Sympathetic pupillary activity in infants.

In an attempt to learn the contribution of the sympathetic system to smaller pupillary size in infants, pupillary responses were tested to agents acting on this system in 12 ihfants and 23 young adults. Phenylephrine dilated the pupils of both groups by the same ratio, with infants' pupils reaching a lesser diameter. The responses to cocaine and hydroxyamphetamine were lower in children. It is concluded that in the first months of life the postganglionic sympathetic nerve releases less norepinephrine. This may be due to a lower number of sympathetic neurons. The post-synaptic apparatus may not be fully developed in infants.

Chloramphenicol optic neuropathy.

Three patients with cystic fibrosis of the pancreas initially were seen because of optic neuropathy caused by a toxic reaction to chloramphenicol. The ocular symptoms were characterized by loss of visual acuity, central scotomas, red-green dyschromatopsia, and fundus changes. An increase in the latency of the occipital evoked potentials paralleled the visual impairment. A transient photopic decline in the red-light-elicited electroretinogram and the occurrence of Uhthoff's sign in the acute stage of the disease were observed. All visual impairment recovered partially or totally after the withdrawal of therapy with the drug.

Sympathetic pupillary tone in old age.

In an attempt to determine whether autonomic neural factors might be involved in senile miosis, we tested pupillary responses to agents acting on the ocular sympathetic system in old subjects and compared them to responses in young adults. Our results suggest that sympathetic tone is decreased in the elderly. The dilator pupillae muscle does not lose its sensitivity to norepinephrine with age.

Intraocular pressure and blood flow of the optic disk: a fluorescent blood cell angiography study.

The damage to disk microcirculation in glaucoma and ocular hypertension is correlated with the damage to the neuronal tissue. However, it is not clear whether the primary damage is vascular or neurogenic. We have developed a new method which allows in vivo observation of the retinal capillary blood cell flow and the plasma flow, separately. The method was used to examine the blood cell flow in the optic disks of cats' eyes. The intraocular pressure was controlled by extra-fine intraocular canula at the anterior chamber. It was found that blood cell flow became stagnant in a few capillaries at the optic disk with an intraocular pressure of 30-45% of the systemic mean blood pressure. When an induced IOP increase to 45% of systemic mean blood pressure was sustained for 30 minutes, microcirculatory blood flow recovery was complete two hours later. When this pressure was sustained for 120 minutes, the recovery was incomplete two hours later. This work represents a new tool in the research of retinal and disk hemodynamics and microvascular pathologies. The results presented in this paper support the hypothesis that early ischemic microdamage might be the basis of the pathogenesis of the chronic glaucomas.

Corneal thickness and curvature in normal-tension glaucoma.

PURPOSE: To determine whether normal-tension glaucoma, defined as a condition in which glaucomatous optic nerve and visual field changes exist without documentation of intraocular pressure greater than 21 mm Hg or other apparent cause for these changes, is overdiagnosed in patients with decreased central corneal thickness and curvature. METHODS: Twenty-one patients with normal-tension glaucoma were compared with 25 patients with primary open-angle glaucoma and 27 age-matched healthy subjects. Corneal thickness was determined by ultrasonic pachymetry. Corneal curvature was determined using a keratometer. Eyes with corneal pathology or previous intraocular surgery were excluded. RESULTS: Mean corneal thickness +/- SD in 21 eyes of 21 patients with normal-tension glaucoma was 0.521 +/- 0.037 mm, significantly (P = .0028) lower than in 25 eyes of 25 patients with primary open-angle glaucoma (0.556 +/- 0.035 mm) and 27 eyes of 27 healthy subjects (0.555 +/- 0.034). Mean corneal curvature in the three groups was not appreciably different: 43.90 +/- 1.81 diopters, 43.66 +/- 1.68 diopters, and 44.36 +/- 1.13 diopters in the patients with normal-tension glaucoma and primary open-angle glaucoma and the healthy subjects, respectively. CONCLUSIONS: Corneal thickness is significantly reduced in patients with normal-tension glaucoma compared with patients with primary open-angle glaucoma (P = .0028) and normal subjects (P = .0037). This may lead to underestimation of intraocular pressure and misdiagnosis in some of these patients. Corneal curvature was similar in patients with normal-tension glaucoma and primary open-angle glaucoma and in healthy subjects.

