Ophthalmological examination

L A 50-year-old male ls seen in the emergency department (ED) with a blood pressure of 260/160 mmHg. Blurring optic discs with indistinct margins are seen on ophthalmologic examination. An intravenous drip of sodium nitroprusside is administered. What is the mechanism of action of sodium nitroprusside ... 

Metabolic studies Ophthalmologic examination Fasting blood sugar... 

Ophthalmologic examinations are typically made immediately prior to initiation of a study (and thus serve to screen out animals with preexisting conditions) and toward the end of a study. 

Ophthalmology. Ophthalmological examination of all animals in study (particularly nonrodents) should be performed both before study initiation and at the completion of the period at which the drug is administered. This should be performed by an experienced veterinary ophthalmologist. 

Various parts of the ophthalmological examination are shown in Table 20.14. The most important common ophthalmological test to evaluate patients for the occurrence of chronic drug-induced toxicity is slit-lamp examination. Specific types of drugs with known potential for ocular toxicity may require that special attention be directed to other evaluations shown in Table 20.14. Most drugs that are to be taken... 

TABLE 20.14. Procedures and Tests Performed in Ophthalmological Examination... 

These tests are of minimal value in determining ocular toxicity and are not recommended for routine use in ophthalmological examination to detect drug toxicities. 

Clinical observations Ophthalmological examination Functional observations (toward end of exposure period - sensory reactivity to stimuli of different types, grip strength, motor activity)... 

Clinical observations Ophthalmological examination Body weight and food/water consumption Hematology (haematocrit, hemoglobin, erythrocyte count, total and differential leucocyte count, clotting potential)... 

Periodic ophthaimoiogic examinations Per o6 c ophthalmologic examinations during isoniazid therapy are recommended even when visual symptoms do not occur. P.1007... 

Ophthalmic effects Irreversible retinal damage has been observed in some patients who had received long-term or high-dosage 4-aminoquinoline therapy for discoid and SLE or RA. When prolonged therapy is contemplated, perform initial (baseline) and periodic (every 3 months) ophthalmologic examinations (including visual acuity, expert slit-lamp, funduscopic, and visual field tests). 

Visual impairment Carefully monitor visual problems. If visual difficulties occur, discontinue the drug and have an ophthalmological examination. 

Antimuscarinic mydriatics, such as tropicamide, are useful in ophthalmological examinations. Prior to administering tropicamide, it would be most important to know... 

NSAIDs. Hematopoietic side effects (e.g., leukopenia, hemolytic anemia, aplastic anemia, purpura, thrombocytopenia, and agranulocytosis) also may occur. Ocular effects (blurred vision, corneal deposits) have been observed in patients receiving indomethacin, and regular ophthalmological examinations are necessary when the drug is used for long periods. Hepatitis, jaundice, pancreatitis, and hypersensitivity reactions also have been noted. 

Baseline and periodic ophthalmologic examinations (visual acuity, slit lamp, fun-duscopic, and visual held tests) periodic tests of knee and ankle reflexes to detect muscular weakness... 

Periodic ophthalmologic examinations even when visual symptoms do not occur... 

In a chronic-duration study, groups of 60 male and 60 female Fiseher 344 rats were exposed to 0, 0.005, 0.025, or 0.164 ppm HDl over a 2-year period. Control rats were sham-exposed rats (conditioned air exposme). HDl caused eye irritation in males exposed to the 0.164 ppm dose only during the first year of the study but not dming the seeond year. No other HDl-related eye lesions were detected during ophthalmologic examinations performed dining the 2-year study (Mobay Corporation 1989). 

The clinical examination of an ocular chemical bum victim includes all the steps of the ophthalmologic examination measurement of visual ACUITY, slit lamp, and evaluation of the ocular tonicity. 

The ophthalmologic examination may require a local anesthesia by instillation of a coUyrium of oxy-buprocain type. As that for skin bums, the absence of pain is very often a sign of gravity, but this is not an absolute rule. In ophthalmology and more specifically, concerning bums, there may be no link between the anatomic lesions and the pain. 

Nasal budesonide or beclomethasone 100 micrograms bd for 3-9 months had no effect on the eyes in 26 patients who had undergone endoscopic sinus surgery (440). Ophthalmologic examination, tonometry, visual field testing, and biomicroscopic studies showed no evidence of ocular hypertension or posterior subcapsular cataract. 

Eyes. Ophthalmologic examination of both cornea and retina should be carried out at the beginning and at the end of the study. 

Clinical Examination and Pathology The clinical examination of the test animals may be made as described for subchronic oral toxicity. These, include ophthalmologic examination, hematology, and clinical biochemistry. Gross necropsy and histopathology of all vital organs may be recorded as described for subchronic oral toxicity study. All observed results, quantitative and incidental, should be evaluated by an appropriate statistical method. 

If there were any special safety examinations performed (e.g., audiometric, electrocardiographic, or ophthalmologic examinations), these should be summarized here. Include any comparisons with active control drugs and placebo, if available, and the numbers of patients receiving each test. 

Therapy is generally the same for acquired immune deficiency syndrome/non-acquired immune defidency syndrome patients except where indicated and should be continued for 2 weeks after the last positive blood culture and resolution of signs and symptoms of infedion. All patients should receive an ophthalmologic examination. Amphotericin B may be switched to fluconazole (intravenous or oral) for the completion of therapy. Susceptibility testing of the infecting isolate is a useful ad und to species identification during seledion of a therapeutic approach because it can be used to identity isolates that are unlikely to respond to fluconazole or amphotericin B. However, this is not currently available at most institutions. 

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