Ocular symptoms

Benign familial neonatal convulsion is an idiopathic form of epilepsy beginning within the first six months after birth. Seizures include generalized and mixed, starting with tonic posture, ocular symptoms, and apnea, and often progress to clonic movements and motor automatisms. 

Ocular eye involvement is common and may precede skin lesions. Ocular symptoms include foreign body sensation, burning or stinging, dryness, itching, ocular photosensitivity, teleangectasia, periorbital edema, chalazia (Fig. 17.8)... 

AR is the most common atopic disease in the United States. It affects between 9% and 24% of adults and up to 42% of children.2,3 More than 80 million Americans experience 7 or more days of nasal-ocular symptoms annually as a result of AR.3 Additionally, AR is responsible for 3.5 million lost work days and 2 million missed school days annually in the United States.4 In addition to decreased quality of life from AR symptoms, patients also suffer from disrupted sleep, resulting in fatigue, irritability, memory deficits, excessive daytime somnolence, and depression that further reduce quality of life.5... 

There is still debate whether oral antihistamines control ocular allergy as well as topical antihistamines. Topical antihistamines are recommended before oral agent in step therapy because of the increased risk of systemic side effects with oral drugs. Additionally, topical antihistamines provide faster relief of ocular symptoms. Consider oral antihistamines... 

Levocabastine (Livostin) and olopatadine (Patanol) are ophthalmic antihistamines that can be used for allergic conjunctivitis that is often associated with allergic rhinitis. However, systemic antihistamines are usually effective for allergic conjunctivitis, making an ocular product unnecessary. They may be a logical addition to nasal glucocorticoids when ocular symptoms occur. 

Periodically evaluate the patient s visual acuity and check for ocular symptoms... 

The clinical, biochemical, and thyroid imaging characteristics of thyrotoxicosis resulting from interferon alfa treatment have been retrospectively analysed from data on 10 of 321 patients with chronic hepatitis (75 with chronic hepatitis B and 246 with chronic hepatitis C) who developed biochemical thyrotoxicosis (505). Seven patients had symptomatic disorders, but none had ocular symptoms or a palpable goiter. Six had features of Graves disease that required interferon alfa withdrawal in four and prolonged treatment with antithyroid drugs in all six. Three presented with transient thyrotoxicosis that... 

Intranasal corticosteroids are effective in reducing ocular symptoms as well as nasal symptoms. The mechanism of action is unclear it may partly be due to a systemic effect resulting from local absorption, although system-ically related adverse effects are uncommon. These are used once or twice daily depending on choice and should be used regularly during the hay fever season. 

Innominate or proximal common carotid artery stenosis or occlusion is quite often seen on angiograms in symptomatic patients but, unless very severe, does not influence the decision about endarterectomy for any internal carotid artery stenosis. Although it is possible to bypass such lesions, it is highly doubtful whether this reduces the risk of stroke unless, perhaps, several major neck vessels are involved and the patient has low-flow cerebral or ocular symptoms. This very rare situation can be caused by atheroma, Takayasu s disease or aortic dissection. Clearly, close consultation between physicians and vascular surgeons is needed to sort out, on an individual patient basis, what to do for the best. 

Semm testing reveals circulating antibodies to acetylcholine receptors in approximately 90% of individuals with generalized myasthenia and in almost 70% of those with ocular symptoms only. False-positive results are rare, and the antibody titer does not correlate with the severity of symptoms. In those patients who are seronegative for antiacetylcholine receptor antibodies, which is about 6% of myasthenia gravis patients overall, anti-MuSK antibodies may be present. MuSK is a muscle-specific transmembrane protein with intrinsic tyrosine kinase activity. Anti-MuSK antibodies are almost never seen in patients who have antiacetylcholine receptor antibodies, and vice versa. 

Many cases of mild bacterial conjunctivitis are self-limiting and resolve without treatment. However, antibiotic therapy often lessens the patient s anxiety and ocular symptoms, shortens the duration of the disease, and prevents recurrence or spread to the fellow eye. Contagion is also a significant risk. Several severe bacterial conjunctivitis outbreaks have been reported. Among the more common requests in ophthalmic practice are releases permitting patients who had conjunctivitis to return to work or school. Epidemiologic data support the clinical and public health benefits of early treatment. 

Pregnant and lactating women and children younger than 8 years should avoid oral doxycycline therapy. In these patients erythromycin base, 500 mg four times daily for 7 days, or amoxicillin, 500 mg three times daily for 7 days, is an alternative to doxycycline. Once systemic therapy has been initiated, topical treatment with lubricants, rasoconstrictors, or a combination antibiotic-steroid may help to relieve the patient s ocular symptoms. 

Because as many as half the patients who develop blepharoconjunctivitis have ocular symptoms before the... 

