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PubMed2006

Factors associated with childhood strabismus: findings from a population-based study.

PURPOSE: To describe strabismus prevalence and associated factors in a representative sample of 6-year-old Australian children. DESIGN: Population-based cross-sectional study. PARTICIPANTS: One thousand seven hundred thirty-nine predominantly 6-year-old children resident in Sydney examined in 2003 and 2004. METHODS: Cover testing was performed at near and distance fixation, and with spectacles if worn. Logarithm of the minimum angle of resolution visual acuity was measured in both eyes before and after pinhole correction, after correcting any cylindrical refraction >0.50 diopters and with spectacles, if worn. Cycloplegic autorefraction (cyclopentolate) and detailed dilated fundus examination were performed. Each child's medical and perinatal histories were sought in a detailed parental questionnaire. MAIN OUTCOME MEASURES: Strabismus was defined as any heterotropia at near or distance fixation, or both, on cover testing. Microstrabismus was defined as a deviation of fewer than 10 prism diopters. RESULTS: Strabismus was diagnosed in 48 children (2.8% of the population), 5 of whom had previously undergone surgical correction; 26 children (54%) had esotropia, 14 (29%) had exotropia, 7 (15%) had microstrabismus, and 1 child had VIth cranial nerve palsy. Prematurity was associated with a 5-fold increase in the risk of esotropia (odds ratio, 5.0; 95% confidence interval, 1.8-14.1). Visual impairment (with presenting correction) was significantly more common in children with (22.9%) than without (1.3%) strabismus (P<0.0001). The presence of strabismus was significantly associated with hyperopia, astigmatism, anisometropia, and amblyopia (P<0.0001). CONCLUSIONS: This report documents the prevalence of strabismus and its relation to other ocular signs and visual impairment in a representative sample of Australian school children. Presence of strabismus was significantly associated with prematurity.

Child↗

PubMed2006

Iritis presumed as secondary to disseminated coccidioidomycosis.

BACKGROUND: Coccidioidomycosis is a systemic disease caused by a fungus found in soil and transmitted through inhalation. It is prevalent in western and southwestern United States, Mexico, and South and Central America. Results of skin testing, serologic testing, and tissue cultures confirm the diagnosis. Coccidioidomycosis can manifest in various ways: the infected individual may present asymptomatically, with an acute respiratory infection, or, in more severe or chronic cases, with a multiorgan presentation. Ocular involvement may include anterior segment, posterior segment, or extraorbital involvement. CASE REPORT: A case concerning a patient with iritis presumed as secondary to disseminated coccidioidomycosis is discussed. The patient initially presented to our clinic with signs and symptoms of acute, unilateral iritis and a recent history of iritis in the contralateral eye. The active inflammation was treated topically with Pred Forte and cyclopentolate and resolved without sequelae. Because the presentation was bilateral with an asymmetric timecourse, laboratory tests were ordered to rule out systemic association. Because all tests yielded negative results, the known history of disseminated coccidioidomycosis was presumed to be the etiology of this iritis. CONCLUSION: Although eye findings are rare, disseminated coccidioidomycosis is an important differential to consider when a patient presents with uveitis. For this reason, awareness and recognition of ocular signs and symptoms of this disease is significant in proper patient care and management.

Coccidioidomycosis↗

PubMedDate not supplied

Prior topical anesthesia reduces time to full cycloplegia in Chinese.

PURPOSE: To investigate the effect of prior anesthesia on the time to full cycloplegia in young Chinese subjects. METHODS: The amplitude of accommodation was monitored over a 50-minute interval after the application of 1% cyclopentolate hydrochloride with a pretreatment of 0.4% benoxinate (oxybuprocaine) or 0.9% saline solution (control). Using a nonlinear mathematical model, the rate of accommodative loss (k) and the time required for 95% of total cycloplegia (T95%) were determined. RESULTS: Statistical analysis revealed a significantly faster rate of accommodative loss (P < .0001) after prior anesthesia (0.129 +/- 0.05) compared with the controls (0.103 +/- 0.04). T95% was noted at 26.43 +/- 10.22 minutes after prior anesthesia, which was significantly shorter (P < .0001) than that after the saline treatment (35.28 +/- 16.51 minutes). CONCLUSIONS: Prior application of topical anesthetic can shorten the time to full cycloplegia for people, such as the Chinese, with dark irides.

