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PubMedDate not supplied

Ophthalmological effects of high altitude.

High altitude has various effects on human beings. Altitude-related illnesses are a frequent cause of morbidity and occasional mortality in travelers to high altitudes throughout the world. The mountaineers all around the world are familiar with this condition, which is called acute mountain sickness (AMS). The primary altitude illnesses are AMS, high-altitude pulmonary edema and high-altitude cerebral edema. Altitude has potential undesired ophthalmological effects. The pathogenesis of these syndromes remains unclear despite considerable research in this field. Most of these problems are primarily preventable with an adequate level of information before and during travel. Further studies are needed to reveal the exact relationship between high altitude and ophthalmological findings. In this article, ophthalmological effects of high altitude, likely to be encountered by mountaineers as well as other enthusiasts of high altitude sports are reviewed. Emphasis on aviation and aerospace medicine is briefly given under related SUB_TITLEs.

Aerospace Medicine↗

PubMed2003

Dermatological and ophthalmological sequels in toxic epidermal necrolysis.

BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare, drug-induced disease characterized by epidermal detachment and mucosal involvement. After an acute period, potentially disabling cutaneous and ocular sequels may appear. Although long-term complications are not rare, only few outcome studies are published. OBJECTIVE: To evaluate the incidence of dermatological and ophthalmological sequels following TEN, to describe its clinical aspects and correlation with acute involvement. PATIENTS AND METHODS: Eight patients surviving to TEN were submitted to dermatological and ophthalmological observation ranging from 0.5 to 8 years after hospitalization. Cutaneous and ocular involvement, during the acute phase, was retrospectively analysed. RESULTS: Dermatological sequels were observed in 6 patients (75%) corresponding to those with more extensive skin involvement in the acute phase. The most frequent complications were cutaneous dyschromia (62.5%) and nail dystrophies (37.5%). Six patients (75%) had ocular complications with tarsal conjunctiva keratinization in 5 (62.5%) and keratoconjunctivitis sicca in 4 of them (50%). Trichiasis, corneal neovascularization and symblepharon were observed in 1 case. There was no correlation between the severity of acute ocular involvement and long-term complications. CONCLUSION: Following TEN, most patients have dermatological and ophthalmological sequels that persist for several years.

Adolescent↗

PubMed1996

Neurologic and ophthalmologic findings in children exposed to cocaine in utero.

We studied a cohort of 73 children exposed to cocaine in utero to characterize the spectrum of neurologic and ophthalmologic abnormalities; 36 children with no documented in utero drug exposure were selected as a control group. Most referrals of cocaine-exposed children to the child neurologist were made in the 1st year of life (81%). Reasons for referral were hypertonia (29%), seizures (22%), developmental delay (11%), tremulousness (11%), and hypotonia (4%). The most common abnormal finding in the cocaine-exposed children was hypertonia/hyperreflexia (63%), which was rarely seen in the control group. In addition, hypertonia/hyperreflexia was underdiagnosed by referring physicians. Similarly, hypotonia was seen on neurologic examination of cocaine-exposed children more frequently than documented by referral (16% versus 4%). Hypotonia was rarely seen in the control group. Twelve (43%) of 28 cocaine-exposed children seen by a pediatric ophthalmologist had structural ophthalmologic abnormalities. Neurologic and ophthalmologic findings suggesting structural lesions of the nervous system must be considered in cocaine-exposed children.

Child↗

PubMed2003

Neuro-ophthalmologic findings in konzo, an upper motor neuron disorder in Africa.

