1/9. garlic and the strabismus surgeon.Potential side-effects caused by complementary medicines are often not anticipated. A case is reported of bilateral retro-bulbar haemorrhages with elevated intraocular pressure during strabismus surgery that occurred as a result of odourless garlic tablet ingestion prescribed by a naturopath. A near-catastrophic event was averted with rapid recognition and medical treatment. This is believed to be the first such report of haemorrhaging in ophthalmic surgery induced by garlic. It is concluded that unregulated naturopathic prescribing is potentially dangerous; doctors need to ask specifically about naturopathic potions.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/9. A case of paradoxical diplopia in large-angle consecutive exotropia.PURPOSE: To describe the investigation and subsequent management of paradoxical diplopia in unsightly exotropia. A 32-year-old lady requested surgical correction of a large manifest consecutive exotropia which, on initial correction with any base-in prism, was accompanied by paradoxical diplopia. methods: Botulinum toxin to the right lateral rectus reduced the deviation to 30 delta over a one-week period. The residual deviation was corrected with base-in Fresnel prisms which the patient wore constantly for another two weeks. Although there was demonstrable diplopia initially, it disappeared after 3-4 days of prism wear. Surgery was carried out comprising right lateral rectus recession (6 mm) and right medial rectus advancement from 12 mm to 6 mm posterior to the limbus. RESULTS: There was no diplopia following the surgery and the residual exodeviation measured 6 delta for near and 16 delta for distance (fixing OD). The patient remains symptom-free and cosmetically excellent. CONCLUSION: A gradual progressive reduction in the deviation using a combination of Botulinum toxin and prisms allowed a more informative conclusion to be made regarding the potential post-operative sensory status in this patient, by allowing her to slowly adjust to an altered ocular alignment. In patients with non-functional strabismus who may be at risk from post-operative diplopia, a trial with prisms over a few weeks with or without the addition of Botulinum toxin is advocated.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/9. Exodeviation following monocular myopic regression after laser in situ keratomileusis.We report a 44-year-old woman with intermittent left exotropia of 35 prism diopters at distance who initially exhibited alignment of both eyes after bilateral laser in situ keratomileusis (LASIK). The exophoria was not preserved due to myopic regression in the dominant eye. An uneventful LASIK treatment was performed to correct -11.00 -0.50 x 130 in the right eye and -13.50 -1.50 x 145 in the left eye. The aim was to achieve emmetropia in both eyes. Although an examination revealed exophoria at near and distance during the 6 months following refractive surgery, the tropic aspect of the divergent deviation appeared in the right eye following the myopic regression. Laser in situ keratomileusis is an effective option to achieve binocular visual quality in myopic anisometropic patients. However, myopic regression after LASIK may disrupt the binocular visual quality.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/9. presbyopia complicating pre-existing strabismus.BACKGROUND: presbyopia may affect pre-existing sensory adaptations or aggravate previously asymptomatic heterophoria. We describe the presentation, underlying problem and management of 11 patients with pre-existing strabismus or heterophoria who presented with new symptoms of double vision attributable to presbyopic change, an association not previously reported. methods: patients with new strabismic symptoms attributable to presbyopia were recruited prospectively over a 1-year period. RESULTS: The 11 patients had had a recent decrease of accommodative amplitude that resulted in blurred vision at near with a breakdown of pre-existing heterophoria (2 patients), alteration of fixation pattern (6 patients), symptomatic alternating fixation (2 patients) or intolerance to correction owing to restrictive strabismus (1 patient). INTERPRETATION: At the onset of presbyopia, symptoms may be varied and subtle. Ophthalmologists and orthoptists should carefully determine the exact nature of the symptoms. Any pre-existing fixation pattern should then be established from the history, old photographs or suppression characteristics. Refractive or surgical management should be aimed at returning the patient to his or her long-standing sensory adaptation. Other important issues, such as incomplete correction of hypermetropia by refractive surgery and problems using bifocals with vertical restrictive strabismus, should be noted.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/9. Unique X-linked mental retardation syndrome with fingertip arches and contractures linked to Xq21.31.We studied 10 members of a 4 generation missouri kindred with a dominant mental retardation syndrome with increasing severity in males. The 21 year-old propositus presented with severe mental retardation, microcephaly, asymmetric face, exotropia, hypogonadism, joint hypermobility, rocker bottom feet, and 10 low digital arches. Two brothers and a male cousin had similar features. The mother, sister, niece, maternal aunt, female cousin, and grandmother were examined and each had 8 to 10 low digital arches. Five of the women had exotropia and one had pes cavus feet. Chromosome analysis for fragile X in multiple relatives was normal. To determine the likelihood that this was an X-linked syndrome. dna from relatives was hybridized to probes which detect 13 different loci spanning the X-chromosome. A peak lod score of 2.78 at theta equal to 0.0 was calculated for the syndrome locus and DXYS1 (pDP34). The more distal Xq loci showed increasing recombination with the syndrome locus. These results are consistent with location for this syndrome near Xq21.31, the chromosomal locus for DXYSI.