SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The article on corneal injuries illustrates the means by which mechanical, chemical, and radiant energies interrupt the normal anatomy and physiology of the cornea. Methods of diagnosis and management of such problems, including those caused by contact lenses, are presented.
Severe corneal ulceration related to self-inflicted injury in the presence of congenital corneal anaesthesia is described in four boys under 2 1/2 years of age. The ulcers had failed to heal until it was recognised that the children were scratching their own eyes. The application of arm splints allowed rapid healing. Although corneal ulceration is a recognised complication of congenital corneal anaesthesia, this preventable cause of the ulceration has not previously been recognised. In two cases there were isolated recurrences which healed quickly with the reapplication of splints. All four children had good vision initially, and, although there were no overt gross development abnormalities, two had neurological signs on detailed investigation suggesting cerebellar or brain stem malformation and one had unilateral anophthalmos, talipes equinovarus, and patent ductus arteriosus. All the children showed normal intellectual development. Whether the eye scratching behaviour was the primary cause of the ulceration or merely an aggravating factor, the identification of this abnormal behaviour is important in any child with idiopathic corneal ulceration, as even in the presence of congenital corneal anaesthesia the eyes heal quickly with effective splinting of the elbows. It is therefore important to test sensation of the cornea and face and to consider the possibility of self-inflicted injury in children with refractory corneal ulceration, as in our cases there were no other consistent diagnostic features.
The perforating injuries of corneal and scleral with and without foreign body must be localised and treated in urgency. The rule of repairing and prophylaxis of complications must be carefully respected.
The immediate polymorphonuclear leukocyte (PMN) response in the tear fluid was investigated following five different types of corneal injury. All injuries produced significant amounts of PMNs in the tear fluid within the first 6 hr of injury. Histological examination of injured corneas demonstrated that PMNs were attached to the denuded surface but were unable to attach to intact epithelium. Topical arachidonic acid, prostaglandin (PG) PGE1 and PGE2, and prostacyclin (PGI2) induced the arrival of PMNs into the tear fluid of normal rabbit eyes, but topical PGF2 alpha, PG-6-keto-PGF1 alpha, and thromboxane did not elicit a PMN response from normal conjunctiva. Tear fluid samples 2 to 4 hr following corneal epithelial denudation demonstrated PGE-type activity. Pretreatment with topical (0.05% and 0.5%) and intraperitoneal (i.p.) indomethacin (100 mg/kg) markedly inhibited the PMN response following partial corneal epithelial denudation. However, an i.p. dose of 5 mg/kg indomethacin potentiated the tear fluid PMN response following corneal injury. The inhibition of the PMN response by indomethacin suggested that arachidonic acid metabolites may be involved in the mediation of PMN chemotaxis following corneal injury.
OBJECTIVE: To assess the analgesic effects of a topical non-steroidal anti-inflammatory agent, flurbiprofen 0.03%, during healing after superficial corneal injuries. METHODS: 401 patients treated for corneal abrasion in a five month period were randomly allocated to one of four treatment groups: polyvinyl alcohol alone (control), homatropine 2%, flurbiprofen 0.03%, or homatropine 2% followed by flurbiprofen 0.03%. Treatments were given for 48 h. Ocular pain was recorded on a visual analogue scale by the patients over the first 24 h, and use of oral analgesics was also recorded. Usable responses were received from 224 patients (55.8%). RESULTS: Patients treated with flurbiprofen had significantly lower pain scores for the 24 h duration of the study than controls (P < 0.05). CONCLUSIONS: Flurbiprofen eye drops provide more effective pain relief than traditional treatments for superficial corneal injuries.
PURPOSE: The effects of anti-inflammatory non-steroidal therapy combined with free-radical scavengers were studied and compared to corticosteroid use in the treatment of experimental corneal injury. METHOD: Eighty New Zealand albino rabbits were used in this study. A corneal alkali burn was induced by applying 1-N NaOH filter paper on the central axis of the right cornea for 30 s. Animals were distributed into five treatment groups: group 1 (control group) was only given gentamicin; group 2 was treated with 0.5% dimethylthiourea (DMU); group 3 received 1% dexamethasone; group 4 was given combined 0.5% DMU and 1% indomethacin; group 5 was treated with 0.5% DMU and 0.1% diclofenac sodium. One 50-microliter drop of gentamicin was instilled every 12 h, whereas the other drugs were instilled every 6 h (50 microliters). All groups received the same antibiotic treatment as the control group. The animals were killed on the 5th day. Inflammatory index, area and perimeter of the wounded corneal zone, and corneal transparency were evaluated. RESULTS: No significant differences in the inflammatory index were found between the treatment groups and the control group after 72 h. Significant differences (p < 0.001) were observed at 24 h in groups 3-5 when compared with the control group. Planimetry showed significant differences in group 4 when compared with the other groups (p < 0.05). Corneal transparency study showed statistically significantly better values in groups 4 and 5, when compared with the other groups, including group 3 (p < 0.05). CONCLUSIONS: The use of 0.5% DMU combined with 1% indomethacin can be considered an alternative to corticosteroid treatment in our experimental chemical corneal injury.
