DOCSLIB.ORG

Ocular Signs, Diagnosis and Long-Term Treatment with Allopurinol in a Cat with Leishmaniasis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ocular Signs, Diagnosis and Long-Term Treatment with Allopurinol in a Cat with Leishmaniasis Schweizer Archiv für Tierheilkunde M. Richter et al., Band 156, Heft 6, Juni 2014, 289 – 294 © 2014 Verlag Hans Huber, Hogrefe AG, Bern DOI 10.1024/0036-7281/a000593 Diagnosis and treatment with allopurinol in a cat with leishmaniasis 289 Ocular signs, diagnosis and long-term treatment with allopurinol in a cat with leishmaniasis M. Richter1, D. Schaarschmidt-Kiener2, C. Krudewig3 ¹Eyevet.ch, Zug, ²Labor am Zugersee, Hünenberg, ³Institut für Tierpathologie, Vetsuisse Fakultät, Universität Bern Summary Augenveränderungen, Diagnostik und Langzeittherapie mit Allopurinol A case of leishmaniasis with predominantly ocular bei einer an Leishmaniose erkrankten Katze signs in a cat living in Switzerland and it's treatment is reported. The cat was imported from Spain 4 years Dieser Fallbericht beschreibt eine in der Schweiz le- earlier and was initially presented with chronic uveitis. bende und an Leishmaniose erkrankte Katze mit vor- Laboratory test results were negative for feline immu- wiegend Augenveränderungen und deren Behandlung. nodefi ciency virus (FIV), feline infectious peritonitis Die Katze wurde 4 Jahre zuvor aus Spanien importiert (FIP), feline leukaemia virus (FeLV) and Toxoplasma und wurde initial mit chronischer Uveitis vorgestellt. gondii, as well as for Bartonella haenselae and Leish- Blutuntersuchungen ergaben negative Resultate für mania spp. das Feline Immunschwäche Virus (FIV), für Feline Twenty-one months later the cat was presented again Infektiöse Peritonitis (FIP), für das Feline Leukämie because of development of keratitis and granuloma- Virus (FeLV), sowie für Toxoplasma gondii, Bartonella tous blepharitis. Blood cell count revealed severe haenselae und Leishmania spp. Pancytopenia; Cytology of fi ne needle aspirates of Einundzwanzig Monate später wurde die Katze erneut granulomatous lesions on both upper eyelids and of vorgestellt, diesmal mit Keratitis und Blepharitis. Das a corneal smear revealed intracytoplasmatic micro- Differentialblutbild zeigte eine schwere Panzytopenie. organisms. A preliminary diagnosis of leishmani- Die zytologische Untersuchung der Feinnadelaspira- asis was supported by positive polymerase chain te der granulomatösen Veränderungen an den beiden reaction from bone marrow and eyelid samples for Oberlidern und des Hornhautabstriches zeigte intra- Leishmania infantum DNA and by a high serum zytoplasmatische Mikroorganismen. Die Verdachts- antibody titer for Leishmania spp. Treatment with diagnose Leishmaniose wurde durch den Nachweis Allopurinol (10 mg/kg, BID) orally led to rapid im- von Leishmania infantum DNA mittels Polymerase- provement of ocular signs, general condition and Kettenreaktion in Proben des Knochenmarkes und blood cell count with complete remission of lid and der Lider und durch hohe Serumantikörpertiter gegen corneal lesions within 2 months of treatment. Leishmania spp. bestätigt. Eine orale Behandlung mit Allopurinol (10 mg/kg, BID) führte zu einer raschen Verbesserung der Augensymptome, des Allgemeinzu- standes und des Differentialblutbildes mit vollständi- ger Remission der Lid- und Hornhautveränderungen innerhalb 2 Monate nach Therapiebeginn. Keywords: cat, leishmaniasis, keratitis, uveitis, Schlüsselwörter: Katze, Leishmaniose, Keratitis, allopurinol Uveitis, Allopurinol Case history and laboratory tests cin for 10 days, followed by doxycycline and carprofen which had to be discontinued due to gastrointestinal side A 7 year old spayed female cat had been presented for effects; laboratory examinations initiated by the local vet- evaluation of chronic uveitis in both eyes. The cat had erinarian were within normal limits regarding blood se- been imported as a stray cat from Spain 4 years earlier. rum chemistry and were negative for FeLV and FIP. According to its owners the cat had been treated by the lo- Initial ophthalmic examination using slit lamp bio- cal veterinarian for uveitis topically with gentamicin and microscopy (Kowa SL-15, Kowa Company, Tokyo, Japan) fl uorometholone as well as systemically with clindamy- and intraocular pressure (IOP) measurements obtained M. Richter et al., Band 156, Heft 6, Juni 2014, 289 – 294 Schweizer Archiv für Tierheilkunde © 2014 Verlag Hans Huber, Hogrefe AG, Bern 290 Fallberichte/Case reports by applanation tonometry (Tonopen XL, Mentor, Nor- vomica C30 and euphrasia C30, followed by