Outcome in refractive accommodative esotropia. (1/164)AIM: To examine outcome among children with refractive accommodative esotropia. METHODS: Children with accommodative esotropia associated with hyperopia were included in the study. The features studied were ocular alignment, amblyopia, and the response to treatment, binocular single vision, requirement for surgery, and the change in refraction with age. RESULTS: 103 children with refractive accommodative esotropia were identified. Mean follow up was 4.5 years (range 2-9.5 years). 41 children (39.8%) were fully accommodative (no manifest deviation with full hyperopic correction). The remaining 62 children (60.2%) were partially accommodative. At presentation 61.2% of children were amblyopic in one eye decreasing to 15.5% at the most recent examination. Stereopsis was demonstrated in 89.3% of children at the most recent examination. Mean cycloplegic refraction (dioptres, spherical equivalent) remained stable throughout the follow up period. The mean change in refraction per year was 0.005 dioptres (D) in right eyes (95% CL -0. 0098 to 0.02) and 0.001 D in left eyes (95% CL -0.018 to 0.021). No patients were able to discard their glasses and maintain alignment. CONCLUSIONS: Most children with refractive accommodative esotropia have an excellent outcome in terms of visual acuity and binocular single vision. Current management strategies for this condition result in a marked reduction in the prevalence of amblyopia compared with the prevalence at presentation. The degree of hyperopia, however, remains unchanged with poor prospects for discontinuing glasses wear. The possibility that long term full time glasses wear impedes emmetropisation must be considered. It is also conceivable, however, that these children may behave differently with normal and be predestined to remain hyperopic. (+info)
Pharmacological mydriasis and optic disc examination. (2/164)AIM: To determine whether pharmacological mydriasis leads to a significant difference in interobserver agreement of optic disc measurement compared with examination without mydriasis. METHOD: A cross sectional study was performed with a pair of observers examining the optic disc of two randomised groups of patients, one group before diagnostic mydriasis, and the other afterwards. Horizontal and vertical disc diameters and cup/disc ratios were measured with a 78 dioptre lens. The study was repeated with another observer pair and two further groups of patients. RESULTS: In study A 86 subjects were examined in total (52 without and 34 with mydriasis). In study B 87 subjects were examined (45 without and 42 with mydriasis). The 95% limits of agreement of the cup/disc ratio measurement differences were significantly larger without mydriasis (p<0.001 for all studies (F test)). For both studies examination after mydriasis gave significantly greater agreement for vertical and horizontal cup/disc ratios. The cases with good agreement (0.1 difference or better) for vertical cup/disc ratios were 37/52 (72%) and 34 /45 (76%) without mydriasis and 33/34 (97%) and 40/42 (95%) respectively with mydriasis. Similar differences were recorded for horizontal cup/disc ratios. Disc diameter measurement results showed similar differences in study A but were not affected by mydriasis in study B. CONCLUSIONS: Examination of the optic disc without pharmacological mydriasis gives significantly poorer interobserver agreement. In this study, the mean 95% limits of agreement values for all cup/disc ratio values were 0.27 for examination without mydriasis and 0.13 for examination with mydriasis. A measure outside these limits would suggest a real difference. This study indicates that mydriasis is important for reproducible clinical examination in glaucoma. (+info)
Factors affecting pupil size after dilatation: the Twin Eye Study. (3/164)BACKGROUND/AIMS: Well dilated pupils make eye surgery easier. A classic twin study was established to examine the relative importance of genes and environment in the variance of pupil size after mydriasis, and to examine the effects of other factors such as age, iris colour, and refractive error. METHODS: 506 twin pairs, 226 monozygotic (MZ) and 280 dizygotic (DZ), aged 49-79 (mean age 62.2 years, SD 5.7) were examined. Dilated pupil size was measured using a standardised grid superimposed over digital retroillumination images taken 50-70 minutes after mydriasis using tropicamide 1% and phenylephrine 10%. Univariate maximum likelihood model fitting was used to estimate genetic and environmental variance components. RESULTS: Dilated pupil size was more highly correlated in MZ compared with DZ twins (intraclass correlation coefficients 0.82 and 0.39 respectively). A model specifying additive genetic and unique environmental factors showed the best fit to the data, yielding a heritability of 78-80%. Individual environmental factors explained 18-19% of the variance in this population. Age only accounted for 2-3% of the variance and refractive error and iris colour did not significantly contribute to the variance. CONCLUSIONS: Pupil size after mydriasis is largely genetically determined, with a heritability of up to 80%. (+info)