PURPOSE: To investigate the neuro-ophthalmological manifestations in konzo, a non-progressive symmetric spastic para/tetraparesis of acute onset associated with consumption of insufficiently processed bitter cassava roots combined with a low protein intake. METHODS: Twenty-one Congolese konzo patients underwent neuro-ophthalmological investigations including visual acuity testing, assessment of light pupillary reflexes, evaluation of ocular motility and deviation, direct ophthalmoscopy, and visual field perimetry. Objective refraction including retinoscopy and keratometry, and slit-lamp biomicroscopy were also done. RESULTS: Five patients had visual impairment, and 14 had temporal pallor of the optic disc. Fourteen presented visual field defects, the most frequent being concentric constriction and peripheral defects. Overall, 11 subjects had symptoms qualifying for the diagnosis of optic neuropathy. Two had spontaneous pendular nystagmus in primary position of gaze. Visual field defects and pallor of the optic discs were found in mild, moderate and severe forms of konzo. No correlation was found between the severity of the motor disability of konzo and the extent of visual field loss. CONCLUSIONS: Konzo was associated with optic neuropathy and a few patients had nystagmus. Although the etiopathogenesis of this optic neuropathy remains to be elucidated, the symmetry of the involvement suggests a toxic origin. We suggest that cyanide causes the neuro-ophthalmological damage in konzo. However, the optic neuropathy in konzo patients does not resemble the features of the epidemic optic neuropathy in Tanzania, Cuba or Nigeria, Leber's hereditary optic neuropathy, tobacco amblyopia or vitamin B deficiency.

Adolescent↗

PubMed2004

[Ophthalmological findings in HIV infected patients in the post-HAART (Highly Active Anti-retroviral Therapy) era, compared to the pre-HAART era].

BACKGROUND: To determine the frequency of the ophthalmological findings in Human Immunodeficience Virus (HIV) infected patients in the post-HAART (Highly Active Anti-retroviral Therapy) era and to compare it to data from the Federal University of São Paulo in the pre-HAART era10,11. METHODS: Charts from 200 consecutive patients examined from May 2000 to February 2001 were reviewed. RESULTS: From the total of 200 patients, 84 (42%) presented ophthalmological findings related to HIV infection in the first ocular examination: 36 (18%) with Cytomegalovirus retinitis (9 active and 27 inactive), 22 (11%) with ocular toxoplasmosis, (9 active and 13 inactive), 15 (7.5%) with retinal detachment (10 secondary to CMV retinitis, 3 to ocular toxoplasmosis and 2 not determined), 8 (4%) with cataract (5 secondary to CMV retinitis, 1 to ocular toxoplasmosis and 2 not determined), 8 (4%) with cotton wool spots, 6 (3%) with acute retinal necrosis (4 active and 2 inactive) and 3 (1.5%) with intersticial keratitis. All patients with acute retinal necrosis showed T CD4 cells under 100 cells/microL. CONCLUSION: The authors identified in the post-HAART era, rise on number of patients with normal ophthalmologic exam and decreased number of cases of CMV retinitis and ocular toxoplasmosis when compared to the pre-HAART era.

Acquired Immunodeficiency Syndrome↗

PubMed2005

[Frequent ophthalmologic problems and visual development of extremely preterm newborn infants].

OBJECTIVES: To review the concepts of visual development and the major ocular abnormalities in preterm newborns. To emphasize the importance of preventive ophthalmologic examination and early treatment of ocular disorders. SOURCE OF DATA: A review of published data. SUMMARY OF THE FINDINGS: Vision is one of the most important senses in the normal physical and cognitive development of children. Schoolchildren who were born preterm have impaired visual, motor and cognitive functions when compared to those of children born full term. This is more a consequence of central nervous system immaturity than of localized injuries to ocular and/ or cortical structures. The literature pinpoints retinopathy of prematurity, strabismus and refractive errors as the main ophthalmologic alterations resulting from prematurity. Retinopathy of prematurity is one of the main causes of preventable blindness in childhood. It is estimated that on average 562 children become blind each year in Brazil, which is a very high socioeconomic cost to result from a treatable disease. Children with visual deficiencies may be helped by programs of early visual stimulation in order to promote their environmental integration. CONCLUSIONS: The recommendation is that every preterm newborn weighing less than 1,500 g and/or with a gestational age of less than 32 weeks should be monitored until complete retinal vascularization and that the first examination should be performed between the fourth and sixth weeks of life. We recommend ophthalmologic outpatients follow-up of all preterm newborns until two years of life with examinations twice yearly, and then, annually, in order to prevent amblyopia.

Eye Diseases↗

PubMed2002

Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes.

OBJECT: The authors reviewed 47 cases of suprasellar meningiomas with special attention to ophthalmological and endocrinological outcomes. METHODS: All patients underwent surgery performed via a unilateral pterional approach between January 1983 and January 1998. Ophthalmological and endocrinological examinations were performed before the operation as well as 1 week and 3 months postoperatively. A special scoring system was adopted to quantify the extent of ophthalmological disturbances. Complete tumor resection was possible in all but one patient. There were no fatalities and the rate of visual improvement was 80%. The best prognoses were found in patients younger than 50 years and in patients in whom the duration of symptoms was less than 1 year. Before surgery, tumor-related endocrine disturbances were present in only three women who suffered from secondary hypogonadism; two of these patients recovered after surgery. Postoperatively, no patient needed replacement therapy for pituitary dysfunction. The overall tumor recurrence rate was 2.1% (one of 47 cases). For patients in whom long-term (> 5 years) follow-up data were available, the recurrence rate was 4.2% (one of 24 cases). CONCLUSIONS: In this series, complete resection of suprasellar meningiomas was possible through a unilateral pterional craniotomy and was associated with a low morbidity rate and no deaths.

Adult↗

PubMed1977

Neuro-ophthalmology, for the pediatrician.

The pediatrician needs to develop some skills in evaluating afferent visual functions and ocular motor abnormalities. He must know some fundamental neuro-ophthalmologic facts to prevent his patients from undergoing unnecessary diagnostic and surgical procedures. In addition, he needs to understand the fundamentals of strabismus and amblyopia, which are briefly considered in this article but are explored thoroughly elsewhere in this issue of PEDIATRIC ANNALS. First, the most common type of nystagmus in children is congenital nystagmus. These children often have a head turn or tilt. Also, it should be remembered that numerous drugs may cause nystagmus. Second, any child with a head turn or tilt must be considered to have some ocular motor abnormality until a complete ophthalmologic evaluation has eliminated this possibility. In addition, before a child is considered to have an isolated sixth-nerve palsy, Duane's retraction syndrome should be looked for. Also, before an inferior oblique palsy is diagnosed, a Brown's tendon sheath syndrome should be considered. Thus, any ocular muscle abnormality deserves an ophthalmologic evaluation. Third, when bilateral swollen optic nerves are noted as an incidental finding, drusen of the optic nerve head should be suspected. A unilateral swollen disk with decreased visual acuity and a Marcus Gunn pupil should bring to mind a papillitis, which is a local inflammatory condition of the optic nerve head. Remember, papilledema is a bilateral condition secondary to increased intracranial pressure with normal vision. Children with papilledema usually have other signs of increased intracranial pressure. If the article has convinced you of only two facts -- that head tilts and turns are usually ocular in origin, and that bilaterally swollen optic nerves in an otherwise asymptomatic child may be optic nerve drusen -- it has accomplished its purpose.

Child↗

PubMed1983

Neuro-ophthalmology for the pediatrician.

The pediatrician needs to develop some skills in evaluating afferent visual functions and ocular motor abnormalities. He must know some fundamental neuro-ophthalmologic facts to prevent his patients from undergoing unnecessary diagnostic and surgical procedures. In addition, he needs to understand the fundamentals of strabismus and amblyopia, which are briefly considered in this article. First, the most common type of nystagmus in children is congenital nystagmus. These children often have a head turn or tilt. Also, it should be remembered that numerous drugs may cause nystagmus. Second, any child with a head turn or tilt must be considered to have some ocular motor abnormality until a complete ophthalmologic evaluation has eliminated this possibility. In addition, before a child is considered to have an isolated sixth-nerve palsy, the child should be examined for Duane's retraction syndrome. Also, before an inferior oblique palsy is diagnosed, a Brown's tendon sheath syndrome should be considered. Thus, any ocular muscle abnormality deserves an ophthalmologic evaluation. Third, when bilateral swollen optic nerves are noted as an incidental finding, drusen of the optic nerve head should be suspected. A unilateral swollen disk with decreased visual acuity and a Marcus Gunn pupil should bring to mind a papillitis, which is a local inflammatory condition of the optic nerve head. Remember, papilledema is a bilateral condition secondary to increased intracranial pressure with normal vision. Children with papilledema usually have other signs of increased intracranial pressure.