euphrasia well, MA, USA) revealed signs of chronic uveitis with C200 and sulphur C200) prescribed by a local veterinarian, iritis in both eyes (OU), aqueous humour fl are + (on but worsened again with time despite homeopathic treat- a scale 0 – +++) OU, endothelial precipitates in the left ment. On general examination the cat was apathetic, the eye (OS), perilimbal deep stromal vascularisation (cili- hair coat was dull, and the mucous membranes were pale. ary fl ush) in the right eye (OD), pigment deposits on the The body temperature and palpable lymph nodes were anterior lens capsule OD, focal retinal scars OU and an normal. Ophthalmic examination revealed nodular dermal IOP of 9 mmHg OD and 5 mmHg OS. Menace response, lesions of upper eyelids OU (Fig. 1), diffuse whitish infi l- light perception and pupillary light refl ex were positive trates, vascularisation and edema of the superfi cial corneal in both eyes. Topical treatment with prednisolon acetate stroma and aqueous fl are + in the OD (Fig. 2). The OS was (Pred forte®, Allergan AG/S. A., Pfäffi kon, Switzerland) visibly enlarged (buphthalmic) with an IOP of 8 mmHg, TID and systemic treatment with meloxicam (Metacam®, clear cornea, aqueous fl are ++, and preiridial fi brovascu- Boehringer Ingelheim GmbH, Basel, Switzerland) SID lar membranes covering the iris and the anterior surface was initiated. One week later signs of active uveitis had of the lens, which showed cortical cataractous changes been cleared, and owners were instructed to slowly taper (Fig. 3). Menace response was positive in the OD and ab- off medication over a period of 4 weeks. sent in the OS. Fine needle aspiration of the nodular le- The cat was presented again 12 months later. Ophthal- sions OU and a smear from the cornea OD were performed mic examination revealed bilateral chronic active uveitis and stained with DiffQuick®. Cytology revealed multiple (aqueous fl are, posterior synechiae, preiridial fi brovascular intracellular and extracellular protozoal organisms in both, membranes, and diffuse cortical cataracts), superfi cial ker- samples from the eyelid lesions and from the cornea OD atitis in the right eye and visible enlargement of the left eye (Fig. 4). The organisms were round, measured 1 – 2 μm (buphthalmos), which is indicative of glaucoma. The IOP in width and 2 – 3 μm in length. With high magnifi cation was 9 mmHg in the OD and 18 mmHg in the OS. Menace (1000 ×), a large oval nucleus and a small rod-shaped ki- response and light perception were present in the OD but netoplast could be detected (Fig. 4, inset). This was con- were absent in the OS. Pupillary light refl ex was absent in sidered to be most consistent with the amastigote form of both eyes due to posterior synechiae between the iris and the genus Leishmania. Due to cytological fi ndings from the anterior surface of the lens. A blood sample was taken ocular samples, bone marrow was sampled to determine to test for various infectious agents known to induce uve- visceral involvement and peripheral blood was taken for a itis in cats. Serum profi le was within normal limits except blood cell profi le and serology. Table 1 shows selected pa- for mild hyperglycaemia (glucose 14.1 mmol/L, reference rameters of clinical chemistry (Konelab 30i, Thermo Fisher range 4.0 – 9.0 mmol/L).The following laboratory tests Corporation, Vantaa, Finland) and hematology (Sysmex all yielded negative results: Toxoplasma gondii (IFA) and XT-2000iV, Sysmex, Norderstedt, Germany). The main feline immunodefi ciency virus (ELISA) antibodies, feline biochemical abnormalities were hypoalbuminemia, hyper- leukemia virus antigen (ELISA), PCR from blood for Bar- globulinemia, and hypergammaglobulinemia. The blood tonella henselae and Leishmania infantum. The antibody count showed a marked anemia, leucopenia and thrombo- titer against feline coronavirus togethser with the results cytopenia, which were confi rmed by manual counting. As of haematology and clinical chemistry were not suggestive for feline infectious peritonitis. Because none of the tests revealed any specifi c cause of infectious uveitis, anti-infl ammatory treatment with top- ical prednisolone acetate (Pred forte®) and oral meloxi- cam (Metacam®) were continued. Due to an IOP within reference range (15 – 25 mmHg) in an eye with active uveitis (which usually induces an IOP below reference range), topical IOP lowering treatment with combina- tion of dorzolamide and timolol maleate (Cosopt®, MSD Merck Sharp & Dohme AG, Luzern, Switzerland) was ini- tiated in the OS to help control the intraocular pressure. Final diagnosis and treatment Nine months later the cat was presented again because of changes in both upper eyelids as well as opacifi cation of the cornea OD. According to its owners the cat had been Figure 1: Nodular lesion (arrow) on upper eyelids in both less playful and active for quite some time. The cat's con- eyes and keratitis (recognizable by the cloudiness of the cor- dition initially improved with homeopathic therapy (nux nea) in the right eye. Schweizer Archiv für Tierheilkunde M. Richter et al., Band 156, Heft 6, Juni 2014, 289 – 294 © 2014 Verlag Hans Huber, Hogrefe AG, Bern Diagnosis and treatment with allopurinol
Load more

Recommended publications
  • 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]
  • Eyelid and Orbital Infections
    27 Eyelid and Orbital Infections Ayub Hakim Department of Ophthalmology, Western Galilee - Nahariya Medical Center, Nahariya, Israel 1. Introduction The major infections of the ocular adnexal and orbital tissues are preseptal cellulitis and orbital cellulitis. They occur more frequently in children than in adults. In Schramm's series of 303 cases of orbital cellulitis, 68% of the patients were younger than 9 years old and only 17% were older than 15 years old. Orbital cellulitis is less common, but more serious than preseptal. Both conditions happen more commonly in the winter months when the incidence of paranasal sinus infections is increased. There are specific causes for each of these types of cellulitis, and each may be associated with serious complications, including vision loss, intracranial infection and death. Studies of orbital cellulitis and its complication report mortality in 1- 2% and vision loss in 3-11%. In contrast, mortality and vision loss are extremely rare in preseptal cellulitis. 1.1 Definitions Preseptal and orbital cellulites are the most common causes of acute orbital inflammation. Preseptal cellulitis is an infection of the soft tissue of the eyelids and periocular region that is localized anterior to the orbital septum outside the bony orbit. Orbital cellulitis ( 3.5 per 100,00 ) is an infection of the soft tissues of the orbit that is localized posterior to the orbital septum and involves the fat and muscles contained within the bony orbit. Both types are normally distinguished clinically by anatomic location. 1.2 Pathophysiology The soft tissues of the eyelids, adnexa and orbit are sterile. Infection usually originates from adjacent non-sterile sites but may also expand hematogenously from distant infected sites when septicemia occurs.
    [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]
  • Reiter's Syndrome
    iMedPub JOURNALS ARCHIVES OF MEDICINE | 2009 | Vol. 1 | No. 1:1 | doi: 10.3823/032 Review Reiter's Syndrome Digna Llorente Molina, Susandra Cedeño Facultad de Ciencias Médicas 10 de Octubre. Ciudad Habana, Cuba. E-mail: [email protected] Reiter’s syndrome is a systemic disorder characterized by ocular conjunctivitis or uveitis, reactive arthritis, and urethritis manifestations. The exact cause of reactive arthritis is unknown. It occurs most commonly in men before the age of 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella or Yersinia. Certain genes may make you more prone to the syndrome. The diagnosis is based on symptoms. The goal of treatment is to relieve symptoms and treat any underlying infection. Reactive arthritis may go away in 3 - 4 months, but symptoms may return over a period of several years in up to a half of those affected. The condition may become chronic. Preventing sexually transmitted diseases and gastrointestinal infection may help prevent this disease. Wash your hands and surface areas thoroughly before and after preparing food. © Archives of Medicine: Accepted after external review ■ The first description of Reiter’s syndrome was attributed in occasionally, cutaneous-mucosal lesions such as keratodermia 1916 to the re-known German physician Hans Reiter, linked to blennorrhagica and balanitis circinata; yellow papule lesions Nazi powers, and to his experiments in the concentration on the soles, palms and with less frequency on the nails, camps. In 1918, Junghanns described the first case in a young scrotum, scalp and trunk, amongst others (3), (4), (5).. The patient (1), (2). earliest manifestation of joint disorder is entesitis, normally in the Achilles tendon and in the plantar fascia of the calcaneus, Due to the syndrome’s abnormal immunological reactivity to causing shortening or lengthening of fingers and toes certain pathogens as a result of the interaction between resembling "sausage fingers and toes".