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/9. The importance of multiple treatment modalities in a case of divergence excess.Divergence excess strabismus is a fairly common anomaly of binocular vision, characterized by constant or intermittent exotropia at distance, absence of significant amblyopia, and normal stereopsis at near. Optometric vision therapy is often effective in treating this condition. In contrast to the emphasis orthoptists (under ophthalmologic supervision) place upon pathological diplopia awareness, optometric vision therapy emphasizes development of sensory fusion and proprioceptive cues to eye alignment. A case is presented in which pathological diplopia awareness and surgery were needed to produce a functional cure after the patient failed to achieve consistent eye alignment using the regimen commonly advocated by optometrists.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/9. Accommodation deficiency in healthy young individuals.Ten patients, ages 10 to 19, with accommodation insufficiency are reported. All patients were in good health and asymptomatic, except for asthenopia during near visual activities. Each patient's amplitude of accommodation was measured and found to be considerably below the minimal normal for their respective ages (an average of 6 diopters). Only three patients had associated convergence insufficiency. No etiology for the diminished accommodation was suggested by history or could be identified by careful examination. All patients were successfully managed optically with bifocals or reading glasses, although three required the addition of base-in prisms for the near exodeviation. Near vision testing and determination of the near point of accommodation should be part of the pediatric ophthalmologic examination in all patients with complaints referable to their reading and visual performance at near.- - - - - - - - - - ranking = 4keywords = near (Clic here for more details about this article) |
8/9. Convergence paralysis after lesions of the cerebellar peduncles.We studied vergence eye movements in a patient with limited hemorrhage affecting the right cerebellar peduncles and the hemisphere. The patient showed exotropia of 30 prism dptr during near vision. Some vergence paradigms were investigated in this patient. We studied fusional vergence evoked by placing a wedge prism before one eye. Accommodative vergence was studied by blur stimulus using a servocontrolled optometer. Lens accommodation was also recorded during blur stimulus. Although accommodative responses were normal, accommodative vergence was almost absent as well as fusional convergence in this patient. It has previously been reported that the cerebellum has a role in the control of vergence in the monkey. Our data suggest that the human cerebellum also relates to the control of vergence.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/9. incontinentia pigmenti (Bloch-Sulzberger-syndrome): case report and differential diagnosisto related dermato-ocular syndromes.BACKGROUND: incontinentia pigmenti (IP; Bloch-Sulzberger syndrome) is an inherited disorder of skin pigmentation that is associated with skin (100%), dental (90%), skeletal (40%), central nervous (40%) and ocular (35%) abnormalities. The pathogenesis is not yet known. The disease is usually seen in females, as it is an X-linked dominantly inherited disease which is lethal in males. PATIENT PRESENTATION: We present a 9-year-old girl with the classical general and ocular signs of IP. She presented in early childhood with inflammatory vesicular skin changes which changed into pigmented skin alterations especially on the trunk. Ocular findings were microphthalmia and retrolental mass formation in one eye and retinal pigmentary changes in the other. In our patient, the spontaneous mutation may have been caused by the family's close neighbourhood to Semipalatinsk, Kasachstan, where regular nuclear tests took place very shortly before the pregnancy with our patient began. DISCUSSION: Ocular involvement is described in about a third of persons affected with IP. A nearly consistent and pathognomonic finding is a pigment retinopathy (mottled diffuse hypopigmentations). A further consistent finding are abnormalities of peripheral retinal vessels with areas of non-perfusion in the outer retina. The retinal pigment epitheliopathy and the abnormalities of retinal vessels are thought to be the underlying pathognomonic findings, with all other ocular signs being secondary (cataract, leucocoria, optic atrophy, strabismus, nystagmus and microphthalmus). Exudative retinal detachment occurs only in a minority, usually in very early childhood, when the skin lesions are exudative as well. IP patients should, however, be clinically observed regularly because of their retinal pigmentary changes.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |