Ophthalmologic Considerations Research Articles

Bilateral proptosis in Marshall-Smith syndrome

ABSTRACT Marshall-Smith syndrome (MSS) is an extremely rare developmental disorder characterized by accelerated skeletal maturation, failure to thrive, dysmorphic facies, respiratory difficulties, and neurological abnormalities. Herein, the authors report bilateral proptosis in a 10-year-old child with MSS. At present, there are limited reports on ophthalmologic considerations in MSS; therefore, this article subserves to broaden the clinical spectrum seen in this syndrome.

Ophthalmological Considerations for COVID-19 Vaccination in Patients with Inflammatory Eye Diseases and Autoimmune Disorders.

The global impact imposed by the coronavirus disease 2019 (COVID-19) pandemic may be soon alleviated by the introduction and worldwide dissemination of safe and effective vaccines. This expedited timetable for development and approval of COVID-19 vaccines is an unprecedented extraordinary, concerted achievement by the scientific community. With the pending global rollout of vaccines, each with different mechanisms of action, physicians of various specialties will need to identify vulnerable patient groups for special considerations or advice. In this commentary, we analyse the important considerations for COVID-19 vaccines in patients with inflammatory eye diseases. Scrutiny of immunogenicity and adverse effects, particularly antibody-dependent enhancement, would better help in counselling these patients undergoing vaccination. More research on pharmacovigilance would allow for tailored guidelines and personalised management strategies.

Ophthalmic and orbital considerations in the evaluation of skull base malignancies.

The orbital contents, afferent and efferent visual pathways, and the cranial nerves involved in eye movement, corneal sensation and eyelid closure traverse the skull base, a region bounded by the intracranial cavity, the paranasal sinuses, and the deep spaces of the face and head. As such, tumors from above or below have potential to affect some aspect of the visual system. We discuss here the clinical ophthalmologic and orbital considerations in the evaluation of patients with these tumors, as well as the ophthalmic sequelae of treatment with radiation or surgery (or both). And for the surgeon, we discuss the ophthalmic and orbital considerations in surgical planning, the role of the orbital surgeon in skull base surgery, and briefly discuss transorbital approaches to the skull base. Ophthalmic and orbital dysfunction may be the main source of disability in patients with skull base malignancy; it is thus incumbent on those who manage patients with tumors of this region to be aware of the ophthalmic, neuro-ophthalmic and orbital manifestations, so as to best tailor therapy and monitor treatment outcomes.

Investigation of Ocular Bioactivation Potential and the Role of Cytochrome P450 2D Enzymes in Rat.

Timolol is clinically administered topically (ocular) to reduce intraocular pressure and treat open-angle glaucoma. Ocular administration of timolol in low doses (0.5% w/v in the form of eye drops) has led to challenges for in vivo metabolite identification. An understanding of drug metabolism in the eye is important for clinical ocular therapeutics and potential drug candidates. We aimed to investigate the metabolism of timolol in rat ocular and liver S9 fractions, as well as rat ocular tissue and plasma following a 0.5% topical (ocular) dose of timolol. We explored the potential in vitro metabolic bioactivation in the eye/liver by conducting trapping studies for putative aldehyde and iminium ion intermediates that may arise from the morpholine functionality. Oxidative metabolism of timolol to its major metabolite (M4) in ocular S9 and recombinant rat cytochrome P450 (CYP) isoforms supports the possible role of rat ocular CYP2D2, 2D4, and/or 2D18. Observation of N-acetyl-timolol (M5) is suggestive that the ocular N-acetyltransferases may also play a larger role in ocular disposition of timolol, a previously unreported finding. This research is the first comprehensive report of in vitro ocular metabolism of timolol in rat. This study also indicates that in vitro hepatic metabolism is over-predictive of ocular metabolism following topically ocular dosed timolol. The research, herein, highlights the eye as an organ capable of first pass metabolism for topical drugs. Thus, new ophthalmologic considerations for studying and designing long term topical therapies in preclinical species are needed in drug discovery.

Toxic Epidermal Necrolysis in Children: Medical, Surgical, and Ophthalmologic Considerations

Toxic Epidermal Necrolysis in Children: Medical, Surgical, and Ophthalmologic Considerations

Toxic Epidermal Necrolysis in Children: Medical, Surgical, and Ophthalmologic Considerations

Toxic epidermal necrolysis is a rare acute inflammatory multisystem life-threatening condition characterized by widespread epidermal necrosis and profound toxic systemic reaction. Implicated etiologic agents in children include drugs, infections, and autoimmune diseases. The pathophysiology includes separation of the epidermis at the dermal-epidermal junction of both skin and extracutaneous epithelium and mucous membranes. The general consensus is that expeditious transfer to a burn center, maintenance of fluid and electrolyte balance, temperature maintenance, control of evaporative losses, avoidance of use of complicating drugs as corticosteroids and topical sulfa compounds, aggressive septic surveillance, vigorous nutritional support via nasoenteric tube, early ophthalmologic consultation, and appropriate wound care with a regimen of therapy relying on basic principles of treatment of partial-thickness epidermal wounds predict better outcome in the treatment of this disease process. The course of toxic epidermal necrolysis in children, even though dramatic at onset, leads to low mortality when managed appropriately. The current limited published evidence does not clearly delineate differences in epidemiology, pathogenesis, and prognosis of severe skin reactions in children as compared with adults. In this article, we review the available literature on the pathogenesis, clinical features, pathophysiology, treatment, and complications of this rare disease in children.

