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Extensive corneal epithelial defect associated with internal hordeolum after uneventful laser in situ keratomileusis.

This report illustrates a retrospective case review in which extensive corneal epithelial ulceration occurred concomitantly with an internal hordeolum in the inferior forniceal conjunctiva 24 hours after an uneventful laser in situ keratomileusis. The internal hordeolum and epithelial defect were successfully managed using a bandage soft contact lens, a course of topical dexamethasone and tobramycin, and generous lubrication.

Administration, Topical↗

[Hordeolum].

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Hordeolum↗

[Ophthalmic application of intravenous cephradine (author's transl)].

Basic and clinical experiments were performed on intravenous cephradine (CED) in ophthalmological field. The results are summarized as follows. 1. Serum concentration: After intravenous injection of 1.0 g CED, in a single dose, to a healthy adult, the peak of serum level (34.0 mug/ml) was attained at 15 minutes, then decreased quickly to 2.3 mug/ml by 6 hours. 2. Ocular penetration in rabbit eye: (1) Aqueous humor concentrations: The peak level of aqueous humor (13.45 mug/ml) was obtained at 30 minutes after intravenous injection of 50 mg/kg, in a single dose. Aqueous/Serum ratio was 38.07%. After instillation of 5 mg/ml solution of CED, 5 times every 5 minutes, the aqueous level was recognized 30 minutes and 1 hour, and no detectable 4 hours. After 50 mg/0.5 ml CED subconjunctival injection, in a single dose, the high aqueous levels were observed at 30 minutes and 1 hour, and still detectable 4 hours later. (2) Ocular tissue concentrations: The ocular tissue concentrations at 30 minutes after intravenous injection of 50 mg/kg CED were high in both outer and inner parts of the eye. After 4 hours, the tissue levels remained relatively high concentrations. (3) CLINICAL RESULTS: Intravenous administration of 0.5, 1.0 or 2.0 g CED 1 or 2 times daily revealed excellent or good effects in 8 of 12 cases, such as external hordeolum, internal hordeolum, lid abscess, chronic dacryocystitis, orbital abscess and corneal ulcer. (4) Side effects: Three cases out of 12 complained burning sensation by intravenous injection of CED, but in neither case was it found necessary to withdraw the drugs. No severe side effects such as allergic reactions were observed. No abnormal findings in hepatic and renal function tests were observed.

Adult↗

Fibrous histiocytoma of the lacrimal sac.

Fibrous histiocytoma is a rare tumor whose ocular manifestations usually involve the orbit or, less commonly, the conjunctiva and ciliary body. We have treated two patients with fibrous histiocytoma of the lacrimal sac. One, a 62-year-old woman who had had hordeolum and trachoma, had a visual acuity of counting fingers at 1 m in the affected eye. The fellow eye had been enucleated ten years previously. The entire lacrimal sac was surgically removed and a brown cystic tumor measuring 28 x 12 x 10 mm was found. The second patient, a 32-year-old man, had undergone an unsuccessful dacryocystectomy for epiphora. When he underwent a dacryocystorhinostomy some months later, a mass measuring 20 x 15 x 12 mm was found in the wall of the lacrimal sac. Microscopic examination of the two excised lacrimal sacs showed that the walls were thickened by cells resembling fibroblasts and by cells resembling histiocytes. The fibroblasts were characterized by collagen production, were fusiform or oval in shape, and were arranged in bundles. The histiocytes were larger and had abundant (and sometimes vacuolated) cytoplasm. All the cells appeared to be mature.

Adult↗

Multiple recurrent hordeola associated with selective IgM deficiency.

An external hordeolum is an acute, suppurative inflammation of the glands of Zeis and sweat glands or hair follicles most commonly caused by staphylococci, usually in the setting of a chronic blepharitis.(1) We report a case of a boy with unilateral multiple recurrent hordeola in association with selective IgM deficiency.

Child↗

[Anesthetic management of a patient with West syndrome].