Child↗

PubMedDate not supplied

Abolition of feeding intolerance following ophthalmologic examination of neonates.

Administration of mydriatic medication and ophthalmologic examination have previously been associated with feeding intolerance, characterized by large retained gastric aspirates and abdominal distention. In an attempt to eliminate this problem, we instituted a policy of withholding feedings for four hours following ophthalmologic examination. A prospective series of 50 consecutive patients was then followed to determine the incidence of feeding intolerance 24 hours prior to and 24 hours following the examination. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride prior to the examination. A critical review of the nursing notes revealed no increased incidence in feeding intolerance during the 24-hour period following examination. There were no cases of necrotizing enterocolitis during either period. This study provides evidence that the incidence of feeding intolerance following ophthalmologic examinations might be reduced by withholding feeding for four hours after the examinations.

Cyclopentolate↗

PubMedDate not supplied

Ophthalmologic screening of deaf students in Oregon.

PURPOSE: To determine the frequency of Usher's syndrome and other ocular disease in students receiving special education services for the deaf in Oregon and to assess the amount of existing ophthalmologic surveillance of this population. A special emphasis was placed on screening for Usher's syndrome. METHODS: From 1980-1990, a prospective two-center visual screening program of 231 deaf students in schools throughout Oregon was conducted using an ophthalmic questionnaire, complete eye examinations, and electroretinography. Students were between the ages of 10 and 21 years and participated on a volunteer basis. Findings for etiology and severity of visual loss and the scope of ophthalmologic surveillance within this population were analyzed. RESULTS: Two hundred seventeen of the 231 students examined received electroretinograms. Significant ocular pathology was found in 111 (48%) of the students. The most common diagnoses were congenital rubella (21%), significant uncorrected ametropia (16%), and ocular hypertension (9%). Five students were diagnosed with Usher's syndrome. Of the students with significant ocular pathology, only 37% were actively followed by an ophthalmologist. CONCLUSION: Deaf students in Oregon's schools had a high frequency of eye disease. Early diagnosis and treatment of eye disease in this population could benefit the quality of life of these students. This study alerted the providers of special education services for the deaf and the ophthalmologic community in Oregon of the need for better eye care for these students.

Adolescent↗

PubMed1999

[The clinico-evolutionary neuro-ophthalmological aspects in multiple sclerosis].

The paper presents the dynamic of the more important neuro-ophthalmologic signs in 112 patients with multiple sclerosis from the first attack to the second one using an interdisciplinary methodology. The existence of ocular signs at the first attack as well as the fortuitous association of the signs of the disease make doubtfully the utility of defining a neuro-ophthalmologic clinical form of the disease. The more significant dominance of the ocular signs at the first attack points out the importance of the ophthalmologic examination for the early diagnosis of the multiple sclerosis.

Diplopia↗

PubMedDate not supplied

[Ophthalmologic evaluation of VDT/PC operators: approach to the diagnosis with neural networks].

The present study was performed to build a neural network as a diagnostic tool to aid ophthalmologic examination of VDT/PC operators. The network was built on anamnesic and ophthalmologic data (visual acuity and mesopic vision, contrast sensitivity) from 278 VDT/pC operators and is able to predict 88% of total cases who need specialist attention, when ocular pathologies are also present, and 91% when only refraction defects are present. The tests chosen for this study are not useful to build a very sensitive discriminant model. This study confirm the absence for useful ophthalmologic tests in screening of VDT/PC operators, particularly when ocular pathologies are present without refractive errors. For their capacity to translate on a clinical-pratic plane knowledge obtained through studies conducted on large populations, the neural networks seem to be a good diagnostic tool.

Computer Terminals↗

PubMed2000

[Evaluation of moderate and severe visual impairments in patients attending an ophthalmology clinic. A prospective study of 1,172 patients].

