Eye Patch Research Articles

Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: Study on pain evaluation and surgical outcome

The authors here describe manual small incision cataract surgery (MSICS) by using topical anesthesia with intracameral 0.5% lignocaine, which eliminates the hazards of local anesthesia, cuts down cost and time taken for the administration of local anesthesia. To evaluate the patients' and surgeons' experience in MSICS using topical anesthesia with intracameral lignocaine in terms of pain, surgical complications, and outcome. Prospective interventional case series. Ninety-six patients of senile cataract were operated by MSICS under topical anesthesia with intracameral lignocaine using "fish hook technique." The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience, and complications. Statistical analysis software "Analyseit." There were 96 patients enrolled in the study. The mean pain score was 0.7 (SD +/- 0.97, range 0-5, median 0.0, and mode 0.0). Fifty-one patients (53%) had pain score of zero, that is, no pain. Ninety-one patients (approximately 95%) had a score of less than 3, that is, mild pain to none. All the surgeries were complication-free except one and the surgeon's experience was favorable in terms of patient's cooperation, anterior chamber stability, difficulty, and complications. The ocular movements were not affected, and hence, the eye patch could be removed immediately following the surgery. MSICS can be performed under topical anesthesia with intracameral lignocaine, which makes the surgery patient friendly, without compromising the outcome.

Occupational therapy treatment with right half-field eye-patching for patients with subacute stroke and unilateral neglect: A randomised controlled trial

Purpose. The right half-field eye-patching technique has been reported to be effective in reducing unilateral neglect (UN) and improving functional ability in stroke patients. This study investigated the efficacy of conventional treatment with right half-field eye patching in treating subacute stroke patients with UN, using a randomised controlled trial.Method. Thirty-five inpatients with subacute stroke were recruited and randomised into intervention and control groups. The patients in the intervention group received 4 weeks of conventional occupational therapy with modified right half-field eye-patching. Those in the control group received 4 weeks of conventional treatment only. Assessors, who were blind to the treatments, assessed the groups using the Behavioural Inattention Test (BIT) and the Functional Independence Measure (FIM) on admission and at 4 weeks.Results. Patients treated with right half-field eye-patching had significantly (p = 0.046) higher BIT gain (mean = 25.06, SD = 30.81) than those treated with the conventional treatment (mean = 8.29, SD = 10.35). There was no significant difference (p = 0.467) in FIM gain between patients in both groups.Conclusions. Right half-field eye-patching improved stroke patients' impairment level in terms of UN, but the potential benefits in impairment tests were not confirmed by improvements in function.

Eye Patch Sandwich Technique for Stabilizing the Intraoral Skin Graft to the Cheek

It is very important to secure skin graft in the defect of oral cavity. The tie-over bolster technique is the most common method for securing intraoral skin grafts. However, gauze is the best material as a bolster that can easily accumulate saliva and debris and cause odor and discomfort to the patient. We describe an alternative technique to stabilize intraoral skin graft between 2 aluminous eye patches and to readily keep the oral hygiene during the securing period.

Poster 177: CNS Vasculitis Localized to the Cerebellum in a Patient With SLE: A Case Report

Setting: Inpatient rehabilitation unit. Patient: A 58-year-old woman with a 2-month history of progressive gait ataxia, dysarthria, diplopia, and a diagnosis of cerebellar vasculitis began a course of intravenous steroids/cyclophosamide and transferred to our rehabilitation unit. Case Description: Examination on admission revealed a malar rash, truncal and appendicular ataxia, ataxic dysarthria, and emotional lability. She complained of diplopia, disabling vertigo, and refractory nausea and vomiting that worsened with activity. The nausea and vomiting responded best to the use of an eye patch, a combination of antiemetics, and initiation of therapy sessions with supine exercises. Brief rests during sessions were helpful and on day 3 her nausea improved to the point that she began to better tolerate treatment. More aggressive techniques to address her ataxia were employed as her nausea improved. Specifically, facilitation feedback techniques were used to prevent hip retraction during the stance phase and to lessen knee hyperextension. A mirror provided visual cues for coordination training and a weighted walker helped improve her gait. Her speech became more intelligible with a program that emphasized decreasing her tone and speech rate. Her biggest challenge was depression. She became profoundly depressed with passive suicidal ideation. Positive reinforcement by staff members, as well as coping strategies, counseling, and medications, were accompanied by a gradual lessening of symptoms. The patient's symptoms and function began to improve and by dismissal she no longer required antiemetics, her speech was more intelligible, and her gait had improved from total dependence to the point of ambulating more than 30m with a front-wheeled walker and the assistance of one. Assessment/Results: This is a rare case of lupus vasculits localized to the cerebellum. With the use of immune modulating medications augmented by a comprehensive rehabilitation program, the patient made great gains, reaching most goals by dismissal. Conclusions: Lupus vasculitis can involve the cerebellum and its effects causes severe impairment, which can be successfully treated with medications and a comprehensive rehabilitation program.

