RESUMO
The major clinical infectious syndromes involving the retina and choroid are discussed. Means for successful diagnosis and treatment are presented, as well as the major complications. This work emphasizes the need to identify the infectious nature of these syndromes in order to avoid the all-too-common pitfall of just treating all cases of uveitis with steroids alone.
Assuntos
Doenças da Coroide/microbiologia , Infecções Oculares , Doenças Retinianas/microbiologia , Animais , Fundo de Olho , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Toxocaríase/diagnóstico , Toxocaríase/tratamento farmacológico , Toxoplasmose Ocular/diagnóstico , Toxoplasmose Ocular/tratamento farmacológico , Tuberculose Ocular/diagnóstico , Tuberculose Ocular/tratamento farmacológicoRESUMO
PURPOSE: To report a rare presentation of the tubulointerstitial nephritis and uveitis syndrome. METHOD: Case report. A 34-year-old woman underwent extensive clinical and laboratory evaluation of bilateral intermediate uveitis and optic nerve edema. RESULTS: Laboratory evaluation and nephrology consultation led to a diagnosis of tubulointerstitial nephritis. The condition resolved with the use of topical and systemic corticosteroids and the discontinuation of ibuprofen. CONCLUSIONS: Tubulointerstitial nephritis and uveitis syndrome is uncommon. It may present with anterior or intermediate uveitis. Chronic intermediate uveitis can cause optic nerve and macular edema. A thorough medical evaluation of any patient presenting with uveitis and systemic disease is essential to the diagnosis and management of uveitis.
Assuntos
Nefrite Intersticial/complicações , Papiledema/etiologia , Uveíte Intermediária/complicações , Adulto , Feminino , Humanos , Disco Óptico/patologia , Papiledema/patologia , SíndromeRESUMO
PURPOSE: To report a rare systemic manifestation of sarcoidosis identified in a 47-year-old white woman while she was undergoing evaluation for bilateral recurrent uveitis. METHODS: The patient underwent clinical and laboratory evaluation for bilateral recurrent uveitis including serologic and radiologic testing, a gallium scan, and an endometrial biopsy. RESULTS: Although the serologic tests and chest x-ray were normal, the gallium scan was consistent with sarcoidosis, and the endometrial biopsy provided a tissue diagnosis. CONCLUSION: Sarcoidosis involving the female reproductive tract is rare. A thorough review of systems is crucial in the evaluation of any patient with recurrent uveitis.
Assuntos
Endométrio/patologia , Menorragia/diagnóstico , Sarcoidose/diagnóstico , Doenças Uterinas/diagnóstico , Uveíte/diagnóstico , Biópsia , Feminino , Humanos , Menorragia/etiologia , Pessoa de Meia-Idade , Sarcoidose/etiologia , Doenças Uterinas/etiologia , Uveíte/etiologia , Acuidade VisualRESUMO
PURPOSE: To describe four cases of delusions of parasitosis in which self-inflicted ocular trauma occurred. Delusions of parasitosis is a somatic delusional disorder in which patients have the irrational belief that their bodies are infested by parasites or other infectious organisms. Self-inflicted trauma can result from attempts to eliminate the supposed infestation. METHODS: We reviewed the case histories of four patients (one male, three females, 35 to 45 years of age) who presented with complaints of ocular infestation but had no evidence of infectious ocular disease. The characteristics of these cases were compared with the features of delusions of parasitosis. RESULTS: All patients maintained their beliefs regarding infestation, despite extensive clinical and laboratory investigations that found no evidence of infectious diseases. Self-inflicted eye injury, associated with attempts to eliminate the infestation, occurred in each case. CONCLUSIONS: The cases presented in this report are consistent with a diagnosis of delusions of parasitosis. The eye can be a principal focus of attention in this disorder, which may lead to vision loss caused by self-inflicted injury.
Assuntos
Delusões/psicologia , Infecções Oculares Parasitárias/psicologia , Adulto , Ectoparasitoses/psicologia , Traumatismos Oculares/etiologia , Traumatismos Oculares/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Automutilação/etiologia , Automutilação/terapia , Comportamento Autodestrutivo , Acuidade VisualRESUMO
Photostress recovery time was measured in 30 eyes from 15 patients with chronic open angle glaucoma, and 30 eyes from 15 individuals of a similar age group with no ophthalmological disorder. The average recovery time in patients with glaucoma was 70.47 (SD 35.39) seconds. The average recovery time in the control population was 41.97 (SD 17.34) seconds. This difference was statistically significant (p less than 0.001). There was a small positive correlation between age and recovery time in the control population, whereas there was no correlation between age and recovery time in the glaucoma group. There was no correlation between visual acuity and recovery time for either group. There was also no correlation between intraocular pressure and recovery time for the glaucoma group. It was not possible to control for pupillary dilatation in this study. However, it has been previously demonstrated that pharmacological meiosis will not delay photostress recovery time in normal subjects. This is the first report of photostress recovery testing in patients with chronic open angle glaucoma. The results are discussed in terms of the pathophysiology of glaucoma and previous photostress studies in patients with macular disease.