PURPOSE: Data on blindness and visual impairment in patients attending ophthalmology clinics at the Orleans regional hospital center serving a semi-rural area in France were prospectively studied to examine prevalence of visual impairment. MATERIAL AND METHODS: Clinical data on 1,172 consecutive and different patients attending the ophthalmology department during half-days over a 3-month period were collected and analyzed using a computerized system. RESULTS: Prevalence of visual impairment (20/30 or less in the better eye) was 3% in subjects under 60 years of age and rose to 13.7% and 35.9% for patients in the 60-79 age range and over 80 years respectively. For patients under 60, the prevalence of severe visual impairment (20/200 or less in the better eye) was 1.2% and rose dramatically in older patients: 5.8% and 14.6% in the 60-79 year old patients and the over 80 patients respectively. There was no significant difference in the prevalence of visual impairment by sex. Leading causes of severe visual impairment among patients aged 60 years or older were macular degeneration (40%), diabetic retinopathy (16.6%) and cataract (13.3%). The prevalence of irreversible severe visual impairment was 7.4% among patients 60years of age or older. CONCLUSION: A large number of patients attending our ophthalmology clinic have severe visual impairment, particularly those over 60 years of age. Our findings are comparable with extrapolations for population-based studies in English speaking countries and can be used to evaluate the prevalence of visual impairment in French rural areas. As the population ages, need for eye health care becomes more and more evident. It is important to organize systematic visual examination in subjects aged 70 to 80 years and to implement educational programs as part of local national health care policies for helping the visually impaired.

Adolescent↗

PubMedDate not supplied

[Paraneoplastic syndromes in otoneuro-ophthalmology].

INTRODUCTION AND OBJECTIVE: The so-called neurological paraneoplastic syndromes (NPNS) are a group of diseases of the central nervous system of unknown etiology which are seen almost exclusively in patients with cancer. We review the main NPNS paying particular attention to those with ophthalmological and otological features. DEVELOPMENT: Certain neuro-ophthalmological findings may constitute, at least partly, some paraneoplastic syndromes. There are alterations of vision in paraneoplastic retinopathy and in optic neuritis of paraneoplastic origin. The latter, unlike the retinopathy, usually coexists with involvement of other structures of the nervous system. Oculomotor function is affected in the opsoclonus-myoclonus syndrome. Diplopia and/or ophthalmoplegia may be a predominant or initial symptom, in patients with paraneoplastic neurological degeneration or brainstem encephalitis. In the Lambert-Eaton syndrome and in paraneoplastic encephalomyelitis, may have blurred vision and alterations of the pupil. Cases of paraneoplastic uveitis have also been described. Paraneoplastic otological involvement is less frequent. Patients with sensorineural deafness in the context of a paraneoplastic encephalomyelitis have been reported. In the NPNS vertigo is caused by cerebellar or brainstem lesions and not by lesions of peripheral organs. When nystagmus occurs in a NPNS it may be of various types and is due to involvement of structures in the brain stem or cerebellum. CONCLUSIONS: The diagnosis of NPNS in patients with no known cancer is important because it may lead to the detection of an occult cancer which is localized or scarcely extended, and therefore is still potentially treatable. Oto-neuro-ophthalmological manifestations may be the first or only symptom of presentation of a paraneoplastic neurological clinical picture.

Autoimmune Diseases of the Nervous System↗

PubMed2002

[Evaluation of the quality of life in ophthalmology].

