DOCSLIB.ORG

Prescription Formulas for the Pediatric Patient Pediatric Pharmacology and Pathology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prescription Formulas for the Pediatric Patient Pediatric Pharmacology and Pathology Prescription Formulas for the Pediatric Patient Pediatric Pharmacology and Pathology Valerie M. Kattouf O.D., F.A.A.O. Illinois College of Optometry Chief, Pediatric Binocular Vision Service Associate Professor No disclosures No conflict of interest April 2019 In the next hour……. ▪ Ocular Medications and Children ▪ Presentations of Pediatric Pathology Ocular Medications & Children ▪ The rules: – birth → 2 years old = 1/2 dose – 2-3 years old = 2/3 dose – > 3 years old = adult dose ▪ If only 50 % is absorbed may be 10x maximum dosage Ocular Medications & Children ▪ Pediatric systems differ in: – drug excretion kidney is the main site of drug excretion diminished 2° renal immaturity – biotransformation liver is organ for drug metabolism Impaired 2° enzyme immaturity Punctal Occlusion for 3-4 minutes ↓ systemic absorption by 40% Ocular Medications & Children ▪ Systemic absorption occurs through….. – Mucous membrane of Nasolacrimal Duct 80% of each gtt passing through NLD system is available for rapid systemic absorption by the nasal mucosa – Conjunctiva – Oropharynx – Digestive system (if swallowed) Modified by variation in Gastric pH, delayed gastric emptying & intestinal mobility – Skin (2° overflow from conjunctival sac) Greatest in infants Blood volume of neonate 1/20 adult Therefore absorbed meds are more concentrated at this age Ocular Medications & Children ▪ Ocular Meds with strongest potential for pediatric SE : – 10 % Phenylephrine – 2 % Epinephrine – 1 % Atropine – 2 % Cyclopentalate – 1 % Prednisone Ocular Medications & Children ▪ Distribution to Site of Action in Pediatric Patients determined by : – Size of body fluid compartment – Muscle mass – Fat storage – Tissue blood flow – Protein binding capabilities Ocular Medications & Children ▪ Package inserts warn ”safety and efficacy has not been established in children” FDA recognizes that accepted medical practice often includes prescribing medications for use in patient populations that are not included in approved labeling (PDR ophthalmology) Ocular Pharmaceuticals Side Effects of Diagnostic Pharmaceutical Agents in Children Medication Class Example Ocular/ Systemic Side Local Side Effect Effect Adrenergic Agonist Phenylephrine Conjunctival Hypertension, Blanching tachycardia, arrhythmias Cholinergic Agents Cyclopentalate Ocular irritation, Hyperactivity, Atropine follicular restlessness, Tropicamide conjunctivitis, delirium, seizures, GI cutaneous disturbance, hyperemia temperature elevation, respiratory depression ADMINISTRATION OF CYCLOPLEGIC IN CLINIC ▪ Cycloplegic Spray 0.5% Tropicamide 0.5% Cyclogel 2.5% Phenylephrine ▪ O’BRIEN Pharmacy 800-627-4360 Side Effects of Diagnostic Pharmaceutical Agents in Children ▪ Phenylephrine risks – Hyperthyroidism and cardiovascular problems may result is tachyarrhythmia ▪ Premature / ROP patients =  systemic side effects – Use Cyclomydril 0.2% cyclo / 1 % phenylephrine no increased blood pressure ▪ Cholinergic Agents – Education: parents may call with dilation concerns not expecting it to last into next day – Atropine toxicity more susceptible to Lightly pigmented Brain damage Down Syndrome Treatment with Atropine ▪ Proper patient selection… – Moderate-high hyperopia – Moderate amblyopia (20/100 or better visual acuity) ▪ Administration schedule – 1 gtt 1.0% Atropine sulfate daily vs. weekend only frequency of installation can be reduced as acuity improvement is observed minimal installation is one drop of 1% Atropine sulfate two times per week ▪ Side Effects / Emergency contact information Atropine Instillation for Amblyopia Our evaluation found that ________________________ has amblyopia of the right / left / both eyes. Amblyopia is reduced