American journal of ophthalmology
-
A 61-year-old woman experienced a cardiopulmonary arrest immediately after the retrobulbar injection of a mixture of 2 ml of 0.5% bupivacaine HCl, 2% mepivacaine HCl, and hyaluronidase. The patient was immediately resuscitated but remained unconscious for a total of 20 minutes. All neurologic deficits resolved completely over the two hours following the cardiopulmonary arrest and no adverse sequelae were noted. We assumed that this cardiopulmonary arrest was precipitated by the local anesthetic being transported via retrograde flow through the ophthalmic artery and then by antegrade flow through the internal carotid artery to the thalamus and other midbrain structures.
-
We examined and followed up 59 patients with conjunctival xerosis with a without classic Bitot's spots. Of these, 50 were responsive and nine were unresponsive to vitamin A. ⋯ Pigmentation and wrinkling were not useful diagnostic criteria and lesions isolated to the nasal corneoscleral limbus suggested a different diagnosis. At least some cases of nonresponsive conjunctival xerosis and Bitot's spots were probably sequelae of past vitamin A deficiency.
-
Twenty-one patients had esotropia diagnosed before age 12 months. In all of these patients esotropia was eliminated, at least initially, by antiaccommodative therapy consisting of either full hypermetropic spectacles or miotics, or both. ⋯ In approximately 50% of these patients early-onset accommodative esotropia deteriorated to a nonaccommodative esotropia that required surgery despite aggressive antiaccommodative therapy. All but one of the surgically treated patients continued to need hypermetropia spectacles postoperatively to maintain alignment.
-
Electrical stimulation in the treatment of postoperative ophthalmologic pain was applied in 25 patients. In 21, stimulation was applied by means of subcutaneously implanted wires and in four patients the therapy was administered by externally placed electrodes. The subcutaneous electrodes were introduced near the supraorbital and infraorbital nerves at the end of the surgical procedures, and stimulation was immediately begun. ⋯ As a result, the stimuli are perceived as a pleasant sensation. Complete pain relief was attained in nine patients, and in 13 patients the pain was diminished. The therapy is appropriate and effective in postoperative ocular pain, because the pain is restricted to a limited area, innervated by superficial nerves that are easily accessible to electrical stimulation.
-
Symptomatic superficial punctate keratitis associated with complete corneal anesthesia occurred in three patients after they had been taking timolol maleate for glaucoma. After discontinuation of the timolol maleate and substitution of conventional antiglaucomatous collyria, the keratitis gradually cleared with restoration of normal corneal sensitivity. Corneal sensitivity, measured in 25 additional patients taking timolol maleate, was markedly diminished in four patients, all of whom were elderly and had been using the drug for a minimum of three months. Timolol maleate does appear to have some local anesthetic properties in human cornea after chronic use by susceptible individuals.