Postoperative Care Following Pituitary Surgery

Patients undergoing surgery for pituitary tumors represent a heterogeneous population each with unique clinical, biochemical, radiologic, pathologic, neurologic, and/or ophthalmologic considerations. The postoperative management of patients following pituitary surgery often occurs in the context of a dynamic state of the hypothalamic-pituitary-end organ axis. Consequently, a significant component of the postoperative care of these patients focuses on vigilant screening and observation for neuroendocrinologic perturbations such as varying degrees of hypopituitarism and disorders of water balance (diabetes insipidus and the syndrome of inappropriate antidiuretic hormone). Additionally, one must be cognizant of other potential complications specific to the transsphenoidal approach for tumor removal including cerebrospinal fluid leakage and meningitis. This review addresses the postoperative management of patients undergoing pituitary surgery with an emphasis on careful screening and recognition of complications.

Ophthalmologic considerations in using antimalarials in the United States

Ophthalmologic considerations continue to be important in the use of antimalarials. In the United States, hydroxychloroquine is prescribed much more frequently than chloroquine. Despite the favorable safety record, potential retinal problems cause patients to often be afraid to take antimalarial medicine. Ophthalmologic visits are recommended every three months by the drug manufacturer, but most often are scheduled every six months by physicians. Ophthalmologic examination includes questioning about visual symptoms, visual acuity tests, careful fundoscopic evaluation and a visual field assessment. Amsler grid self evaluation is not yet wide-spread.

Ophthalmologic Considerations in Maxillofacial Trauma

Educational objectives: To evaluate the globe, lids, lacrimal system, and orbit inpatients with maxillofacial trauma and to recognize common injuries and provide appropriate management.

Spontaneous arteriovenous shunts of the cavernous sinus--ophthalmological considerations.

Australian and New Zealand Journal of OphthalmologyVolume 17, Issue 4 p. 439-443 Free Access Spontaneous arteriovenous shunts of the cavernous sinus—ophthalmological considerations G. M. Halmagyi MB BS, FSc(Med), FRACP, Corresponding Author G. M. Halmagyi MB BS, FSc(Med), FRACP Eye and Ear Unit, Neurology Department, Royal Prince Alfred Hospital, SydneyNeurology Department, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.Search for more papers by this authorJ. M. Hallinan MB BS, FRACR, J. M. Hallinan MB BS, FRACR Radiology Department, Royal Prince Alfred Hospital, SydneySearch for more papers by this authorV. S. Grinnell MD, V. S. Grinnell MD Radiology Department, Royal North Shore Hospital, SydneySearch for more papers by this author G. M. Halmagyi MB BS, FSc(Med), FRACP, Corresponding Author G. M. Halmagyi MB BS, FSc(Med), FRACP Eye and Ear Unit, Neurology Department, Royal Prince Alfred Hospital, SydneyNeurology Department, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.Search for more papers by this authorJ. M. Hallinan MB BS, FRACR, J. M. Hallinan MB BS, FRACR Radiology Department, Royal Prince Alfred Hospital, SydneySearch for more papers by this authorV. S. Grinnell MD, V. S. Grinnell MD Radiology Department, Royal North Shore Hospital, SydneySearch for more papers by this author First published: November 1989 https://doi.org/10.1111/j.1442-9071.1989.tb00568.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Deschweinitz GA, Holloway TB. Pulsating exophthalmos, its etiology, symptomatology, pathogenesis and treatment. Being an essay based upon 69 case histories of this affection. Philadelphia : WB Saunders Co, 1908. 2 Sanders MD, Hoyt WF. Hypoxic ocular sequelae of carotid-cavernous sinus fistulae: study of the causes of visual failure before and after neurosurgical treatment in a series of 25 cases. Br J Ophthalmol 1969; 53: 82– 97. 3 Newton TH, Hoyt WF, Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1970; 1: 71– 81. 4 Grove AS, The dural shunt syndrome. Pathophysiology and clinical course. Ophthalmology 1983; 90: 31– 44. 5 Vinuela F, Fox AJ, Debrun G. Spontaneous carotid-cavernous sinus fistulas: clinical, radiological and therapeutic considerations. J Neurosurg 1984; 60: 976– 984. 6 Kupersmith MJ, Berenstein A, Choi IS, Warren F, Flamm E. Management of non-traumatic vascular shunts involving the cavernous sinus. Ophthalmology 1987; 95: 121– 130. 7 Barrow DI, Spector RH, Braun AF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985; 62: 248– 256. 8 Halbach V, Higashida RT, Hieshima GB, Reicher M, Norman D, Newton TH. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology 1987; 163: 437– 442. 9 Vinuela F, Fox AJ, Pelz DM, Drake CG. Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg 1986; 64: 554– 558. 10 Hawke SH, Mullie M, Hoyt WF, Hallinan JM, Halmagyi GM. Painful oculomotor nerve palsy due to dural-cavernous sinus shunt. Arch Neurol (in press). 11 Phelps CD, Thompson HS, Ossoining KC. The diagnosis and prognosis of atypical carotid-cavernous sinus fistula (red-eyed shunt syndrome). Am J Ophthalmol 1976; 54: 423– 436. 12 De Keizer RJ. Spontaneous carotid-cavernous sinus fistulas. The importance of the typical limbal vascular loops for the diagnosis, the recognition of glaucoma and the uses of conservative therapy in this condition. Documenta Ophthalmologica 1979; 46: 403– 412. 13 Keltner JL, Satterfield D, Dublin AB, Lee BC. Dural and carotid cavernous sinus fistulas. Diagnosis, management and complications. Ophthalmology 1987; 94: 1585– 1600. 14 Leonard T, Moseley I, Sanders MD. Ophthalmoplegia in carotid cavernous sinus fistula. Br J Ophthalmol 1984; 68: 128– 134. 15 Moster ML, Sergott RC, Grossman RI. Dural carotid-cavernous sinus vascular malformation with facial nerve paresis. Can J Ophthalmol 1988; 23: 27– 29. 16 Keltner JL, Gittinger JW, Miller NR, Burde RM. A red eye and high intraocular pressure. Surv Ophthalmol 1986; 31: 328– 336. 17 Tress BM, Thomson KR, ApSimon T, King J, Brownbill D, Klug GL, Crawford B. Treatment of caroticocavernous fistulae with detachable balloons introduced by percutaneous catheterization. Med J Aust 1983; 1: 373– 377. 18 Sergott RC, Grossman RI, Savino PJ. The syndrome of paradoxical worsening of dural-cavernous sinus malformations. Ophthalmology 1987; 94: 205– 212. Citing Literature Volume17, Issue4November 1989Pages 439-443 ReferencesRelatedInformation