    [Show full text]
  • The Uveo-Meningeal Syndromes
    ORIGINAL ARTICLE The Uveo-Meningeal Syndromes Paul W. Brazis, MD,* Michael Stewart, MD,* and Andrew G. Lee, MD† main clinical features being a meningitis or meningoenceph- Background: The uveo-meningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. alitis associated with uveitis. The meningeal involvement is Review Summary: We review the clinical manifestations of uveitis often chronic and may cause cranial neuropathies, polyra- and describe the infectious, inflammatory, and neoplastic conditions diculopathies, and hydrocephalus. In this review we define associated with the uveo-meningeal syndrome. and describe the clinical manifestations of different types of Conclusions: Inflammatory or autoimmune diseases are probably uveitis and discuss the individual entities most often associ- the most common clinically recognized causes of true uveo-menin- ated with the uveo-meningeal syndrome. We review the geal syndromes. These entities often cause inflammation of various distinctive signs in specific causes for uveo-meningeal dis- tissues in the body, including ocular structures and the meninges (eg, ease and discuss our evaluation of these patients. Wegener granulomatosis, sarcoidosis, Behc¸et disease, Vogt-Koy- anagi-Harada syndrome, and acute posterior multifocal placoid pig- ment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a The uveo-meningeal syndromes are a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in heterogeneous group of disorders that share patients 40 years of age or older with bilateral uveitis, especially involvement of the uvea, retina, and meninges.
    [Show full text]
  • Management of Chronic Anterior Uveitis Relapses: Efficacy of Oral Phospholipidic Curcumin Treatment. Long-Term Follow-Up
    Clinical Ophthalmology Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up Pia Allegri1 Abstract: Curcumin has been successfully applied to treat inflammatory conditions in Antonio Mastromarino1 experimental research and in clinical trials. The purpose of our study is to evaluate the efficacy Piergiorgio Neri2 of an adjunctive-to-traditional treatment with Norflo tablets (curcumin-phosphatidylcholine complex; Meriva) administered twice a day in recurrent anterior uveitis of different etiologies. The 1Uveitis Center, Ophthalmological Department of Lavagna Hospital, study group consisted of 106 patients who completed a 12-month follow-up therapeutic period. Genova, Italy; 2Uveitis Unit, The We divided the patients into three main groups of different uveitis origin: group 1 (autoimmune Eye Clinic, Azienda Ospedaliero- uveitis), group 2 (herpetic uveitis), and group 3 (different etiologies of uveitis). The primary Universitaria, Ospedali Riuniti di Ancona, Ancona, Italy end point of our work was the evaluation of relapse frequency in all treated patients, before and after Norflo treatment, followed by the number of relapses in the three etiological groups. Wilcoxon signed-rank test showed a P , 0.001 in all groups. The secondary end points were the evaluation of relapse severity and of the overall quality of life. The results showed that Norflo was well tolerated and could reduce eye discomfort symptoms and signs after a few weeks of treatment in more than 80% of patients. In conclusion, our study is the first to report the potential therapeutic role of curcumin and its efficacy in eye relapsing diseases, such as anterior uveitis, and points out other promising curcumin-related benefits in eye inflammatory and degenerative conditions, such as dry eye, maculopathy, glaucoma, and diabetic retinopathy.
