How to Relieve Eye Strain

Quantum Vision System

The Quantum Vision System is an overall package to heal and thereby improve vision all together. The step by step guide and the instructional videos contain lots of information regarding the dos and don'ts to protect eyes from further damage. The program is not based on the treatment but also saves us from damaging vision with the use of lenses or glasses. The 3 in one package contains methods to nourish, cleanse, and effectively improve the vision with simple exercise. The eye chart provided is to be used to track the vision improving progress. According to the treatment program, Quantum Vision System can be used to treat various eye problems like Myopia or Near sightedness, Hyperopia or Farsightedness, Prebyopia, Dyslexia, Macular Degeneration, Lazy Eye or Amblyopia, Astigmatism, Cataract, Glaucoma, Tension Headache and Eye strain. The program can treat visual problems within 2 to 3 months.

Quantum Vision System Summary


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Immunopathogenesis of Thyroid Eye Disease

A causative role of stimulating TSH-R antibodies (TSI) in the development of GO is very attractive as it allows a unifying hypothesis for the various clinical manifestations of GD Graves' hyperthyroidism (GH), GO and thyroid dermopathy. Arguments against such a hypothesis cannot, however, be dismissed. TSI, in contrast to T cells, cross the placenta and may cause fetal and neonatal hyperthyroidism. GO, however, has never been observed in neonatal thyrotoxicosis TSI are almost always present in GH, but clinically apparent GO develops only in a subset of the patients. Lastly, serum TSI are only slightly related to the severity of GO, although more so to the activity of the eye disease 18 . Whereas TSI might contribute to further progression of GO, it remains doubtful if TSI act as the primary mediator in the immunopathogene-sis of GO.

Treatment of Thyroid Eye Disease in Childhood

One important issue is the use of steroids in patients with TED who received radioiodine treatment (RAI) for hyperthyroidism. Two randomized, prospective, controlled clinical trials by Tallstedt et al. 33 and Bartalena et al. 39 clearly demonstrated in adults that radioiodine administration may be associated with a progression of ophthalmopathy in a small proportion of patients ( 15 ). GC can prevent, at relatively low doses and for short periods of time, exacerbation of eye disease and can effectively cure pre-existing ocular manifestations.


The simplest assay system is represented by cells grown in vitro. Isolated cells of the TM, ciliary muscle, and ciliary process, and various retinal neurons in culture have proven useful for validating disease targets, for studying the mechanisms of action of ocularly indicated drugs, for studying the etiologies of ocular hypertension and glaucoma, and for discovering new drugs for treating ocular hypertension and glaucoma. For example, human CM and TM cells33 have mRNAs and functionally active receptors for FP-class PGs that potently and efficaciously lower IOP in nonhuman primates and humans. These cells release MMPs4,34 in response to FP-receptor activation and are involved in digesting the ECM in the anterior chamber, thereby enhancing the AH efflux and lowering IOP. Similar human TM and CM cell-based studies have demonstrated the existence of the cellular machinery for 5HT2 receptor agonists, which also induce Clearly, the best models to study glaucoma are animals and human...


Between July -November 1998 patients were selected from the practices of 9 ophthalmologists in a group practice of the Southern California Kaiser-Permanente Medical Group. All consecutive adult patients coming to cataract surgery were invited to participate. 1. Rosen P, Kaplan B, David K. Measuring Outcomes of Cataract Surgery Using the Quality of Well-Being Scale and the VF-14. Journal of Cataract & Refractive Surgery. Cataract baseline (pre - surgery scores) 1. Rosen P, Kaplan B, David K. Measuring Outcomes of Cataract Surgery Using the Quality of Well-Being Scale and the VF-14. Journal of Cataract & Refractive Surgery. Cataract baseline (pre - surgery scores)


Xerophthalmia occurs in one third of patients during isotretinoin therapy and is caused by decreased meibomian gland secrection, leading to an altered composition of the tear film and shortening of the tear film break-up time. This may lead to blepharoconjunctivitis, exposure keratitis, and corneal ulceration in extreme cases. Some patients may also develop a contact lens intolerance. Application of artificial tears several times a day can help alleviate these symptoms. Other ophthalmologic toxicities from retinoids include corneal opacities, decreased night vision (as a result of interference with steps in the rhodopsin cycle), transient acute myopia, papilledema, and cataracts. Rarely, dry eye syndrome and decreased night vision have been reported to persist after discontinuation of therapy. Etretinate and acitretin use have been shown to cause many of the same ocular side effects as isotretinoin therapy. However, isotretinoin seems to have a greater ability to suppress meibomian...

Sharp Eyesight

Human infants show clear evidence of being able to see at birth. For example, they stare for longer periods of time at a familiar face, such as their mother. However, their visual skills appear to be very poor as compared to those of an adult. Visual acuity, or the ability to detect fine detail, is almost entirely absent at birth (Figure 10.13). One measure of visual acuity is the number of black and white lines that can be observed per degree of visual space. (The rule of thumb states that, at arms distance, your thumb occupies about one degree of visual space.) Adults can see about 30 black and white lines per degree, but babies can only see about one. In the more common language of an eye doctor, the baby sees at 20 feet what a normal adult can see at 600 feet, and adult sensitivity is reached between 3 and 5 years of age (Birch et al., 1983). In principle, this level of acuity would permit an infant to distinguish the fingers of a hand, but their actual abilities remain somewhat...


A cataract is a cloudy area in the normally clear lens inside the eye. The cloudy area worsens as protein fibers in the lens clump together, preventing light rays from passing through the lens and focusing on the retina, the light-sensitive membrane that lines the back of the eye. Cataracts usually develop very gradually, and early changes in the lens of the eye may go unnoticed. As the cataract continues to develop, symptoms begin to appear. The person may have blurred vision in one eye. Bothersome glare caused by bright sunlight or vehicle headlights is common. The person also may have poor night vision. Colors appear to be less bright. The person may experience increased nearsightedness that requires frequent changes in his or her eyeglass prescription. The person also may find it more difficult to see well enough to read and perform other daily tasks. Cataracts in adults can be classified into three general types, depending on their location in the lens. The most common type is...

Genetic Considerations

Examine the patient's fingers for signs of thickening. Inspect the patient's torso, noting a barrel chest or kyphosis. Note any signs of bowed legs. Assess the patient's skin for signs of oiliness or excessive sweating (diaphoresis). Assess the patient's hand strength. Test the patient's vision for bitemporal hemianopia and loss of visual acuity. Note a deep, hollow-sounding voice.

The question of homology

Reasons for this lack of comparability are suggested, including fundamental grade differences between the groups such as the lesser visual acuity of lemurs. This is clearly an example of too many concurrent dissimilarities alongside other similarities, rendering the comparative method unusable, and further theoretical groundwork is needed first. In other words, the conditions are not met for the Method of Agreement, the Method of Differences, or the Joint Method.

Evaluation of Eyelid Malpositions

Levator Muscle Test With Rule

A history of previous eye surgery is important. Eyelid malpositions are not uncommon sequelae of retinal detachment surgery, strabismus surgery or cataract extraction. Ptosis is reported to occur following cataract surgery in 7-8 of cases. Other surgery, especially intracranial or thoracic procedures, may result in central third nerve palsy or Horner's syndrome respectively. For all patients with eyelid malpositions a complete ophthalmic examination is mandatory. Visual acuity with a current refraction is recorded, and especially in children presenting with upper eyelid ptosis, the presence of amblyopia must be ruled-out. In any patient unexplained decrease in vision requires comprehensive investigation. Pupil size and reactivity should be measured, and any asymmetry noted. Corneal examination must evaluate the presence of keratopathy secondary to corneal exposure as a result of the malpositioned eyelid. Appropriate documentation of all eyelid malpositions with photographs and formal...

Pharmacokinetics and Uses

Pharmacokinetics An antibacterial-antifungal halogenated hydrocarbon similar chemically to trichloroethanol, the active metabolite of chloral hydrate ( Mickey Finn ). Uses Antimicrobial preservative in cosmetics and drugs, especially injectables, otic and ophthalmic topicals (contact lens cleansers).

Blepharophimosis Syndrome

Blepharophimosis Ptosis Epicanthus

TREATMENT Treatment is indicated when visual function is threatened or for improved cosmesis. When the ptosis is severe enough to cause amblyopia, repair must be undertaken at an early age. When levator muscle function is poor or absent a frontalis suspension procedure will be required. Correction of the epicanthus and telecanthus are best delayed until the child is at least two years old in order to allow for tissues around the nose to develop enough to make surgery easier. In most cases any telecanthus does not have to be repaired since correction of the epicanthus will give adequate cosmetic results. The epicanthus is repaired with a Y to V procedure or a more complicated four-flap technique that combines a Y to V with multiple Z-plasties. When telecanthus is to be corrected, medial displacement of the canthal tendons with or without resection of bone will usually be required.