Granulomatous kerato-conjunctivitis as a manifestation of Hodgkin lymphoma.

PURPOSE: To report atypical kerato-conjunctivitis as a manifestation of Hodgkin disease. METHODS: Case report. RESULTS: A 19-year old woman presented with conjunctival nodules and corneal infiltrates. Diffuse lymph node enlargement occurred, but not in the preauricular or submandibular areas. Extensive microbiologic examination was negative. Conjunctival biopsy showed noncaseating granulomas. Inguinal lymph node biopsy showed Hodgkin lymphoma, and chemotherapy was instituted. Ocular signs resolved after 6 weeks, but a corneal scar remained. CONCLUSIONS: The appearance of conjunctival granulomas and corneal infiltrates may represent a clinical manifestation of Hodgkin lymphoma.

Combined timolol and pilocarpine vs pilocarpine alone and timolol alone in the treatment of glaucoma.

We compared the effects of pilocarpine 4% alone, timolol 0.5% alone, and a combination of timolol 0.5% and pilocarpine 4% in the treatment of glaucoma. We treated 43 patients with glaucoma using each drug and then with the combination of drugs for four weeks each. Only patients with a morning intraocular pressure of at least 24 mm Hg without treatment were included. The patients were examined, after one and four weeks of treatment with pilocarpine, timolol, or combined timolol 0.5% and pilocarpine 4%, before the morning dose and at two and five hours after it. At the end of the study, the mean reduction in intraocular pressure from baseline was 9.2 +/- 5.1 mm Hg (28.5% +/- 12.7%) with combined timolol 0.5% and pilocarpine 4%, 5.6 +/- 3.6 mm Hg (17.6% +/- 9.7%) with pilocarpine, and 7.5 +/- 5.0 mm Hg (21.2% +/- 12.6%) with timolol. Intraocular pressure was consistently lower with the combination treatment than with timolol or pilocarpine alone. We believe that this combined solution of timolol-pilocarpine is a valuable contribution to the treatment of open-angle glaucoma.

Ocular saccades in Duane's syndrome.

Since Hering's law might be affected when paradoxical innervation exists, 10 patients with Duane's syndrome were studied. Eye movements were measured by binocular recording of electro-oculogram. Our study shows clearly that the sound eye's motility is also affected. When adduction of the affected eye is present, Hering's law holds, whereas when adduction is limited this law cannot be demonstrated.

Sector retinitis pigmentosa in juvenile nephronophthisis.

In a patient with juvenile nephronophthisis, sector retinitis pigmentosa was found as an extrarenal manifestation, establishing a hitherto undescribed variety of retinal degeneration occurring in this disorder. The retinal function in this case was identical with that in the classic type of sector retinitis pigmentosa, namely, subnormal ERG amplitudes but normal cone and rod implicit times. The range of the retinal findings and their autosomal recessive transmission are discussed. Paucity of information makes it difficult to elucidate the basic genetic defect operating in this condition.

Retinal detachment in median cleft-face syndrome.

A 7-year-old boy had an unusual association of median cleft-face syndrome, a characteristic physiognomy, unilateral retinal dysplasia, and bilateral retinal detachment. Despite surgical treatment to both eyes he became blind. The hereditary pattern operating in this complex disorder was found to be consistent with an autosomal dominant trait.

Influence of patient age on refraction and corneal haze after photorefractive keratectomy.

AIMS/BACKGROUND: Since wound healing processes are known to be more rapid in those who are young, it was decided to examine the effect of patient age on refractive outcome of photorefractive keratectomy (PRK). METHODS: The records of 599 eyes that had undergone PRK were studied retrospectively. The eyes were categorised by baseline myopia and patient age. Spherical equivalent and corneal haze were compared in the baseline refraction and age groups at 3, 6, and 12 months after PRK. RESULTS: There were no differences in postoperative refraction and corneal haze in the different age groups. CONCLUSION: Patient age had no statistically significant effect on refraction and corneal haze 1 year after PRK.