vision in an eye that has not received adequate or appropriate use during early childhood, often known as “lazy eye”, and has many causes which have been explained by your doctor. If not treated, the amblyopic eye may never develop good vision and may even be functionally blind. The treatment of amblyopia may require multiple therapy methods in which your doctor may prescribe occlusion therapy with patching or atropine instillation. Active amblyopia vision therapy may be recommended to enhance the effectiveness of occlusion therapy. Glasses are also prescribed in most cases. The following Atropine instillation program is prescribed: Prescription glasses should be worn for: full time / near activities / distance activities Install 1 Drop Atropine into the RIGHT / LEFT eye on the indicated days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday ***please keep medication out of reach from other family members*** Special Instructions: ____________________________________________________________________________ Possible Atropine Ophthalmic Solution Side Effects: Burning/stinging/redness of the eye, eye irritation, or temporary blurred vision may occur. Most people do not experience serious side effects from using this medication. Tell your doctor immediately if any of these unlikely but serious side effects occur: dizziness, fainting, new or increased eye pressure/pain/swelling/discharge, rash, or itching/swelling (especially of the fact/tongue/throat. Rare, but very serious side effects include: slow/shallow breathing, mental/mood, fast/irregular heartbeat. Your next appointment is on ______________. If you have any questions, please feel free to contact us at (312) 949-7280 or after hours via our EMERGENCY number at (312) 225-6200. Ocular Pharmaceuticals Commonly Used Ocular Anti-Biotic Medications in Children Administration of Ocular Meds Ointment vs. Drops ▪ Ointment – blurred vision – contact dermatitis ▪ Drops – risk of systemic toxicity – contact time with cornea (diluted by tears) Ocular Medications & Children Anti-biotic Ointments Drug Age Approval Erythromycin > 2 months Tobrex > 2 months Ciloxan > 2 years Polysporin > 2 years Ocular Medications & Children Anti-biotic Ointments Drug Dosing Erythromycin qid Tobrex qid Ciloxan tid x 2 days, bid x 5 days Polysporin qid Ocular Medications & Children Anti-biotic Drops Drug Age Approval Polytrim 2 months Fluoroquinolones Besivance 1 yr Moxeza > 4 months Ciloxan 1 yr Ocuflox 1 yr Quixin 1 yr Vigamox 1 yr Zymaxid 1 yr Iquix 6 yr Other Antibiotics Azasite > 1 yr Gentamycin unknown Sulfacetamide unknown Ocular Medications & Children Anti-biotic Drops • Polytrim – Broad spectrum, effective, inexpensive • AzaSite – macrolide anti-biotic (Z-pack) • Prolonged ½ life - dosing schedule • 1 gtt q 8-12 hrs (tid) x 2 days • 1 gtt qd x 5 days • Broad spectrum, effective, expensive Ocular Medications & Children Anti-biotic Drops • Fluoroquinolones (concentration dependent) • Besivance (0.6%)– new, Advanced A-B Vehicle: DuraSite mucoadhesive – provides enhanced ocular surface residency time Dosing = tid (q 8 hrs) Pediatric schedule: AM → after school → at bed time • Ciloxan (0.3%) • Ocuflox (0.3%) • Moxeza (0.5%) prolonged contact due to gum base = bid dosing • Quixin (0.5%) • Vigamox (0.5%) no preservative • Zymar (0.3%) • Zymaxid (0.5%) ↑ concentration may enhance clinical results • Iquix (1.5%) Ocular Medications & Children Anti-biotic Drops Drug Dosing Polytrim qid Flouroquinolones Besivance tid Moxeza bid Ciloxan 1gtt q 2hrs x 2days, qid x 5 days Ocuflox 1gtt q 2hrs x 2days, qid x 5 days Quixin 1gtt q 2hrs x 2days, qid x 5 days Vigamox tid Zymar 1gtt q 2hrs x 2days, qid x 5 days Zymaxid 1gtt q 2hrs x 2days, qid x 5 days Azasite tid x 2days, qd x 5days Ocular Medications & Children Anti-biotic Drops Drug Dosing Polytrim qid Azasite tid x 2days, qd x 5days Besivance tid Moxeza bid Ciloxan qid Ocuflox qid Quixin qid Vigamox tid Zymar qid Zymaxid qid Anterior Segment Pathology Nasolacrimal Duct Obstruction Nasolacrimal Duct Obstruction ▪ Clinical Characteristics – 5-6% of newborns – Constant tearing – Redness irritation of lids – **With secondary conjunctivitis discharge injection swelling over innermost aspect of lower lid pain fever Nasolacrimal Duct Obstruction Etiology and Anatomy ▪ Incomplete opening of lower end of the NLD along side of nose between inner canthus of eyelid and inferior turbinate of the nasal cavity Nasolacrimal Duct Obstruction TREATMENT OPTIONS 1) Warm compress / Hydrostatic Massage 2) Topical Antibiotic Drops 3) Probing The Course of Nasolacrimal Duct Obstruction 1983 T. Otis Paul 55 infants diagnosed with NLDO prior to 3 month old Percentage of Spontaneous Resolution by 1 year of age 3 months - 15% 6 months - 46% 12 months - 93% Resolution of Congenital Nasolacrimal Duct Obstruction with Nonsurgical Management Pediatric Eye Disease Investigator Group ▪ Objective To determine how often nasolacrimal duct obstruction (NLDO) resolves with 6 months of nonsurgical management in infants aged 6 to <10 months old. ▪ Baseline Characteristics Evaluated Age gender Laterality specific clinical signs of NLDO ▪ Results At the 6-month examination, which was completed for 117 of the 133 eyes (88%), the NLDO had resolved without surgery in 77 eyes. None of the baseline characteristics we evaluated were found to be associated with resolution Primary Treatment of Nasolacrimal Duct Obstruction with Probing In Children Less Than Four Years Old Pediatric Eye Disease Investigator Group* ▪ Objective To report the outcome of nasolacrimal duct probing as the primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children less than 4 years of age ▪ Participants Nine hundred fifty-five eyes of 718 children AGES 6 to <48 months no prior nasolacrimal surgical procedure with at least
Load more

Recommended publications
  • Cytomegalovirus Retinitis: a Manifestation of the Acquired Immune Deficiency Syndrome (AIDS)*
    Br J Ophthalmol: first published as 10.1136/bjo.67.6.372 on 1 June 1983. Downloaded from British Journal ofOphthalmology, 1983, 67, 372-380 Cytomegalovirus retinitis: a manifestation of the acquired immune deficiency syndrome (AIDS)* ALAN H. FRIEDMAN,' JUAN ORELLANA,'2 WILLIAM R. FREEMAN,3 MAURICE H. LUNTZ,2 MICHAEL B. STARR,3 MICHAEL L. TAPPER,4 ILYA SPIGLAND,s HEIDRUN ROTTERDAM,' RICARDO MESA TEJADA,8 SUSAN BRAUNHUT,8 DONNA MILDVAN,6 AND USHA MATHUR6 From the 2Departments ofOphthalmology and 6Medicine (Infectious Disease), Beth Israel Medical Center; 3Ophthalmology, "Medicine (Infectious Disease), and 'Pathology, Lenox Hill Hospital; 'Ophthalmology, Mount Sinai School ofMedicine; 'Division of Virology, Montefiore Hospital and Medical Center; and the 8Institute for Cancer Research, Columbia University College ofPhysicians and Surgeons, New York, USA SUMMARY Two homosexual males with the 'gay bowel syndrome' experienced an acute unilateral loss of vision. Both patients had white intraretinal lesions, which became confluent. One of the cases had a depressed cell-mediated immunity; both patients ultimately died after a prolonged illness. In one patient cytomegalovirus was cultured from a vitreous biopsy. Autopsy revealed disseminated cytomegalovirus in both patients. Widespread retinal necrosis was evident, with typical nuclear and cytoplasmic inclusions of cytomegalovirus. Electron microscopy showed herpes virus, while immunoperoxidase techniques showed cytomegalovirus. The altered cell-mediated response present in homosexual patients may be responsible for the clinical syndromes of Kaposi's sarcoma and opportunistic infection by Pneumocystis carinii, herpes simplex, or cytomegalovirus. http://bjo.bmj.com/ Retinal involvement in adult cytomegalic inclusion manifestations of the syndrome include the 'gay disease (CID) is usually associated with the con- bowel syndrome9 and Kaposi's sarcoma.