Discharge And Home Healthcare Guidelines

Cataract DRG Categ ry 039 Cataracts are the leading cause of preventable blindness among adults in the United States. The incidence of cataracts in the United States is 1.2 to 6.0 cases per 10,000 people. A cataract is defined as opacity of the normally transparent lens that distorts the image projected on the retina. The lens opacity reduces visual acuity. As the eye ages, the lens loses water and increases in size and density, causing compression of lens fibers. A cataract then forms as oxygen uptake is reduced, water content decreases, calcium content increases, and soluble protein becomes insoluble. Over time, compression of lens fibers causes a painless, progressive loss of transparency that is often bilateral. The rate of cataract formation in each eye is seldom identical. Without surgery, a cataract can lead to blindness.

Primary Nursing Diagnosis

Sensory and perceptual alterations (visual) related to decreased visual acuity SURGICAL. There is no known medical treatment that cures, prevents, or reduces cataract formation. Surgical removal of the opacified lens is the only cure for cataracts. The lens can be removed when the visual deficit is 20 40. If cataracts occur bilaterally, the more advanced cataract is removed first. Extracapsular cataract extraction, the most common procedure, removes the anterior lens capsule and cortex, leaving the posterior capsule intact. A posterior chamber intraocular lens is implanted where the patient's own lens used to be. Intracapsular cataract extraction removes the entire lens within the intact capsule. An intraocular lens is implanted in either the anterior or the posterior chamber, or the visual deficit is corrected with contact lenses or cataract glasses. COMPLICATIONS. Complications may include retinal disorders, pupillary block, adhesions, acute glaucoma, macular edema, and retinal...

Deceiving an Orb Weaver

Gasteracantha's eyesight is too poor to recognize Portia as a predator. However, Gasteracantha has an acute ability to detect and interpret web signals displacements, even very small displacements, of its web's silk lines (Witt, 1975). Portia's task is to get within attacking distance without eliciting the wrong response from Gasteracantha. This large spider is fully capable of preying on Portia should it get the upper hand. Just walking across the web will not work for Portia. The resulting web signals will give it away.

Rehabilitation of the Upper Third of the Face

The main problems to be addressed in this region are improvement of eye closure and correction of laxity of the lower eyelid. Although dynamic muscle procedures have been described to restore eyelid function, most surgeons today rehabilitate the eye with static procedures because they are simple and effective. Inadequate eye closure can be improved by placement of a gold weight in the upper eyelid or insertion of an eyelid spring. Most surgeons prefer gold weight insertion over springs because the procedure is simple and easier to perform. The disadvantage of gold weight is that it requires gravity on the weight of the gold to pull the eyelid down and thus does not work effectively when the patient is supine. The advantage of a spring over gold weight is that its function is not dependent on gravity therefore, it automatically protects the cornea during sleep. However, it is much more complicated and difficult to place a spring, and the potential for complications is greater....

Tamoxifen and Breast Cancer Prevention

An assessment of the incidence of cataract formation was made using patient self-report. A small increase in cataracts was noted in the tamoxifen group a rate of 24.8 women per 1000 compared to 21.7 in the placebo group. There was also an increased risk of cataract surgery in the women on tamoxifen. These differences were marginally statistically significant and observed in the older patients in the study. These findings emphasize the need to assess the patient's overall health status before making a decision to use tamoxifen for breast cancer risk reduction. These observations are also particularly interesting based on the early controversy in the 1960s (see Section 8.08.2) about the safety of this drug group.

Neurofibromatosis Type

Multiple meningiomas (two or more) and unilateral vestibular schwannoma or any two of the following schwannoma, glioma, neurofibroma, or cataract. 2. First-degree family relative with NF2 and unilateral vestibular schwannoma at less than 30 years of age or any two of the following meningioma, schwannoma, glioma, or juvenile lens opacity (posterior subcapsular cataract or cortical cataract). 1. Unilateral vestibular schwannoma at less than 30 years of age and at least one of the following menin-gioma, schwannoma, glioma, or juvenile lens opacity (posterior subcapsular cataract or cortical cataract). 2. Multiple meningiomas (two or more) and unilateral vestibular schwannoma at less than 30 years of age or at least one of the following schwannoma, glioma, or juvenile lens opacity (posterior subcap-sular cataract or cortical cataract). In the Manchester criteria, any two of' refers to two individual tumors or cataract, whereas in the other sets of criteria, it refers to two tumor types...

Congenital And Perinatal Infection

Anecdotal reports have suggested that embryopathy may occur in very rare cases of primary maternal EBV infection in early gestation (9,10). However, the exact risk of congenital infection with EBV is not known. Various congenital defects have been described in the few reported infants with documented congenital EBV infection or whose mothers had infectious mononucleosis during pregnancy (11). No specific pattern has been recognized. Reported abnormalities include micrognathia, congenital heart disease, cataract, microphthalmia, hip dysplasia, biliary atresia, and central nervous system abnormalities. Other studies of women with infectious mononucleosis or primary asymptomatic EBV infection in early pregnancy failed to document serologic or virologic evidence of EBV infection in their offspring (7). Although intrauterine transmission of EBV has been documented in a study using PCR, none of infants with positive PCR had clinical abnormalities (12). Maternal human immunodeficiency virus...

Additional Contraindications

Ophthalmic use Infants less than 3 months of age, primary glaucoma or a tendency toward glaucoma, adhesions between the iris and the lens, geriatric clients and others where undiagnosed glaucoma or excessive pressure in the eye may be present, in children who have had a previous severe systemic reaction to atropine. Special Concerns Use with caution in infants, small children, geriatric clients, diabetes, hypo- or hyper-thyroidism, narrow anterior chamber angle, individuals with Down syndrome. Additional Side Effects Ophthalmologic Blurred vision, stinging, increased intraocular pressure, contact dermatitis. Long-term use may cause irritation, photophobia, eczematoid dermatitis, conjunctivitis, hyperemia, or edema.

Heart Pacemaker Cellm2 Receptor Activation

Sympathetic Parasympathetic Vaso

The choline ester, carbachol, activates M-cholinoceptors, but is not hydrolyzed by AChE. Carbachol can thus be effectively employed for local application to the eye (glaucoma) and systemic administration (bowel atonia, bladder atonia). The alkaloids, pilocarpine (from Pil-ocarpus jaborandi) and arecoline (from Areca catechu betel nut) also act as direct parasympathomimetics. As tertiary amines, they moreover exert central effects. The central effect of muscarine-like substances consists of an enlivening, mild stimulation that is probably the effect desired in betel chewing, a widespread habit in South Asia. Of this group, only pilocarpine enjoys therapeutic use, which is limited to local application to the eye in glaucoma. Uses. The quaternary carbamate neostigmine is employed as an indirect parasympathomimetic in postoperative atonia of the bowel or bladder. Furthermore, it is needed to overcome the relative ACh-deficiency at the motor endplate in...

Disturbances of Body Image Perception

Constructional apraxia is characterized by the inability to represent spatial relationships in drawings, or with building blocks. Affected patients cannot copy a picture of a bicycle or clock. Everyday activities are impaired by the inability to draw diagrams, read (analog) clocks, assemble pieces of equipment or tools, or write words in the correct order (spatial agraphia). Hemineglect is the inability to consciously perceive, react to, or classify stimuli on one side in the absence of a sensorimotor deficit or exceeding what one would expect from the severity of the sensorimotor deficit present. Hemineglect may involve unawareness of one side of the body (one-sided tooth brushing, shaving, etc.) or of one side of an object (food may be eaten from only one side of the plate, eyeglasses may be looked for on only one side of the room). When addressed, the patient always turns to the healthy side. Neurological examination reveals that double simultaneous stimulation (touch, finger...

Gender Ethnicracial And Life Span Considerations

When assessing vital signs, you may note hypertension, a common complication in diabetic patients. Palpate the peripheral pulses to determine their strength, regularity, and symmetry. During the neurological examination, use an ophthalmoscope to evaluate the patient for retinopathy or cataracts. Assess the patient for any signs and symptoms of hypoglycemia or hyperglycemia (Table 2).

