Dermacentor variabilis: uncomplicated eyelid involvement.

Ocular eyelid infestation of Dermacentor variabilis, the American dog tick, occurred in a 34-year-old man who had been sleeping in an open-floored tent in an Indiana field. The tick was mechanically removed with steady and firm pressure with cilia forceps, with care taken to remove all mouth structures. The involved eyelid area healed rapidly without ocular or systemic complications.

Human tear osmotic pressure: diurnal variations and the closed eye.

Using a micro-osmometry technique, 450 nonreflex tear samples were collected hourly from six subjects throughout their waking hours, and on initial opening of the eyes following six to eight hours of sleep. While the waking day mean found for this population agreed closely with current values in the literature, considerable variation did occur among individuals, both in their mean as well as in their hour-to-hour levels. The prolonged lid closure condition resulted in a considerable decrease in tear osmotic pressure and was found to be significantly different from the open-eye condition (P less than .001). No significant differences could be shown however between findings for men and women for either condition, and no consistent impact of food or fluid intake could be demonstrated.

The nonstress test.

Antepartum fetal evaluation by heart rate monitoring was carried out on a clinical service during a 1-year period utilizing the nonstress test as the primary screening device. Nonreactive nonstress tests were supplemented by the oxytocin contraction stress test. In this study, the use of the nonstress test appropriately led to the identification of all fetuses who were in jeopardy and, in the majority of instances, identified fetuses in good condition who did not require the administration of oxytocin to determine fetal well-being. In our experience, the nonstress test is a reliable, inexpensive, convenient, time-saving screening procedure which can be made available to a greater number of patients than the contraction stress test alone.

Relation between cholesterol levels, statins and Alzheimer's disease in the human population.

This review paper discusses potential relationships between Cholesterol levels, the therapeutic use of Statins and the risk of Alzheimer s Disease. Comparisons have also been made between the Western populations and Oriental populations. Epidemiological studies have shown that statins, which reduce the levels of plasma cholesterol by inhibiting the enzyme 3 hydroxy-3methylglutaryl-coenzyme A (HMGCoA) reductase, reduce the risk of Alzheimer s disease by up to 70%. Further research is required to determine whether cholesterol levels have a direct, causative, or indirect relationship with Alzheimer disease. Also, it is not clear why some statins reduce the prevalence of AD and others do not. Statins may have an affect on other AD risk factors, or act by mechanisms which are independent of their effects on cholesterol levels?

The interpretation of systemic arterial blood pressure. Part III: hypertension retinopathy.

Systemic blood pressure is a vital sign and fundamental variable and as such the areas of its involvement in all individuals are indeed multifaceted. The purpose of this paper is to discuss the interpretation of systemic blood pressure readings as they specifically relate to a detailed analysis of hypertensive retinopathy.

The measurement of systemic arterial blood pressure.

The measurement of blood pressure, sphygmomanometry, can provide much significant information for the optometrist's evaluation of his patient's ocular and related systemic conditions when the principles involved are understood and skill in its measurement is achieved. This paper will discuss the procedural details of blood pressure measurement.

Gonioscopy: evaluation and interpretation.

Gonioscopy is the ocular health examination technique which offers to the practitioner the means to directly study the anterior chamber angle. Its uses are numerous and include glaucoma classification, predilation angle evaluation, and the presence of iris tumors, foreign bodies and anterior synechiae. Since a meaningful gonioscopic examination depends upon the examiner's recognition of the chamber landmarks, a detailed analysis of each structural element is presented. In addition, the techniques for performing gonioscopy with the popular lens types are viewed as is the system for interpretation and recording.

Mydriatic angle-closure glaucoma--mechanism, evaluation and reversal.

Ocular mydriatics are diagnostic agents that generally facilitate a preferable ophthalmoscopic examination. However, the optometrist should be aware of certain iatrogenic side effects including the precipitation of an acute angle-closure. The purpose of this paper is to summarize the mechanism of mydriatic angle-closure glaucoma. In addition, a shallow anterior chamber is a fundamental ocular variable which should be evaluated before inducing mydriasis and/or cycloplegia. The technical procedures for the oblique illumination shadow test and the van Herick slit lamp test are presented, both of which provide an accurate estimation of the anterior chamber angle. The risk of precipitating an attack after reasonable circumspection by such evaluations approaches zero. However, should an attack occur, the procedures to rapidly lower the intraocular pressure and open the chamber angle are discussed.

Dendriform keratitis.

Since the cornea responds to various toxic stimuli by swelling and ulcerating, these changes may assume a dendriform pattern. A case of herpes simplex dendritic keratitis is presented along with its treatment. In addition, several other etiologic sources of an arborescent keratitis are discussed as to their differentiation and management implication.

Ocular pathogenicity of Streptococcus pneumoniae.

Streptococcus pneumoniae is a Gram-positive organism that commonly is the etiologic agent for external ocular infections. The conjunctival response may be relatively mild or quite intense with abundant discharge. Pharmaceutical management with various topical antibiotics is extremely effective in resolving the infection.

Eye disease of the elderly.