    [Show full text]
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • A Description of the Clinical Features of Brimonidine- Associated Uveitis Alyssa Louie Primary Care Resident, San Francisco VA
    Drug-induced intraocular inflammation: A description of the clinical features of brimonidine- associated uveitis Alyssa Louie Primary Care Resident, San Francisco VA Abstract: A description of the clinical features, diagnostic work-up, and management of acute anterior uveitis caused by brimonidine, a widely used glaucoma medication. I. Case History a. Patient demographics: 74 year-old white male b. Chief complaint: eye pain, redness, irritation for last 2 weeks c. Ocular and medical history: i. Ocular history 1. Primary open angle glaucoma OU, diagnosed 8 years ago 2. Senile cataracts OU, not visually significant 3. Type 2 Diabetes without retinopathy OU 4. No prior history of uveitis ii. Medical history: Diabetes Mellitus Type 2 iii. No known drug allergies d. Medications i. Ocular: dorzolamide BID OU (1.5 years), brimonidine BID OU (11 months), travatan QHS OU (5.5 years) ii. Medical: metformin 500mg tab BID PO II. Pertinent Findings a. Clinical exam i. Visual acuities: OD 20/20-, OS 20/20- ii. Goldmann applanation tonometry: 13 mm Hg OD, 13 mm Hg OS iii. Anterior segment 1. OU: 3+ diffuse conjunctival injection 2. OU: central and inferior granulomatous keratic precipitates 3. OU: Grade 1+ cell, 1+ flare 4. OU: No synechiae or iris changes were present iv. Posterior segment 1. Optic Nerve a. OD: Cup-to-disc ratio 0.70H/V, distinct margins b. OS: Cup-to-disc ratio 0.75H/V, distinct margins 2. Posterior pole, periphery, vitreous: unremarkable OU b. Laboratory Studies i. ACE, Lysozyme, FTA-ABS, VDRL, HLA-B27, Rheumatoid Factor, ANA, PPD, Chest X- ray: all negative/unreactive III.
    [Show full text]
  • Eyelid Conjunctival Tumors
    EYELID &CONJUNCTIVAL TUMORS PHOTOGRAPHIC ATLAS Dr. Olivier Galatoire Dr. Christine Levy-Gabriel Dr. Mathieu Zmuda EYELID & CONJUNCTIVAL TUMORS 4 EYELID & CONJUNCTIVAL TUMORS Dear readers, All rights of translation, adaptation, or reproduction by any means are reserved in all countries. The reproduction or representation, in whole or in part and by any means, of any of the pages published in the present book without the prior written consent of the publisher, is prohibited and illegal and would constitute an infringement. Only reproductions strictly reserved for the private use of the copier and not intended for collective use, and short analyses and quotations justified by the illustrative or scientific nature of the work in which they are incorporated, are authorized (Law of March 11, 1957 art. 40 and 41 and Criminal Code art. 425). EYELID & CONJUNCTIVAL TUMORS EYELID & CONJUNCTIVAL TUMORS 5 6 EYELID & CONJUNCTIVAL TUMORS Foreword Dr. Serge Morax I am honored to introduce this Photographic Atlas of palpebral and conjunctival tumors,which is the culmination of the close collaboration between Drs. Olivier Galatoire and Mathieu Zmuda of the A. de Rothschild Ophthalmological Foundation and Dr. Christine Levy-Gabriel of the Curie Institute. The subject is now of unquestionable importance and evidently of great interest to Ophthalmologists, whether they are orbital- palpebral specialists or not. Indeed, errors or delays in the diagnosis of tumor pathologies are relatively common and the consequences can be serious in the case of malignant tumors, especially carcinomas. Swift diagnosis and anatomopathological confirmation will lead to a treatment, discussed in multidisciplinary team meetings, ranging from surgery to radiotherapy.
    [Show full text]
  • Herpetic Viral Retinitis
    American Journal of Virology 2 (1): 25-35, 2013 ISSN: 1949-0097 ©2013 Science Publication doi:10.3844/ajvsp.2013.25.35 Published Online 2 (1) 2013 (http://www.thescipub.com/ajv.toc) Herpetic Viral Retinitis Hidetaka Noma Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women’s Medical University, Chiba, Japan Received 2012-05-30, Revised 2012-07-09; Accepted 2013-07-22 ABSTRACT Human Herpes Virus (HHV) is a DNA virus and is the most important viral pathogen causing intraocular inflammation. HHV is classified into types 1-8. Among these types, HHV-1, HHV-2, HHV-3 Varicella Zoster Virus (VZV) and HHV-5 Cytomegalovirus (CMV) are known to cause herpetic viral retinitis, including acute retinal necrosis and CMV retinitis. Herpes viral retinitis can be diagnosed from characteristic ocular findings and viral identification by PCR of the aqueous humor. Recently, therapy has become more effective than in the past. Herpes viral retinitis gradually progresses if appropriate treatment is not provided with regard to the patient’s immune status. Further advances in diagnostic methods and treatment are required in the future. Keywords: Human Herpes Virus (HHV), Varicella Zoster Virus (VZV), Acute Retinal Necrosis, Polymerase Chain Reaction (PCR), CMV Retinitis, Pathogen Causing Intraocular Inflammation 1. INTRODUCTION by Young and Bird (1978). In the 1980s, the etiology of the disease was shown to be infection by HSV and Human Herpes Virus (HHV) is a DNA virus and VSV. Widespread adoption of the Polymerase Chain the most important viral pathogen causing intraocular Reaction (PCR) method from early the 1990 made it inflammation. It is classified into types 1-8, among possible to easily detect the presence of intraocular which HHV-1, HHV-2, HHV-3 (Varicella Zoster viruses, after which many cases of ARN were Virus: VZV) and HHV-5 Cytomegalovirus (CMV) are diagnosed.
    [Show full text]
  • A Rare Presentation of Lower Conjunctival Fornix Eyelashes Cyst Dr Mohammad Aldroos (MD)* *Department of Ophthalmology, Jordanian Royal Medical Services
    Int J Biol Med Res.2018 ;9(1):6259-6260 Int J Biol Med Res www.biomedscidirect.com Volume 6, Issue 2, April 2015 Contents lists available at BioMedSciDirect Publications International Journal of Biological & Medical Research Journal homepage: www.biomedscidirect.com BioMedSciDirect International Journal of Publications BIOLOGICAL AND MEDICAL RESEARCH Case report A rare presentation of lower conjunctival fornix eyelashes cyst Dr Mohammad Aldroos (MD)* *Department of Ophthalmology, Jordanian Royal Medical Services A R T I C L E I N F O A B S T R A C T Keywords: Purpose: To describe a rare presentation of a right lower conjunctival fornix eyelashes cyst. Case Report: A 56 year-old lady presented to our clinic complaining of blackish mass in the lower conjunctival fornix of the right eye ( see fig.1), with mild conjunctival hyperemia around the mass. There was no history of discharge and difficulty in extraocular muscles movements also there was no history of trauma. A gradually enlarging mass over the past few years with recurrent conjunctivitis. Slit lamp examination of the mass showed normal appearing eyelashes surrounded by capsule only. The mass was surgically excised with good cosmetic appearance and without any complications c Copyright 2010 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved. Introduction Fig.2 Eyelashes grow on the edge of the eyelid. A normal eyelid has a single row of eyelashes located along its anterior margin. The posterior portion of the lid contains a row of Meibomian glands orifices, which secrete the oily component of the tear film (1). There are approximately 100 eye lashes on the upper lid and approximately 50-75 on the lower lid, they protect the eyeball.