Unilateral Sudden Visual Loss

Patients complain of impairment of central vision (e.g., puff of smoke, fluffy ball ). The examination reveals impaired visual acuity (20 200), a central scotoma, and occasionally papilledema (when the inflammation is just behind the nerve head) Trauma (fracture of the anterior cranial fossa extending into the optic foramen) Amblyopia with papilledema (transient attacks associated with raised intracranial pressure, e.g., benign intracranial hypertension)

Inhaled corticosteroids

Inhaled corticosteroids are usually free of toxicity. Dose-dependent slowing of linear growth may occur within 6-12 weeks in some children. Decreased bone density, glaucoma and cataract formation have been reported. Churg-Strauss vasculitis has been reported rarely. Dysphonia and oral candidiasis can occur. The use of a spacer device and rinsing the mouth after inhalation decreases the incidence of candidiasis.

Alloplastic Implants

I consider e-PTFE the implant of choice for reconstructing moderate to large dorsal defects. This implant has the advantage of being readily available. It also reduces operative time, as no second surgical site is needed to harvest a graft. The implant is easily contoured and very well tolerated by patients. When stacked autologous cartilage implants are used over the nasal dorsum, grafts can become dislodged, and irregularities result when sunglasses or reading glasses are worn. This problem is less likely with the solid alloplastic implant.

Stephen A Boppart Mark E Brezinski and James G Fujimoto 1 Introduction

OCT was originally developed and demonstrated in ophthalmology for high-resolution tomographic imaging of the retina and anterior eye (2-4). Because the eye is transparent and is easily optically accessible, it is well suited for diagnostic OCT imaging. OCT is promising for the diagnosis of retinal disease because it can provide images of retinal pathology with 10- m resolution, almost one order of magnitude higher than previously possible using ultrasound. Clinical studies have been performed to assess the application of OCT for a number of macular diseases (3,4). OCT is especially promising for the diagnosis and monitoring of glaucoma and macular edema associated with diabetic retinopathy because it permits the quantitative measurement of changes in the retinal or retinal-nerve fiber layer thickness. Because morphological changes often occur before the onset of physical symptoms, OCT can provide a powerful approach for the early detection of these diseases.

The Personality of Portia

The term araneophagic refers to these spiders' preference for other spiders as prey, and jumping spider is the common English name for members of the family Saltici-dae. Although both their common and the scientific Latin names acknowledge their jumping behavior, it is really their unique, complex eyes that set this family of spiders apart from all others. Among spiders (many of which have very poor vision), salticids have eyes that are by far the most specialized for resolving fine spatial detail. We focus here on the most extensively studied genus, Portia.

Introduction Ocular Anatomy and Diseases

Most information about our surroundings is gathered by the eye, which is literally a 'window' for the brain. With an aging population, the prevalence of sight-threatening ocular diseases continues to increase. Thus, for instance, more than 70 million people suffer from glaucoma worldwide.1-3 Visual impairment caused by diabetes affects up to 90 of diabetics over 10 years of age. Likewise, pathological dry eye and ocular allergic conditions afflict 100 million patients worldwide, and age-related macular degeneration (AMD) is the leading cause of blindness among the elderly, affecting up to 28 of patients after the seventh decade of life.2 Consequently, the discovery and development of therapeutic products for the treatment of these various ocular diseases is of paramount importance, and is being actively pursued within the pharmaceutical industry.1-3

Age Related Macular Degeneration

In AMD, central visual acuity is lost due to death of macula photoreceptors located in the central portion of the retina. This pattern of vision loss is different than that in glaucoma, where peripheral vision is progressively lost. AMD can be broadly divided into two categories nonexudative, or 'dry,' AMD and exudative, or 'wet,' AMD. Dry AMD is characterized by the loss of photoreceptor cells in the macula following the death of supporting retinal pigmented epithelium (RPE) cells. Vision decline is usually gradual. Wet AMD is characterized by neovascularization of the choroidal capillaries (choroidal neovascularization (CNV)), which supply oxygen and nutrients to and remove waste products from photoreceptors and RPE cells. Wet AMD can be further subcategorized by the appearance upon examination by angiography of newly formed capillaries (1) predominantly classic, in which most of the newly formed blood vessels are well formed (2) minimally classic, in which most of the capillaries...

Clinical Trial Issues Glaucoma From an efficacy perspective, clinical trials of ocular hypotensive agents can be relatively short with well-defined endpoints of IOP reduction following once or twice daily dosing. However, recruitment of glaucoma and ocular hypertensive patients and the provision of the NCE in the correct formulation with reasonable shelf-life and stability are formidable challenges fraught with logistics issues and, ultimately, patient compliance.

Figure 7 The structures of 5fluoruracil and mitomycin C

PDT is different from and offers several distinct advantages over laser retinal photocoagulation, which was previously the only treatment option for wet AMD. The latter case involves thermal destruction of the neovascular lesion with a laser, which because of the vagaries of laser targeting and thermal energy transfer leads to collateral destruction of some surrounding tissue. The destroyed tissue permanently loses visual functionality, and patients frequently experience an immediate drop in visual acuity. PDT, however, involves the use of a 'cold' laser that only directly transfers energy to the porphyrin. The reactive oxygen species produced as a downstream event is likely to react only with the closest surrounding tissue, leading to less collateral damage. The apparent preferential accumulation of verteporfin in newly formed capillaries also helps limit unwanted tissue destruction. There are several limitations of PDT however. First, relative to placebo this therapy only slows the...

New Research Areas Glaucoma While FP prostaglandin analog esters currently dominate the therapeutic scene for treatment of ocular hypertension and glaucoma, investigators are keen to discover new drugs that may supplant the prostaglandins and or be combined with the prostaglandins in the future. On the horizon are some new ocular hypotensive agents with a variety of mechanisms of action. These include protein kinase inhibitors such as rho kinase inhibitors (e.g., Y-27632)71 myosin-II ATPase inhibitor (blebbistatin)72 5HT2 receptor agonists (a-methyl-5HT AL-34662) adenosine agonists (2-alkynyladenosine) diadenosine polyphosphates73 calcium antagonists (nivaldepine and flunarizine)74 an angiotensin AT1 receptor antagonist (CS-0 88)75 5HT1A agonists76 melatonin agonists74 dopamine agonists (PD128907, 3-PPP, CHF1035, and CHF10 24)77 agents that degrade glyocosaminoglycans (AL-3037A)78 cannabinoid agonists79 natriuretic peptides80 marine macrolides (e.g., latrunculins and bumetamide)2 chloride...

The Heritability of Chronometric Variables

The pleiotropic gene will show both phenotypic traits the child who does not have the gene will show neither of the traits. An example is the double-recessive gene for phenylketonuria (PKU), which results in two effects (1) mental retardation and (2) a lighter pigmentation of hair and skin color than the characteristic of the siblings without the PKU gene. (Nowadays, the unfortunate developmental consequences of PKU are ameliorated by dietary means.) Another likely example of pleiotropy is the well-established correlation (about + .25) between myopia and IQ. The absence of a within-family correlation between two distinct phenotypic traits contraindicates a pleiotropic correlation. The presence of a within-family correlation between two distinct phenotypes, however, is not by itself definitive evidence of pleiotropy, because the correlation could possibly be caused by some environmental factor that affects both phenotypes. Pleiotropy can be indicated by the method of cross-twin...

Arteriovenous Hemangioma Malformation

Arteriovenous Malformation Eyelids

TREATMENT Treatment is not indicated during infancy or childhood unless visual symptoms or amblyopia threatens. When treatment is required surgical resection with prior occlusion of feeder vessels is best, but is usually very difficult and can be mutilating. Identification and ligation of feeder vessels will give only temporary relief since rapid recruitment of flow from nearby arteries will reestablish blood supply in most cases. Embolization can be considered, but it carries a risk of undesirable intracranial or retinal vessel obstruction when employed in periorbital lesions. Sclerotherapy can be useful if the feeder vessels are first ligated. While laser therapy is useful for slow flow venous malformations they are less useful for the AVM.

Risk Of Fetalneonatal Infection

Maternal Varicella

This infant, whose mother had varicella during the 13th to 15th weeks of pregnancy, had bilateral microphthalmia with cataracts and an atrophic left leg. The infant died of broncho-pneumonia at age 6.5 months. (From ref. 9 with permission.) Fig. 2. This infant, whose mother had varicella during the 13th to 15th weeks of pregnancy, had bilateral microphthalmia with cataracts and an atrophic left leg. The infant died of broncho-pneumonia at age 6.5 months. (From ref. 9 with permission.) striking. The eyes may be hypoplastic, and there may be chorioretinitis, cataract, Horner's syndrome, and nystagmus. The typical limb deformity is hypoplasia, which is thought to be related to failure of the normal development of the nervous system of the extremity, which prohibits normal growth. In terms of pathogenesis of the syndrome, it has been proposed that these infants not only experience varicella in utero, but also experience zoster, which leads to the neurological damage. The...