Probing peripheral and central cholinergic system responses. (4/164)OBJECTIVE: The pharmacological response to drugs that act on the cholinergic system of the iris has been used to predict deficits in central cholinergic functioning due to diseases such as Alzheimer's disease, yet correlations between central and peripheral responses have not been properly studied. This study assessed the effect of normal aging on (1) the tropicamide-induced increase in pupil diameter, and (2) the reversal of this effect with pilocarpine. Scopolamine was used as a positive control to detect age-dependent changes in central cholinergic functioning in the elderly. DESIGN: Randomized double-blind controlled trial. PARTICIPANTS: Ten healthy elderly (mean age 70) and 9 young (mean age 33) volunteers. INTERVENTIONS: Pupil diameter was monitored using a computerized infrared pupillometer over 4 hours. The study involved 4 sessions. In 1 session, tropicamide (20 microL, 0.01%) was administered to one eye and placebo to the other. In another session, tropicamide (20 microL, 0.01%) was administered to both eyes, followed 23 minutes later by the application of pilocarpine (20 microL, 0.1%) to one eye and placebo to the other. All eye drops were given in a randomized order. In 2 separate sessions, a single dose of scopolamine (0.5 mg, intravenously) or placebo was administered, and the effects on word recall were measured using the Buschke Selective Reminding Test over 2 hours. OUTCOME MEASURES: Pupil size at time points after administration of tropicamide and pilocarpine; scopolamine-induced impairment in word recall. RESULTS: There was no significant difference between elderly and young volunteers in pupillary response to tropicamide at any time point (p > 0.05). The elderly group had a significantly greater pilocarpine-induced net decrease in pupil size 85, 125, 165 and 215 minutes after administration, compared with the young group (p < 0.05). Compared with the young group, the elderly group had greater scopolamine-induced impairment in word recall 60, 90 and 120 minutes after administration (p < 0.05). CONCLUSION: There is an age-related pupillary response to pilocarpine that is not found with tropicamide. Thus, pilocarpine may be useful to assess variations in central cholinergic function in elderly patients. (+info)
A rapid method for measuring miotic activity of drugs in the intact mouse eye. (5/164)A rapid and precise method for evaluating the miotic activity of cholinergic drugs has been developed based on Long's method for measuring the rate of mydriasis. The rate of reversal of mydriasis developed previously in the intact mouse eye by a mild mydriatic (phenycyclidine) is used to evaluate the miotic activity. The method provides a useful tool for measuring and comparing the miotic activity of acetylcholine agonists and cholinesterase inhibitors. (+info)
Evaluation of potentiating effect of a drop of lignocaine on tropicamide-induced mydriasis. (6/164)PURPOSE: To analyze whether preinstillation of lignocaine potentiates mydriasis by tropicamide in dark eyes and to determine possible mechanisms for this effect. METHODS: This investigation was conducted in two phases, the first being a double-masked, placebo-controlled, randomized clinical trial, enrolling 60 healthy dark brown eyes in 30 subjects aged 7 to 58 years. The control eye received a drop of (nonlignocaine) placebo before tropicamide 1%, and the contralateral study eye received a 4% lignocaine drop 3-minutes before the 1 drop of tropicamide was administered. A ruled pupillometer recorded pupil diameters every 10 minutes for 50 minutes. In phase II, to elucidate pathomechanisms after lignocaine, corneal and tear parameters were compared with baseline records in a further 60 such eyes. RESULTS: Pupillary diameters in the study eyes increased by 3.62 +/- 0.75 mm, significantly more than in the placebo (control) group (P = 0.000). Ninety percent of study eyes attained the clinically significant 6-mm size with preinstillation of lignocaine-many more than the 67% of control eyes (P = 0.016). The median time to achieve this critical 6-mm size was significantly faster in the study group (P = 0.005). In phase II, the 1 drop 4% lignocaine did not show corneal changes with slit lamp or fluorescein staining and did not reduce media clarity or induce a significant change in tear pH. It markedly decreased Schirmer values (P = 0.000), reduced tear break-up time (P = 0.003), and increased corneal thickness measured by optical pachymetry (P = 0.010). CONCLUSIONS: The phase II findings indicate corneal microepithelial damage and reduced tearing. Both may enhance intraocular penetration and hence potentiation of tropicamide. This remarkable phenomenon could find use with many other important topical medications. (+info)
