DOCSLIB.ORG

TUBERCULOUS IRIDOCYCLITIS AS a CAUSE of the HETEROCHROMIA of FUCHS* Heterochromia, in Its Literal Meaning, Signifies Different C

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
TUBERCULOUS IRIDOCYCLITIS AS a CAUSE of the HETEROCHROMIA of FUCHS* Heterochromia, in Its Literal Meaning, Signifies Different C 380 KING: The Heterochromia of Fuchs 2. Benedict, W. L.: Retinitis of Cardiovascular and of Renal Disease, Am. J. Ophth., 1921, iv, p. 495. 3. Benedict, W. L.: Retinitis Associated with Disease of the Cardiovascular System, N. Y. M. J., 19293, cxvii, p. 741. 4. Cushing, Harvey, and Bordley, James: Subtemporal Decompression in a Case of Chronic Nephritis with Uremia; with Especial Consideration of the Neuroretinal Lesion, Am. J. M. Sc., 1908, cxxxvi, p. 484. 5. Ellis, A. W. M., and Marrack, J. R.: An Investigation of Renal Function in Patients with Retinitis and High Blood-Pressure, Lancet, 1923, i, p. 891. 6. Morax, V.: Pathologic Oculaire, Felix Alcan, Paris, 1921, p. 278. 7. Schieck, F., and Volhard, Franz: Netzhautveranderungen und Nieren- leiden, Zentralbl. f. d. ges. Ophth. u. i. Grenzgeb., 1921, v, p. 465. 8. Volhard, Franz: Die doppelseitigen hamotogenen Nierenerkrankungen, Berlin. Julius Springer, 1918, p. 576. 9. Wagener, H. P.: Retinitis and Renal Function in Cardiovascular Renal Disease, Am. J. Ophth., 1924, vii, p. 272. 10. Wagener, H. P., and Keith, N. M.: Cases of Marked Hypertension, Adequate Renal Function and Neuroretinitis, Arch. Int. Med., 1924, xxxiv, p. 374. TUBERCULOUS IRIDOCYCLITIS AS A CAUSE OF THE HETEROCHROMIA OF FUCHS* CLARENCE KING, M.D. Cincinnati (From the I. University Eye Clinic, Vienna, Professor Meller) Heterochromia, in its literal meaning, signifies different coloring. As commonly used in ophthalmology, the term indicates a different coloring of the irides of an individual. The term as used in this paper does not include changes of color of the iris due to acute inflammation, or those changes following intra-ocular hemorrhage, or changes due to stain- ing by metal salts, or changes which are secondary to glau- coma. This condition early attracted the attention of ophthalmologists, and the numerous articles dealing with it in the literature of recent years indicate the wide-spread interest which attaches to it. Despite the work which has * Candidate's thesis for membership accepted by the Committee on Theses. The author forwarded with this thesis sixteen excellent water colors, but owing to the cost of color reproduction it was impossible to include these in the manu- script.-Editor. KING: The Heterochromia of Fuchs 381 been done upon the subject, no explanation of the problems connected with it received general recognition as being entirely adequate, and no classification of the various types of heterochromia obtained general acceptance. Hetero- chromia is commented upon early in the literature in articles by Wilde (1848), Lawrence54 (1853), and Hutchinson38 (1869). The first detailed study of this condition upon which subse- quent work was based was made by E. Fuchs before 1902. Reference was made to this work in his textbook, which was published in that year. Extensive articles appeared in 190625 and 1917.26 In connection with the following statements it may be useful to refer to some observations of Salzmann on the color and structure of the normal iris. Salzmann80 distinguished between two types of irides-the brown iris and the iris which was lighter in color. The two types differed not only in color but also in the character of the relief of the anterior surface. In the light-colored iris it was possible to observe many more details of the deeper layers than was the case with the brown iris. The radial arrangements of the trabec- ulae could be observed more readily; the crypts were larger and more definitely marked; the contraction furrows, on the contrary, were clearly discernible only in lateral illumina- tion. The brown iris showed a coarse relief; the ciliary zone was flatter; the crypts were few and smaller; the contrac- tion furrows were clearly seen even when the pupil was contracted. The anterior limiting membrane determined the color of the iris not only by its pigment content but by its thickness. According to Salzmann, the blue iris had a delicate limiting membrane and the cells contained just a few color particles. According to Munch (discussion of Bistis's7 paper), the cells of the anterior layer of the blue iris contained pigment, but this pigment was not ordinarily apparent and could be demonstrated only by special staining methods. The heterochromia of Fuchs represented a distinct type of 382 KING: The Heterochromia of Fuchs this condition with certain well-known characteristics. The observations of Fuchs have been generally confirmed by subsequent writers on the subject. The clinical picture which was established in the literature of the subject will first be described. Departures from this typical appearance which have been noted in the