Clinical manifestation

Onset in early childhood organs most involved the bone, the viscera, the connective tissue, and the brain lichenified, dry, thick skin with diminished elasticity increased pigmentation on the dorsum of the hands sclerodermalike changes hypertrichosis of the extremities pale colored hair neurologic symptoms hypertensive hydrocephalus syndrome, changes in the tonus of the musculature and the tendon reflex, and damage of the cranial nerves myxedema in patients with associated hypothyroidism dwarfism hepat-osplenomegaly cardiovascular involvement progressive deterioration of intellect after a period of apparently normal development speech disturbances ocular symptoms progressive clouding of the cornea, megalocornea, hereditary glaucoma, and congestion and atrophy of the optic disc death often occurs before age 10 years from progressive neurologic and cardiovascular deterioration

Batrachus porosissimus See Toadfishes

Except for studies of symmetry, studies devoted to the perception of 'beauty' in fishes do not appear to have been conducted to date. However, its perception is likely, as many species combine a high visual acuity with complexly structured colour patterns on their bodies. (See also Asymmetry Handicap principle Reproduction Sexual selection Social Darwinism).

Marcus Gunn Jaw Winking Syndrome

Marcus Gunn Syndrome

In most patients the synkinesis is used to reduce the true degree of ptosis which often is greater than appears clinically. With contraction of the masticatory muscles, most commonly the external pterygoid muscle, the ptotic eyelid shows coordinated elevation or even retraction. The characteristic appearance is a winking of the eyelid during eating or chewing. The degree of ptosis and the amount of kinetic lid elevation are related proportionately. Aberrant and sometimes bizarre synkinetic movements between the eyelid and other muscles, such as the masseter or temporalis, may be seen. Levator muscle function may be normal or somewhat decreased. Unlike congenital myogenic ptosis, the eyelid crease is usually normal in position. Various types of strabismus may be seen in 25 to 35 of cases, and amblyopia in 35 to 60 . An association between the Marcus Gunn Jaw Winking syndrome and Duane's Retraction syndrome, another neural miswiring disorder, has been reported. TREATMENT Therapy is...

Dehydrogenases and reductases

ADH is a member of the family of medium-chain alcohol dehydrogenases.32 The major function of most short-chain alcohol dehydrogenases32 in mammals is steroid metabolism. Nevertheless, many of them play important roles in drug toxification and detoxification. The 3a-hydroxysteroid dehydrogenase (3a-HSD) of rat and man oxidizes vicinal dihydrodiols of polycyclic aromatic hydrocarbons to catechols and these to quinones.33 Hence, 3a-HSD is also called dihydrodiol dehydrogenase. This reaction sequesters the pre-bay dihydrodiols of polycyclic aromatic hydrocarbons away from their critical toxification pathway to the ultimate carcinogenic dihydrodiol bay-region epoxides to produce instead the much less toxic catechols33 (Figure 3). In addition, it inactivates the highly mutagenic and carcinogenic bay region diol epoxides.34 Both of these reactions are protective, but the formation of catechols, which are further oxidized to quinones, is on the other hand also a potential toxification, since...

Safety concerns with statins

Data from animal studies have indicated that pronounced inhibition of cholesterol biosynthesis with high doses of statins induced multiple toxic side effects, including liver enzyme elevations, cataracts, skeletal muscle changes, central nervous system lesions, and certain tumors. However, overall, good safety and tolerability have been observed for the first- and second-generation statins in multiyear clinical trials, and millions of patients have been safely treated with approved doses of these agents. Withdrawals due to adverse events from statins in several multiyear trials were similar to placebo, and the overall incidence of clinically significant adverse events has been quite low. Initial concerns about cataract formation are no longer considered a significant safety issue since several clinical studies monitoring optical lens opacity with the early statins showed that these occurred at the same rate in both statin-treated and placebo groups. Since statins target cholesterol...

Ketorolac tromethamine

Clients with advanced renal impairment or in those at risk for renal failure due to volume depletion. Use in suspected or confirmed cardiovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis and in those with a high risk of bleeding. Use as an obstetric preoperative medication or for obstetric analgesia. Routine use with other NSAIDs. Intrathecal or epidural administration. Use in labor and delivery. The ophthalmic solution should not be used in clients wearing soft contact lenses. Special Concerns Use with caution in impaired hepatic or renal function, during lactation, in geriatric clients, and in clients on highdose salicylate regimens. The age, dosage, and duration of therapy should receive special consideration when using this drug. Safety and effectiveness have not been determined in children. Following cataract extraction. 1 gtt to the affected eye(s) q.i.d. beginning 24 hr after surgery and continuing for 2 weeks postoperatively.

Elements of a visual neuroprosthesis

In order for a visual neuroprosthesis to become an accepted therapeutic approach to sight restoration, it is clear that those who will utilize this technology must realize that they will not be receiving sight like those with normal vision. It is also clear that a clinically acceptable system must be virtually invisible. This means that the components must be integrated into normal systems typically worn by individuals such as eyeglasses and an external package not much larger than a pocket organizer. While such invisibility would be the eventual goal of a commercial system, first-generation experimental systems are not expected to be so constrained.

Care and Maintenance of Optical Filters

Colored glass filters are relatively robust but should be kept free of fingerprints while in use or storage. Clean with lens tissue as you would eyeglasses and handle around edges. Final cleaning with alcohol on a Q-tip cotton swab followed by wiping with lens tissue will remove most fluorescent materials that might be present. Colored glass filters should be very stable unless used directly in high-intensity light. These filters should be inspected visually for unevenness in color about every 6 months.

Experimental Autoimmune Uveoretinitis in the Rat and Mouse

Experimental autoimmune uveoretinitis (EAU) in rats and mice is a prototypic T cellmediated autoimmune disease that targets the neural retina and related tissues. The model is used to represent human sight-threatening inflammatory eye diseases that are believed to have an autoimmune etiology, and to study basic mechanisms of tolerance and autoimmunity to organ-specific antigens from immunologically privileged sites. EAU is an induced, as opposed to spontaneous, autoimmune disease model. It can be elicited by peripheral immunization with a number of purified retinal proteins or peptides derived from them (uveitogens) in adjuvant, or by adoptive transfer of lymphocytes specific to these antigens. The hallmarks of EAU are onset of ocular inflammation, disruption of the retinal architecture, and partial to complete destruction of the photoreceptor cell layer. The type, number, and size of lesions serve as a basis for a semiquantitative grading system used to score disease severity. A...

Epidermal Necrolysis Disease Spectrum

Early Photos Stevens Johnson Syndrome

Powers WJ, Ghoraishi M, Merayo-Lloves J, Neves RA, Foster CS. Analysis of the acute ophthalmic manifestations of the erythema multiforme Stevens-Johnson Syndrome toxic epidermal necrolysis disease spectrum. Ophthalmology 1995 102 1669-1676. Watts MT, Nelson ME. External Eye Disease A Color Atlas. Edinburgh Churchill Livingstone, 1992. Whitmore PV. In Duane TD ed Clinical Ophthalmology. Vol. 5. Philadelphia Harper & Row, 1983, Chap. 27.

Telemetry and power interface

Power between transmitters and receivers can be achieved with very high efficiencies over such short distances. One possible design would be the use of transmitting coils built into the image-encoding eyeglasses. Such a design will have the advantage that registering the transmitting coil over the implanted receiving coil can be readily accomplished and will not vary significantly during the course of normal daily activities of the wearer. Further, the external electronics would consist only of the eyeglasses, signal-processing electronics, and the telemetry circuitry.

Cicatricial Pemphigoid

Pemphigoid Eye

Mondino BJ, Brown SI, Lempert S, Jenkins MS. The acute manifestations of ocular cicatricial pemphigoid Diagnosis and treatment. Ophthalmology 1979 85 543-555. Mondino BJ, Brown SI. Ocular cicatricial pemphigoid. Ophthalmology 1981 88 95-100. Shore JW, Foster CS, Westfall CT, Rubin PA. Results of buccal mucosal grafting for patients with medically controlled ocular cicatricial pemphigoid. Ophthalmology 1992 383-385.