Accommodation, Ocular↗

PubMed2001

Ocular injury from the venom of the Southern walkingstick.

PURPOSE: To report a case of severe conjunctival and corneal epithelial defects resulting from exposure to the venom of the Southern walkingstick, Anisomorpha buprestoides. DESIGN: Case report. INTERVENTION: The patient was treated with cyclopentolate 1% and underwent daily examinations until the corneal and conjunctival epithelial defects resolved. MAIN OUTCOME MEASURE: Resolution of corneal and conjunctival epithelial defects. RESULTS: The corneal and conjunctival epithelial defects slowly resolved over 6 days. Visual acuity improved to 20/20 in the affected eye. No residual corneal scarring was evident. CONCLUSIONS: Slowly resolving corneal and conjunctival epithelial defects can occur from direct contact with the venom from the Southern walkingstick, A. buprestoides; therefore, this insect should be approached with caution.

Animals↗

PubMed2003

Intraocular lens movement caused by ciliary muscle contraction.

PURPOSE: To investigate intraocular lens (IOL) movement, measured as a change in anterior chamber depth (ACD) caused by pilocarpine-induced ciliary muscle contraction. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: In this prospective study, the ACD was measured using high-precision, high-resolution, dual-beam partial coherence interferometry in 62 pseudophakic eyes of 55 patients under pilocarpine- and cyclopentolate-induced ciliary muscle contraction and relaxation. The following were studied: 2 models of a ring-haptic IOL (designed to accommodate), a plate-haptic IOL, and 3 types of 3-piece IOLs. Measurements were performed 3 months after surgery. RESULTS: The ring-haptic IOLs and plate-haptic IOL showed a forward movement (ring haptic 43A, -116 microm; ring haptic 43E, -222 microm; plate haptic -162 microm). The 3-piece IOLs showed no change in ACD except in 1 IOL type in which there was backward movement (156 microm). CONCLUSIONS: Pilocarpine-induced ciliary muscle contraction caused forward movement of ring- and plate-haptic IOLs that resulted in an estimated accommodative amplitude of less than 0.50 diopter in most cases. The accommodating ring-haptic IOLs did not perform better than the conventional plate-haptic IOL.

Accommodation, Ocular↗

PubMed1996

No change in ST segment during instillation of eyedrops of ophthalmic surgery: a study in elderly patients with heart disease (is present software/technology sufficiently sensitive)?

STUDY OBJECTIVE: To study the safety of instillation of eyedrops prior to ophthalmic surgery, which may potentially affect myocardial function, using continuous ST segment recording. DESIGN: Prospective study. SETTING: Ambulatory surgery preoperative area at a university hospital. PATIENTS: 30 nonpremedicated ASA status III adults (aged 73 to 92 years) scheduled for cataract surgery with monitored anesthesia care (MAC). INTERVENTIONS: All patients were given ophthalmic drugs consisting of phenylephrine 2.5%, flubiprofen 0.03%, mydriacyl 1%, and cyclopentolate 1%. MEASUREMENTS AND MAIN RESULTS: ST segments were continuously monitored after the instillation of the eyedrops for a period of up to 15 minutes. A change of 2 mm or more in ST segments from baseline was considered significant. Results showed no significant change in ST segment. No patient reported any new cardiac symptoms or showed any evidence of dysrhythmias or hemodynamic changes. CONCLUSIONS: The lack of significant finding most likely reflects the safety of these ophthalmic drops in their present dilute concentration, but it is also possible that the software and/or monitors used were not sensitive enough in their current configuration to detect possible subtle changes. Based on the results of this study, we conclude that the preoperative ophthalmic drugs used in our institution do not seem to have any adverse cardiovascular effects in this elderly patient population who are about to undergo cataract surgery with MAC.

Aged↗

PubMed2003

Posthypnotic suggestion and the modulation of Stroop interference under cycloplegia.

Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation (e.g., visual blurring or looking away) could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing.

Adult↗

PubMed1999

Visual acuity after cycloplegia in children: implications for atropine penalization.