A 21-year-old female with West syndrome was scheduled for resection of hordeolum. She had an episode of convulsion at three months of age, and was diagnosed as having West syndrome at one year of age. She had epileptic seizures twice a week in spite of administration of phenytoin, clonazepam and sodium valproate. These drugs had been administered till the morning of the surgery. After premedication with atropine 0.25 mg, anesthesia was induced with propofol (12-->10-->8 mg.kg-1.h-1). The tracheal intubation was performed with vecuronium 0.1 mg.kg-1 and anesthesia was maintained with continuous infusion of propofol 6-8 mg.kg-1.h-1 and local infiltration with 1.0% lidocaine 5 ml. We administered phenytoin to prevent epileptic seizures during the surgery. No epileptic seizures occurred perioperatively. We conclude that propofol may be useful for a patient with West syndrome, and we should be careful not to lower the threshold for convulsion during the perioperative period.

Adult↗

[Ophthalmic use of clindamycin-2-phosphate (author's transl)].

Bacterial and clinical experiments for ophthalmic use of clindamycin-2-phosphate (CLDM-2-P) were performed and the results were summarized as follows. 1. The distribution of sensitivity for 100 strains of Staphylococcus aureus isolated in 1975 was in the range of less than or equal to 0.19 approximately greater than or equal to 100 mug/ml, and majority of them (96.0%) were in less than or equal to 0.39 mug/ml. 2. The serum concentration by intramuscular injection of 300 mg and 600 mg CLDM-2-P in a single dose respecitvely reached the peak level after 2 hours and decreased gradually until 12 hours in both of them. 3. Ocular penetrations were examined in rabbit eyes. (1) After instillation of 1% CLDM-2-P solution, the aqueous level reached the highest after 1 hour and measurable after 6 hours. (2) After subconjunctival injection of 5 mg/0.5 ml CLDM-2-P, the aqueous level reached the highest after 2 hours and decreased until 6 hours. (3) After intramuscular injection of 100 mg/kg, the aqueous concentration was recognized from 1 to 8 hours, and peak was reached after 1 hour. 1 to 8 hours, and peak was reached after 1 hour. Aqueous-serum ratio in 1 hour was 37.13%. The ocular tissue concentrations at 2 hours showed relatively high levels in both of outer and inner parts of the eye. 4. The intramuscular injection of CLDM-2-P, 300 approximately 1800 mg daily, against suppurative ocular infections revealed excellent effects on cases of external hordeolum, acute chalazion, lid abscess, orbital phlegmone, corneal infiltration, corneal ulcer, and iridocyclitis purulenta. 5. Side effects: Two cases out of 22 cases complained of diarrhoea and bitter taste after injection, and able to be treated continuously by the drug. No abnormal findings in hepatic and renal tests were observed and no servere side effects like allergic reactions were recognized.

Abscess↗

[Studies on fortimicin in the field of ophthalmology].

Bacteriological and clinical studies of fortimicin in the field of ophthalmology were performed and the results obtained were as follows. 1. The concentration of fortimicin in serum, primary aqueous humor and secondary aqueous humor after intramuscular injection of 30 mg/kg to rabbit reached the peak value of 23.36 microgram/ml after 1/2 hour, 6.07 microgram/ml after 1 hour and 60.6 microgram/ml after 1 hour, respectively. 2. The concentration of fortimicin in primary aqueous humor after subconjunctival injection of 10 mg (0.5 ml) in the rabbit eye reached the peak value of 8.06 microgram/ml after 1/2 hour. 3. The concentration of fortimicin in plasma and primary aqueous humor after intramuscular injection of 200 mg in patients of cataract before operation reached the value of 8.85 microgram/ml and 0.74 microgram/ml after 1 hour. 4. Fortimicin was administered to 5 cases of internal hordeolum and 2 cases of corneal ulcer. Clinical effects were excellent in 3 cases, good in 2 cases and fair in 2 cases. Side effect was observed diarrhea, but the causal relationship with fortimicin was unknown.

Adult↗