    [Show full text]
  • Herpetic Corneal Infections
    FocalPoints Clinical Modules for Ophthalmologists VOLUME XXVI, NUMBER 8 SEPTEMBER 2008 (MODULE 2 OF 3) Herpetic Corneal Infections Sonal S. Tuli, MD Reviewers and Contributing Editors Consultants George A. Stern, MD, Editor for Cornea & External Disease James Chodosh, MD, MPH Kristin M. Hammersmith, MD, Basic and Clinical Science Course Faculty, Section 8 Kirk R. Wilhelmus, MD, PhD Christie Morse, MD, Practicing Ophthalmologists Advisory Committee for Education Focal Points Editorial Review Board George A. Stern, MD, Missoula, MT Claiming CME Credit Editor in Chief, Cornea & External Disease Thomas L. Beardsley, MD, Asheville, NC Academy members: To claim Focal Points CME cred- Cataract its, visit the Academy web site and access CME Central (http://www.aao.org/education/cme) to view and print William S. Clifford, MD, Garden City, KS Glaucoma Surgery; Liaison for Practicing Ophthalmologists Advisory your Academy transcript and report CME credit you Committee for Education have earned. You can claim up to two AMA PRA Cate- gory 1 Credits™ per module. This will give you a maxi- Bradley S. Foster, MD, Springfield, MA Retina & Vitreous mum of 24 credits for the 2008 subscription year. CME credit may be claimed for up to three (3) years from Anil D. Patel, MD, Oklahoma City, OK date of issue. Non-Academy members: For assistance Neuro-Ophthalmology please send an e-mail to [email protected] or a Eric P. Purdy, MD, Fort Wayne, IN fax to (415) 561-8575. Oculoplastic, Lacrimal, & Orbital Surgery Steven I. Rosenfeld, MD, FACS, Delray Beach, FL Refractive Surgery, Optics & Refraction C. Gail Summers, MD, Minneapolis, MN Focal Points (ISSN 0891-8260) is published quarterly by the American Academy of Ophthalmology at 655 Beach St., San Francisco, CA 94109-1336.
    [Show full text]
  • Characteristics of Allergy in Autoimmune Thyroid Diseases Ildikó
    Characteristics of allergy in autoimmune thyroid diseases Ildikó Molnár MD, PhD, EndoMed, Hungary ImmunSum, Baltimore, 2014 Relationship between allergic responses and thyroid autoimmunity IgE levels IgE deposits are present in Graves’ thyroid and orbital tissues (Werner SC et al., N Engl Med, 1972;287:421-425.; Raikow RB et al., Ophthalmol. 1990; 97:629-635.) Elevated IgE levels associated with hyperthyroid Graves’ disease (Akira S et al., J Clin Endocrinol Metab 1999; 84:3602-3605.; Takashi Y et al., J Clin Endocrinol Metab 2000; 85:2775- 2778.) Evidence of immunglobulin E autoantibodies to thyrotropin receptor (TSH rec) and thyroid peroxidase (TPO) (Metcalfe R et al., J Clin Endocrinol Metab 2002;87:1754-1761.; Gou J et al., Clin Immunol Immunopathol 1997; 82: 157-162.) Th2-derived cytokine profils Elevated serum levels of IL-5 and IL-13 cytokines. (Hidaka Y et al., Thyroid 1998; 8:235-239.; Ichiro K et al., J Clin Endocrinol Metab 2001; 86:3540-3544.) Allergic rhinitis associated frequently with Graves’ disease (Amino N et al., Thyroid 2003; 13:811-814.; Hidaka Y et al., Thyroid 1996; 6: 349-351.) Common key factors regulate the immune responses in both allergic and autoimmune conditions (Rottem M et al., Dev Immunology 2002; 9: 161-167.) ImmunSum, Baltimore, 2014 Previous results Graves’ ophthalmopathy associated with increased total IgE serum levels. Molnár I et al., Eur J Med Rev 1996; 1:543-546. Hyperthyroid Graves’ ophthalmopathy demonstrated elevated serum IL-5 levels compared to patients who had no eye signs. Molnár I , Abstract: ACT International Suppl., 2000; 2: 220. Decreased serum levels of nerve growth factor (NGF) associated with hyperthyroid Graves’ ophthalmopathy compared to those who had no eye signs.
    [Show full text]
  • Ophthalmic and Adnexal Complications of Radiotherapy
    Acta Ophthalmologica Scandinavica 2007 Review Article Ophthalmic and adnexal complications of radiotherapy Shane R. Durkin,1 Daniel Roos,2 Braden Higgs,2 Robert J. Casson1,3 and Dinesh Selva1,3 1Department of Ophthalmology and Visual Sciences, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia 2Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia 3Department of Medicine and Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide South Australia, Australia ABSTRACT. The efficacy of radiotherapy is The role of radiotherapy in ophthalmic practice continues to grow. This determined by aspects of radiation growth has seen an expansion of indications for radiotherapy, a refinement of delivery and the biological conse- the modalities that can be used and a reduction in the ocular and adnexal com- quences to the tumour and normal tis- plications that result from this form of therapy. The compendium of indica- sues. By giving radiation doses over a tions for radiotherapy in ophthalmology continues to grow and now includes number of fractions, damage to nor- many conditions such as the treatment of lid and adnexal disease, ocular sur- mal tissues can be reduced due to the repair of sublethal damage between face disorders and both benign and malignant disease of the posterior segment fractions and repopulation of cells and optic pathways. The radiotherapeutic modalities employed to manage during the course of treatment. these conditions are numerous and include
    [Show full text]
  • PEA's NEWSLETTER July Welcome to PEA's Very First Newsletter, Prisms
    Issue 1 | Volume 1 | July 2019 Pacific Eye Associates www.pacificeye.com Prisms415.923.3007 PEA'S NEWSLETTER July Welcome to PEA's very first newsletter, Prisms. In our quarterly newsletter we'll deliver updates about our office, doctors, and eye treatments, as well as create a community of like- minded professionals. We'll keep each of our newsletters to a five minute read. Time is precious and so are your eyes, no dry eyes on our account! We count on doctors to make our newsletters better each time. Please email us with topics about which you would like to read. In this quarter's newsletter: - Dr. Oxford writes about our newest dry eye treatment, LipiFlow. - Dr. Heiden awarded the Outstanding Humanitarian Service Award. Dr. David Heiden received the 2018 Outstanding Humanitarian Service Award from the American Academy of Ophthalmology. He was nominated by Pacific Vision Foundation and Seva Foundation. Out of 32,000 members, only two physicians were selected for this honor. Dr. Heiden received the award in recogni- tion of his work to bring state- of- the- art blindness prevention techniques to HIV/ AIDS patients in politically unstable and poverty- stricken environments across the globe. He pioneered the practice of training primary care AIDS doctors how to use eye exams to diagnose and treat Cytomegalovirus (CM V) retinitis, a disease that can increase AIDS- related mortality and lead to sudden, irreversible blindness. He also trained AIDS doctors how to perform intraocular injection of medication to treat CM V retinitis, something that had never been considered before. CM V retinitis is a complication of AIDS and now almost forgotten in the David Heiden, M .D.