personal material will be com- mented upon subsequently. Fuchs's description is as follows: "On examination, the iris of one eye appears lighter in color than the other. The iris tissue in the lighter eye presents a peculiar appearance. The difference in the two eyes is especially apparent when one eye is blue and the other a lighter blue. In the normal blue eye, the pigment layer can be discerned in the inter- stices of the trabeculae of the overlying tissue. The trabec- ule are sharply outlined. In the lighter heterochromic iris, the retinal pigment layer is sometimes dinily apparent or not visible at all. The whole iris has a dull, blurred, less transparent appearance. The difference in the irides of the two eyes may be so slight as to escape attention except with the loupe. The relief of the anterior surface is not so apparent as in the sound eye. The fine, radial markings of the pupillary zone are not so prominent or may be entirely absent. There is an absence of any evidence of pronounced inflammation or its sequele. No marked exudative changes are seen; posterior synechie are absent; defects in the ret- inal pigment layer are frequently found; the pupillary pig- ment border may be partially or entirely absent. It may appear sharp in contour and may be replaced by a fine, grayish line with a gnawed-out appearance. The pupil in the lighter eye, with a normal reaction, may be wider than the other." In this type of heterochromia, precipitates on the posterior surface of the cornea are nearly always seen, and catarac- tous changes are frequently present. The precipitates are fine and few in number; they are sharply circumscribed KING: The Heterochromia of Fuchs 383 and located usually in the lower half of the cornea. They show no tendency to become confluent. The cataract, which is so frequently a feature of the clinical picture, usually begins in the posterior cortex. When complete, the cataract has a bluish-white appearance, with pronounced sector markings and a decided tendency to swelling. Despite the fact that the cataract is complicated, its extraction ordinarily causes no difficulty and the result is usually good. The precipitates may be absent and the cataract alone be present, or vice versa. It may be well to note that as the result of the disclosures made by the slit-lamp, it may be necessary entirely to revise our impression as to the presence or absence of minute changes in the cornea, iris, or lens in heterochromia. Early studies of this condition were made without the aid of even the loupe. It is to be presumed that observations with the slit-lamp in future cases will afford valuable data for more accurate classification. The hetero- chromia of Fuchs may be accompanied by opacities of the vitreous, also by choroidal inflammatory changes. A sym- pathetic nerve paralysis or a paresis may be present. Opin- ions of its significance differ. The lighter eye in heterochromia is inclined to increase in pressure. In some of Fuchs's cases, congenital defects were found in other parts of the eye. Clinical history: The patients with Fuchs's heterochromia usually seek the advice of the ophthalmologist because of defects or difficulties in vision. No complaint is made of pain or redness of the eyes. The history sometimes dis- closes that the difference in the color of the two eyes has ex- isted from birth or from the early years of life. Other patients state that they have accidentally noticed the color difference later in life, or that one eye has gradually become lighter. One rarely encounters cases like those reported in this paper, in which a positive statement is made that the color of the eye has become lighter within a definite period. The patients often have dark hair but the condition is seen also in 384 KING: The Heterochromia of Fuchs blond races. With the exception of two cases, the disease in all of the reported cases is confined to one eye. In a report in 1906, Fuchs discussed a case of heterochromia in which similar pathologic changes were observed in both eyes removed from a cadaver. Other references in the literature indicate that there is a possibility of a double heterochromia. The family history as to the color of the eyes frequently discloses the fact that one parent has brown eyes and the other light eyes; or that there were variations in this respect in the ancestral line on either side. In the cases reported, the disease has not been connected with any general dis- turbance; and the history has not been considered signifi- cant. Heine discussed in a paper, to which reference will subsequently be made, the possibility of tuberculosis as a factor in complicated heterochromia. In the cases of Fuchs, there was a predominance of women. However, taking the average of reported cases, the distribution of sexes was about equal. The time of the onset of the color difference is obviously uncertain, as already indicated. The symptoms of the cyclitis seem to occur from the twentieth to the thirtieth year.