Dodger and Me (review)

Reviewed by: Dodger and Me Karen Coats Sonnenblick, Jordan; Dodger and Me. Feiwel, 2008; [176p] ISBN 978-0-312-37793-9 $16.95 Reviewed from galleys M Gr. 4-6 Taking a shortcut home from yet another humiliating baseball game, Willie Ryan comes across a fast-food bag in the middle of the woods. He picks it up only to [End Page 495] have it transform into a teapot, out of which emerges a bright blue chimpanzee wearing an eye patch and surfer shorts who immediately proclaims himself to be Willie's new best friend. Despite the strange appearance of his new companion, Willie quickly deduces that any creature who comes out of a teapot must be a genie, and he sets about making wishes to deal with his chief problems in life: an overprotective mother, an overinterested girl named Lizzie, and an overlong losing streak on the baseball field. Dodger, however, only succeeds in making things much worse, as he spreads blue fur and chaos in his wake. Still, by the time Willie finds out that Dodger isn't a real genie but an inferior lackey, he's grown attached to the obnoxious blue chimp, and he must make a hard decision about how to use his last wish. Sonnenblick is writing for a much younger crowd here than he usually does, and the result isn't particularly successful; in trying to capture the attitude of a junior-high boy, the prose often seems written by one, complete with cheesy dialogue over-cluttered with "dude" and "awesome," and slapstick scenarios randomly inserted, relying on wet messes rather than tight comic pacing. The abrupt appearance of the real genie serves to get the plot out of the impasse it reaches with Dodger's antics, but the resolution he brings about is convenient and unconvincing as he behaves against character to help Willie get his happy ending while leaving things open-ended enough for a sequel. Kids who feel generally oppressed by their circumstances will enjoy that it-could-be-worse feeling that Dodger's "solutions" engender, but kids looking for middle-grades boyish humor will be better off with M. T. Anderson, Dan Gutman, or Dan Elish. Copyright © 2008 The Board of Trustees of the University of Illinois