Assuntos
Glaucoma de Ângulo Aberto/fisiopatologia , Luz , Acuidade Visual , Adulto , Fatores Etários , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
PURPOSE: Tear lysozyme and tear lactoferrin are enzymes synthesized by the lacrimal gland. Their concentration in human tears reflects tear gland function. Tear gland dysfunction can lead to ocular surface disease. We developed a colorimetric lysozyme assay. The objective of this study was to determine the diagnostic power and the clinical application of this assay that allows rapid and precise quantification of tear lysozyme. METHODS: Tear specimens of 120 eyes (30 Sjögren's patients and 30 controls) were collected using standardized filter paper discs. Tear lysozyme concentration was determined using p-nitrophenyl penta-N-acetyl-beta-chitopentaoside as substrate in the colorimetric assay. The results were compared to clinical findings and to two commonly used tests, the Micrococcus agar diffusion assay for tear lysozyme and the tear lactoferrin immunodiffusion assay. RESULTS: The colorimetric assay showed a good dose-response relationship. The use of the assay as a method of diagnosing aqueous tear deficiency, using the clinical findings and the medical history as gold standard, demonstrated 85% sensitivity and 92% specificity. The results of the colorimetric assay when compared with the Micrococcus agar diffusion assay showed a linear relationship of r=0.77; when compared with the lactoferrin immunoassay r=0.73. CONCLUSIONS: The colorimetric assay is simple to perform and does not require sophisticated laboratory equipment and personnel. Results can be precisely quantified within one hour after tear collection. The diagnostic power of the test is comparable to previously reported assays for lysozyme and lactoferrin and will be useful in the diagnosis of ocular surface disease.
Assuntos
Colorimetria/métodos , Muramidase/metabolismo , Síndrome de Sjogren/enzimologia , Lágrimas/enzimologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Imunodifusão , Aparelho Lacrimal/enzimologia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Síndrome de Sjogren/diagnósticoRESUMO
The purpose of the present study was to investigate attachment and fear of intimacy among rape survivors. As previous research has documented that several domains of functioning are affected by the experience of rape, it was hypothesized that the survivors may have difficulties with attachment and intimacy. Subjects were selected from an undergraduate general psychology class on the basis of responses to a questionnaire on sexual experiences. All of the subjects were female and included 44 rape survivors and 57 controls. As predicted, rape survivors reported greater fear surrounding intimacy. Survivors also differed from the controls on all of the attachment dimensions. They reported less confidence in others' dependability, less comfort with closeness, and more fear of abandonment. Trait anxiety was also controlled in the analyses, and except for fear of abandonment, it attenuated the differences between the groups such that they were no longer significantly different.
Assuntos
Medo , Relações Interpessoais , Apego ao Objeto , Estupro/psicologia , Sobreviventes/psicologia , Adolescente , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Feminino , Humanos , Inventário de PersonalidadeAssuntos
Úlcera da Córnea/microbiologia , Enterococcus faecalis , Infecções Oculares Bacterianas , Infecções por Bactérias Gram-Positivas , Ceratoplastia Penetrante , Cloranfenicol/uso terapêutico , Úlcera da Córnea/tratamento farmacológico , Quimioterapia Combinada , Infecções Oculares Bacterianas/tratamento farmacológico , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Vancomicina/uso terapêuticoAssuntos
Fibrina/metabolismo , Ceratoplastia Penetrante/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Câmara Anterior , Úlcera da Córnea/etiologia , Úlcera da Córnea/cirurgia , Infecções Oculares Bacterianas/complicações , Fibrinólise/efeitos dos fármacos , Humanos , Injeções , Masculino , Infecções por Pseudomonas/complicações , Ativador de Plasminogênio Tecidual/administração & dosagemAssuntos
Endoftalmite/microbiologia , Infecções Oculares Bacterianas , Moraxella/enzimologia , Infecções por Neisseriaceae , beta-Lactamases/metabolismo , Idoso , Antibacterianos/uso terapêutico , Endoftalmite/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Moraxella/isolamento & purificação , Corpo Vítreo/microbiologiaAssuntos
Proteínas do Olho/análise , Glucosídeos , Muramidase/análise , Oligossacarídeos , Lágrimas/enzimologia , Colorimetria , Glucosídeos/síntese química , Humanos , Indicadores e Reagentes , Métodos , Oligossacarídeos/síntese química , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Especificidade por SubstratoAssuntos
Criopreservação , Proteínas do Olho/análise , Muramidase/análise , Lágrimas/enzimologia , Adulto , Idoso , Criança , Ensaios Enzimáticos Clínicos , Estabilidade Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmologia/métodos , Estudos Retrospectivos , Rosa Bengala , Síndrome de Sjogren/diagnósticoAssuntos
Túnica Conjuntiva/patologia , Córnea/patologia , Glândulas Salivares/patologia , Síndrome de Sjogren/diagnóstico , Xerostomia/patologia , Biópsia , Feminino , Humanos , Ceratoconjuntivite Seca/complicações , Ceratoconjuntivite Seca/patologia , Masculino , Pessoa de Meia-Idade , Rosa Bengala , Síndrome de Sjogren/complicações , Xerostomia/complicaçõesAssuntos
Corioide/irrigação sanguínea , Macula Lutea/irrigação sanguínea , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Microcirculação/anatomia & histologia , Microcirculação/ultraestrutura , Microscopia Eletrônica de Varredura , Pessoa de Meia-IdadeRESUMO
Vascular casts were prepared from ten human orbits removed at autopsy from patients with no previous history of vascular disease. The ages ranged from 7 months to 68 years. The time interval between death and injection of the orbit was always less than 12 h. The vascular casts were examined under scanning electron microscopy with particular attention to the submacular region. We present photomicrographs of common findings seen in each of our specimens, and discuss our results with respect to current models of the submacular angioarchitecture.
Assuntos
Órbita/irrigação sanguínea , Adolescente , Adulto , Idoso , Capilares/ultraestrutura , Criança , Pré-Escolar , Humanos , Lactente , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Órbita/ultraestruturaRESUMO
We describe the clinical course of a young woman with a peripheral T-cell lymphoma who presented in a leukemic phase of the disease with an initial complaint of bilateral conjunctival swelling.