THE IMPORTANCE OF VISUAL FUNCTION IN THE ASSESSMENT OF QUALITY OF LIFE: The notion of visual function is related to visual acuity but also to many other parameters such as the visual field, perception of colour, contrasts, and the resistance to blinding. These factors are difficult to measure during routine ophthalmic examination but can be assessed during questionnaires on quality of life. MARKERS OF QUALITY OF LIFE IN OPHTHALMOLOGY: Various quality of life questionnaires have been developed in ophthalmology because the non-specific generic instruments appear inadequate. The SF 36 and SF 20 scales, which are generic instruments widely used in many fields, do not adequately explore the problems related to vision. The first efficient instrument is the VF 14, which is a questionnaire specific to ophthalmic diseases, developed by C. Mangione in 1992. This self-administered questionnaire permits calculation of a 0 to 100 score exploring 5 dimensions (long-sight acuity, near-sight acuity, unclear sight, and driving during the day and at night) during 14 activities with 18 questions. It was translated and adapted into French by Gresset in 1997. Today it is the most commonly used questionnaire in ophthalmology, particularly in the assessment of efficacy and impact in surgery. Along the other specific questionnaires developed, there is the NEI-VQF which was created in 1995 to assess vision and the impact of visual problems on the quality of life of patients, independently of an ophthalmic pathology. Many studies have been conducted on various diseases that affect vision, such as diabetes or hypertension. THE LIMITS OF EXISTING INSTRUMENTS: The specific scales appear far more sensitive and specific than generic scales with regard to ophthalmic problems, but they provide less information on the general status of the patient, except for the NEI-VQF. They are limited in some parameters and do not, unfortunately, take into account the patient's age. No specific scale has been developed for children or adolescents, although the impact of vision on daily life is fundamental. The complexity of vision means that the elaboration of an ideal instrument is difficult. However, in the meantime, it is essential that the practitioners continue to use and to test the instruments available in order to improve with regard to pathologies, or in particular sub-groups of the population.

Activities of Daily Living↗

PubMed2002

[Pathologic ophthalmologic changes in prematurity].

The personal author's experiences has been presented, with regards to the early discovering and adequate preventing of ophthalmology diseases at prematurely born children. Thanks to the development of perinatology, almost every organ can be monitored and functionally examined even before the child is born. Despite all problems, the work of ophthalmo-paediatritians is extremely challenging, because that is the only situation in which embryology of the eye can be seen "In Vitro" and in which the physiological development of the eye's function can been monitored. During the period from 1999 to 2002, it was examined 66 children in total, who had an anamnestical data about prematurity, as well as the data about delivery-weight. Out of these 66 children, there were 40 (60.6%) boys and 26 (39.4%) girls, with 1-4 of age. All children were examined by usual, in daily work available, examination methods. The biggest percentage of children (80%) were sent to us by the paediatritian-neonathologist, and 20% war sent from the Primary Health Care centers, or they were sent from other centers. At 52 (78.7%) of children, the certain changes on the eyes were found, while at 10 (15.1%) children no changes at all were found. At 4 (6.2%) cases, we found minor changes, but we monitored those children as well. Ophthalmology changes were found in almost all forms, from the most complicated (ROP, coloboma horioretinae, congenital glaucoma, congenital cataract), to the simpler ones on which are less difficult to treat (refraction changes, amblyopia, strabismus, ptosis etc). Since these changes are still present with prematuruses, it is necessary to intensively monitor this population, as a part of the multidisciplinary team, made of the experts of the different profiles (paediatritian-neonatologist, otologist, logopedist, ophthalmologist, etc), and which would be possible through the Register of Prematurity. Author introduces her own experience of ophthalmologic diseases in children who are categorized as "risky". A team of different specialists does treatment.

Eye Diseases↗

PubMed1992

Ophthalmologic manifestations of type B Niemann-Pick diseases.

Type B Niemann-Pick Disease (NPB) is a rare lysosomal storage disease resulting from diminished activity or deficiency of sphingomyelinase and is characterized by multi-system involvement with visceromegaly. Rare ocular involvement (the Macula Halo Syndrome) has been reported. Eight patients (ages 4-36) with NPB underwent complete ophthalmologic evaluations. All patients had periorbital fullness, a hitherto unreported clinical feature. Two patients had a classic Macula Halo Syndrome. One patient developed peri-macular granular deposits forming an incomplete Macula Halo over 5 years. Another patient had macular granular deposits and developed deterioration of central vision and abnormal visual evoked potentials. Ophthalmologic involvement in NPB is more common than previously described. Complete ophthalmologic evaluation is recommended in all patients suspected to have NPB.

Adolescent↗