltrate was present in the choroid of either eye. CONCLUSIONS: Clinically effective ablation of ciliary processes is achieved with contact krypton laser. Little chronic inflammation and no signs of sympathetic ophthalmia were present. Atrophy of the ciliary muscle may reduce accommodative capacity in younger patients undergoing cyclophotocoagulation.

Actins↗
PubMed1997

Apoptosis in patients with posterior uveitis.

BACKGROUND: Apoptosis plays a part in the pathogenesis of autoimmune diseases. OBJECTIVE: To investigate the expression of apoptotic markers in the eyes of patients with uveitis. METHODS: With the use of immunohistochemical and in situ apoptotic detection techniques, apoptotic molecules (Fas or Fas ligand [FasL]) and nuclear DNA fragmentation were examined in 8 enucleated eyes with Behçet's disease (1), sarcoidosis (1), subretinal fibrosis and uveitis (1), sympathetic ophthalmia (4), and the Vogt-Koyanagi-Harada syndrome (1); in 5 chorioretinal biopsy specimens with acute retinal necrosis (2), multifocal choroiditis (1), sarcoidosis (1), and subretinal fibrosis and uveitis (1); and in 3 normal control eyes. RESULTS: Fas and FasL were constitutively expressed in the normal human retina, but they were expressed much less in the choroid. Increased expression of Fas and FasL was found in the retina, chorioretinal scar, and choroidal granulomas in uveitic eyes. However, Fas and FasL expression was absent in the biopsy specimens with acute retinal necrosis, and little Fas or FasL was noted on infiltrating lymphocytes. DNA fragmentation was also identified in eyes with chorioretinal scar and gliosis. CONCLUSIONS: Apoptosis occurs in uveitic eyes and may play a regulatory role in limiting ocular inflammation. In uveitic eyes, a dysregulation of the Fas-FasL apoptotic pathway may lead to gliosis and fibrosis.

Adolescent↗