Use Of Therapeutic Immunosuppressants During Pregnancy

Two of the studies mentioned previously reported a teratogenic outcome in pregnant women who received immunosuppressive therapy. Increased risk of such morphologic defects was an early concern of physicians monitoring pregnancies of transplant recipients. Early reports suggested that cyclosporine A administration during pregnancy may increase risk of some birth defects, including dysmorphic facial appearance (Reznik et al. 1987), cataracts (Tyden et al. 1989 Dieperink et al. 1987), and cleft palate (Bung and Dietmar 1991). However, recent retrospective investigations have examined considerably more births to immune-suppressed mothers, and concluded that structural birth defects are not increased by use of therapeutic immunosuppressants during pregnancy (Riely 2001 Armenti et al. 2002 Tendron et al. 2002).

Facial Nerve Management

Perineural spread for some distance from the area of the primary tumor.14 In certain cases, achieving negative surgical margins on the proximal stump of the facial nerve may require a mastoidectomy and facial nerve dissection along its course in the temporal bone. If the facial nerve is sacrificed, nerve repair may be done by using either direct neurorrhaphy of the cut edges, or a cable graft, depending on the length of the resected segment. Immediate rehabilitation of the paralyzed face requires diligent eye care to prevent exposure keratitis. This involves liberal use of artificial tears, lubricating ointment, and protection with an appropriate eye dressing and eyewear. A temporary tarsorrhaphy may be needed for patients with lower eyelid ectropion. A gold weight implant may be needed in patients with corneal exposure. If the facial nerve is not repaired or grafted, one or more of the surgical procedures for static or dynamic facial rehabilitation of the paralyzed face may be...

Herpes and Varicella Zoster

Dermis Multinucleated Cells Neutrophils

CLINICAL PRESENTATION Following an incubation period of approximately two weeks and a prodrome of fever and malaise, the cutaneous lesions begin as a mild maculo-papular eruption. The papules evolve into clear vesicles that show an umbilicated center. Characteristic vesicles overlie a larger patch of erythema and develop in several successive crops. The vesicles become cloudy, rupture, and form crusts. Healing occurs over the ensuing few weeks with little or no scarring unless they become infected. In contrast to varicella, the lesions in herpes zoster are limited to a single dermatome however, hematologic dissemination of the virus can result in a few distant skin lesions as well. Pain in the region supplied by the involved nerve is not common but can precede the skin changes by several days. Preauricular adenopathy is often seen. The nasociliary branch of the ophthalmic nerve supplies sensation to the eye, with terminal branches going to the tip of the nose. Lesions on the tip of...

Inverted Follicular Keratosis

Inverted Follicular Keratosis

Lever WF. Inverted follicular keratosis is an irritated seborrheic keratosis. Am J Dermatopathol 1983 5 474. Mehregan AH. Inverted follicular keratosis is a distinct follicular tumor. Am J Dermatopathol 1983 5 467-470. Sassani JW, Yanoff M. Inverted follicular keratosis. Am J Ophthalmol 1979 87 810-813. Schweitzer JG, Yanoff M. Inverted follicular keratosis. Ophthalmology 1987 94 1465-1468.

Optical characteristics of the eye

Myopia (near-sightedness) Astigmatism produced by the ciliary muscles attaching to the peripheral suspensory ligament. Ciliary muscle relaxation causes flattening of the lens, increasing its focal length. Focussing on a closer object is achieved by ciliary muscle contraction. The closest point on which the eye can focus is the near point. The amplitude of accommodation decreases with age (presbyopia). Overall, the refractive power of the eye depends on

Juvenile Xanthogranuloma

Langhans Cell Touton

INTRODUCTION Juvenile xanthogranuloma (JXG) is a rare systemic childhood disease of non-Langerhans cell histiocytes. It is characterized by cutaneous and, on occasion, intraocular lesions. It may be a gran-ulomatous reaction of histiocytes to an unidentified stimulus. There is special predilection for skin and eye involvement. It affects children below the age of five years with 85 of the cases being under one year of age. Most patients are younger than two years of age at presentation. There is no sexual or racial predilection. Other sites of ocular involvement include the orbit, conjunctiva, cornea, episclera, iris, and ciliary body. Iris lesions are associated with spontaneous hyphema, unilateral glaucoma, uveitis, and heterochromia iridis. Although lesions are common on the face CLINICAL PRESENTATION The eyelid is the most frequent site of ocular involvement. Lesions on the lid often appear quite suddenly. They typically present as a rapidly growing solitary papular or nodular...

Glycemia and Quality of wellbeing in patients with diabetes

As described in the study methods, the sample included 1522 patients 634 with type 1 diabetes and 888 with type 2 diabetes who attended endocrinology, diabetes, and ophthalmology clinics at the University of Michigan Health System between June 29,1998 and March 15,2001 and had HbA1c measurements on the day of the visit. All patients were over 18 years of age or older, able to give informed consent, and able to either self-administer the questionnaires or, if visually impaired, to respond to a research assistant reading the questionnaires

Diuretics of the Sulfonamide Type

The enzyme is used in tubule cells to generate H+, which is secreted into the tubular fluid in exchange for Na+. There, H+ captures HCO3-, leading to formation of CO2 via the unstable carbonic acid. Membrane-permeable CO2 is taken up into the tubule cell and used to regenerate H+ and HCO3-. When the enzyme is inhibited, these reactions are slowed, so that less Na+, HCO3- and water are reabsorbed from the fast-flowing tubular fluid. Loss of HCO3- leads to aci-dosis. The diuretic effectiveness of CAH inhibitors decreases with prolonged use. CAH is also involved in the production of ocular aqueous humor. Present indications for drugs in this class include acute glaucoma, acute mountain sickness, and epilepsy. Dorzolamide can be applied topically to the eye to lower intraocular pressure in glaucoma.

Delayed Manifestations

CNS neurotoxicity predominates Confined to basal ganglia globus pallidus, putamen, hippocampus (CT confirmation) resulting in toxic parkinsonism, with bradykinesia, dystonia, dysarthria, no rigidity (L-dopa resistant). Chronic low-level cyanide toxicity occurs in (1) Tobacco amblyopia (male smokers) (2) tropical (cassava root) ataxic neuropathy, (3) Leber's hereditary optic atrophy (males). Mechanism low endogenous stores of CN-detoxify-ing hydroxocobalamin and thiosulfate. Results from depletion of detoxifying substances by chronic low-grade CN poisoning from cigarette smoking (tobacco amblyopia and Leber's heredity optic atrophy) or frequent cassava root ingestion (tropical ataxic neuropathy).

Drug Dependence Versus Physical Dependence

A patient who seeks to continue using a medicine because it is helpful is no more demonstrating drug-seeking behavior than is a patient who finds eyeglasses helpful in the treatment of myopia demonstrating glasses-seeking behavior if deprived of a corrective lens. Drug abuse and drug dependence are characterized by use despite problems caused by that use (loss of control) and by denial (and dishonesty) neither of which is seen in appropriate medical treatment (DuPont & Gold, 1995).

Ocular pathologies in animals and available drugs4244

Ocular inflammation is one of the most common eye disorders in animals.45 The precise observation and interpretation of signs provides the basis for diagnosing the disease and its associated disorders, and for establishing their etiology (trauma, lid or lacrimal abnormalities, viral or bacterial infection, immune-related phenomena, corneal ulceration). Topical steroidal therapy in combination with non steroidal anti-inflammatory drugs, immunosuppressive agents such cyclosporine and azathiopr-ine, antimicrobial agents, mydriatic-cycloplegic agents (atropine) and additional specific therapies are frequently prescribed to treat conjunctivitis, keratitis and uveitis (Table l).46,47 Topically applied steroids are in most cases used in combination with an antimicrobial agent. The reason is probably that the concomitant administration of steroid can increase the efficacy of antibiotics.48 In addition, this association prevents a secondary infection that may occur after a corticosteroid...

Classification Vitamin B complex

Side Effects GI N&V, diarrhea, peptic ulcer activation, abdominal pain. Dermatologic Flushing, warm feeling, skin rash, pruritus, dry skin, itching and tingling feeling, keratosis nigricans. Other Hypotension, headache, macular cystoid edema, amblyopia. NOTE Megadoses are accompanied by serious toxicity including the symptoms listed in the preceding as well as liver damage, hyperglycemia, hyperuricemia, arrhythmias, tachycardia, and dermatoses.