    [Show full text]
  • Pediatric Pharmacology and Pathology
    7/31/2017 In the next 2 hours……. Pediatric Pharmacology and Pathology . Ocular Medications and Children The content of th is COPE Accredited CE activity was prepared independently by Valerie M. Kattouf O.D. without input from members of the optometric community . Brief review of examination techniques/modifications for children The content and format of this course is presented without commercial bias and does not claim superiority of any commercial product or service . Common Presentations of Pediatric Pathology Valerie M. Kattouf O.D., F.A.A.O. Illinois College of Optometry Chief, Pediatric Binocular Vision Service Associate Professor Ocular Medications & Children Ocular Medications & Children . Pediatric systems differ in: . The rules: – drug excretion – birth 2 years old = 1/2 dose kidney is the main site of drug excretion – 2-3 years old = 2/3 dose diminished 2° renal immaturity – > 3 years old = adult dose – biotransformation liver is organ for drug metabolism Impaired 2° enzyme immaturity . If only 50 % is absorbed may be 10x maximum dosage Punctal Occlusion for 3-4 minutes ↓ systemic absorption by 40% Ocular Medications & Children Ocular Medications & Children . Systemic absorption occurs through….. Ocular Meds with strongest potential for pediatric SE : – Mucous membrane of Nasolacrimal Duct 80% of each gtt passing through NLD system is available for rapid systemic absorption by the nasal mucosa – 10 % Phenylephrine – Conjunctiva – Oropharynx – 2 % Epinephrine – Digestive system (if swallowed) Modified by variation in Gastric pH, delayed gastric emptying & intestinal mobility – 1 % Atropine – Skin (2° overflow from conjunctival sac) Greatest in infants – 2 % Cyclopentalate Blood volume of neonate 1/20 adult Therefore absorbed meds are more concentrated at this age – 1 % Prednisone 1 7/31/2017 Ocular Medications & Children Ocular Medications & Children .
    [Show full text]
  • Retinitis Pigmentosa, Ataxia, and Peripheral Neuropathy
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.46.3.206 on 1 March 1983. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry 1983;46:206-213 Retinitis pigmentosa, ataxia, and peripheral neuropathy RR TUCK, JG McLEOD From the Department ofMedicine, University ofSydney, Australia SUMMARY The clinical features of four patients with retinitis pigmentosa, ataxia and peripheral neuropathy but with no increase in serum phytanic acid are reported. Three patients also had sensorineural deafness and radiological evidence of cerebellar atrophy. Nerve conduction studies revealed abnormalities of sensory conduction and normal or only mild slowing of motor conduc- tion velocity. Sural nerve biopsy demonstrated a reduction in the density of myelinated fibres. There were no onion bulb formations. These cases clinically resemble Refsum's disease, but differ in having no detectable biochemical abnormality, and a peripheral neuropathy which is not hypertrophic in type. They may represent unusual cases of spinocerebellar degeneration. Retinitis pigmentosa occurs infrequently as an iso- (WAIS). He had a speech impediment but was not dysar- Protected by copyright. lated finding in otherwise healthy individuals and thric. He was of short stature, had a small head and pes families. Its association with deafness, with or with- cavus but no kyphoscoliosis. His visual acuity in the right eye was 6/60 while in the left he could count fingers only. out other neurological abnormalities is much less The right visual field was constricted but the left could not common but nevertheless well recognised.1 In be tested. The optic discs were pale, the retinal vessels heredopathia atactica polyneuritiformis (Refsum's small in diameter and throughout the retinae there was disease), abetalipoproteinaemia, and the Keams- scattered "bone corpuscle" pigmentation.
    [Show full text]