Orbital myositis in scleritis.

AIMS: To investigate the association between scleritis and myositis. METHODS: Retrospective, non-comparative case series. Records and ultrasonograms were examined of 132 patients, with a diagnosis of episcleritis or scleritis, who attended the ophthalmology department at Leiden University Medical Center between 1997 and 2000. 103 were eligible for comprehensive examination. Medical records were evaluated. Ultrasonography was performed in all patients diagnosed with episcleritis or scleritis. Clinical features, precipitating factors, systemic associations, ocular complications, treatment, and outcome of each patient were assessed. RESULTS: Of the 103 patients, 27 (26.2%) had episcleritis and 76 (73.8%) had scleritis. Myositis was found to be present in 11 patients. It was present in 14.5% of all patients with scleritis and 30.5% of those in whom the posterior sclera was affected. The presence of the associated myositis did not worsen the visual prognosis and the presence of myositis was not associated with other systemic diseases. There were no cases of unilateral scleritis with bilateral orbital myositis. During an attack ocular complications were more common in patients with scleritis and myositis (64%) than in patients with scleritis alone (30.4%), indicating a more diffuse and potentially dangerous inflammation. There was no evidence that the inflammatory changes in the orbit had spread to involve the sclera, so it is assumed that the muscle changes are an extension of a generalised response to intense inflammation of the episclera and sclera. CONCLUSION: This study found a frequent association between myositis and scleritis. Prognosis for vision was not affected by coexistence of myositis.

A sensitivity index F, useful to classify patients with glaucoma simplex.

Using a new method to determine the scotoma pressure by means of an Amsler grid chart and an ophthalmodynamometer in addition to three other parameters (the brachialis blood pressure and the intra-ocular pressure), a sensitivity factor F was calculated, useful to classify patients with visual field defects due to glaucoma simplex.

Ophthalmological examination of patients taking chloroquine.

EOGs have been routinely measured once a year in rheumatoid arthritis (RA) patients treated with chloroquine derivatives. Criterion for the advice to stop the treatment was a decrease in the EOG of more than 20% of the value obtained before treatment was started or, where this value had not been determined, a decrease in the EOG to below 1.85, i.e. the Arden criterion. Evaluating the results, it appears that in RA patients, examined once a year, the variability of the EOG is approximately 30% of the value obtained. Furthermore, instead of a lower limit for the normal value of 1.85, we found in the rheumatism group 1.6. If these new criteria were to be applied, less than 4% of the patients would be advised to stop chloroquine treatment. We wounder whether check-ups of these patients remain necessary when dosage of chloroquine or its equivalent is below 75 g per year.

Drusen of the optic disc and occipital transient pattern reversal responses.

Compression of visual nerve fibres generally markedly increases the latency times of visually evoked occipital responses. If a visual fluid defect in optic disc drusen is caused by compression of nerve fibres, delayed responses would be expected in this condition too. Examination of 23 patients (43 eyes) with optic disc drusen revealed that even the cases with serious field defects showed no marked delay in the pattern responses. As a consequence, examination of pattern responses is of no value in predicting progressive visual damage in patients with drusen. As to an understanding of the cause of the field defects, the normal pattern responses excluded direct mechanical compression on the nerve fibres by drusen. More likely they are due to a circulatory disturbance in the small vessels, which in its turn may even be caused by gentle compression by the drusen.

Exophthalmos in obesity.

AIMS: To establish the relationship between exophthalmos and obesity. METHODS: A group of 19 obese patients (body mass index, BMI >/=30 kg/m(2)) was compared with a control group of 45 nonobese individuals (26 > BMI >/= 20 kg/m(2)). Both groups underwent Hertel's exophthalmometry, Goldmann applanation tonometry and measurement of the medial rectus muscle by echography. RESULTS: Obese patients had higher Hertel values and enlarged medial rectus muscle diameter (p < 0.05). Indeed, bilateral exophthalmos was observed in 33% of obese subjects. However, this did not cause any ocular morbidity. In some cases the difference in intraocular pressure was enlarged but together with the exophthalmos not statistically significant. CONCLUSIONS: Standard values for exophthalmometry and orbital echography may have to be adapted for obese individuals. In several cases the eye signs had a remarkable resemblance to patients with Graves' orbitopathy. So in each patient with bilateral exophthalmos and eye signs suspicious of Graves' orbitopathy obesity should be considered as a possible cause.