Load more

Recommended publications
  • Ophthalmic Pathologies in Female Subjects with Bilateral Congenital Sensorineural Hearing Loss
    Turkish Journal of Medical Sciences Turk J Med Sci (2016) 46: 139-144 http://journals.tubitak.gov.tr/medical/ © TÜBİTAK Research Article doi:10.3906/sag-1411-82 Ophthalmic pathologies in female subjects with bilateral congenital sensorineural hearing loss 1, 2 3 4 5 Mehmet Talay KÖYLÜ *, Gökçen GÖKÇE , Güngor SOBACI , Fahrettin Güven OYSUL , Dorukcan AKINCIOĞLU 1 Department of Ophthalmology, Tatvan Military Hospital, Bitlis, Turkey 2 Department of Ophthalmology, Kayseri Military Hospital, Kayseri, Turkey 3 Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey 4 Department of Public Health, Gülhane Military Medical School, Ankara, Turkey 5 Department of Ophthalmology, Gülhane Military Medical School, Ankara, Turkey Received: 15.11.2014 Accepted/Published Online: 24.04.2015 Final Version: 05.01.2016 Background/aim: The high prevalence of ophthalmologic pathologies in hearing-disabled subjects necessitates early screening of other sensory deficits, especially visual function. The aim of this study is to determine the frequency and clinical characteristics of ophthalmic pathologies in patients with congenital bilateral sensorineural hearing loss (SNHL). Materials and methods: This descriptive study is a prospective analysis of 78 young female SNHL subjects who were examined at a tertiary care university hospital with a detailed ophthalmic examination, including electroretinography (ERG) and visual field tests as needed. Results: The mean age was 19.00 ± 1.69 years (range: 15 to 24 years). A total of 39 cases (50%) had at least one ocular pathology. Refractive errors were the leading problem, found in 35 patients (44.9%). Anterior segment examination revealed heterochromia iridis or Waardenburg syndrome in 2 cases (2.56%).
    [Show full text]
  • Congenital Cataract
    3801 W. 15th St., Bldg. A, Ste. 110 Plano, TX 75075 Phone: (972) 758-0625 Fax: (972) 964-5725 Email: [email protected] Website: www.drstagerjr.com Congenital Cataract Your eye works a lot like a camera. Light rays focus through the lens on the retina, a layer of light-sensitive cells at the back of the eye. Similar to photographic film, the retina allows the image to be “seen” by the brain. Over time, the lens of our eye can become cloudy, preventing light rays from passing clearly through the lens. The loss of transparency may be so mild that vision is barely affected, or it can be so severe that no shapes or movements are seen—only light and dark. When the lens becomes cloudy enough to obstruct vision to any significant degree, it is called a cataract. Eyeglasses or contact lenses can usually correct slight refractive errors caused by early cataracts, but they cannot sharpen your vision if a severe cataract is present. The most common cause of cataract is aging. Occasionally, babies are born with cataracts or develop them very early in life. This condition is called congenital cataract. There are many causes of congenital cataract. Certain diseases can cause the condition, and sometimes it can be inherited. However, in most cases, there is no identifiable cause. Treatment for cataract in infants varies depending on the nature of each patient’s condition. Surgery is usually recommended very early in life, but many factors affect this decision, including the infant’s health and whether there is a cataract in one or both eyes.