Tropicamide (1%): an effective cycloplegic agent for myopic children. (7/164)PURPOSE: To evaluate the cycloplegic effect of 1% tropicamide in myopic children and to determine whether its efficacy is associated with age, gender, iris color, ethnicity, magnitude of the refractive error, or latent error. METHODS: Four hundred sixty-nine children enrolled in the Correction of Myopia Evaluation Trial (COMET; a multicenter, randomized, double-masked clinical trial evaluating the rate of progression of juvenile-onset myopia in children wearing progressive-addition versus single-vision lenses) were given 1 drop of proparacaine in each eye followed 1 minute later by 1 drop of 1% tropicamide and then a second drop of 1% tropicamide 4 to 6 minutes later. Five accommodative responses to 20/100 letters located at 4 m and 33 cm were obtained in each eye with an autorefractor, 20 minutes after the second drop. Residual accommodation was calculated as the difference between the mean spherical equivalent responses obtained at the two distances. An examiner graded iris color, and ethnicity was reported by the children's parents or guardians. RESULTS: The mean residual accommodation was small: 0.38 +/- 0.41 diopters (D) in the right eye and 0.30 +/- 0.41 D in the left eye. Small but statistically significant differences in residual accommodation were associated with ethnicity, but not with any of the other factors. CONCLUSIONS: Tropicamide (1%) is an effective cycloplegic agent in myopic children. (+info)
Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor. (8/164)The photopigment in the human eye that transduces light for circadian and neuroendocrine regulation, is unknown. The aim of this study was to establish an action spectrum for light-induced melatonin suppression that could help elucidate the ocular photoreceptor system for regulating the human pineal gland. Subjects (37 females, 35 males, mean age of 24.5 +/- 0.3 years) were healthy and had normal color vision. Full-field, monochromatic light exposures took place between 2:00 and 3:30 A.M. while subjects' pupils were dilated. Blood samples collected before and after light exposures were quantified for melatonin. Each subject was tested with at least seven different irradiances of one wavelength with a minimum of 1 week between each nighttime exposure. Nighttime melatonin suppression tests (n = 627) were completed with wavelengths from 420 to 600 nm. The data were fit to eight univariant, sigmoidal fluence-response curves (R(2) = 0.81-0.95). The action spectrum constructed from these data fit an opsin template (R(2) = 0.91), which identifies 446-477 nm as the most potent wavelength region providing circadian input for regulating melatonin secretion. The results suggest that, in humans, a single photopigment may be primarily responsible for melatonin suppression, and its peak absorbance appears to be distinct from that of rod and cone cell photopigments for vision. The data also suggest that this new photopigment is retinaldehyde based. These findings suggest that there is a novel opsin photopigment in the human eye that mediates circadian photoreception. (+info)
Mydriasis is a condition where the pupil remains dilated for an extended period, even in low light conditions. It can be caused by various factors such as injury to the head or eye, stroke, brain tumors, multiple sclerosis, and certain medications. Mydriasis can cause problems with vision, including blurred vision, double vision, and sensitivity to light. Treatment options for mydriasis depend on the underlying cause, but may include glasses or contact lenses to correct refractive errors, prism lenses to align images properly, or medications to reduce inflammation or treat underlying conditions.
Causes of Mydriasis
Mydriasis can be caused by a variety of factors, including:
1. Trauma to the head or eye: A blow to the head or a penetrating eye injury can cause mydriasis due to damage to the nerves that control pupil size.
2. Stroke or cerebral vasculature disorders: A stroke or other conditions that affect blood flow to the brain can cause mydriasis due to damage to the nerves that control pupillary constriction.
3. Brain tumors: Tumors in the brain, such as melanoma, can cause mydriasis by compressing or damaging the nerves that control pupil size.
4. Multiple sclerosis: This autoimmune disease can damage the nerves that control pupillary constriction, leading to mydriasis.
5. Medications: Certain medications, such as anticholinergic drugs and certain antihistamines, can cause mydriasis as a side effect.
Symptoms of Mydriasis
The symptoms of mydriasis may include:
1. Dilated pupils that do not constrict in response to light
2. Blurred vision or double vision
3. Sensitivity to light
4. Headaches or eye strain
5. Seeing halos around lights
6. Difficulty seeing at night or in low light conditions
7. Nausea and vomiting
Diagnosis of Mydriasis
To diagnose mydriasis, a comprehensive eye exam is necessary to rule out other causes of dilated pupils. The doctor may perform a series of tests to evaluate the function of the nervous system and the muscles that control pupillary constriction. These tests may include:
1. Pupillometry: This test measures the size of the pupils and their reaction to light.
2. Ophthalmoscopy: This test allows the doctor to visualize the inside of the eye and assess the function of the retina and optic nerve.
3. Eye movement testing: This test evaluates the muscles that control eye movement and their coordination with the pupillary constriction reflex.