As Sources Of Distress

Functional impairment, along with high rates of depression, anxiety, and emotional distress (Berman and Brodaty, 2006). In a study focusing on patients' attitudes toward visual loss from subfoveal choroidal neo-vascularization, patients reported that they would rather suffer medical illnesses such as dialysis-dependent renal failure and AIDS than visual impairment (Bass et al., 2004). Similar findings have been noted in studies of diabetes mellitus-associated visual loss (Cox et al., 1998). Clearly, across multiple medical conditions, acquired visual loss has a profound impact on self-perception of overall health-related quality of life, distress, and suffering.

Sensory Deficits Introduction

Vision disorders are common in children with the most prevalent problems of a refractive type (myopia or hyperopia) and others that include amblyopia, strabismus, cataracts, and glaucoma. Eye injury may occur as a result of trauma from blunt or sharp objects, or from infection resulting in conjunctivitis, keratitis, or even blindness or loss of the eye. Hearing and vision screenings vary with the age of the infant child and are performed as part of physical assessment of all children. Treatment focuses on the correction and rehabilitation of any actual or potential impairment.

Currently investigated systems for ocular controlled drug delivery in animals

Hydrogels can be classified into two distinct groups preformed gels and in situ forming gels.118 The preformed gels can be defined mainly as simple, highly viscous solutions which do not undergo further modification after administration (see Section IV.A. 1.), whereas in situ gelling systems can be described as viscous liquids or suspensions that, upon exposure to physiological eye conditions (ionic strength, temperature or pH), will shift to a gel phase (see Section IV.A.2.). The latter formulations are superior to classical gels in that they allow administration of accurate and reproducible quantities which exhibit a high final viscosity. Preformed, as well as in situ forming gels, can be based on natural, semi-synthetic or synthetic polymers.

Clinical Features

Extracutaneous involvement may occur in visceral organs, lymph nodes, soft tissue, and skeletal muscles. Eye involvement occurs in up to 10 of cases and may lead to secondary glaucoma due to hemorrhage into the anterior chamber (1-3). The association of JXG with neurofibromatosis I and chronic juvenile myelogenous leukemia is well-established. Many other perhaps coincidence associations have also been reported such as with Niemann-Pick disease and urticaria pigmentosa (4-6).

Linking the Visual Module with the Language Module

Figure 7.13 illustrates a simple concept for such a text annotation system. Video input from the eyeglasses-mounted camera are operated upon by the gaze controller and objects that it selects are segmented and represented by the already-developed visual module, as described in the previous sub-section. The objects that were used in the visual module development process were those that a blind person would want to be informed of (curbs, roads, cars, people, etc.). Thus, by virtue of its development, the visual module will search each new frame of video for an object of operational interest (because these were the objects

Congenital Toxoplasmosis And Clinical Disease

A neonate presenting with overt symptomatic disease may have the classic triad of hydrocephalus (secondary to periaqueductal stenosis), intracranial calcifications, and chorioretinitis (typically bilateral, focal, necrotizing retinitis). This triad, however, occurs in only a minority of symptomatic patients (27,33). The clinical manifestations are usually protean and include one or more of the following manifestations, which occur in more than 50 of affected infants diffuse maculopapular rash, generalized lym-phadenopathy, hepatosplenomegaly, jaundice, ocular disease (cataracts, microphthalmia, optic atrophy, and chorioretinitis), abnormal spinal fluid, convulsions, fever, and anemia (1,27,34).

Clinical Development of Aldurazyme

Stiffness, the airway problems with associated sleep apnea, respiratory insufficiency, the diverse cardiac problems, recurrent infections, and the eye disease. Other compound clinical problems that were studied, but with more difficulty, included the fatigue malaise, severe headaches, the enlarged tongue, and signs of cord compression. Besides clinical measures, the elevated level of GAG in the urine, which reflects excessive renal distal tubular storage, is commonly used as a screen for MPS disease as well.

Phase 1 Open Label Study in Ten Mps I Patients 12711 Study Objectives and Design

NYHA classification), and eye disease. In prepubertal patients, height and weight growth velocity were also studied. Safety evaluations included the standard clinical laboratory studies, adverse event monitoring, assessments for antibodies to rhIDU, and complement activation.

Classification Antihistamine ophthalmic

Contraindications Not to be injected. Not to be instilled while the client is wearing contact lenses. Special Concerns Use with caution during lactation. Safety and efficacy have not been determined for children less than 3 years of age. Side Effects Ophthalmic Burning or stinging, dry eye, foreign body sensation, hyperemia, keratitis, lid edema, pruritus. Nose throat Pharyngitis, rhinitis, sinusitis. Oral Taste perversion. Miscellaneous Headache, asthenia, cold syndrome. Drug Interactions None reported. How Supplied Solution 0.1 Solution in a 5-mL drop dispenser

Study Results in the Clinical Manifestations

Evaluation of range of motion showed that there were improvements in shoulder flexion, elbow extension, and knee extension that increased with time over 104 weeks. Sleep apnea declined 61 by 26 weeks, and the three patients with the most clinically severe sleep apnea all improved. NYHA classifications improved at least one class in all patients by 52 weeks. Visual acuity improved in the three patients with the worst vision. Height and weight growth velocity increased 85 and 131 , respectively, in the six prepubertal patients.

Phase3 Study of Aldurazyme 12721 Study Objectives and Design

The phase-3 study was designed as a randomized, double-blind, placebo-controlled study in 45 MPS I patients treated with weekly infusions of Aldurazyme over a 26-week period 13 . The patient population was restricted to patients over 5 years of age and was predominantly Hurler-Scheie in phenotype. The primary endpoints were the change between baseline and week-26 in the forced vital capacity (FVC), and the 6-min walk test. FVC is a measure of lung capacity, which is severely restricted in MPS I patients such that respiratory insufficiency is a common contributor to death. The 6-min walk test is commonly used in congestive heart failure studies as a measure of endurance. In MPS I, the 6-min walk distance can be severely restricted due to a combination of factors that includes poor respiratory function, cardiac disease, and joint stiffness and pain. In addition to these endpoints, secondary endpoints in the study were liver size, sleep apnea, shoulder flexion, and the Health Assessment...

Retinal anatomy and physiology

Retinal Anatomy

Figure 11.2 Normal human retina as viewed through an ophthalmoscope, highlighting the regional specialization of the retina. The optic nerve head, also known as the optic disk, is where the axons of the retinal ganglion cells are collected together into the optic nerve as these axons course towards their subcortical targets. This region is devoid of photoreceptors. Additionally, the blood vessel of the retinal circulation originates from the optic nerve head. The fovea, the region of darker pigmentation, subserves the central 6 degrees of visual space and is the region of greatest visual acuity. The photoreceptors in this region are primarily cones. The macula lutea, outlined with a dashed line, subserves the central 20 degrees of visual space. Both rod and cone photoreceptors are found outside the fovea, with rod photoreceptors becoming more prevalent the farther one is from the fovea. The two principal sources of untreatable blindness, age-related macular degeneration and retinitis...

Color Vision Deficiency

Some people have defective color vision that is not inherited. Aging can cause the lens of the eye to darken, affecting a person's ability to differentiate colors. Certain drugs and eye diseases also can disturb normal color vision. There is no cure for inherited color vision deficiency, but affected people can take steps to counteract the problem. Some people learn to compensate by developing their own methods of distinguishing different colors for example, by brightness or location. Tinted prescription eyeglasses may help some people who have red-green color vision deficiency. If you have a family history of color vision deficiency and work in an occupation that requires distinguishing colors, or if you are having trouble identifying colors, see an ophthalmologist to be tested for color vision deficiency. He or she can recommend steps you can take to compensate for the problem.

Surgical Retinal Procedures

K retinal detachment occurs when the retina is pulled away from or out of its normal position. Approximately 5 of the U.S. population has retinal breaks, but most do not lead to retinal detachment, which has a prevalence of 0.3 . Estimates are that 15 of people with retinal detachments in one eye develop detachment in the other eye, and the risk of bilateral detachment increases to 30 in people who have had bilateral cataract surgery. optic nerve and at the ciliary body. The remaining retina relies on the vitreous (jelly-like mass that fills the cavity of the eyeball) to apply pressure against the lining to maintain its position. The detachment can occur spontaneously as a result of a change in the retina or vitreous this detachment is referred to as a primary detachment. Secondary detachment occurs as a result of another problem, such as trauma, diabetes, or pregnancy-induced hypertension. Complications from retinal detachment include visual impairment and blindness.