    [Show full text]
  • Ocular Injury; Hazard to Society: a Case Series
    Quest Journals Journal of Medical and Dental Science Research Volume 7~ Issue 8 (2020) pp: 34-44 ISSN(Online) : 2394-076X ISSN (Print):2394-0751 www.questjournals.org Research Paper Ocular Injury; Hazard to Society: A Case Series Dr Rashmi kujur1, Dr Pallavi. M.P2, Dr Harshita Dubey3, Dr Varsha4 1Dept. of ophthalmology, Madhav dispensary JAH, GRMC, Gwalior, Madhyapradesh. 2Senior girls hostel, GRMC, Gwalior, Madhyapradesh. 3Senior girls hostel, GRMC, Gwalior, Madhyapradesh. 4Senior girls hostel, GRMC, Gwalior,Madhyapradesh. Corresponding Author: Dr.Pallavi.M.P ABSTRACT Purpose: To describe various types of ocular trauma due to different modes of injuryoccured on the same day Design: Prospective interventional study (case series) Materials & Methods: A series of cases of ocular trauma in different age group on the same day. Results: Five patients of ocular trauma were studied & managed. All five patients were males. Out of 5 cases, 3 cases had open globe injury and 2 cases had closed globe injury. Three out of five patients required surgical intervention while 2 patients were managed with medical therapy. Conclusion: This study describes the types and characteristics of ocular trauma presenting in eye department. The frequency of ocular trauma is common in males. Eye injuries resulting from ocular trauma pose a frequent threat to vision the world over. While afocussed history and prompt ocular examination are essential to immediate management, patient educationregarding safety precautions and risk reduction help to prevent future recurrences. KEYWORDS: Ocular morbidity, Ocular Injury, globe rupture, iridodialysis, fire cracker injury, hyphema, Road Traffic accident (RTA), loss of vision. Received 05 December, 2020; Accepted 20 December, 2020 © The author(s) 2020.
    [Show full text]
  • MIOTICS in CATARACT SURGERY by Harold Beasley, MD
    MIOTICS IN CATARACT SURGERY BY Harold Beasley, MD PROMPT MIOSIS OF the pupil after delivery of the lens in round pupil cataract surgery is recommended to protect the vitreous face, to prevent iris incarceration, and to facilitate the postplacement of corneoscleral sutures.1 It has been postulated that miosis also prevents the formation of peripheral anterior synechia, but this has not been demonstrated experimentally.2 An ideal miotic should produce prompt pupillary constriction and for a duration of 12 to 24 hours. It should also be nonirritating to anterior chamber structures. Acetylcholine ( 1.0 per cent)37 and a weak solution of carbachol (0.01 per cent) ,8 as well as pilocarpine, have been found to be satisfactory for this purpose. The purposes of this study were (1) to evaluate the effectiveness of miotics in preventing peripheral anterior synechia and in preserving the integrity of the vitreous face; and (2) to compare the effectiveness of acetylcholine 1 per cent and carbachol 0.01 per cent as miotics in round pupil cataract surgery. PROCEDURE This study compared three experimental treatments in a double blind procedure in which the code was left unbroken until all the data were accumulated. Selected patients were gonioscoped prior to surgery and only patients with grades Im or iv angles were chosen for this study. All patients were predosed with 2 per cent homatropine and 10 per cent phenylephrine. Prior to the injection of the test solution the pupillary diameters were measured before the section was made and immediately after lens extraction. Measurements were then made at two minutes and at five minutes after the intracameral instillation of 0.4- to 0.5-cc of the test solutions.