    [Show full text]
  • UVEITIS Eye74 (1)
    UVEITIS Eye74 (1) Uveitis Last updated: May 9, 2019 Classification .................................................................................................................................... 1 Etiologic categories .......................................................................................................................... 2 Treatment ......................................................................................................................................... 2 Complications ................................................................................................................................... 2 COMMON UVEITIC SYNDROMES ............................................................................................................. 2 Masquerade Syndromes ................................................................................................................... 3 UVEITIS - heterogenous ocular diseases - inflammation of any component of uveal tract (iris, ciliary body, choroid). CLASSIFICATION ANTERIOR UVEITIS (most common uveitis) - localized to anterior segment - iritis and iridocyclitis. IRITIS - white cells confined solely to anterior chamber. IRIDOCYCLITIS - cellular activity also involves retrolental vitreous. etiology (most do not have underlying systemic disease): 1) idiopathic postviral syndrome (most commonly 38-60%) 2) HLA-B27 syndromes, many arthritic syndromes (≈ 17%) 3) trauma (5.7%) 4) herpes simplex, herpes zoster disease (1.9-12.4%) 5) iatrogenic (postoperative). tends to
    [Show full text]
  • Freedman Eyelid Abnormalities
    1/16/2018 1 1/16/2018 Upper Lid Lower Lid Protractors Retractors: Levator m. 3rd nerve function Muller’s m. Cranial Nerve VII function Sympathetic Function Inferior Tarsal Muscle Things to Note Lid Apposition to Globe Position of Lid Margins MRD = 3‐5 mm Canthal Insertions Brow Positions 2 1/16/2018 Ptosis Usually age related levator dehiscence, but sometimes a sign of neurologic, mechanical orbital or inflammatory disease Blepharospasm Sign of External Irritation or Neurologic Disease 3 1/16/2018 First Consider Underlying Orbital Disease Orbital Cellulitis, Pseudotumor, Wegener’s Graves Ophthalmopathy, Orbital Varix Orbital Tumors that can mimic inflammatory process: Lacrimal Gland CA, Lymphoma, Lymphangioma, etc. Lacrimal Gland – Dacryoadenitis or tumor Sinus Mucocele Without Inflammatory Appearance, consider above but also… Allergic Eyelid Edema Hormonal Shifts Systemic Disorder – Cardiac, Renal, Hepatic, Thyroid with edema Cutaneous Lymphoma Graves Ophthalmopathy –can just have lid edema w/o inflammatory appearance Lymphedema after trauma, surgery to lids or orbit (e.g. lymphatics in lateral canthus) Traumatic Leak of CSF into upper eyelid (JAMA Oph 2014;312:1485) Blepharochalasis Not True Edema, but might mimic it: Dermatochalasis, Hidden Eyelid or Sub‐Conjunctival Mass, Prolapsed Orbital Fat When your concerned about: Orbital Cellulitis Orbital Pseudotumor Orbital Malignancy Vascular – e.g. CC fistula Proptosis Chemosis Poor Motility Poor Vision Pupil abnormality – e.g. RAPD Orbital Pseudotumor 4 1/16/2018 Good Vision Good Motility
    [Show full text]
  • Blepharitis and the Sjögren's Patient
    Volume 28, Issue 10 November 2010 Blepharitis and the Sjögren’s Patient by Gary N. Foulks, MD, Arthur and Virginia Keeney,Professor of Ophthalmology, University of Louisville, Louisville, KY lepharitis, one of the most common problems seen by eye care specialists, may affect as many as 30 mil- The SSF Announces Blion Americans.1 Its prevalence increases with age, though eye care specialists are seeing it more in young- 2010 Research Grant Recipients – er patients. Most significantly, this condition appears to be more prevalent in Sjögren’s syndrome patients.2,3 If left untreated, blepharitis can impact a patient’s Donations Made the Difference! eye health, appearance, contact lens use, and quality by Katherine Hammitt, SSF Vice President of Research, and of life. Unchecked blepharitis can compromise results Cynthia Williamson, SSF Research Associate of cataract or LASIK surgery. e are experiencing a distressing dichotomy in research What is Blepharitis? with more scientific opportunities in Sjögren’s than ever Blepharitis involves inflammation of the eyelid.4 It Wbefore that are ripe for research, and yet, with tough economic times experienced in the U.S. and throughout can be caused by a variety of factors (e.g., age, allergy, the world, the future of medical and scientific research is immune system problems, hormone changes, bacteria, uncertain. The National Institutes of Health, the federal and dermatitis). agency and largest dispenser of research funds in the world, Symptoms can range from irritation and redness of reports that the percentage of research grant applications the eyelid margin to problems with reading, using a that are funded by the NIH has dropped from 40% to computer, or watching television.