Phenylephrine hydrochloride

Uses Systemic Vascular failure in shock, shock-like states, drug-induced hypotension or hypersensitiv-ity. To maintain BP during spinal and inhalation anesthesia to prolong spinal anesthesia. As a vasoconstrictor in regional analgesia. Paroxysmal SVT. Nasal Nasal congestion due to allergies, sinusitis, common cold, or hay fever. Ophthal-mologic 0.12 Temporary relief of redness of the eye associated with colds, hay fever, wind, dust, sun, smog, smoke, contact lens. 2.5 and 10 Decongestant and vasoconstrictor, treatment of uveitis with posterior synechiae, open-angle glaucoma, refraction without cyclople-gia, ophthalmoscopic examination, funduscopy, prior to surgery. Contraindications Severe hypertension, ventricular tachycardia. Special Concerns Use with extreme caution in geriatric clients, severe arteriosclerosis, bradycardia, partial heart block, myocardial disease, hyperthyroidism and during pregnancy and lactation. Nasal and ophthalmic use of phenylephrine may be systemically...

Alignment Of The Eyepieces

The binocular usually has adjustments for the inter-eyepiece distance and visual acuity in each eye. The goal is for the image to be in focus for each eye without any eyestrain or discomfort. Only the left eyepiece tube or eyepiece is adjustable on a typical microscope. However, if the microscope has a target reticle in the microscope stand that can be rotated into view, then usually both eyepieces are adjustable.

Accidental Firesetting

Firesetting is a unique manifestation of HAD. Cohen and Alfonso (1998) have described several cases of fire-setting behavior among persons with cognitive impairment and HIV infection and suggest a multifactorial etiology for the behavior. Accidental firesetting often occurs in the context of cigarette smoking by persons both with and without cognitive impairment. The cognitive impairment concomitant with HAD exaggerates the lapses in attention, memory, or judgment that may lead to accidental firesetting from lit cigarettes. HAD is characterized by motor abnormalities such as tremor and bradykinesia, which may contribute to fine motor dyscontrol, thereby increasing the risk of, for example, dropping a lit cigarette. In addition to encephalopathy, persons with HIV may have HIV-associated neuropathy, which may further increase the likelihood of an accident by decreasing the perception of heat. A person with visual acuity limited by cytomegalovirus (CMV) retinitis would have further...

Clinical testing of eyes and eye movements

6 With the head stationary, the patient should be asked to follow with both eyes together an object moving not-too-quickly (e.g. the examiner's finger or a pen) as it describes a large square with both diagonals. Should any abnormality be observed, each eye may be tested more carefully. Or, if you want the easy way out, send the patient to an optician or ophthalmologist.

Y Iontophoresis a novel approach for drug delivery to the eye

Use of iontophoresis has not been widespread. In fact, the absence of scientific rationale for drug penetration into or through ocular tissues, the lack of systematic pharmacokinetic studies, and the effect of pathology on the drug concentration time course and the description of tissular lesions induced by iontophoresis using high current densities, have hindered clinical development of iontophoresis. However, iontophoresis could have potential interest in many therapeutic fields in ophthalmology particularly to treat posterior segment inflammations and infections and to deliver new potential antiangiogenic or trophic agents to the retina and or the choroid. The innovative application of modern electronics and materials science as well as further research in ocular toxicology could help to place iontophoresis among the efficient means of treatment of the posterior segment of the eye.

Clinical Application Questions

A 75-year-old man in good general health presents at your office regarding a blistering rash on the right face and nose of 48 hours' duration. Lancinating pain was noted for 2 or 3 days before the rash. He also complains of diminished visual acuity in the right eye. You diagnose herpes zoster of the ophthalmic division of the trigeminal nerve.

General Comments From The Dermatology And Cosmetic Perspectives

The advantage of using HA in cosmetic preparations was recognized very soon after its discovery. Difficulties in preparing large enough amounts of HA free of contaminating glycoproteins, lipids, and other tissue materials prevented its convenient use in commercial preparations including its use in cosmetics. Initially, HA was isolated from rooster combs. This HA was highly purified, and used in ophthalmology as a viscoelastic to replace fluid loss following cataract surgery. The revolution in biotechnology and molecular genetics made it possible more recently to engineer bacteria with augmented HA production, by amplifying the HA synthase gene. This generates a material much lower in molecular weight that has the additional disadvantage of frequent contamination by residual bacterial pyrogens. Such HA, processed from vast fermentation of engineered bacteria has reduced the price of HA drastically, bringing the price into a range that is reasonable for its use in cosmetics. However,...

Figure 2 11cis and 11fransretinaldehyde

AMD is a chronic disease resulting from a malfunctioning of this system at several loci. Although there are many gaps in understanding of the disease pathology and progression, a general hypothesis with several variations has emerged, based on consistent clinical and epidemiologic observations in AMD patients.2'15 Dry AMD is characterized by increased deposition of a material called ldmsen which can be observed clinically using an ophthalmoscope, between the RPE and Bruch's membrane. Drusen likely originate from material discharged from RPE cells. Although this process probably occurs throughout life due to the heavy phagocytosis burden of RPE cells, the composition of the material expelled from dying dysfunctional cells may be more heavily weighted toward injurious components such as oxidized lipids, proinflammatory cytokines, and acute phase inflammatory proteins.16 Intriguingly, it has recently been reported that drusen commonly contain amyloid beta, a proinflammatory protein...

Therapeutic Hyaluronidases

Hyaluronidase exerts it therapeutic effect by making tissue more permeable to injected fluids, leading to increased speed of drug absorption. Preparations of bovine testicular hyal-uronidase have been applied therapeutically in the fields of orthopedics, ophthalmology, and internal medicine for many years with efficacy and safety. A common field of application is its addition to local anesthetic agents, especially ophthalmic anesthesia, to improve the rapidity of onset, dispersion, depth, and duration of the local anesthesia 153,154 .

Oculodermal Melanocytosis

Pigment Stratum Corneum

Conjunctiva, sclera, and uveal tract. Other ipsilateral involved tissues may be orbital fat and muscles, bone, periorbita, dura, and brain. The nevus tends to be unilateral, but bilateral involvement may occur. Pigmentation is irregular and may occur in small isolated disconnected patches. It may be so pale as to be overlooked on casual observation. Glaucoma can be an associated finding. Intraocular nevi, choroidal malignant melanoma, and orbital melanoma may occur.

Plexiform Neurofibroma

Plexiform Neurofibroma

INTRODUCTION Plexiform neurofibromas are the most common benign peripheral nerve tumor occurring in the eyelid and are considered pathognomonic for type 1 neurofibromatosis (NF-1). The lesion arises from and grows along any peripheral nerve. Plexiform neurofibromas typically present in children during the first decade of life. Mechanical ptosis can be profound, and in younger children may cause deprivation amblyopia. Associated systemic and ocular findings in patients with neurofibromas are related to underlying neurofibromatosis. Systemic findings may include hamartomas of the CNS, and cranial and peripheral nerves. Patients are at increased risk of developing pheochromocytoma, breast carcinoma, medulllary thyroid carcinoma, and gastrointestinal tumors. Ocular findings may include iris nodules (Lisch nodules), glaucoma, retinal astrocytic hamartoma, optic nerve glioma or meningioma, pulsating exophthalmos due to defects of the sphenoid wing, and orbital schwannoma. Rarely an eyelid...

Phakomatous Choristoma

Dacryocystocele Images

CLINICAL PRESENTATION Phakomatous choristoma appears in newborns or in young children usually within the first few months of life and not associated with other developmental abnormalities. It presents as a circumscribed firm to rubbery subcutaneous mass in the medial lower eyelid near the inner canthus and can occasionally occur in or extend to the anterior orbit. They may range up to several centimeters in size. When large there may be concern about amblyopia or astigmatism. HISTOPATHOLOGY Within dense collagenous tissue are nests and irregular islands of polygonal epithelial cells having lightly eosinophilic cytoplasm and round to oval nuclei without nucleoli. The nests and islands of epithelial cells are surrounded by basement membrane material that stains positively with periodic acid-Schiff reagent (PAS stain), and thick strands of PAS-positive material often accumulate between cells (shown below on the right). Swollen epithelial cells may resemble bladder cells occurring in...