    [Show full text]
  • Genes in Eyecare Geneseyedoc 3 W.M
    Genes in Eyecare geneseyedoc 3 W.M. Lyle and T.D. Williams 15 Mar 04 This information has been gathered from several sources; however, the principal source is V. A. McKusick’s Mendelian Inheritance in Man on CD-ROM. Baltimore, Johns Hopkins University Press, 1998. Other sources include McKusick’s, Mendelian Inheritance in Man. Catalogs of Human Genes and Genetic Disorders. Baltimore. Johns Hopkins University Press 1998 (12th edition). http://www.ncbi.nlm.nih.gov/Omim See also S.P.Daiger, L.S. Sullivan, and B.J.F. Rossiter Ret Net http://www.sph.uth.tmc.edu/Retnet disease.htm/. Also E.I. Traboulsi’s, Genetic Diseases of the Eye, New York, Oxford University Press, 1998. And Genetics in Primary Eyecare and Clinical Medicine by M.R. Seashore and R.S.Wappner, Appleton and Lange 1996. M. Ridley’s book Genome published in 2000 by Perennial provides additional information. Ridley estimates that we have 60,000 to 80,000 genes. See also R.M. Henig’s book The Monk in the Garden: The Lost and Found Genius of Gregor Mendel, published by Houghton Mifflin in 2001 which tells about the Father of Genetics. The 3rd edition of F. H. Roy’s book Ocular Syndromes and Systemic Diseases published by Lippincott Williams & Wilkins in 2002 facilitates differential diagnosis. Additional information is provided in D. Pavan-Langston’s Manual of Ocular Diagnosis and Therapy (5th edition) published by Lippincott Williams & Wilkins in 2002. M.A. Foote wrote Basic Human Genetics for Medical Writers in the AMWA Journal 2002;17:7-17. A compilation such as this might suggest that one gene = one disease.
    [Show full text]
  • Traumatic Retinal Detachment Br J Ophthalmol: First Published As 10.1136/Bjo.75.1.18 on 1 January 1991
    18 BritishJournalofOphthalmology, 1991,75, 18-21 Traumatic retinal detachment Br J Ophthalmol: first published as 10.1136/bjo.75.1.18 on 1 January 1991. Downloaded from P B Johnston Abstract trauma is a well recognised cause of rhegmato- Seventy-seven patients developed retinal genous retinal detachment, which was reported breaks following an episode of ocular con- by Eagling' to affect 4-6% of such injuries. The tusion, and 65 (84.4%) of these developed characteristics of postcontusion retinal detach- rhegmatogenous retinal detachment. Surgical ments were described by Cox et all and the treatment successfully restored or maintained mechanism ofbreak formation was elucidated by retinal apposition in 74 (96-1%) of the eyes. Delori et all who studied the effect of high speed Thirty-six (46-8%) eyes recovered visual acuity projectiles on enucleated pig eyes. Experimental of6/9orbetter. Ofthe retinal breaks recognised evidence indicates that retinal breaks form at the dialysis at the ora serrata was observed in 49 time of ocular impact. However, clinical reports eyes, of which 28 were situated at the lower show considerable delay in the diagnosis of temporal quadrant. Seventeen eyes had post-traumatic retinal detachment. For example, irregular breaks arising within necrotic retina Cox et all reported that only 30% of post- at the site of scleral impact. Twenty-four traumatic retinal detachments were diagnosed (31.2%) patients had retinal break or retinal within one month of injury, and Ross4 found detachment diagnosed within 24 hours ofinjury 40% in a similar period. and 49 (63-6%) within six weeks. Immediate The following study is of a series of patients retinal detachment was a feature of necrotic who developed retinal breaks or retinal detach- retinal breaks, while inferior oral dialyses led ment after ocular contusion.
