Ulcer tears

Sulfur mustard, 2,2 -dichlorodiethyl sulfide, is a chemical warfare agent (Newman-Taylor and Morris 1991 Smith and Dunn 1991 Ruhl et al. 1994). It has been dumped into the sea, and fishermen have been injured when leaking containers get in their nets. The chemical is a viscous liquid below and a gas above 14 °C. On the skin, the liquid causes blisters and necrosis 10-12 h after skin exposure. The gas attacks mainly the eyes and the respiratory organs. Sometimes the skin is also affected by direct contact with the gas, and the chemical burn then clinically appears 3-6 h after exposure initial redness is followed by blisters and ulcers. Tear gas can give a bullous dermatitis (Zekri et al. 1995). 

A. Ethambutol is associated with retrobulbar neuritis, resulting in loss of central vision and impaired red-green discrimination. Ethionamide (B) is an analogue of isonicotinic acid and is associated with GI intolerance and peripheral neuropathy, but not the optic neuritis or color vision discrimination problems. Aminosalicylic acid (C) can cause GI irritation and bleeding problems, so caution is required in peptic ulcer patients. It has no neurological side effects. Rifampin (D) is associated with red-orange discoloration of saliva, tears, and urine but not the color vision problems. Isoniazid (E) is associated with peripheral neuritis in chronic alcoholics and malnourished individuals and requires pyridoxine supplements. It is not associated with optic neuritis. 

Fisher,14 discussing tear gases and their effect on human skin, remarked that CS Is a sensitizer and a primary Irritant capable of causing first- and second-degree burns and even ulcers if not washed off the skin. In experimentally sensitized subjects, CS elicited a skin response in one of nine when tested at 0.1%, but none reacted at 0.01Z.2/ Concentration is a factor in the elicitation of a skin response to a sensitizer, as well as an Irritant. 

Acute injuries of the eyes, primarily from effects of blast and missiles, may occur from tear-gas weapons, such as pen guns. The lnmeulate effects of these Injuries include swelling and edema of the lids, with penetration of skin, conjunctiva, cornea, sclera, or globe by gunpowder and CN conjunctival ischemia and chemosls corneal edema, erosion, Inflammation, or ulceration and focal hemorrhage. 13,20... 

Riboflavin deficiency is not associated with a specific disease per se (19,80,81). However, a lack of riboflavin in the diet produces changes in the eye, including photophobia, corneal opacity and ulceration, presenile cataracts, circumcomeal infections, and reduced tearing, as well as skin lesions, especially around the mouth, nose, and ears. 

The toxieity of both neat and vapor exposures of SM to the eye is highly predictable. After a time period of no symptoms, laerimation begins and quickly progresses to eonjunetivitis, pain, blepharospasm, and photophobia. Comeal edema follows rapidly as a result of the loss of the epithelium, whieh allows water to enter the stroma from the preeomeal tear film (Slatter, 1990). By 24 h after exposure, it is not unusual to see a 100 to 300% increase in comeal thiekness evident by a substantial increase in opacification. Fluorescein staining at 24 h will reveal ulcers that may eover a majority of the eomeal surface. By 48 h, evidence of healing is seen, and by 96 h, it is not imusual to have... 

Instillation of the dye in the cul-de-sac allows detection of corneal and conjunctival lesions, such as abrasions, ulcers, and edema, and aids in the detection of foreign bodies. When the cobalt blue filter of the slit lamp is used to excite the dye, the epithelial defect usually appears outlined in vivid green fluorescence.The dye turns green in the tear film, in spite of being introduced as a yellow-orange liquid, due to dilution with tear fluid. 

Noninfectious indolent epithelial ulcers also can occur in HSK.These ulcers, formerly referred to as metaherpetic lesions, tend to be ovoid, 2 to 8 mm in size, with smooth rolled edges. They may be caused by damage to the epithelial basement membrane due to inflammation, tear film abnormalities, neurotropic cornea, or toxicity from antiviral medications. These ulcers may be recalcitrant, resulting in neovascularization and scarring. 

Mucous plaque keratitis can be treated with 10% acetylcysteine but also resolves without treatment. Keeping the eye moist with artificial tears may be helpful. Exposiue keratitis and neruotropic keratitis are best treated with artificial tears, lid taping at bedtime, and, if necessary, tarsorrhaphy. Therapeutic contact lenses should not be used because of the risk of developing infectious ulcers in an eye with decreased sensitivity. 

Cobblestone-appearing papillae under upper Ud, mucous discharge Chemosis and injection of conjunctiva, SPK Injection, chemosis, tearing, mucopurulent discharge Severe injection, chemosis, possible ulceration of corneal epithelium and stroma, mucopurulent discharge, stromal infiltrate... 

Xeropthalmia Xeropthalmia is an eye disease characterized by drying of the eyes. The cells of lachrymal glands become keratinized and stops secreting tears hence the bacteria are not washed away. The external surface of cornea becomes dry with dull appearance. The eyelids, swells and becomes sticky and there will be severe eye infection. Ulcers may develop and if not treated in time blindness results. Less severe sub clinical... 

A corneal ulcer associated with deposits of norfloxacin in the right eye has been reported in a 40-year-old man with right trigeminal and facial nerve palsies and reduced tear secretion. He stopped using norfloxacin ophthalmic solution and recovered (3). 

Local tissue inhibitors (TIMPs), a neutrophil-derived inhibitor and systemic inhibitors, such as a2-macroglobulin and the lower-molecular-weight prealbumin proteinase inhibitor, variably inhibit endogenous MMPs and neutrophil serine proteinases. Inhibitors are present in the mammalian cornea and in the tear film, where they maintain a dynamic equilibrium with endogenously or exogenously derived proteinases as part of the normal molecular homeostasis of the ocular surface. Where this equilibrium is deranged, either by local overexpression of enzyme or by reduction in inhibitory capacity, then keratolysis and ulceration are the probable results. 

Heparin (1000 lU/ml) has been used to promote re-epithelialization in chronic refractory ulceration in the horse. Its mode of action is unknown but it may have an indirect antiproteinase activity by impeding the extravasation of leukocytes into the tear film. 

Greenfield SM, Green AT, Teare JP, et al. A randomized controlled study of evening primrose oil and fish oil in ulcerative colitis. Aliment Pharmacol Ther 1993 7 159-166. 

Eyes, conjunctivae - swelling (edema) Eyes, cornea - ulcer Eyes, tearing - excess (lacrimation) Eyes, vision - loss [2]... 

Drug penetration into the eye is approximately linearly related to its concentration in the tear film. Certain disease states, such as comeal ulcers and other comeal epithelial defects, may increase drug penetration when anatomic barriers are compromised or removed. Experimentally, drugs may be screened for their potential clinical utility by assessing their comeal permeability coefficients. These pharmacokinetic data combined with the drug s octanol/water partition coefficient (for lipophilic drugs) or distribution coefficient (for ionizable drugs) yield a parabolic... 

The one limitation at this medial malleolus site of high shear pressure is an occasional (one in four of the test cases, DP-7T) splitting or tearing of the disk, with early signs for ulcer for-... 

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