BACKGROUND: Atropinization of the sound eye is an alternative to patching in the treatment of amblyopia. Whether atropine treatment can induce a switch in fixation depends on the refractive error of the sound eye, visual acuity of the amblyopic eye, distance from the fixation target, and presence of any optical correction or penalization. General guidelines are needed on the basis of refractive error and visual acuity in the amblyopic eye to predict which patients may potentially benefit from atropine penalization. METHODS: Refractive error and visual acuity at distance (6 m) and/or at near (33 cm) were recorded in a normal eye of 126 consecutive children (mean age, 8.2 years), 30 to 60 minutes after receiving cyclopentolate 1%. Visual acuity was plotted versus refractive error at distance and at near, and best-fit curves were calculated. RESULTS: There was a consistent, reproducible relationship between refractive error and visual acuity after cycloplegia at both distance and near in healthy children. CONCLUSIONS: The results of this study can be used to quickly determine whether atropine penalization has the potential for success on the basis of a patient's visual acuity in the amblyopic eye and refractive error in the sound eye. When adequate hyperopia is present in the sound eye, one should consider testing for fixation preference or initiating a therapeutic trial of atropine. Those children with insufficient hyperopia in the sound eye relative to visual acuity in the amblyopic eye can be spared the time, expense, and potential side effects of atropine penalization.

Adolescent↗

PubMed1991

The oval pupil.

The dynamics of pupillary dilation induced by Phenylephrine 10% and Cyclopentolate 1% have been examined by flash photography. A correlation between anterior chamber depth and the pupil shape on dilation with Phenylephrine Hydrochloride 10% is described. It is postulated that these pupillary dilation dynamics support a sympathetic abnormality as a trigger for acute primary angle closure glaucoma.

Adolescent↗

PubMed1992

Can retinoscopy be used to screen infants for amblyopia? A longitudinal study of refraction in the first year of life.

One hundred normal babies were refracted by two observers in a double-masked study within 24 hours of delivery and 30 minutes after instillation of 1% cyclopentolate. The procedure was repeated at 6 weeks, 3 months, 6 months and 1 year. At birth agreement between the two refractionists to within 1 dioptre spherical equivalent was 82%, rising to 94% at 1 year. Astigmatism of greater than 1 dioptre increased from 10% at birth to 42% at 6 months but decreased to 15% at 1 year. Myopia was uncommon (4%) but 80% of eyes were hypermetropic more than +2 dioptres and 25% more than +4 dioptres at birth, although these percentages decreased to 5% and 3% at 1 year. Anisometropia of more than 1 dioptre between the two eyes was uncommon but in the two cases where it persisted in the presence of high hypermetropia, reversible amblyopia was encountered in both cases.

Aging↗

PubMed1995

A pre-operative mydriatic regime using a single application of tropicamide Novel Ophthalmic Delivery System and guttae phenylephrine 10%.

Tropicamide Novel Ophthalmic Delivery System (NODS) and guttae (g.) phenylephrine 10% was applied once, 2 hours before cataract surgery, as an alternative to our standard pre-operative regime of g. cyclopentolate 1% and g. phenylephrine 10% used four times before surgery. The two treatment groups were compared using a randomised, prospective, observer-masked study design. The horizontal pupil diameter was significantly smaller using the new regime but the per-operative decrease in diameter was not significantly different, suggesting that surgical miosis was not influenced by reducing the number of mydriatic applications. There was no difference in the subjective grading of the pupil, suggesting that adequate mydriasis suitable for cataract surgery was obtained using the alternative regime. No major complications were documented in relation to the use of NODS. We discuss why less intensive mydriasis is likely to be as efficacious and describe its potential advantages.

Aged↗

PubMed1996

A comparative study of the efficacy of 2.5% phenylephrine and 10% phenylephrine in pre-operative mydriasis for routine cataract surgery.

It is common practice in many ophthalmic units to administer multiple applications of 10% phenylephrine in combination with an anti-cholinergic agent to ensure adequate pupil mydriasis prior to routine cataract surgery. Phenylephrine is a pure alpha-1 adrenoreceptor agonist known to produce marked systemic vasoconstriction and associated hypertension with occasional profound reflex bradycardia. Many reviews have suggested caution in the use of 10% phenylephrine in the elderly or hypertensive patient. In a prospective, randomised trial we have assessed pupil dilation comparing the efficacy of 10% phenylephrine (53 patients) versus 2.5% phenylephrine (62 patients). When administered in conjunction with 1% cyclopentolate four times over 1 hour pre-operatively, 2.5% phenylephrine was found to be as effective as 10% phenylephrine in the initiation and maintenance of mydriasis during both extracapsular and phacoemulsification cataract extraction.

Aged↗

PubMed1997

The maintenance of per-operative mydriasis in phacoemulsification with topical diclofenac sodium.

PURPOSE: To determine whether the use of topical diclofenac sodium (diclofenac) pre-operatively improves the maintenance of per-operative mydriasis, in conjunction with irrigating solutions containing adrenaline. METHODS: Sixty-four consecutive patients undergoing phacoemulsification were randomised to receive either diclofenac or no diclofenac in conjunction with cyclopentolate 1% and phenylephrine 10% pre-operatively. They subsequently underwent routine phacoemulsification by one consultant surgeon. Irrigating solutions of balanced salt solution contained adrenaline 1:10(6). Pupil diameters were measured pre-sclerostomy, post-phacoemulsification, post-irrigation/aspiration and on day 1 post-operatively. These were then compared by Student's t-test. RESULTS: The two groups were statistically similar in age and sex. The mean pre-sclerostomy pupillary diameters were 8.1 mm in both groups. The mean post-phacoemulsification diameters were 7.6 mm in those receiving diclofenac and 7.2 mm in those not (p = 0.03). The mean diameters after infusion/aspiration were 7.7 mm in those receiving diclofenac and 7.1 mm in those not (p = 0.008). The mean pupillary diameters on day 1 were 5.3 mm in those receiving diclofenac and 4.6 mm in those not (p = 0.003). CONCLUSION: Diclofenac improves the maintenance of per-operative mydriasis, in the presence of irrigating solutions containing adrenaline.

Aged↗

PubMed1999

Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis.

PURPOSE: (i) To describe the course of ocular symptoms and recurrent corneal erosion (RCE) following traumatic corneal abrasion (TCA). (ii) To assess the efficacy of a regimen of nightly eye ointment in preventing symptoms and RCE. METHODS: Patients presenting with TCA were treated with g. cyclopentolate 1% stat. and oc. chloramphenicol q.d.s. for 5 days. Eye pads were not used. For injuries caused by a fingernail, patients were randomised to receive either this 'standard regimen' alone, or to follow with a lubricating ointment (Lacrilube) nocte for 2 months. Follow-up was by telephone, using a symptom-based questionnaire. Recurrent symptoms were graded as: (i) none or minimal, (ii) mild, (iii) moderate (difficulty with some activities, or sought further opinion) and (iv) disabling (confirmed macroform RCE). After 2 years, case-notes were reviewed. The study is continuing, with further telephone follow-up taking place. RESULTS: Three-month follow-up was completed for 42 'fingernail' injuries and 32 'non-fingernail' TCAs. When treated with our standard regimen, 'mild' symptoms were reported in 10% of 'fingernail' and 10% of 'non-fingernail' injuries. Symptoms were 'moderate' in 0 and 12% respectively. Chisquared test confirmed a significantly higher prevalence of recurrent symptoms in the 'additional nightly ointment' group of 'fingernail' injuries (p = 0.016). Two macroform RCEs were confirmed by 2 years: one from each treatment group of 'fingernail' injury. CONCLUSIONS: When TCA is managed as above, there is a high prevalence of recurrent symptoms in the following 3 months. Additional nightly ointment appears to worsen prognosis. Macroform RCE is not common in the 2 years following TCA.

Anti-Bacterial Agents↗

PubMed2001

[Experiences with cycloplegic drops in German-speaking centers of pediatric ophthalmology and stabology--results of a 1999 survey].

BACKGROUND: Because of its advantages, topical cyclopentolate is often preferred over the gold standard, atropine. The purpose of the study was to obtain an overview over current cycloplegia protocols and to estimate the likelihood of severe complications due to the use of cycloplegics. METHODS: A questionnaire was sent to 107 German-speaking centres with a supposed high cycloplegia frequency. RESULTS: 57 centres answered, whereby 1,112 cumulated years of experience with cycloplegia were available for analysis. The frequency of cycloplegias varied between 2 and 180/week/centre, median 25/week/centre. A cumulated amount of 1.7 million cycloplegias was computed. The average extrapolated experience with cycloplegia was 49,000 cycloplegias/30 years. Severe complications which would cause a medical follow up of several hours or which led to a follow up in a ward were named 47 times and 2 times, respectively. CONCLUSIONS: During 30 years of a cycloplegia career with an average of 34 cycloplegias/week, one may expect 2-10 severe complications. In current practice, the patient risk of severe complications is very small. Health care professionals and parents should be informed about the frequent occurrence of light side effects in order to reach a good compliance with cycloplegia.