Charles Bonnet Syndrome: Two Case Reports

Charles Bonnet Syndrome: Two Case Reports

Einfluss der Prismenüberkorrektur auf den postoperativen Restschielwinkel

Prism overcorrection is a complementary procedure to reduce the residual postoperative esotropia caused by anomalous retinal correspondence (ARC) after surgery for esotropia. We have investigated the results of this treatment. For Group 1, the files of 63 patients treated with postoperative prism overcorrection in the Department of Ophthalmology, University of Giessen, were evaluated regarding the pre-and postoperative squint angles (SPCT, simultaneous and APCT, alternate prism and cover test) and the angle of ARC, determined by the red filter test and by the increase of esotropia after neutralisation of the squint angle (APCT). Postoperatively, squint angles had been measured immediately (APCT) after removal of the eye patch and 10 minutes to 2 hours later (SPCT and APCT). Subsequently, prism overcorrection was performed with a Fresnel prism foil (40 PD basis temporally) in front of the fellow eye for a maximum of 3 months. After 3 months, SPCT and APCT were performed. For Group 2, the files of 28 patients with a preoperative angle of ARC of 5 degrees or more, treated in the Department of Ophthalmology, University of Heidelberg, were evaluated. These patients had not been treated with prism overcorrection. The squint angles had been measured (SPCT and APCT) on the preoperative day, on the first postoperative day, a few hours after removing the eye patch, and after three months. For Group 1, at surgery, the patients were 4 to 12 years old (median: 6.2 years). The preoperative squint angle ranged from + 5 degrees to + 27 degrees (median: + 12 degrees) in the SPCT and from + 7 degrees to + 27 degrees (median: + 14 degrees) in the APCT. The angle of ARC was between + 4 degrees and + 15 degrees (median: + 7 degrees). Both combined recess and resect surgery (with or without additional oblique muscle surgery) or bilateral retroequatorial medial rectus myopexy, in part depending on the squint angle pattern with medial rectus recession, were performed. Immediately after removing the patch, the squint angle (APCT) was between - 10 degrees and + 5 degrees (median: + 1 degrees). Ten minutes to 2 hours later, the manifest squint angle ranged from 0 to + 12 degrees (median: + 7 degrees). The angle had decreased significantly to - 6 to + 12 degrees (median: + 5 degrees) after 3 months. For Group 2, the patients' ages were between 5 and 12 years (median: 6.5 years). The squint angles ranged from + 11.5 degrees to + 35 degrees (median: + 20 degrees) in the SPCT and APCT. The angle of ARC was between + 5 degrees and + 17 degrees (median: + 8 degrees). Combined recess and resect surgery or bilateral recession of the medial rectus (with or without oblique muscle surgery both) were performed. The SPCT several hours after removal of the patch showed angles of - 4 degrees to + 14 degrees (median: + 4.25 degrees). Three months later the manifest squint angles ranged from - 5 degrees to + 14 degrees (median: + 3 degrees). After prism overcorrection (Group 1), there was a significant reduction of the residual esotropia. Without this additional treatment (Group 2), there was no significant change in the postoperative squint angle. However, neither the positive outcome in Group 1 nor the difference to Group 2 do unequivocally prove that there is a beneficial effect of prism overcorrection, since preoperative conditions were different and the sample size in Group 2 was small, especially after matching for equal preoperative conditions. A spontaneous reduction of the postoperative esotropia cannot be excluded. Further studies are necessary in order to investigate the specific effect of prism overcorrection.

Be Aware of the Patient with an Eye Patch

To the Editor: A 78-yr-old woman was scheduled for right upper lobectomy under general anesthesia. She weighed 54 kg and was 5 feet 10 in. tall. Her medical history was significant for hypertension, a 50-yr history of cigarette smoking, and an enucleation of the right eye for an unknown tumor 10 years previously. She had a glass eye but preferred to wear a large black (pirate) eye patch that covered the entire orbit including the eyebrows. Her physical examination was unremarkable with a class 2 airway. After induction of anesthesia with fentanyl and thiopental, vecuronium was given for muscle relaxation. Mask ventilation with sevoflurane in 100% oxygen proved difficult as a large leak was detected around her face. A new larger and well-inflated face mask was placed on her face but a large leak was still detected. A second anesthesiologist assisted by holding the mask with both hands, but the leak was still present. Only by increasing the fresh gas flow to 12 L were the lungs ventilated adequately despite the leak. A repeat pressure leak test of the anesthetic machine was done but no abnormality was seen. The cause of the problem was discovered when the eye patch was removed. The orbital cavity had no glass eye and an anatomical passage from the mouth cavity to the orbit of the eye was clearly seen. The problem was easily solved by packing the orbit with a 4 in. moist vaginal pack. Be aware of the patient with an eye patch. Should it be difficult to ventilate via mask due to a large orbital leak a moist vaginal pack can be used.

Anaphylactoid reaction to Haemaccel® infusion and contact sensitization to Opticlude® orthoptic eye patches: a case report

SUMMARYA 46‐year‐old female patient undergoing hemiglossectomy with supraomohyoid neck dissection under general anesthesia suffered acute bronchospasm which was successfully treated with subcutaneous terbutaline. The only other noticeable adverse event during induction of anesthesia was the development of periorbital skin erythema encircling the Opticlude® orthoptic eye patches within a few minutes of application. The eye patches were immediately removed. Eight weeks later, negative intradermal skin testing to Haemaccel® implicated anaphylactoid reaction instead of anaphylaxis. This case report illustrates the importance of routine history taking of known allergies and dermatological conditions that can require caution in the use of allergen drugs and associated agents such as Haemaccel® and Opticlude® orthoptic eye patches.

The effect and availability of prism adaptation test in patients with intermittent exotropia

Purpose: To evaluate the effect and availability of prism adaptation test in patients with intermittent exotropia. Methods: We compared the deviation angle measured with a prism and alternate cover test, with repeat measurements after one eye patching and prism adaptation. After measuring the deviation with 1 hour occlusion of nondominant eye, Fresnel prisms were placed on the patient’s spectacle correction for 30 minutes. If exotropia remained, the prism power was increased until exodeviation disappeared.

A role for N‐glycosylation in differential growth control and Drosophila development: phenotypic analysis of alg10

In this study we begin to phenotypically characterize Alg10, an enzyme that adds the terminal glucose residue to the growing dolichol-linked oligosaccharide during N-glycosylation prior to its en masse transfer to a nascent polypeptide. Genetic and molecular approaches were developed to characterize the alg10 loss of function phenotype during Drosophila development. While pleotrophic phenotypes were observed in alg10 mutant embryos, clonal analysis of the alg10 mutation in the developing wing yielded a smaller and rounder adult wing phenotype as compared to wild type. This implicates a potential link between glycosylation and pathways governing growth control. Both the Insulin receptor (InR) signaling pathway and the Epidermal growth factor pathway acting through c-myc are known to control growth in Drosophila, roles that are conserved in mammals. To begin to address whether alg10 disrupts InR signaling, I examined the genetic interaction between alg10 and an activated form of InR that produced large disordered eyes. By removing half the Alg10 activity in this background, an enhanced phenotype was observed with an irregular eye surface, fused ommatidia, and patches of necrotic tissue. This indicates a genetic interaction between alg10 and the dInR pathway and suggests alg10 influences InR mediated growth control. This work was funded by an HHMI Undergraduate Research Fellowship.

Visual fMRI Responses in Human Superior Colliculus Show a Temporal–Nasal Asymmetry That Is Absent in Lateral Geniculate and Visual Cortex

Eye patching has revealed enhanced saccadic latencies or attention effects when orienting toward visual stimuli presented in the temporal versus nasal hemifields of humans. Such behavioral advantages have been tentatively proposed to reflect possible temporal-nasal differences in the retinotectal pathway to the superior colliculus, rather than in the retinogeniculate pathway or visual cortex. However, this has not been directly tested with physiological measures in humans. Here, we examined responses of the human superior colliculus (SC) to contralateral visual field stimulation, using high spatial resolution fMRI, while manipulating which hemifield was stimulated and orthogonally which eye was patched. The SC responded more strongly to visual stimulation when eye-patching made this stimulation temporal rather than nasal. In contrast, the lateral geniculate nucleus (LGN) plus retinotopic cortical areas V1-V3 did not show any temporal-nasal differences and differed from the SC in this respect. These results provide the first direct physiological demonstration in humans that SC shows temporal-nasal differences that LGN and early visual cortex apparently do not. This may represent a temporal hemifield bias in the strength of the retinotectal pathway, leading to a preference for the contralateral hemifield in the contralateral eye.

A stereo advantage in generalizing over changes in viewpoint on object recognition tasks

In four experiments, we examined whether generalization to unfamiliar views was better under stereo viewing or under nonstereo viewing across different tasks and stimuli. In the first three experiments, we used a sequential matching task in which observers matched the identities of shaded tube-like objects. Across Experiments 1-3, we manipulated the presentation method of the nonstereo stimuli (having observers wear an eye patch vs. showing observers the same screen image) and the magnitude of the viewpoint change (30 degrees vs. 38 degrees). In Experiment 4, observers identified "easy" and "hard" rotating wire-frame objects at the individual level under stereo and nonstereo viewing conditions. We found a stereo advantage for generalizing to unfamiliar views in all the experiments. However, in these experiments, performance remained view dependent even under stereo viewing. These results strongly argue against strictly 2-D image-based models of object recognition, at least for the stimuli and recognition tasks used, and suggest that observers used representations that contained view-specific local depth information.

Parents adopt many strategies to comply with eye patching

Parents adopt many strategies to comply with eye patching

Toxic anterior segment syndrome and possible association with ointment in the anterior chamber following cataract surgery

To report clinical and laboratory findings of 8 cases of toxic anterior segment syndrome (TASS) related to an oily substance in the anterior chamber of patients following cataract surgery with intraocular lens (IOL) implantation. John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Eight patients had uneventful phacoemulsification by the same surgeon via clear corneal incisions with implantation of the same 3-piece silicone IOL design. Postoperative medications included antibiotic/steroid ointment and pilocarpine gel; each eye was firmly patched at the end of the procedure. On the first postoperative day, some patients presented with diffuse corneal edema, increased intraocular pressure, and an oily film-like material within the anterior chamber coating the corneal endothelium. The others presented with an oily bubble floating inside the anterior chamber, which was later seen coating the IOL. Additional surgical procedures required included penetrating keratoplasty, IOL explantation, and trabeculectomy. Two corneal buttons were analyzed histopathologically. Two explanted IOLs had gross and light microscopic analyses (as well as surface analyses of 1 of them), and 4 other explanted IOLs had gas chromatography-mass spectrometry. Pathological examination of the corneas showed variable thinning of the epithelium with edema. The stroma was diffusely thickened and the endothelial cell layer was absent. Evaluation of the explanted IOLs confirmed the presence of an oily substance coating large areas of their anterior and posterior optic surfaces. Gas chromatography-mass spectrometry of the lens extracts identified a mixed chain hydrocarbon compound that was also found in the gas chromatography-mass spectrometry analyses of the ointment used postoperatively. The results indicate that the ointment gained access to the eye, causing the postoperative complications described. These cases highlight the importance of appropriate wound construction and integrity, as well as the risks of tight eye patching following placement of ointment.

Twenty-eight retinas but only twelve eyes: An anatomical analysis of the larval visual system of the diving beetleThermonectus marmoratus (Coleoptera: Dytiscidae)

The larvae of the sunburst diving beetle, Thermonectus marmoratus (Coleoptera: Dytiscidae), are highly efficient visually guided predators. Their visual system consists of a cluster of six stemmata and one eye patch on each side of the head capsule. Histological investigations show that the organization of individual stemmata differs strongly from any eye that has previously been described. Based on general morphology, ultrastructural data, and the presence of actin-rich areas that are typical for rhabdoms, we find that each eye is characterized by several retinas. The most dorsal eye on each side is relatively long and tubular, and we have identified three spatially distinct areas with retinula cells: 1) a band of two rows of rhabdoms along the medial side of the eye tube; 2) a flattened cone-shaped region towards the bottom of the tube that is formed by the rhabdoms of retinula cells that are oriented perpendicular to the light path; and 3) two horizontal rows of long rhabdoms parallel to the light path at the base of the tube. A second large eye is organized similarly but lacks the medial band. The remaining four eyes are nearly spherical and each has two distinct retinas. The 12 eyes hence account for a total of 26 retinas, and two further retinas are present in eye patches lacking lenses. Our anatomical findings suggest that this is an example of a visual system in which specific visual tasks are distributed among the eyes, and which relies on a variety of highly specialized retinas.

Occlusion Treatment for Amblyopia: Assessing the Performance of the Electronic Occlusion Dose Monitor