    [Show full text]
  • Prominent and Regressive Brain Developmental Disorders Associated with Nance-Horan Syndrome
    brain sciences Article Prominent and Regressive Brain Developmental Disorders Associated with Nance-Horan Syndrome Celeste Casto 1,†, Valeria Dipasquale 1,†, Ida Ceravolo 2, Antonella Gambadauro 1, Emanuela Aliberto 3, Karol Galletta 4, Francesca Granata 4, Giorgia Ceravolo 1, Emanuela Falzia 5, Antonella Riva 6 , Gianluca Piccolo 6, Maria Concetta Cutrupi 1, Pasquale Striano 6,7 , Andrea Accogli 7,8, Federico Zara 7,8, Gabriella Di Rosa 9, Eloisa Gitto 10, Elisa Calì 11, Stephanie Efthymiou 11 , Vincenzo Salpietro 6,7,11,*, Henry Houlden 11 and Roberto Chimenz 12 1 Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Unit of Emergency Pediatric, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; [email protected] (C.C.); [email protected] (V.D.); [email protected] (A.G.); [email protected] (G.C.); [email protected] (M.C.C.) 2 Unit of Ophthalmology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; [email protected] 3 Casa di Cura la Madonnina, Via Quadronno 29, 20122 Milano, Italy; [email protected] 4 Department of Biomedical, Dental Science and Morphological and Functional Images, Neuroradiology Unit, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; [email protected] (K.G.); [email protected] (F.G.) 5 Azienza Ospedaliera di Cosenza, Via San Martino, 87100 Cosenza, Italy; [email protected] 6 Pediatric Neurology and Muscular Diseases Unit,
    [Show full text]
  • Vertical Perspective Medical Assistance Program
    Kansas Vertical Perspective Medical Assistance Program December 2006 Provider Bulletin Number 688 General Providers Emergent and Nonemergent Diagnosis Code List Attached is a list of diagnosis codes and whether the Kansas Medical Assistance Program (KMAP) considers the code to be emergent or nonemergent. Providers are responsible for validating whether a particular diagnosis code is covered by KMAP under the beneficiary’s benefit plan and that all program requirements are met. This list does not imply or guarantee payment for listed diagnosis codes. Information about the Kansas Medical Assistance Program as well as provider manuals and other publications are on the KMAP Web site at https://www.kmap-state-ks.us. If you have any questions, please contact the KMAP Customer Service Center at 1-800-933-6593 (in-state providers) or (785) 274-5990 between 7:30 a.m. and 5:30 p.m., Monday through Friday. EDS is the fiscal agent and administrator of the Kansas Medical Assistance Program for the Kansas Health Policy Authority. Page 1 of 347 Emergency Indicators as noted by KMAP: N – Never considered emergent S – Sometimes considered emergent (through supporting medical documentation) Y – Always considered emergent Diagnosis Emergency Diagnosis Code Description Code Indicator 0010 Cholera due to Vibrio Cholerae S 0011 Cholera due to Vibrio Cholerae El Tor S 0019 Unspecified Cholera S 019 Late Effects of Tuberculosis N 0020 Typhoid Fever S 0021 Paratyphoid Fever A S 0022 Paratyphoid Fever B S 0023 Paratyphoid Fever C S 024 Glanders Y 025 Melioidosis
    [Show full text]
  • Expanding the Phenotypic Spectrum of PAX6 Mutations: from Congenital Cataracts to Nystagmus
    G C A T T A C G G C A T genes Article Expanding the Phenotypic Spectrum of PAX6 Mutations: From Congenital Cataracts to Nystagmus Maria Nieves-Moreno 1,* , Susana Noval 1 , Jesus Peralta 1, María Palomares-Bralo 2 , Angela del Pozo 3 , Sixto Garcia-Miñaur 4, Fernando Santos-Simarro 4 and Elena Vallespin 5 1 Department of Ophthalmology, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] (S.N.); [email protected] (J.P.) 2 Department of Molecular Developmental Disorders, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] 3 Department of Bioinformatics, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] 4 Department of Clinical Genetics, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] (S.G.-M.); [email protected] (F.S.-S.) 5 Department of Molecular Ophthalmology, Medical and Molecular Genetics Institue (INGEMM) IdiPaz, CIBERER, Hospital Universitario La Paz, 28046 Madrid, Spain; [email protected] * Correspondence: [email protected] Abstract: Background: Congenital aniridia is a complex ocular disorder, usually associated with severe visual impairment, generally caused by mutations on the PAX6 gene. The clinical phenotype of PAX6 mutations is highly variable, making the genotype–phenotype correlations difficult to establish. Methods: we describe the phenotype of eight patients from seven unrelated families Citation: Nieves-Moreno, M.; Noval, with confirmed mutations in PAX6, and very different clinical manifestations.
