La isla mínima / The minimun island

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[Unique mechanism in heart-shaped balloon burst resulting in blunt ocular injury].

We have previously shown that heart-shaped balloons have a different explosion mechanism than spherical balloons in which the former splits into two rubber parts still attached to the balloon base with a backward whiplash motion. This backward whiplash motion may cause significant blunt ocular trauma if the balloon is inflated by mouth. In this article, the energy of the blunt ocular trauma is estimated by the high speed camera photos analysis of the balloon burst. Furthermore, we describe the followup of eight patients with ocular trauma following inflation of heart-shaped balloons.

Assessment and management of patients with acute red eye.

This article provides an overview of the role of the nurse in the assessment and management of five ocular conditions that give rise to an acute red eye in older people. The conditions discussed are acute closed angle glaucoma, acute iritis, acute conjunctivitis, herpes zoster ophthalmicus and bacterial corneal ulcer.

Ocular inflammation and infection.

Ocular inflammation and infection may involve any part of the eye and surrounding tissue. A complete examination, including visual acuity, extraocular movements, pupillary response, slit lamp examination, and fluorescein staining, is often required to establish the diagnosis. Pain relief may be achieved with oral analgesics and cycloplegics. In most cases, prompt follow-up is required.

Novel molecular imaging approach for subclinical detection of iritis and evaluation of therapeutic success.

There is an urgent need for early diagnosis in medicine, whereupon effective treatments could prevent irreversible tissue damage. Acute anterior chamber inflammation is the most common form of uveitis and a major cause of vision loss. The proximity of the iris vasculature to the light-permeable cornea and its involvement in ocular inflammation make it an ideal target for noninvasive molecular imaging. To accomplish this, carboxylated fluorescent microspheres (MSs) were conjugated with recombinant P-selectin glycoprotein ligand-1 and systemically injected in endotoxin-induced uveitic animals. MS adhesion in the microcirculation of the anterior and posterior chamber was visualized by intravital microscopy and scanning laser ophthalmoscopy. In iritic animals, significantly higher numbers of recombinant P-selectin glycoprotein ligand-1-conjugated MSs adhered to the endothelium (P = 0.03) matching the increase in leukocyte adhesion. Conjugated MSs specifically interacted with firmly adhering leukocytes, allowing quantification of the endogenous immune response. Topical eye drop treatment with dexamethasone (P < 0.01) or cyclosporine A (P < 0.01) significantly lowered MS adhesion in iris vessels. Surprisingly, topical dexamethasone significantly reduced MS interaction in the fundus vessels (P < 0.01), while cyclosporine A did not. In vivo MS accumulation preceded clinical signs of anterior uveitis and leukocyte adhesion in iris vasculature. This work introduces noninvasive subclinical detection of endothelial injury in the iris vasculature, providing a unique opportunity for quantifying vascular injury and immune response in vivo.

Management of the red eye for the primary care physician.

For the primary care physician, the occurrence of a red eye is a frequent and prominent finding of a disease process in patients. A careful history and simple examination with the observation of typical clinical signs are important for the management of this common disorder. The causes can be classified as painful red eye, trauma, and other common conditions. The most frequent causes of a red eye, such as dry eye, conjunctivitis, keratitis, iritis, acute glaucoma, subconjunctival hematoma, foreign bodies, corneal abrasion, and blunt or penetrating trauma, are described in this article. Simple diagnostic methods and an emergency management with some useful topical ophthalmic preparations are included. Although several conditions can be treated by the primary care physician the clinical signs that require an urgent ophthalmic consultation are chemical burns, intraocular infections, globe ruptures or perforations, and acute glaucoma.

Common eye disorders: six patients to refer.

Thorough ocular history taking and physical examination are essential to establish a diagnosis in patients presenting with eye conditions. Some conditions require ophthalmologic referral to avoid serious complications and even vision loss. These include corneal ulcers, retinal detachment, iritis, glaucoma, retinal artery occlusion, and endophthalmitis. Because primary open-angle glaucoma can have an insidious onset and cause irreversible damage, funduscopic examination should be a part of every complete physical examination.