    [Show full text]
  • Shift Work: a Risk Factor for Central Serous Chorioretinopathy
    Shift Work: A Risk Factor for Central Serous Chorioretinopathy ELODIE BOUSQUET, MYRIAM DHUNDASS, MATHIEU LEHMANN, PIERRE-RAPHAE¨L ROTHSCHILD, VIRGINIE BAYON, DAMIEN LEGER, CIARA BERGIN, ALI DIRANI, TALAL BEYDOUN, AND FRANCINE BEHAR-COHEN PURPOSE: To investigate if shift work or sleep distur- and focal serous detachments of the neurosensory retina bances are risk factors for central serous chorioretinop- and retinal pigment epithelium alterations. The role of athy (CSCR). choroid hyperpermeability in the pathogenesis of CSCR DESIGN: Prospective case-control study. has been well documented recently with multimodal imag- 2 METHODS: Forty patients with active CSCR and 40 ing modalities. In CSCR patients, a thick choroid has controls (age- and sex-matched) were prospectively been reported not only in the affected eye but also in the recruited from the Ophthalmology Department of Hoˆtel fellow eye, which is consistent with bilateral choroidal Dieu Hospital, Paris, between November 2013 and hyperpermeability.2,3 December 2014. All patients were asked to complete a To date, several risk factors for CSCR have been questionnaire addressing previously described risk factors identified,3 and the most consistent is corticosteroid and working hours, as well as the Insomnia Severity exposure from therapeutic administration or from endog- Index (ISI), a validated instrument for assessing sleep enous overproduction, as in Cushing syndrome.4–6 disturbances. Corticosteroids were recently shown to induce RESULTS: The mean age of the CSCR group was 44
    [Show full text]
  • Clinical Practice Guidelines: Care of the Patient with Anterior Uveitis
    OPTOMETRY: OPTOMETRIC CLINICAL THE PRIMARY EYE CARE PROFESSION PRACTICE GUIDELINE Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 32,000 full-time equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 7,000 communities across the United States, serving as the sole primary eye care provider in more than 4,300 communities. Care of the Patient with The mission of the profession of optometry is to fulfill the vision and eye Anterior Uveitis care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ANTERIOR UVEITIS Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Anterior Uveitis: Kevin L. Alexander, O.D., Ph.D., Principal Author Mitchell W. Dul, O.D., M.S. Peter A. Lalle, O.D. David E. Magnus, O.D. Bruce Onofrey, O.D. Reviewed by the AOA Clinical Guidelines Coordinating Committee: John F. Amos, O.D., M.S., Chair Kerry L. Beebe, O.D. Jerry Cavallerano, O.D., Ph.D. John Lahr, O.D.
    [Show full text]
  • Vogt-Koyanagi-Harada's Disease: Literature Review
    Artigo de Revisão Vogt-Koyanagi-Harada’s Disease: Literature Review Stephanie Gonçalves Carneiro*, Dorivaldo Lopes da Silva**, Angélica Cristina Pezzin Palheta***, Francisco Xavier Palheta Neto****, Cláudio Tobias Acatauassú Nunes*****, Thaís Oliveira Ferreira******, Talita Valleska de Campos Pereira******, Viviane Cristina dos Santos Monteiro******. * 5th year student of Medicine at Universidade do Estado do Pará (Monitor of Ophthalmology discipline). ** 5th year student of Medicine at Universidade do Estado do Pará (Monitor of Otorhinolaryngology discipline). *** Assistant teacher of ENT discipline at Universidade do Estado do Pará (Master degree in ENT by Universidade Federal do Rio de Janeiro – Doctorate student on Neuroscience by Universidade do Estado do Pará). **** Assistant teacher of ENT discipline at Universidade do Estado do Pará and Universidade Federal do Pará (Máster degree in ENT by Universidade Federal do Rio de Janeiro – Doctorate student on Neuroscience by Universidade do Estado do Pará). ***** Adjunt Professor and Head of ENT Discipline of Universidade do Estado do Pará. Visiting Professor of ENT at Universidade Federal do Pará. Master and PhD in ENT by UNIFESP). ****** Medical school student (3rd year) at Universidade do Estado do Pará. Institution: Universidade do Estado do Pará – UEPA (State Universtity). Belém / PA – Brazil. Mail address: Stephanie Gonçalves Carneiro – Travessa Rui Barbosa 619, Apto. 1301 – Belém / PA – Brazil – Zip code: 66053-260 – Telephone: (+55 91) 3242-7178 / 8123-1638 - E-mail: [email protected] Article received on December 1st, 2007. Article approved on March 16th, 2007. SUMMARY Introduction: Vogt-Koyanagi-Harada’s disease is a rare syndrome that affects tissues with melanocytes like eyes, central nervous system, skin and inner ear.
    [Show full text]