    [Show full text]
  • Causes of Heterochromia Iridis with Special Reference to Paralysis Of
    CAUSES OF HETEROCHROMIA IRIDIS WITH SPECIAL REFER- ENCE TO PARALYSIS OF THE CERVICAL SYMPATHETIC. F. PHINIZY CALHOUN, M. D. ATLANTA, GA. This abstract of a candidate's thesis presented for membership in the American Ophthal- mological Society, includes the reports of cases, a general review of the literature of the sub- ject, the results of experiments, and histologic observations on the effect of extirpation of the cervical sympathetic in the rab'bit, the conclusions reached from the investigation, and a bib- liography. That curious condition which con- thinks that the word hetcrochromia sists in a difference in the pigmentation should apply to those cases in which of the two eyes, is regarded by the parts of the same iris have different casual observer as a play or caprice of colors. In those cases where a cycli- nature. This phenomenon has for cen- tis accompanies the iris decoloration, turies been noted, and was called hcte- Butler8 uses the term "heterochromic roglaucus by Aristotle1. One who cyclitis," but the "Chronic Cyclitis seriously studies the subject, is at once with Decoloration of the Iris" as de- impressed with the complexity of the scribed by Fuchs" undoubtedly gives a situation, and soon learns that nature more accurate description of the dis- plays a comparatively small part in its ease, notwithstanding its long title. causation. It is however only within The commonly accepted and most uni- a comparatively recent time that the versally used term Hetcrochromia Iri- pathologic aspect has been considered, dis exactly expresses and implies the and in this discussion I especially wish picture from its derivation (irtpoa to draw attention to that part played other, xpw/xa) color.
    [Show full text]
  • Textbook of Ophthalmology, 5Th Edition
    Textbook of Ophthalmology Textbook of Ophthalmology 5th Edition HV Nema Former Professor and Head Department of Ophthalmology Institute of Medical Sciences Banaras Hindu University Varanasi India Nitin Nema MS Dip NB Assistant Professor Department of Ophthalmology Sri Aurobindo Institute of Medical Sciences Indore India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD. New Delhi • Ahmedabad • Bengaluru • Chennai Hyderabad • Kochi • Kolkata • Lucknow • Mumbai • Nagpur Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002 I ndia Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672 Rel: +91-11-32558559 Fax: +91-11-23276490 +91-11-23245683 e-mail: [email protected], Visit our website: www.jaypeebrothers.com Branches 2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015, Phones: +91-79-26926233, Rel: +91-79-32988717 Fax: +91-79-26927094, e-mail: [email protected] 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East Bengaluru 560 001, Phones: +91-80-22285971, +91-80-22382956, 91-80-22372664 Rel: +91-80-32714073, Fax: +91-80-22281761 e-mail: [email protected] 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road Chennai 600 008, Phones: +91-44-28193265, +91-44-28194897 Rel: +91-44-32972089, Fax: +91-44-28193231, e-mail: [email protected] 4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road Hyderabad 500 095, Phones: +91-40-66610020, +91-40-24758498 Rel:+91-40-32940929 Fax:+91-40-24758499, e-mail: [email protected] No. 41/3098, B & B1, Kuruvi Building, St.
    [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]