RESUMO
The authors explain the reasons for and the timing of surgery for convergent strabismus, or esotropia, in children as a function of the particular type of strabismus. The goal of surgery is to correct the cross-eyed deviation by choosing the most opportune time so as to obtain the best binocular result with the minimum number of surgeries. The authors take a position in the debate over age at time of surgery for childhood esotropia, which is still controversial. Their arguments are based on recent neurophysiological and clinical data.
Assuntos
Esotropia/cirurgia , Acomodação Ocular/fisiologia , Fatores Etários , Toxinas Botulínicas Tipo A/administração & dosagem , Pré-Escolar , Convergência Ocular/fisiologia , Diplopia/diagnóstico , Diplopia/etiologia , Diplopia/fisiopatologia , Diplopia/cirurgia , Esotropia/diagnóstico , Esotropia/etiologia , Esotropia/fisiopatologia , Humanos , Lactente , Injeções Intraoculares , Resultado do Tratamento , Visão Binocular/fisiologiaRESUMO
Whiplash is a lay term combining all the complications of a cervical sprain or distortion associated with an extension. It may lead to cervical or back pain, but patients may also complain about functional visual impairment. These visual complaints: fixation disparity, heterophoria or convergence insufficiency, are frequently neglected and difficult to quantitate and treat. Establishing the relationship between the indirect cervical trauma and the visual signs may be challenging for the medical-legal expert and must include consideration of the previous oculomotor status of the patient.
Assuntos
Doenças Musculares/etiologia , Músculos Oculomotores , Traumatismos em Chicotada/complicações , HumanosRESUMO
BACKGROUND: Previous studies have shown an effect of the tranquilizer lorazepam on visual perception. We explored the effects of the drug on binocular vision, visual acuity and accommodation. SUBJECTS AND METHODS: Twenty-four paid healthy volunteers (13 women, 11 men) were recruited from the University of Strasbourg (mean age: 23.6 years, mean weight: 66.8 Kg). They were randomly assigned to one of two parallel groups of 12 subjects each (a placebo group and a lorazepam 0.038 mg/kg group). Visual acuity was measured for each eye separately (Snellen chart and Parinaud scale). Binocular vision was studied using the cover tests, measurement of the fusional amplitudes (with Berens prisms), and the Duane Scale Test (near point rule) measuring convergence and/or accommodation in centimeters or diopters as a function of age. RESULTS: Regarding vision, there was no lorazepam effect, at either 33 cm or 5 m. An esophoria was observed after the intake of lorazepam (0Delta before intake and 2.8Delta after intake, p=0.001). Both fusional convergence and fusional divergence amplitudes decreased by lorazepam, (p=0.008, and p=0.002). Lorazepam also impaired the near point of convergence but did not affect accommodation. CONCLUSION: A single dose of lorazepam induces an esophoric oculomotor imbalance and impaired fusional convergence and divergence amplitudes without impairing visual acuity or accommodation.
Assuntos
Acomodação Ocular/efeitos dos fármacos , Ansiolíticos/farmacologia , Lorazepam/farmacologia , Visão Binocular/efeitos dos fármacos , Acuidade Visual/efeitos dos fármacos , Administração Oral , Adulto , Ansiolíticos/administração & dosagem , Método Duplo-Cego , Esotropia/induzido quimicamente , Feminino , Humanos , Lorazepam/administração & dosagem , Lorazepam/efeitos adversos , Masculino , Estudos ProspectivosRESUMO
INTRODUCTION: The number of staff subjected to significant amounts of on-screen work with visual complaints is currently increasing. OBJECTIVE: This epidemiological study aimed to observe the influence of changes in working conditions and an ophthalmological treatment on vision and eye complaints due to on-screen work. MATERIALS AND METHODS: This comparative study included a transversal initial study on the visual symptoms and function as well as a longitudinal follow-up of the efficacy of the recommendations given by the company medical officer. The studied subjects were be exposed to screen irradiation for at least 4 hours a day during the study. The control group was selected according to the age, sex, and education level of the investigated group. RESULTS: We examined 814 subjects under investigation and 325 control subjects. The subjective signs of visual fatigue with on-screen work (burning or stinging eyes, diplopia or blurred vision after work, tearing, globe heaviness and fatigue, and headaches, the latter particularly in female subjects) were significantly more frequent in the exposed group than in the control group. A statistically significant correlation was found with the following factors: poor working conditions, frequent keyboard data entry, far vision optic correction, far vision significantly more often corrected to less than 10/10 at least in one eye, and, finally, near vision exophoria more than 7 diopters. We re-examined 465 exposed and 139 control subjects 1 and 2 years after consultation with the company medical officer. Following the recommendations proved to be effective in 50.5% of the employees. Improving vision by changing the optical correction showed the strongest statistical relation with the decrease in visual fatigue complaints. Organizational and material improvements also led to positive effects on functional discomfort. DISCUSSION: The far vision of those exposed to screen irradiation was significantly worse than in those who were not exposed. The people from the exposed group had vision correction significantly more often. The probable relation between progressive myopia and on-screen work is not excluded, but further investigation is needed. The proposed measures were effective for preventing visual fatigue. However, 49.5% of the study group had persistent visual symptoms, probably because of not following the recommendations, not having an ergonomic correction, or because modifications of blinking, tear film, and the ocular surface were ot taken into account. CONCLUSION: The coordination between the occupational medicine and ophthalmology departments during this study has significantly reduced visual fatigue. Nevertheless, there is still a considerable number of people from the exposed group with persistent symptoms.
Assuntos
Terminais de Computador , Oftalmopatias/etiologia , Oftalmopatias/terapia , Doenças Profissionais/etiologia , Doenças Profissionais/terapia , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To demonstrate the benefits of a low-vision intervention upon the quality of life of visually disabled adults. METHODS: The survey was proposed to patients who sought a low-vision intervention at the Colmar and Strasbourg hospital centres over a period of 9 months. Patients in agreement with the survey were asked to complete the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ25) in interview format by telephone, once they had attended the first meeting and again 2 months after the end of the low-vision intervention. RESULTS: The low-vision intervention led to overall improvement as judged by the 25 items of the questionnaire. Some items involving visual function and psychological issues showed significant benefits: the patients reported a more optimistic score concerning their general vision, described better nearby activities, and felt a bit more autonomous. CONCLUSION: More than mainstream psychological counselling, low-vision services help patients cope with visual disabilities during their daily life. The low-vision intervention improves physical and technical issues necessary to retaining autonomy in daily life.