4. Neurological exam: A neurological exam may be performed to rule out other conditions that can cause dilated pupils, such as brain tumors or multiple sclerosis.
Treatment of Mydriasis
The treatment of mydriasis depends on the underlying cause of the condition. In some cases, treating the underlying condition can resolve the mydriasis. Other treatments that may be used to manage mydriasis include:
1. Pupillary constriction medications: These medications can help reduce the size of dilated pupils and improve vision.
2. Prism glasses: In some cases, prism glasses may be prescribed to help align the visual fields and improve binocular vision.
3. Eye exercises: Eye exercises may be recommended to strengthen the muscles that control eye movement and improve coordination between the pupils.
4. Surgery: In rare cases, surgery may be necessary to treat mydriasis caused by a physical obstruction or other abnormality in the eye.
Prognosis of Mydriasis
The prognosis for mydriasis is generally good if the underlying cause is treated promptly and effectively. However, if the condition is left untreated, it can lead to complications such as:
1. Vision loss: Prolonged dilated pupils can lead to vision loss due to retinal damage or optic nerve damage.
2. Eye strain: Dilated pupils can cause eye strain and fatigue, which can lead to headaches and other symptoms.
3. Increased risk of eye injuries: Dilated pupils may increase the risk of eye injuries, as the pupil is more vulnerable to trauma when it is dilated.
4. Increased risk of infection: Dilated pupils may increase the risk of infection, as the pupil is more exposed to foreign substances and bacteria.
Prevention of Mydriasis
There are several steps you can take to help prevent mydriasis:
1. Get regular eye exams: Regular eye exams can help detect any underlying conditions that may be causing dilated pupils, such as cataracts or glaucoma.
2. Wear protective eyewear: Wearing protective eyewear, such as goggles or safety glasses, can help prevent eye injuries and reduce the risk of mydriasis.
3. Avoid exposure to bright lights: Bright lights can cause dilated pupils, so it is best to avoid exposure to bright lights, especially during the day.
4. Use artificial tears: Artificial tears can help keep the eyes moist and reduce the risk of mydriasis.
5. Get enough sleep: Getting enough sleep can help prevent eye strain and fatigue, which can lead to mydriasis.
6. Take breaks when working on a computer: Taking breaks when working on a computer can help reduce eye strain and fatigue, which can lead to mydriasis.
7. Use good lighting: Good lighting can help reduce eye strain and fatigue, which can lead to mydriasis.
8. Avoid smoking: Smoking can increase the risk of mydriasis, so it is best to avoid smoking.
9. Maintain good hygiene: Maintaining good hygiene, such as washing your hands frequently and avoiding sharing makeup or other products, can help prevent infection and reduce the risk of mydriasis.
Mydriasis is a common condition that can cause eye strain and fatigue, as well as increase the risk of eye injuries and infection. There are several steps you can take to prevent mydriasis, including avoiding smoking, getting enough sleep, using artificial tears, and taking breaks when working on a computer. Additionally, maintaining good hygiene and using good lighting can help reduce the risk of mydriasis. If you experience any symptoms of mydriasis, it is important to seek medical attention as soon as possible to prevent complications.
There are two main types of DR:
1. Non-proliferative diabetic retinopathy (NPDR): This is the early stage of DR, where the blood vessels in the retina become damaged and start to leak fluid or bleed. The symptoms can be mild or severe and may include blurred vision, floaters, and flashes of light.
2. Proliferative diabetic retinopathy (PDR): This is the advanced stage of DR, where new blood vessels start to grow in the retina. These vessels are weak and can cause severe bleeding, leading to vision loss.
DR is a common complication of diabetes, and it is estimated that up to 80% of people with diabetes will develop some form of DR over their lifetime. The risk of developing DR increases with the duration of diabetes and the level of blood sugar control.
Early detection and treatment of DR can help to prevent vision loss, so it is important for people with diabetes to have regular eye exams to monitor their retinal health. Treatment options for DR include laser surgery, injections of anti-vascular endothelial growth factor (VEGF) medications, and vitrectomy, a surgical procedure to remove the vitreous gel and blood from the eye.
Preventing Diabetic Retinopathy
While there is no surefire way to prevent diabetic retinopathy (DR), there are several steps that people with diabetes can take to reduce their risk of developing this complication:
1. Control blood sugar levels: Keeping blood sugar levels within a healthy range can help to slow the progression of DR. This can be achieved through a combination of diet, exercise, and medication.
2. Monitor blood pressure: High blood pressure can damage the blood vessels in the retina, so it is important to monitor and control blood pressure to reduce the risk of DR.