The elderly population is particularly susceptible to a number of eye diseases and degenerations. A summary of the more commonly encountered conditions is presented to include eyelid, conjunctival and corneal disorders. In addition, discussions of the retinopathies, macular degenerations, neuropathies, and glaucoma are given.

Ankylosing spondylitis and recurrent anterior uveitis.

An acute anterior uveitis often is associated with a number of systemic inflammatory conditions such as ankylosing spondylitis. Both the ocular and systemic effects begin during the second or third decades of life and involve males more frequently than females. The uveitis begins acutely but may become quite chronic with a number of reported sequelae. This case describes a recurring case of anterior uveitis, its systemic and ocular signs and symptoms, and the appropriate management.

Ocular manifestations of thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura is a serious and uncommon disease of hemostasis. Severe disturbances in both blood components and chemistry may cause marked changes both systemically and in ocular tissues. Ocular manifestations include retinal and vitreal hemorrhage, retinal detachment, papilledema, and disc neovascularization. Management of mild cases is limited to supportive therapy and monitoring changes in the fundus. In advanced cases, photocoagulation, vitrectomy, and retinal reattachment surgery may be necessary. This article reviews the effects of this relatively rare blood disorder on the visual system.

Atypical foveomacular vitelliform degeneration, adult type.

Foveomacular vitelliform degeneration, adult type (FVDAT) is a disciform, macular degeneration that is usually encountered in the fifth to seventh decade of life. It appears ophthalmoscopically similar to the vitelliform or "egg-yolk" stage of Best's disease (vitelliform degeneration), but shows no inheritance pattern. Electrooculographic (EOG) testing reveals a normal or only slightly reduced Arden ratio (light peak/dark trough). The prognosis is optimistic, as most patients retain reading vision throughout life. This case report describes an atypical case in which the signs and symptoms of FVDAT are not exactly those regularly seen. However, it does closely resemble the disease sufficiently to warrant this diagnosis.

Acute posterior multifocal placoid pigment epitheliopathy.

The pathogenesis of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is not fully understood. Some believe it to be a primary dysfunction of the retinal pigment epithelium while others assume that its development follows a choroidal vasculitis. It generally presents as a bilateral condition and shows no sex predilection. The visual prognosis is generally good, though severe and permanent visual loss occasionally occurs. The funduscopic presentation consists of multiple flat, yellow-white lesions of the posterior pole at the level of the retinal pigment epithelium. This paper discusses a case of APMPPE and reviews and summarizes the current literature on this disorder.

Differential diagnosis of spontaneous hyphema associated with central retinal vein occlusion.

Spontaneous hyphema refers to a nontraumatic hemorrhage in the anterior chamber. It is uncommon and may result from such conditions as rubeosis iridis, intraocular neoplasms, blood dyscrasias, severe iritis, fibrovascular membranes in the retrolental or zonular area, and vascular anomalies of the iris. A case is presented describing a spontaneous hyphema occurring as a result of iris neovascularization in a patient who suffered from occlusion of the central retinal vein. Spontaneous hyphema and the presenting ocular conditions as they pertain to its occurrence are discussed.

Mid-peripheral hemorrhages secondary to Waldenström's macroglobulinemia.

Waldenström's macroglobulinemia is a progressive neoplastic syndrome of the reticuloendothelial system and is characterized by the presence of monoclonal IgM paraproteins. The ocular manifestations of macroglobulinemia can include mid-peripheral hemorrhages, sludging of blood in the conjunctival vessels, blurred disc margins, exudates in the fundus and serous retinal detachment. Waldenström's macroglobulinemia and its ocular complications are herein presented.

Treatment of chalazia with intralesional triamcinolone injection.

Chalazia are commonly encountered lesions of the eyelids. They often resolve spontaneously or respond to a conservative therapeutic regimen. Chalazia not responding to this type of treatment are often referred for surgical extirpation. This article presents an alternative to surgery, namely intralesional injection of a synthetic glucocorticoid. Reports show a high success rate with few complications using this procedure. A patient with chronic bilateral chalazia was given intralesional injections after conservative therapy was unsuccessful. Two corticosteroid injections produced complete resolution of the lesions.

A pupil-sparing oculomotor palsy from a contralateral giant intracavernous carotid aneurysm.

A patient presenting with a left pupil-sparing oculomotor palsy and periorbital pain was subsequently found to have a giant saccular aneurysm of the right internal carotid artery within the cavernous sinus. The aneurysm was of the contralateral artery compared to the side of all presenting neuro-ophthalmic signs and symptoms. Diagnosis was achieved by bilateral carotid arteriography and surgical treatment with a Crutchfield arterial clamp and bypass graft has returned the patient essentially to normalcy.

Osmotic adaptation to rigid contact lenses.

Using a precision thermocouple hygrometer, requiring just 5 microliters of sample, the tear osmotic pressures of 6 subjects were monitored throughout their adaptation to rigid contact lenses. Relative to the prefitting baselines established for each previous to this study, these subjects showed a range of hypotonic shifts on initially receiving their lenses, but this imbalance was rectified by the end of the first wearing week and a new relatively hypertonic level of tear osmotic pressure was commonly established. This new baseline was reflected in the pre-insertion samples of several of the subjects as well once adaptation was advanced.