Corneal endothelial cells in essential iris atrophy. A specular microscipic study

The specular microscope was used to study the corneal endothelium in three patients with essential iris atrophy and three patients with anterior mesodermal disorders with uncertain diagnose. Pleomorphic and enlarged endothelial cells were found to be typical for essential iris atrophy. The changes were also present in one eye with normal pressure. In the patients with other types of iridal disorder the endothelial cells were normal in form. In one of these patients high intraocular pressure and surgery had seemingly led to enlargement of the endothelial cells. According to our findings, the specular microscope is a useful aid differentiating essential iris atrophy from other disorders of the iris.

Pupil size after extracapsular cataract extraction and posterior chamber lens implantation: a prospective randomized trial of epinephrine and acetylcholine

The effects of using epinephrine in the irrigating fluid and intracameral acetylcholine were studied by measuring changes in pupil size in the 48 hours following extracapsular cataract extraction and intraocular lens implantation in 39 eyes. Epinephrine reduced peroperative pupil constriction, but its effect was insignificant thereafter. The pupil constriction following acetylcholine was maximal at 2 hours and was still significant at 4 hours, but pupils redilated by 6 hours. Neither drug had any effect after this time. The edge of most lens implants was visible at 6 hours, after which pupils steadily constricted.

Miotic Adie's pupils

Two young adults, aged 24 and 31, had a long history of small, poorly reactive pupils. There was no history of large pupils, and a review of old photographs confirmed 10 and 5 years, respectively, of miosis. Both were found to have bilateral tonic pupils that were supersensitive to diluted pilocarpine. Although it is possible that they had an unusually early onset of bilateral Adie's syndrome with dilated pupils that was not noticed, it is suggested that some patients might have primary miotic Adie's pupils without ever passing through a mydriatic phase.

Mesencephalic hemorrhage and unilateral pupillary deficit

An isolated dilated and fixed pupil in the absence of other neurological dysfunction usually suggests ciliary ganglion dysfunction or direct pharmacological blockade of the parasympathetic fibers to the pupil. A unilateral dilated pupil as a manifestation of a mesencephalic hemorrhage has not, to our knowledge, previously been reported. We now describe a 35-year-old woman who had a headache and a dilated and nonreactive right pupil. A cranial computed tomography scan showed a small hemorrhage in the midbrain, and a cerebral angiogram was normal. Mesencephalic hemorrhage should be considered in the differential diagnosis of an isolated dilated pupil.

Ocular trauma following amniocentesis as the cause of leukocoria

Among the various causes of leukocoria in a newborn, intrauterine ocular trauma following amniocentesis is not included. We describe a three-day-old girl whose leukocoria of the left eye resulted from traction retinal detachment, caused by the perforation of the globe during diagnostic amniocentesis.

Cluster headache: further observations on the dissociation of pain and autonomic findings

A 51-year-old male cluster headache patient had during five bouts in the course of 11 years always had the headache attacks on the left side. Autonomic abnormalities were, however, present on the right side. Pupillometrically, there was thus a Horner-like syndrome on the right (non-symptomatic) side, with miosis and a relatively more marked dilatation of that eye subsequent to topical application of a directly working sympathomimetic agent (phenylephrine) than after an indirectly working one (hydroxyamphetamine), whereas this was not the case on the symptomatic side. The findings on evaporimetry were not as clear-cut as the pupillometric findings; however, even facial sweating was consistent with a pathologic condition on the right (non-symptomatic) side. A primary dichotomy of pain and autonomic signs (that is, not due to change of side of pain localization) thus seems to be present in this case.

Cluster headache-like headache, Hageman trait deficiency, retrobulbar neuritis, and giant aneurysm. Autonomic function studies

A 56-year-old, previously reported woman with cluster headache-like headache with bouts of unilateral (the side of predominance changing through the years) severe headache had a familial history (three generations) of partial Hageman factor deficiency and bleeding episodes. A giant aneurysm was found to be lodged in the anterior communicating artery on the left side. Clinically, the features were atypical for cluster headache: onset at a young age (14 years), episodes of retrobulbar neuritis appearing at the side of pain, etc. Studies of forehead sweating indicated that the right side was the pathologic one, from an autonomic point of view, as did pupillometric studies. However, during attacks, which were left-sided at the time, forehead sweating was marked laterally on the left side and on the upper eyelid, but not on the right. The "signal" usually reaching the autonomically stigmatized side during attacks of cluster headache, therefore, did not seem to reach the sweat glands on that (the right) side during the attack in the present case. This headache may, therefore, be distinct from cluster headache, both from a clinical and from an autonomic function point of view.

Cervicogenic headache. Pupillometric findings

Eleven female patients with cervicogenic headache (mean age, 43 years; range, 25-59 years) have been examined with the pupillometer. The pupillary diameter was examined in the basal state (that is, the status before pharmacologic stimulation) and after topically administered tyramine (2%), phenylephrine (1%), and hydroxyamphetamine (1%). A total of 51 tests were performed, 35 in the asymptomatic period and 16 during pain attacks. In a control group consisting of 26 age-matched women a total of 39 tests were carried out. Before pharmacologic stimulation (that is, in the "basal state") the pupils were smaller in the asymptomatic (pain-free) period than during pain attacks in the patients and also as compared with that of control individuals. The anisocoria (the difference in pupillary size in the same individual) observed was not significantly different between the patient group and control individuals either in the basal state (before pharmacologic stimulation) or after pharmacologic stimulation. The mydriasis resulting from the instillation of the three sympathicomimetic drugs was symmetrical in both controls and patients both during and between the pain attacks. This finding is in clear contrast to what is found in cluster headache, in which there is a "Horner-like" syndrome on the symptomatic side. These two headaches thus seem to differ essentially with regard to this variable.

"Mild" cluster headache(?)

Three cases of what could be considered "mild" cluster headache have been described. All three patients were generally able to carry out their work during attacks; all three were men and had unilateral headache with the predominant pain in the ocular region. Relatively few symptoms and signs indicated autonomic system involvement, but at least tearing was invariably present on the symptomatic side. The bouts were generally short-lasting in two of the patients (and partly in the third one), fitting the pattern of "mini-bouts". Thus, in one of the cases four of the five major criteria (male sex, excruciating severity, cluster phenomenon, autonomic involvement, and unilaterality) were present. In the two other patients the full-blown cluster phenomenon was lacking. Such cases may represent the left-side slope of a "Gaussian severity distribution scale" with regard to cluster headache.

Accommodative weakness and mydriasis following laser treatment at the peripheral retina

Transient accommodative paresis and pupillary disturbances are some of the less known and uncommon complications of peripheral retinal laser treatment extending over at least one third of the retinal periphery. They are the result of damage by the laser applications to parasympathetic nerve fibers that lie beneath the coagulated area and innervate the ciliary body and iris sphincter. Six myopic patients who suffered from these complications following peripheral laser treatment for retinal tears are presented. A mechanism of direct damage to ciliary muscle fibers during photocoagulation is proposed.

Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm

In 12 patients with minimal oculomotor nerve deficits due to unruptured intracranial aneurysm, the nerve-related findings were incomplete and at least one element (ptosis, mydriasis, or extraocular muscle weakness) was spared in every patient. Although symptomatic, the affected cranial nerve III functions were only partially lost. Six patients had ptosis and mydriasis, three had ptosis and diplopia, two had mydriasis and diplopia, and one had mydriasis alone. Eleven patients had accompanying headaches that were remarkably variable and difficult to categorize. Cerebral angiography showed the aneurysms, but computed tomography missed one third of them. The symptomatic aneurysm arose from the internal carotid artery in six patients, and from the distal basilar artery in six. Fragments of a cranial nerve III palsy associated with recent onset and ipsilateral headache suggest an enlarging internal carotid or distal basilar artery aneurysm.

A case of leucocoria caused by visceral larva migrans

A four-year-old boy was seen in the Eye Department at the Queen Elizabeth Military Hospital, Woolwich, because his parents had noticed that his right pupil appeared white. The diagnosis of toxocaral endophthalmitis was later made. The pathogenesis and management of infestation by Toxocara species are described.

Morphological changes after extracapsular cataract extraction with implantation of posterior chamber lenses. A prospective clinical study

Morphological changes and lens position were examined in 66 patients 3 to 5.5 (mean 4) months after extracapsular cataract extraction with intended implantation of posterior chamber lenses in the ciliary sulcus. Important findings were: capsulotomy-requiring secondary cataract (3%), iris-lens synecchiae (18%), iris-capsule synecchiae (14%), pupillar capture (2%) and haptic-malposition (17%). The lens optic was slightly decentered in 33%. The internal anterior chamber depth was measured with optical pachymetry and averaged 3.5 mm (range 2.3-4.5 mm). The central distance between the posterior lens surface and the posterior capsule (LPCD) was measured pachymetrically and averaged 0.14 mm (range 0-0.6 mm).