3. Maintain healthy blood lipids: Elevated levels of low-density lipoprotein (LDL) cholesterol and lower levels of high-density lipoprotein (HDL) cholesterol can increase the risk of DR.
4. Quit smoking: Smoking can damage the blood vessels in the retina and increase the risk of DR.
5. Maintain a healthy weight: Obesity is a risk factor for DR, so maintaining a healthy weight can help to reduce the risk of this complication.
6. Get regular eye exams: Regular eye exams can help to detect DR in its early stages, when it is easier to treat and prevent vision loss.
Preventing Diabetic Retinopathy
While there is no cure for diabetic retinopathy (DR), there are several treatment options available to help manage the condition and prevent vision loss. These include:
1. Laser surgery: This is a common treatment for early-stage DR, where a laser is used to shrink abnormal blood vessels in the retina and reduce the risk of further damage.
2. Injection therapy: Medications such as anti-vascular endothelial growth factor (VEGF) injections can be used to shrink abnormal blood vessels and reduce swelling in the retina.
3. Vitrectomy: In severe cases of DR, a vitrectomy may be performed to remove scar tissue and blood from the center of the eye.
4. Blood pressure control: Maintaining healthy blood pressure can help to slow the progression of DR.
5. Blood glucose control: Keeping blood sugar levels under control can also slow the progression of DR.
6. Follow-up care: Regular follow-up appointments with an eye doctor are important to monitor the progress of DR and adjust treatment as needed.
Early detection and treatment of diabetic retinopathy can help to prevent vision loss and improve outcomes for individuals with this complication of diabetes. By managing blood sugar levels, blood pressure, and cholesterol, and by getting regular eye exams, individuals with diabetes can reduce their risk of developing DR and other diabetic complications.
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- The TRC-50DX series of mydriatic retinal cameras incorporate the latest digital-ready features to provide the most complete retinal image capture device today, including color, red free, fluorescein angiography, fundus auto fluorescein and indocyanine green angiography. (insighteye2020.com)
- The TRC-50DX is a mydriatic retinal camera incorporating digital-ready features to provide complete retinal imaging, including color, red-free, and fluorescein angiography (FA). (topconhealthcare.ca)
- We aim to evaluate a non-mydriatic retinal camera as a safe and efficacious screening tool, for diabetic retinopathy, in diabetes centers. (brieflands.com)
- 221 consecutive patients attending a Diabetes Center submitted to retinal photographs using a non-mydriatic camera. (brieflands.com)
- The Topcon NW-6S Non-Mydriatic Fundus Camera generates clear images and makes diagnosis faster and more reliably. (emseye.com)
- Phenylephrine hydrochloride is a sympathomimetic amine recommended for use as a nasal decongestant and as a mydriatic in ophthalmic applications. (nih.gov)
- Combinations, which in addition contain antiinfectives, are classified in S01CB - Corticosteroids/antiinfectives/mydriatics in combination. (whocc.no)
- IMSEAR at SEARO: Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution. (who.int)
- Context: Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages. (who.int)
- To compare Mydrane®, mydriatic eye drops , and Mydriasert® in terms of pupil site stability, surgical time , visual field , and anterior chamber configuration modifications among patients with primary open-angle glaucoma (POAG) during cataract extraction surgery . (bvsalud.org)
- Patients divided into groups 1, 2, and 3 (n = 20 in each group) received topical mydriatic eye drops , Mydriasert®, and an intracameral injection of Mydrane®, respectively, immediately after the first incision. (bvsalud.org)
- Cycloplegic mydriatics reduce pain by blocking ciliary spasm, and they reduce intraocular inflammation by stabilizing the blood-aqueous barrier. (medscape.com)
- Cyclopentolate is in a class of medications called mydriatics. (medlineplus.gov)
- Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. (who.int)
- The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. (who.int)
- Efficacy of the intracamerally administered mydriatics for cataract surgery in patients with primary open-angle glaucoma. (bvsalud.org)
- Therapy of the mydriatic drugs. (nih.gov)
- The use of a non-mydriatic camera to determine need for ophthalmologic referral was found to be safe and efficacious, with no serious delays in referral noted. (brieflands.com)
Transient elevation of intraocular pressure1
- Mydriatics may produce a transient elevation of intraocular pressure. (nih.gov)
- Phenylephrine hydrochloride is a sympathomimetic amine recommended for use as a nasal decongestant and as a mydriatic in ophthalmic applications. (nih.gov)
- Periorbital pallor post application of mydriatic in infants with hydrocephalus associated to systemic effects]. (bvsalud.org)