Ophthalmologic considerations and testing in patients receiving long-term antimalarial therapy

We do not as yet understand all the mechanisms involved in retinal toxicity. Such risk is lower with hydroxychloroquine than with chloroquine. The risk of true retinopathy rises with duration of therapy. The benefit/risk ratio for hydroxychloroquine is at least equal to or better than that of chloroquine, and when the currently recommended dosages of 400 mg per day of hydroxychloroquine and 250 mg per day of chloroquine are not exceeded, this ratio is medically and ophthalmologically acceptable. The most useful tests to detect retinopathy are ophthalmoscopic and/or photographic observation of the macular area for changes in pigmentation, sensitive central visual field testing, and automated computerized perimeter. These tests can be conducted by the attending physician provided that (1) baseline ophthalmologic studies are done (to exclude pre-existing ocular abnormalities); (2) such studies are conducted every six months thereafter; ∗ ∗ The manufacturer's recommendation is that Ophthalmologic examinations be made every three months during long-term therapy. and (3) the patient with ocular abnormalities is immediately referred to an ophthalmologist for further evaluation, even in the absence of symptoms.

Ophthalmologic considerations in maxillofacial trauma: Anatomy and diagnostic evaluation

The high incidence of orbital involvement in facial injuries necessitates a thorough ophthalmologic evaluation in virtually all cases. This article will provide the oral and maxillofacial surgeon with a review of the anatomy of the eye and ocular adnexa and present a systematic method of conducting and interpreting an ophthalmologic examination.

Ophthalmological Considerations in the Rehabilitation of the Blind

Ophthalmological Considerations in the Rehabilitation of the Blind

Book Review: Ophthalmological Considerations in the Rehabilitation of the Blind

Book Review: Ophthalmological Considerations in the Rehabilitation of the Blind

Ophthalmologic considerations of hemangiomas in and about the eyes.

The Journal of Dermatologic Surgery and OncologyVolume 4, Issue 11 p. 862-862 Article Ophthalmologic Considerations of Hemangiomas in and about the Eyes First published: November 1978 https://doi.org/10.1111/j.1524-4725.1978.tb00565.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume4, Issue11November 1978Pages 862-862 RelatedInformation

Juvenile-Type Diabetes and Its Complications.

This volume is one of a series attempting to interrelate advances in biochemistry and clinical medicine in an effort to present a rational approach to diagnosis and management of the patient. Since energy metabolism and the action of hormones have been in the forefront of biochemical advances for the last half century, diabetes mellitus would seem to lend itself to an unusual extent to this integrative approach. This volume of almost 500 pages surveys all the major aspects of juvenile diabetes with considerable skill. There is some unevenness of treatment due to multiple authorship. A long (57 page) section on ocular complications comprises a monograph in itself and would seem more appropriate in a much larger volume. This is especially the case since much of the long chapter on the pathology of diabetes is also devoted to ophthalmologic considerations. On the other hand, the chapter on renal disease is disconcertingly