Adverse Drug Reaction Reporting Systems↗

PubMed1995

Microbore liquid chromatography of tertiary amine anticholinergic pharmaceuticals with tris(2,2'-bipyridine)ruthenium(III) chemiluminescence detection.

The post-column chemiluminescent reaction of six anticholinergic alkaloid compounds with tris(2,2'-bipyridine)ruthenium(III) (Ru(bpy)3(3+)) is applied to microbore high-performance liquid chromatography (HPLC). At flow rates less than 200 microL/min, the capillary mixing cell in which Ru(bpy)3(3+) and the analyte are mixed directly allows for good light detection. In contrast, a diminished signal occurs at these low flow rates with conventional post-column mixing in a tee. Optimal chemiluminescent pH conditions for atropine, scopolamine, dicyclomine, cyclopentolate, cyclobenzaprine, and procyclidine are determined at moderately basic conditions (pH 7 to 9). 2-Butanone is found to be compatible with the chemiluminescent reaction, whereas tetrahydrofuran and propionitrile cause an increase in background noise and a chemiluminescent signal loss. As 2-butanone is more nonpolar than acetonitrile, it assists in the elution of these hydrophobic anticholinergic compounds. Five anticholinergic compounds are resolved successfully with a PRP-1 polymeric column and a slightly basic mobile phase, but a C8 silica column is better suited for the more hydrophobic compounds (cyclobenzaprine, procyclidine, and dicyclomine).

2,2'-Dipyridyl↗

PubMed1994

Asthenopia and the dark focus of accommodation.

To study asthenopia, we compared the dark focus of accommodation of 54 symptomatic and 56 asymptomatic control subjects. The two groups were matched for age and cycloplegic refractive error. Symptomatic subjects were defined as those who complained of asthenopia daily even though their refractive error had been corrected. Subjects with other eye diseases that could produce asthenopia such as strabismus or aniseikonia were excluded. Using a Nidek Autorefractometer AR1600, we first measured non-cycloplegic refractive error (Non-Cyclo R) in a bright room, then the dark refractive state (Dark R) in complete darkness using the instrument with the optical target light extinguished and, finally, determined the cycloplegic refractive error (Cyclo R) after instilling cyclopentolate hydrochloride. The difference between Dark R and Cyclo R was defined as DFcus (Cyclo R) and that between Dark R and Non-Cyclo R as DFcus (Non-Cyclo R). We found both DFcus (Cyclo R) and DFcus (Non-Cyclo R) to be smaller in the symptomatic than in the asymptomatic subjects, indicating that asthenopia is associated with a low rather than a high level of tonic accommodation.

Accommodation, Ocular↗

PubMed1997

Sterility of ophthalmic drugs dispensed from spray bottles.

BACKGROUND: Spray application of cycloplegics and mydriatics is efficacious and frequently easier to use than a standard dropper bottle in the pediatric population. However, no documentation regarding the sterility of drugs dispensed from spray bottles is available. This study was conducted to determine whether contamination of ophthalmic drugs occurs with spray bottle use. METHODS: Fifteen milliliters of 1% cyclopentolate hydrochloride or 0.5% tetracaine hydrochloride were transferred to each of 15 disinfected spray bottles, stored at room temperature or refrigerated, and sprayed three times weekly for 12 weeks. Cultures were obtained from the spray bottles and drugs before transfer of the drug and from spray bottle contents at 0, 2, 4, and 6 to 12 weeks of storage. RESULTS: No cultures showed significant bacterial growth. The bactericidal action of the preservative and sterility of the drugs were maintained. CONCLUSIONS: Despite the transfer to and use of a spray bottle there appears to be minimal risk of instilling contaminated diagnostic drugs using the spray method when a single drug is stored in a spray bottle.

Anesthetics, Local↗