Ocular Surface Diseases

Another series of disorders of the ocular surface is 'dry eye.' Dry eye is characterized by deficits in tear production secretion and deficiencies in the quality of tears, thereby causing ocular discomfort, itching, and a foreign body sensation on the ocular surface.95 It has recently been recognized that several aspects of dry eye involve an inflammatory cascade. Sjogren's syndrome (keratoconjunctivis sicca) is a common (affects 0.5 of adult women) autoimmune disorder of the lacrimal and salivary glands that causes ocular dryness. Treatments for dry eye have traditionally sought to reduce the symptoms of dryness by hydrating and lubricating the ocular surface with artificial tears. However, this is rarely sufficient and pharmacotherapy is necessary to prevent corneal and or conjunctival damage. Therapeutic approaches include use of immune suppressive anti-inflammatory agents, such as the fungal-derived peptide, cyclosporin, and topical corticosteroids, such as methylprednisolone,...

Mussen 1997 On Drug Abuse

American Academy of Ophthalmology. (1992, June). The use of marijuana in the treatment of glaucoma. Statement by the Board of Directors of the American Academy of Ophthalmology, San Francisco. Hepler, R. S., & Petrus, R. J. (1976). Experiences with administration of marijuana to glaucoma patients. In S. Cohen & R. C. Stillman (Eds.), The therapeutic potential of marijuana (pp. 63-75). New York Plenum Medical Books. National Eye Institute. (1997, February 18). The use of marijuana for glaucoma. Retrieved February 1, 2004, from

Lowpolarization Surface Electrodes

Warning The materials used to form Ag AgCl electrodes are relatively dangerous. Do not breathe dust or mist and do not get in eyes, on skin, or on clothing. When working with these materials, safety goggles must be worn. Contact lenses are not protective devices. Appropriate eye and face protection must be worn instead of, or in conjunction with, contact lenses. Wear disposable protective clothing to prevent exposure. Protective clothing includes lab coat and apron, flame- and chemical-resistant coveralls, gloves, and boots to prevent skin contact. Follow good hygiene and housekeeping practices when working with these materials. Do not eat, drink, or smoke while working with them. Wash hands before eating, drinking, smoking, or applying cosmetics.

Nonsteroidal Antiestrogens

Figure 1 The formulae of the first nonsteroidal antiestrogen, MER25, and the structurally related compound MER29 used to lower circulating cholesterol. MER29 was withdrawn from the market because of the increased incidence of cataracts. The next antiestrogen, MRL41, was a mixture of the cis and trans isomers of a substituted triphenylethylene later named clomiphene. It is relevant to point out that the antiestrogen MER25 is a structural derivative of the cholesterol-lowering drug triparanol (MER29) (Figure 1). In the late 1950s there was initial enthusiasm about the potential benefits of triparanol as a hypocholesterolemic drug.14 However, the finding that triparanol caused an accumulation of desmosterol (an intermediate in cholesterol biosynthesis)15-18 and the linking of this biochemical effect to cataract formation,19-21 caused withdrawal of the drug in 1962 (Figure 2). Nevertheless, triparanol was first evaluated as a potential therapy for breast cancer22 but again the results...

HUI3 Multi Attribute Health Status Classification System from Feeny et al Pharmaco Economics 199576 Table III page 494

Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, without glasses or contact lenses. Able to see well enough to read ordinary newsprint and recognize a friend on the other side of the street, but with glasses or contact lenses. Able to read ordinary newsprint with or without glasses but unable to recognize a friend on the other side of the street, even with glasses or contact lenses. Able to recognize a friend on the other side of the street with or without glasses but unable to read ordinary newsprint, even with glasses or contact lenses. Unable to read ordinary newsprint and unable to recognize a friend on the other side of the street, even with glasses or contact lenses. Unable to see at all.

Laboratory Diagnosis Of Congenital Toxoplasmosis

All neonates suspected of having a congenital infection should have a complete blood cell count (20), including a platelet count to screen for thrombocytopenia (40,41) and eosinophilia (42) (although the latter has not been a common finding in many infected infants), and liver function tests. A lumbar puncture should be done to determine if there is a disproportional increase in cerebrospinal fluid (CSF) protein relative to the degree of pleocytosis (25,43,44) and a computed axial tomographic scan of the brain with contrast to detect diffuse cerebral calcifications (27). Every infant suspected to be congenitally infected (especially those who are asymptomatic) should have a thorough ophthalmologic examination to detect any ocular complications (i.e., chorioretinitis) (Table 1) (1).

Eye Movements Stereoscopic Vision Depth Perception

A greater power of accommodation for nearvision is required in hyperopia than in normal vision. Since accommodation is always linked with a convergence impulse, hyperopia is often associated with squinting. If the visual axes wander too far apart, vision in one eye will be suppressed to avoid double vision (diplopia). This type of visual impairment, called strabismic amblyopia, can be either temporary or chronic.

Ophthalmic agents

The eye is a key part of the CNS connecting to the brain via the second cranial or optic nerve. Many other receptors and signal transduction process in the eye recapitulate those present in the CNS proper although the cellular architecture of the eye and its function are unique (see 6.12 Ophthalmic Agents). The anterior pole of the eye, composed of the cornea, iris, and lens, serves to focus light onto the photoreceptors of the retina. The retina is a layered structure composed of retinal ganglion cells, amacrine cells, horizontal cells, and photoreceptors that transduces, processes, and integrates visual stimuli. The ganglion cells are the output neurons of the retina, sending axons to the lateral geniculate nucleus by way of the optic nerve. This highly evolved complex system allows for accurate processing of visual stimuli with an exceptional dynamic range. However, it is susceptible to multiple disorders including glaucomas and macular degeneration that ultimately can produce...


Patient with xanthelasma in all four lids. (From Tasman W, Jaeger EA The Wills Eye Hospital Atlas of Clinical Ophthalmology, Philadelphia, Lippincott-Raven, 1996, with permission.) Patient with xanthelasma in all four lids. (From Tasman W, Jaeger EA The Wills Eye Hospital Atlas of Clinical Ophthalmology, Philadelphia, Lippincott-Raven, 1996, with permission.)

The editors

Finn, Ph.D., is an Associate Professor of Medical Physiology in the Department of Pharmacology and Physiology in the Biomedical Sciences Program at the Oklahoma State University Center for Health Sciences. Dr. Finn earned his Baccalaureate and Masters of Science degrees in zoology at University of Wisconsin. In addition, he earned his Ph.D. in the biological sciences, physiology from Texas A&M University in College Station, TX. Dr. Finn teaches medical and graduate students in the fields of cellular, molecular and integrative neurophysiology. His research interests are in the areas of cell culturing and the electrophys-iology of retinal neurons. He co-coordinates with Dr. LoPresti the Artificial Vision Project, a multidisciplinary research program studying vision neuroprosthetics. This project provides research training for students in medicine, biomedical sciences, and electrical engineering. Dr. Finn has worked on various bioengineering projects, such as the biophysics of...

Cold weather

Medications Many modern medications have been reported to aggravate PV. The most frequently implicated are lithium, quinine derivatives, 4- and 8-amino-quionolone compounds, -adrenergic blocking agents, and systemic corticos-teroids. These drugs can exacerbate existing disease or provoke latent cases into activity. The flares following withdrawal of systemic steroids can be so severe as to be life-threatening, and use of these agents in a psoriatic for treatment of PV or other conditions must be weighed very carefully as to the potential benefits. Less severe flaring of PV has been documented after withdrawal of potent group I topical steroids and with ocular administration of -blockers for glaucoma.

Patient Interview

Of course, the visual impairment is also terrible, adds Marcus, but he has learned to live with that. In contrast, 10 years of dialysis seem unimaginable and he doesn't plan to put up with it. He is already on the waiting list for a new kidney transplant. This time the operation will be combined with the insertion of pancreatic islet cells. A very promising procedure has been developed in Canada which gives a relatively good chance that the islet cells are not destroyed by the recipient's own immune defence system. This Canadian method is being used in Giessen in Germany and Marcus will have his next operation there.


Usually wears glasses or contact lenses Trouble seeing (with eyeglasses on) Difficlty vision makes difficlt doing Can't read regular print newspprs-lttrs Can't read the telephone directory Can't read labels or prices in shops Can't recognize people on the street Problems hear-see interfre w' doing Difficlty w' items relying on vision Can't perform tasks requiring vision Items relying on vision contraindicated Obs rating of vision

Eyepiece Adjustment

The microscope's eyepieces provide the port through which information, in the form of an image, is transferred from the microscope to the user. Differences in visual acuity between users, and even between the eyes of the same user, require that the eyepieces be adjusted to accommodate each individual's interocular distance and each eye's visual acuity. Otherwise, the observed image quality may suffer dramatically and the user may experience discomfort, caused by eye strain, when using the microscope.

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