Goniodysgenesis in elderly glaucoma and non-glaucoma patients. A masked slit-lamp and gonioscopy study

The aim was to elucidate whether goniodysgenesis is more frequently observed in elderly patients with glaucoma, and furthermore, which signs of goniodysgenesis are of importance and most unanimously detected. Thus, 3 examiners evaluated 21 glaucoma patients and 19 non-glaucoma patients in a masked fashion. None of the patients had a first-degree heredity. Gonioscopy, slit-lamp examination and measurements of the corneal and pupillary diameter were performed, in all 26 variables. Significantly (P less than 0.05) more frequent in glaucoma were an increased corneal diameter, scleral overriding, hypoplasia of the pupillary seam, abnormal Schwalbe's line and an opaque pretrabecular membrane (one examiner). Less frequent were a peripupillary yellow pigment ring and pigment stars on the lens. Inter-observer variation was small regarding e.g. corneal diameter but rather large regarding e.g. the pretrabecular membrane.

[Computer-assisted static and light-evoked dynamic pupillometry in psychosomatic patients]

Microprocessor-assisted pupillometry was used in this psychophysiological study to investigate the pupillary diameter (static pupillometry) and visual-evoked pupillary reactions (dynamic pupillometry) in psychosomatic patients (duodenal ulcers, ulcerative colitis, cardiac phobia, anorexia nervosa, bronchial asthma) as compared with age-and sex-matched normal controls. Statistical analyses including multivariate methods demonstrated interesting differences between psychosomatic patients and normal controls, as well as between various subtypes of psychosomatic disorders and elucidated also the influence of a 6 weeks' course of psychotherapy. The data give valuable clues to symptom/syndrome-specific psychophysiological reaction types, which may be of considerable relevance for the characterization of psychosomatic diseases.

Pupillary block associated with posterior chamber lenses

Two patients developed pupillary block glaucoma after extracapsular cataract extraction with implantation of a posterior chamber lens but without peripheral iridectomies. The intraocular pressure of each eye was successfully controlled with laser iridotomy. No long-term medication was necessary to control their intraocular pressures.

Complications of intraocular lenses. A historical and histopathological review

Recent improvements in intraocular lens (IOL) design, manufacturing techniques, and surgical techniques have greatly reduced the incidence of complications following implantation, and many authors now consider IOL implantation to be among the most safe and effective major surgical procedures. However, adverse reactions are still seen--some as late sequelae of earlier IOL designs and implantation techniques and some as sequelae of more recent implantations using "state-of-the-art" lenses and surgical techniques. Complications may be due to various factors, including surgical technique, IOL design, or the inability of some eyes with preexisting disease to tolerate an implant. The authors trace the evolution of IOLs since Ridley's first implant, summarizing the modifications in lenses and surgical techniques that were made as complications were recognized. They then review the clinical and histopathological features of selected cases from more than 200 IOLs and/or globes removed due to IOL-related complications and studied in the University of Utah Ocular Pathology Laboratory. It is hoped that this review will provide insights into the pathogenesis of IOL complications, enhancing the current success of implant procedures and stimulating further basic and clinical research in this area.

Oval pupils

The records of 17 patients whose neurological examination disclosed oval pupils in one or both eyes were reviewed. Sixteen of the 17 had serious cerebrovascular illnesses--hypertensive cerebral hemorrhage (five patients), ruptured saccular aneurysm (five patients), epidural hemorrhage (one patient), bilateral cerebral infarction (two patients), brainstem strokes (two patients), and cerebral anoxia (one patient). One patient was recovering from an oculomotor palsy. Oval pupils usually represent a transient, unstable phase in progressive injury to the oculomotor complex and less frequently a transient phase of recovery.

Migration of a wooden foreign body into the lens: report of a case

A penetrating ocular injury caused by a tree branch resulted in a small corneoscleral laceration that healed after primary repair. Post-traumatic inflammation persisted and a vitreous mass developed. The mass finally protruded through the pupil and touched the posterior cornea. Histologic examination of the enucleated eye showed that the lens had been replaced by a wooden foreign body that filled the pupillary space and was surrounded by lens capsule. No intact lens fibers remained.

Anterior lens curvature. Comparisons between normal eyes and those with primary angle-closure glaucoma

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The dilated pupil and head trauma 1517-1867

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Photographic comparison of pupillary and corneal diameters when one eye is deviated

A method is presented for predicting the horizontal pupillary and corneal diameters when one eye is deviated. When the actual diameters are equal, the apparent diameter of the deviated pupil or cornea is equal to the cosine of the angle of deviation multiplied by the pupillary or corneal diameter of the undeviated eye.

Colobomas in non-human primates

Four cases of coloboma affecting various ocular structures in non-human primates are described. The gross and histologic features of each case are illustrated, and a possible reason for the lack of reports of this condition is discussed.

The pupillary membrane in premature infants

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