Refractory intraocular pressure increase after photorefractive keratectomy.

A patient with developmental angle anomaly developed a corticosteroid-induced refractory increase in intraocular pressure (IOP) after photorefractive keratectomy (PRK). Trabeculectomy was required to reduce the pressure. Although rare, corticosteroid-induced refractory IOP increase is a serious complication of PRK and may necessitate trabeculectomy. More frequent monitoring of IOP in post-PRK patients and a re-evaluation of postoperative treatment are indicated.

Tono-Pen versus Goldmann tonometry after excimer laser photorefractive keratectomy.

PURPOSE: To compare intraocular pressure (IOP) measurements by the Tono-Pen 2 tonometer and Goldmann applanation tonometer (GAT) in post-photorefractive keratectomy (PRK) patients. SETTING: Refractive Surgery Center, Assaf Harofeh Medical Center, Zerifin, Israel. METHODS: In 18 patients, IOP was measured by GAT and then by Tono-Pen 2 tonometer 2 to 18 months following PRK (mean 6.6 months +/- 5.1 [SD]). Photorefractive keratectomy had been performed in 1 eye of each patient; the fellow eyes served as controls. Corneal curvature and thickness were evaluated. Ten of the 18 patients were treated with topical steroids. RESULTS: In the post-PRK eyes, mean GAT IOP was 1.8 +/- 3.1 mm Hg lower than mean Tono-Pen IOP (P = .012); there was no significant IOP difference in the control (fellow) eyes. In steroid-treated post-PRK eyes, mean GAT IOP (12.2 mm Hg) was 2.2 +/- 1.3 mm Hg lower than mean Tono-Pen IOP (14.4 mm Hg) (P = .0007). Mean Tono-Pen IOP in steroid-treated post-PRK eyes was 4.3 +/- 3 mm Hg higher than in the fellow eyes (P = .0014); mean GAT IOP was only 2.3 +/- 3.5 mm Hg higher (P = .04). In post-PRK eyes without topical steroid treatment, mean GAT IOP was 2.0 +/- 1.18 mm Hg lower than in the fellow eyes (P = .001); there was no significant difference in Tono-Pen IOP. There was a negative correlation between the difference in IOP values (Tono-Pen minus GAT) and corneal curvature in post-PRK eyes (r = 0.76, P = .0108, n = 15). CONCLUSIONS: The Tono-Pen tonometer appeared to be less affected than the GAT by the relative flattening, thinning, and anterior stromal decreased rigidity of the central cornea that occur following PRK. Post-PRK steroid-induced IOP elevation may be masked by the artifactual decrease in GAT IOP.

Excimer laser phototherapeutic keratectomy for recurrent corneal erosion.

PURPOSE: To evaluate the outcome of excimer laser phototherapeutic keratectomy (PTK) for recurrent corneal erosion. SETTING: Laser Institute, Assay Harofeh Medical Center, Zerifin, Israel. METHODS: Twenty-three patients with a mean age of 50.56 years +/- 13.87 (SD) were referred between 1991 and 1995 for recurrent corneal erosion that did not respond to conservative treatment. All were treated by excimer laser PTK. Patients were interviewed and examined before and after treatment. RESULTS: Disease duration ranged from 2 months to 10 years. Frequency of attacks ranged from weekly to three to four times a year. Re-epithelialization of the cornea was established within an average of 3 days after PTK treatment. Follow-up was 12 to 60 months (mean 38.43 +/- 12.08 months). Nineteen (83%) patients were free of recurrences, and 3 had one recurrence treated successfully by patching. One patient who had two recurrences had a second PTK procedure and was symptom free for 14 months. No patient reported reduced visual acuity or quality. Postoperative best corrected visual acuity was unaltered in 21 eyes and improved in 2. There was no significant difference between preoperative and postoperative manifest refractions. CONCLUSION: Excimer laser PRK appears to be a safe and effective treatment for recurrent erosions of the cornea.

