Ocular complications of Tangier disease.

Tangier disease, or familial high-density lipoprotein deficiency, is an inherited disorder resulting in tissue deposition of excessive cholesterol esters. Although associated corneal clouding has been reported to produce little visual impairment, this patient with Tangier disease had corneal clouding, decreased corneal sensation, and cicatricial ectropion and experienced slowly progressive marked visual impairment. All ocular cases of Tangier disease are reviewed. Ectropion and incomplete eyelid closure may precede corneal clouding and should be recognized as signs associated with Tangier disease. The combination of exposure keratopathy and corneal infiltration can cause significant visual impairment.

Orbital teratoma.

An orbital teratoma with extension into the maxillary sinus, pterygopalatine fossa nasal cavity, and middle cranial fossa is presented. Through combined efforts of the services of Ophthalmology, Otolaryngology, and Neurosurgery, a tumor that was 4.5 cm in greatest diameter was removed, leaving the globe and optic nerve within the orbit. Within the 2 1/2-year period since surgery, the condition of the patient has been satisfactory.

Medical management of self-enucleation.

Self-enucleation or oedipism is a specific manifestation of psychiatric illness distinct from the milder forms of self-inflicted ocular injury. In this article, we discuss the previously unreported medical complication of subarachnoid hemorrhage accompanying self-enucleation. The diagnosis was suspected from the patient's history and was confirmed by computed tomographic scan of the head. This complication may be easily missed in the overtly psychotic patient. Specific steps in the medical management of self-enucleation are discussed, and medical complications of self-enucleation are reviewed.

Eye manifestations in acrodermatitis enteropathica.

A case of acrodermatitis enteropathica is presented that is the first to manifest punctal stenosis, the fourth to show corneal changes, and the sixth to survive into adulthood.

Orbital apex syndrome.

A case is presented of a 16-year-old anticoagulated, immunocompromised male presenting with a blind, proptotic left eye, total ophthalmoplegia, and central retinal artery occlusion. Ophthalmic examination revealed other features of the orbital apex syndrome. Mucormycosis misdiagnosed as a traumatic orbital hemorrhage led to the patient's death. In this review, differential diagnosis of the orbital apex syndrome (loss of cranial nerves II, III, IV, ophthalmic division of V, and VI) is outlined, and features, diagnosis, and treatment of mucormycosis are discussed. Although mucormycosis is most commonly seen in diabetics, it should be considered in any immunocompromised patient presenting with the constellation of features of orbital apex syndrome.

Coats'-type retinitis pigmentosa.

Coats'-like changes (i.e., retinal telangiectasia and/or exudative detachment) have been reported in as many as 1.2 to 3.6 percent of patients with retinitis pigmentosa. In severe cases this disorder may progress to total retinal detachment and visual loss in the context of longstanding retinitis pigmentosa. Forty-six cases of Coats'-type retinitis pigmentosa gathered from the literature are reviewed. Historical and epidemiological features, hereditary factors, clinical features, histopathological findings, pathogenesis, differential diagnosis, prognosis and possible treatment are discussed.

Methicillin-resistant Staphylococcus epidermidis blepharitis.

Blepharoconjunctivitis caused by methicillin-resistant strains of Staphylococcus epidermidis occurred in two hospitalized patients, a 74-year-old man and a 19-year-old man. Both strains were resistant to multiple courses of topical antibiotic therapy. Successful treatment in both cases depended upon antibiotic sensitivity testing. These methicillin-resistant strains of S. epidermidis, like methicillin-resistant strains of Staphylococcus aureus, demonstrated almost complete cross-resistance to cephalosporins despite apparent sensitivity on Kirby-Bauer disk sensitivity testing. Topical vancomycin was curative in one case. In the other case, treatment with topical gentamicin, intravenous cefoperazone, and oral rifampin led to resolution of the symptoms.

Control of intraocular pressure with apraclonidine hydrochloride after cataract extraction.

We conducted a randomly assigned, double-masked, controlled clinical trial to assess the efficacy of 1% apraclonidine hydrochloride in controlling postoperative intraocular pressure increases in patients undergoing extracapsular cataract extraction. Apraclonidine hydrochloride was given either one hour preoperatively or immediately after uncomplicated, extracapsular cataract extraction with posterior chamber intraocular lens implantation and compared with artificial tears given immediately postoperatively. Those who received apraclonidine hydrochloride preoperatively had significantly lower mean intraocular pressure at the first postoperative reading (P = .0005). After preoperative and postoperative apraclonidine hydrochloride, the mean early postoperative intraocular pressure was 19.8 mm Hg and 32.0 mm Hg, respectively, and 27.6 mm Hg after artificial tears. No patient who received preoperative apraclonidine hydrochloride had an intraocular pressure increase to 30 mm Hg or higher postoperatively. Nine of 20 patients (45%) who received postoperative apraclonidine hydrochloride and eight of 18 patients (44%) who received postoperative artificial tears had an increase of intraocular pressure to 30 mm Hg or higher in the early postoperative period. These differences were also highly significant (P = .0005).

Prolonged complementary chromatopsia in users of video display terminals.

Induced prolonged complementary chromatopsia in four subjects (two men, 26 and 34 years old, and two women, 34 and 45 years old) was documented by abnormal responses to pseudoisochromatic color plates 30 minutes after cessation of monochrome video display terminal use. This phenomenon was unrelated to preexisting color vision anomalies, known ocular disease, or drug use, and defines a specific phenomenon probably related to afterimages. All four patients missed AOH-R-R plate 3 after using the video display terminal. One patient also had a delayed response to plate 6. One patient patched one eye before using the video display terminal and noted that the complementary chromatopsia occurred only in the unpatched eye.

Comparative efficacy of the beta-blockers for the prevention of increased intraocular pressure after cataract extraction.

We conducted a randomized, double-masked study of intraocular pressure in 80 patients treated with betaxolol, levobunolol, timolol, or placebo after extracapsular cataract extraction. Intraocular pressures were measured preoperatively and early (four to seven hours) and late (20 to 24 hours) postoperatively. There was a significant mean increase in pressure from the preoperative period to the early postoperative period for the placebo group (5.35 mm Hg), betaxolol group (6.73 mm Hg), and the timolol group (3.83 mm Hg). However, the levobunolol group had a mean decrease in pressure (0.43 mm Hg). There was no significant difference between preoperative and late postoperative pressures for any of the groups. One-way analysis of covariance of the changes in pressure from the preoperative to early postoperative period showed a significant increase for the placebo and betaxolol groups compared to the levobunolol group, without significant difference between the levobunolol and timolol groups. Overall, levobunolol proved most effective in preventing an increase in intraocular pressure after extracapsular cataract extraction; timolol was partially effective.