The red eye.

The red eye is a clinical problem encountered on a daily basis in most emergency departments. A careful history and focused ophthalmologic examination will lead to a correct diagnosis and proper therapy. The red eye without photophobia, pain, or visual disturbance is most commonly a result of conjunctivitis. The presence of any of these symptoms indicates a need to investigate for a more serious cause. Infectious causes of conjunctivitis should always be investigated, but allergies and hypersensitivity also should be considered if the history is appropriate. Emergency department treatment of the red eye should only include corticosteroids when the diagnosis is certain and ophthalmologic consultation is obtained.

Ojo rojo, una afección grave? / Red eye, a dangerous disease?

Al enfrentar este problema, el médico debe considerar como diagnósticos diferencial la posibilidad de conjuntivitis, iritis, glaucoma agudo, úlcera corneana, queratitis herpética o traumatismo de la cornea. En este artículo se pasa revista a las principales claves diagnósticas y a las bases de la terapéutica de cada una de estas enfermedades.

Acute iritis associated with primary Sjögren's syndrome and high-titer anti-SS-A/Ro and anti-SS-B/La antibodies. Treatment with combination immunosuppressive therapy.

OBJECTIVE: We describe a patient with primary Sjögren's syndrome who developed severe, acute, anterior uveitis (iritis), an uncommon complication in this setting. METHODS: We present the case report of the clinical findings, course, treatment, and resolution of the acute uveitis. Titers of anti-SS-A/Ro and anti-SS-B/La antibodies were assessed (by immunodiffusion), as were fluorescent antinuclear antibodies (on HEp-2 cells) and cryoglobulins. RESULTS: Initial treatment with topical steroids, oral prednisone (20 mg/day), and oral methotrexate was unsuccessful. The iritis resolved after combined treatment with intravenous cyclophosphamide (1,500 mg/month), high-dose prednisone (60 mg/day), and cyclosporine (5 mg/kg/day). CONCLUSION: An uncommon, severe complication of primary Sjögren's syndrome is acute uveitis. Combination immunosuppressive therapy may be needed to control this condition.

[Results of the treatment of ocular toxoplasmosis in personal experience]. / Wyniki leczenia toksoplazmozy ocznej w materiale wlsnym.

Ocular toxoplasmosis manifested itself in following clinical forms: as central serous chorioretinitis, pars planitis, iritis, intrabulbar neuritis and central retinal degeneration. The diagnosis was based on the clinical picture, serological examinations, the course of the disease and the effect of the specific treatment. The authors used piridimide++ compounds, sulfonamides, steroids, folic acid and Tavegyl, Decaris as well as photo-coagulation. The efficacy of all these methods was compared.

Ocular trauma. Triage and treatment.

Many types of ocular trauma can be diagnosed and treated in the primary care office, particularly if a slit lamp is available. Treatment for corneal abrasions consists of applying a cycloplegic medication, antibiotic ointment, and a patch (unless a corneal ulcer is suspected). Iritis can be treated with cycloplegics and topical corticosteroids; the prescribing physician should be familiar with the potential ocular side effects and complications. Hyphemas are treated with bed rest, topical atropine sulfate drops and topical corticosteroids, as well as measures to prevent rebleeding. A slit lamp, topical anesthesia, and a foreign-body spud greatly facilitate the removal of foreign bodies from the cornea. Acid and alkali burns should be irrigated until the pH is normal and then should be treated like a corneal abrasion. Lid lacerations must be repaired with care to preserve proper functioning of the lid. Ruptures of the globe are serious injuries requiring surgical repair and long-term follow-up.

Managing the red eye.

The commonest causes of a red eye, excluding trauma, are conjunctivitis, allergies and lid conditions. These can usually be managed by the GP and are not serious if properly treated. Keratitis and corneal ulcers, acute iritis and acute glaucoma are uncommon conditions but are always serious and require immediate referral to an ophthalmologist for treatment.