Ultrastructure of the conjunctiva, skin, and gingiva: a case of Sandhoff's disease in a Jewish patient.

Pleomorphic membranous cytoplasmic bodies that indicated glycolipid storage were found in the conjunctiva, skin, and gingiva of a Jewish patient with Sandhoff's disease. The clinical symptoms were typical of GM2 gangliosidosis. Both hexosaminidase A and hexosaminidase B activities were deficient in the leukocytes and serum. Glycosaminoglycan levels in cultured fibroblasts were elevated. Membranous cytoplasmic bodies were observed in high concentrations in a large proportion of the vascular endothelial cells, pericytes, and Schwann cells and to a somewhat lesser extent in the fibrocytes of all tissues studied. Ultrastructural analysis of the conjunctiva, skin, and gingiva as an aid for the diagnosis of Sandhoff's disease is suggested.

Medial transposition of the lateral rectus muscle in combined third and fourth nerve palsy.

Surgical treatment of combined third and fourth nerve palsy is a challenging problem in strabismology. Five of the 6 extraocular muscles are paralyzed, which leaves the lateral rectus muscle with no antagonist to counteract its activity and usually results in a maximal exotropia. The goal of surgery is to achieve orthophoria in primary position with limited ductions. Because some believe that a conventional recession-resection procedure will inevitably result in a drift back to exotropia,(1) several other methods have been proposed to treat this disorder. These include temporal mattress suture,(2) eye muscle prosthesis, (3,4) splitting and reattaching the lateral rectus muscle near the vortex veins,(5) and fixation of the eye with fascia lata.(6) Taylor(7) suggested using medial transposition of the lateral rectus muscle in a case of isolated third nerve palsy. We report the outcome of a procedure that included such a transposition for the treatment of combined third and fourth nerve palsy.

Visual acuity tests using chart, line, and single optotype in healthy and amblyopic children.

PURPOSE: The purpose of this study was to evaluate the difference between full chart, single line, and single optotypes visual acuity (VA) test results in healthy and amblyopic children. METHODS: Thirty-five children with amblyopia (20 with strabismus and 15 with anisometropia) and 40 ophthalmologically normal age-matched children were examined. The mean age of the patients in the study and control groups did not differ significantly (P= .9). A commercial projector that projected tumbling-E randomly placed optotypes was used. The VA of the amblyopic eye of the patients in the study group and the right eye of the patients in the control group was examined first using a full chart of optotypes, then using a single line of optotypes, and finally with individual symbols. The procedure was repeated with the other eye. RESULTS: LogMAR VA improved when the full chart was substituted with a single line, and improved by a similar increment further with single optotypes, in both the study and control groups. VA improved significantly more in eyes with amblyopia than in control subjects. Results were not influenced by age. CONCLUSION: VA testing using a single line gives better, sometimes misleading results, than tests with a full chart because it reduces but does not eliminate the crowding effect. When using a device that can employ more than 1 mode, the exacttest mode should be specified and maintained throughout the follow-up.

Falciform fold of retina.

A boy of 2 had evidence of congenital retinal non-attachment. The mother had a veil like fold in one eye. There was no evidence of any systemic disorder. The inheritance might be X-linked recessive. Mild manifestations of the disease in the carrier mother may be more frequent than has been assumed and should be looked for.

Pitfall of acquired ocular torticollis.

Following a posttraumatic concussion syndrome, a 24-year-old female presented at left clavicular fracture and dislocation with a compensatory head posture thought to be due to her sternocleidomastoid muscle involvement. Further investigation disclosed the existence of a concomitant superior oblique muscle palsy seemingly also of traumatic origin. The clinical course and the constellation of her symptoms are described.

Benign palsy of superior oblique muscle.

Thirteen patients with nontraumatic superior oblique muscle palsy were examined during a four to seven year follow-up period. Extensive investigations disclosed no underlying systemic or neurologic diseases. In all patients a quick improvement and recovery of the motility imbalance occurred spontaneously in about 10 weeks, suggesting a benign prognosis in the condition.