Electronic Occlusion Dose Monitors (ODMs) are a fairly recent development (; ). As part of the international Electronic Recording of Patching for Amblyopia Group (ERPAG), we are the first center in Germany to apply these devices. The aim of our independent study was a further assessment of their potential, including technical features and the practicability of long-term use under near-clinical conditions.The ODMs, taped to the occlusion patch, measure the temperature difference between the surface of the eye and the surroundings. Investigators and patients' families kept occlusion diaries while using ODMs. Measurements were performed on the eye (patch tight or detached), forehead, arm and in trouser pockets, and while varying the room temperature. Patients' occlusion was monitored for several months together with acuity development. ODM acceptance was assessed by questionnaire.Written and monitored occlusion times corresponded excellently. Proper measurements on the eye could be distinguished more readily from those with the patch detached or in the pocket than from measurements on the arm and forehead. Very high temperatures (33–37°C) prevented reliable measurements. Using ODMs was convenient for parents but time-consuming for researchers. Despite occasional data loss (incomplete diaries, ODM failure), acuity development could be followed as a function of monitored occlusion dose.This study contributes to the specification of the ODM features and their refinement for clinical use.

Monocular patching in subjects with right-hemisphere stroke affects Monocular patching in subjects with right-hemisphere stroke affects

Monocular patching is a possible inexpensive treatment for spatial neglect. Previous studies were unpromising, but since neglect symptoms are heterogeneous, fractionating spatial bias may detect significant effects of patching. Poststroke, perceptual-attentional (PA) spatial bias, motor-intentional (MI) spatial bias, or both may occur. In this study, six poststroke subjects bisected lines while self-monitoring their performance via a camera/video apparatus. We dissociated PA and MI spatial bias by right-left reversing visual feedback in some trials. Subjects were tested with and without right and left eye patches. Patching did not affect group line-bisection error, but both right and left patches decreased individual subject PA spatial bias (p < 0.05). We detected no patching effect on individual subject MI spatial bias (significant patch side by bias interaction, p = 0.03). When we examined each subject's results separately, patching improved performance in subjects who had greater PA and MI spatial biases. We conclude that monocular patching may primarily affect poststroke PA spatial bias. Further studies on this intervention are needed.

Common Visual Defects and Peer Victimization in Children

To investigate whether wearing glasses, having manifest strabismus, or having a history of wearing an eye patch predisposes preadolescent children to being victimized more frequently at school and whether the impact may be different on boys than on girls. Data were examined on 6536 children from the Avon Longitudinal Study of Parents and Children (ALSPAC) based in the United Kingdom. At 7.5 years, the children undertook a detailed eye examination by orthoptists, including a cover test and visual acuity assessment. At 8.5 years, trained psychologists assessed the children's bullying involvement as either victim or perpetrator for overt and relational bullying, in a standard interview. Children currently wearing glasses or with a history of wearing eye patches were 35% to 37% more likely to be victims of physical or verbal bullying, even after adjustment for social class and maternal education. No interactions were found between sex and visual problems in the prediction of bullying. For those children who require glasses, opticians should be aware of the risks of bullying, and strategies should be developed and discussed that help reduce their vulnerability.

Transcutaneous Bilirubinometry in Preterm Infants Receiving Phototherapy

The accuracy of transcutaneous bilirubin (TcB) measurements obtained with a Bilicheck device in 70 preterm neonates before phototherapy and during phototherapy from the exposed and unexposed skin of the forehead (under the eye patch) was evaluated by comparing the TcB with the total serum bilirubin (TSB) that was performed within +/- 30 minutes of the TcB measurements. The correlation and proportion of similar, overestimated, and underestimated paired TcB/TSB measurements was calculated. A TSB point estimate of +/- 1.5 mg/dL was used for comparison of differences between the TcB and TSB. There was weaker correlation between TcB and TSB when the TcB was obtained from the exposed skin (r = 0.70; p > 0.05) as compared with an unexposed area (r = 0.77; p < 0.04) or before initiation of phototherapy (r = 0.86; p < 0.01). The TcB measurements from the area unexposed to phototherapy were predominantly (97.2%) in the similar (57%) or overestimation categories (40.2%). A significantly lower proportion of the paired TcB/TSB measurements obtained from exposed area were similar (42%) or overestimated (27%; p < 0.001). More importantly, in 31% of the measurements, the TSB levels were underestimated by the TcB. We conclude that the Bilicheck can be used for the evaluation of bilirubin levels in preterm neonates receiving phototherapy by using the unexposed skin of the forehead (under the eye patch) for TcB measurements; this may significantly reduce the number of blood draws.