83 cases (97 eyes) of keratoplasty after chemical corneal injury were followed up for a mean 14 months with the results that 21 (21.6%) grafts were transparent and 76 (78.4%) opaque or semitransparent. The success rate depended on the severity of the chemical injury; it was 87.5% for type A corneal scarring and 15.7% for type B. The causes of graft failure were postoperative epithelial erosion (70.7%) and corneal rejection (28.0%). Most patients with epithelial erosion had problems of insufficient tear secretion and tear-film defects. The prevention and management of graft failure were discussed.
Delayed re-epithelialization of the cornea after injury usually precedes stromal ulceration. Previous findings using a rat thermal injury model suggested that re-epithelialization is impeded by products of resident corneal cells, which destroy adhesive structures at the basement membrane zone. In this study, we provide additional evidence for this concept. Failure to re-epithelialize was found to correlate with an increase in the amounts of gelatinolytic matrix metalloproteinases present in the rat cornea. One of these gelatinases, gelatinase B, is synthesized by the resident corneal cells, and inhibitions of its synthesis correlated with inhibition of basement membrane dissolution. The matrix metalloproteinases collagenase and stromelysin are also synthesized by resident corneal cells in thermally injured corneas of rabbits, but the timing of bulk enzyme synthesis correlated more closely with deposition of repair tissue in the stroma than with failure to re-epithelialize. Nevertheless, in human corneas with repair defects, gelatinase B and collagenase are synthesized by cells in the basal layer of the epithelium directly adjacent to the basement membrane, suggesting that both could participate in dissolution of this structure. Importantly, treatment of thermally injured corneas with a synthetic inhibitor of matrix metalloproteinases significantly improved basement membrane integrity. These data support the concept that over-expression of matrix metalloproteinases by resident corneal cells impedes re-epithelialization after some types of corneal injury.
BACKGROUND: Recognising self-inflicted injuries is the prerequisite to initiate specific, psychiatric, therapy of the often underlying psychiatric disorders. The differential diagnosis of Oedipism, self-inflicted ocular injury, includes Munchausen's-syndrome, neuroses and schizophrenic psychoses. PATIENT: We present a patient in whom a self-inflicted corneal lancinating injury was the first sign of an acute relapse of his previously known paranoid-hallucinating schizophrenia, requiring immediate treatment. CONCLUSION: In patients with unexplained ocular disease self-inflicted ocular injury needs to be taken into consideration as the treatment of such patients requires close cooperation of Ophthalmologists and Psychiatrists.
A corneal abrasion is the most common eye complication during general anesthesia and recovery. It is painful, may progress to inflammation of the uveal tract, and in the presence of contamination may lead to a serious infection. Both eyes may be involved, as the two reported cases show. Possible causes include mask friction on the open eye or other careless technics. Treatment includes local application of an antibiotic ointment and an eye pressure patch. In addition, a cycloplegic and mydriatic solution is instilled to prevent synechiae (in the presence of a secondary iridocyclitis) and to relieve the pain associated with spasm of the iris and ciliary muscle. Topical application of local anesthetics should be avoided, as they delay regeneration of corneal epithelium and may promote keratitis.
Explore the source record for details and available documents.
Central corneal alkali burn injuries were induced in rabbits by applying five NaOH concentrations on uniformly soaked 7 mm filter paper discs. Clinical parameters were evaluated daily by microscopic examination and photography, and corneal myeloperoxidase levels were measured periodically. Satisfactory alkali burn models of corneal inflammation, vascularization and ulceration were developed by manipulating the alkali concentration.
Fibronectin plays an important role in wound healing and cell differentiation. The present study measures fibronectin levels in aqueous humor from injured corneas. In response to transcorneal freezing treatments, a thickened scar-like matrix is deposited on the posterior surface of rabbit corneas. This posterior collagenous layer (PCL) is visible grossly and has a uniform diameter. Aqueous humor from eyes with established posterior corneal scarring has significantly less fibronectin compared with control eye aqueous humor. Tissue culture experiments show that corneal endothelial cells from control eyes and PCL-associated cells from injured eyes produce similar amounts of fibronectin. The marked decline in fibronectin levels in aqueous humor in scarred corneas supports the hypothesis that fibronectin plays a role in the pathological events which result from corneal injury.
To avoid cross-infection, tonometers are sterilised before use on patients. When not carefully handled, the sterilising solutions could cause ocular injury. Two cases of corneal damage caused by alcohol used in sterilising the Schiotz tonometer are reported. Suggestions are made on how to avoid such iatrogenic injuries.
Explore the source record for details and available documents.
He-Ne laser stimulation was used in multiple-modality treatment of 512 patients with various corneal conditions: 217 with perforating wounds, 75 with chemical and thermal burns, 48 with ulcers of various origins, and 162 with endothelial-epithelial dystrophy resulting from cataract extraction with implantation of the intraocular lens. A course of treatment consisted of 6 to 10 daily 3 min exposures at radiation power density of 50-100 micro W/cm2 on the cornea. The effect achieved by laser stimulation was significantly superior to that of routine methods of treatment used in the reference groups. He-Ne laser stimulation was conducive to a sooner reduction of the inflammatory processes, to recovery of the corneal sensitivity and epithelialization, and to shortening hospital treatment.
Explore the source record for details and available documents.
Explore the source record for details and available documents.