Controversial reports of ocular symptoms have been published in patients taking oral ciclosporin, with ptosis and diplopia attributed to unilateral or bilateral sixth nerve palsies in four patients (who had also taken ganciclovir), and nystagmus in one patient (SEDA-21, 383). Peripheral optic neuropathy, with visual loss, nystagmus, and ophthalmoplegia, has also been reported (38). Acute cerebral cortical blindness complicating ciclosporin therapy in a 5-year-old girl (39) and transient cortical blindness and occipital seizures with visual impairment (40,41) have also been reported in association with ciclosporin. 

Most people tolerate aspirin well, but not patients with asthma, of whom there is a subgroup in whom aspirin precipitates asthmatic attacks (61,62). This is a distinct clinical syndrome, called aspirin-induced asthma, which affects about 10% of adults with asthma (63). Aspirin-induced asthma is usually accompanied by naso-ocular symptoms and can be triggered not only by aspirin, but by several NSAIDs, a fact that makes immunological cross-reactivity most unlikely. The propensity of an NSAID to precipitate an attack of asthma is probably related to inhibition of COX (63). There is evidence that potent inhibitors of COX-1 (such as ibuprofen, indometacin, and naproxen) are more likely to precipitate bronchoconstriction than NSAIDs that inhibit COX-2 preferentially (such as meloxicam and nime-sulide) (64,65). A widely accepted hjrpothesis is that in patients with asthma and aspirin intolerance, NSAJD-induced COX inhibition results in increased products from the 5-lipoxygenase pathway, the leukotrienes, which are both potent bronchoconstrictors and also inducers of... 

Other ocular symptoms after PUVA include photophobia, conjunctivitis, keratitis, and dry eyes (SEDA-7,166). Adequately protecting the eyes from the sun reduces the... 

Hemady RK, Sinibaldi VJ, Eisenberger MA. Ocular symptoms and signs associated with suramin sodium treatment for metastatic cancer of the prostate. Am J Ophthalmol 1996 121(3) 291-6. 

Thiamin deficiency in alcoholics may be caused by decreased intake, reduced absorption, and impaired ability to use ihe absorbed vitamin. The ataxia and ocular symptoms associated with the deficiency in alcoholics are known as Wernicke s disease. Vitamin therapy can provide relief from nystagmus within a few hours of treatment and from ataxia within several weeks. The treatment of alcoholics also involves the supply of other nutrients lacking in the diet, such as folate, vitamin B12, and protein. Left imtreated, patients suffering from Wernicke s disease continue to develop Korsakoff s psychosis, which involves amnesia and confusion. Only about 25% of patients with Korsakoff s psychosis can be completely cured by thiamin treatment, which must be continued for a few weeks or months. The two conditions just described constitute the Wemicke-Korsakoff syndrome. The S5mdrome was named after two researchers. Karl Wernicke, a German, noted impaired or paralyzed eye movements and imstable walking and disorientation in his patients, most of whom were alcoholics. Polyneuropathy, a weakness of the hands, calves, and feet, was also noted. Sergei Korsakoff, a Russian, observed amnesia and confusion and an inability to learn new names or tasks in alcoholic patients. 

Both allergic and irritant mechanisms have been proposed as explanations for eye symptoms. More rapid tear-film break-up time, a measure of tear film instability, is associated with increased levels of symptoms. Fat-foam thickness measurement and photography for documentation of ocular erythema have also been used. Some authors attribute eye symptoms at least in part to increased individual susceptibility based on those factors. In addition, office workers with ocular symptoms have been demonstrated to blink less frequently when working at video display terminals. Conjunctival staining with fluorescent dyes is a common clinical test for conjunctivitis sicca. 

Ocular symptoms and signs, including burning and stinging also occur immediately after exposure, followed quickly by blepharospasm and edema, and within a few hours, iritis and corneal haziness. Blindness may result without eye decontamination within 1 min of exposme (2). 

MS is a multifocal disease frequently starting with ocular symptoms like diplopia when it becomes established in the brain stem, or a reduction of visual acuity, or disturbances in colour vision and pain when established as optic nerve neuritis. The typical plaques are initial sites of demyelination, whereas inflammatory elements... 

XXIF was selected for initial clinical trial. A total dose of 60-120 mj over 1-Jj- days cured I6 of Ij-ii- subjects infected with haematobium. The drug gave rise to no ocular symptoms, but did produce serious vomiting. 

Logical addition to nasal steroids if ocular symptoms are present. 

Allergic conjunctivitis, often associated with allergic rhinitis, can be treated with an ophthalmic antihistamine such as levocabas-tine. Since systemic antihistamines usually are also effective for allergic conjunctivitis, levocabastine is a logical addition to nasal steroids when ocular symptoms occur, and is an acceptable approach in patients whose only symptoms involve the eyes. 

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