Can J Ophthalmol
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Randomized Controlled Trial Clinical Trial
Effect of a topical anesthetic cream (EMLA) in reducing pain caused by infiltration of local anesthetic in eyelid surgery.
EMLA (eutectic mixture of local anesthetics) cream is a topical formulation of a mixture of lidocaine and prilocaine. It has been used to achieve local analgesia after application under an occlusive dressing. We carried out a double-blind randomized controlled clinical trial to assess the effect of 5% EMLA (25 mg/mL of lidocaine and of prilocaine) in reducing the pain caused by infiltration of local anesthetic in eyelid surgery. ⋯ Clinical significance was defined as a difference in pain scores of 3 or more between EMLA and placebo. The mean pain scores for EMLA and placebo were 3.1 and 4.0 respectively, a nonsignificant difference. The EMLA preparation was found not to be clinically effective in reducing pain caused by infiltration of local anesthetic in eyelid surgery.
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Colour flow Doppler ultrasonography is a relatively new technique in which colour-encoded representations of flowing blood are imposed over a conventional grey-scale ultrasound image. This allows interrogation of a relatively large volume of tissue to determine the presence and direction of blood flow. ⋯ The technique can also be used to evaluate ocular membranes and masses. Colour flow Doppler imaging promises to be an important advance in ophthalmic ultrasonography.
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Brain-stem anesthesia is a serious complication of orbital regional anesthesia that may occur when the injected local anesthetic agent gains access to the central nervous system by direct spread from the apex of the orbit via submeningeal pathways. In most studies the reported incidence rate during retrobulbar block is one case per 350 to 500 patients. Failure to recognize the condition or to treat it adequately may be life threatening. ⋯ In all situations in which orbital block is to be done, basic cardiopulmonary resuscitation equipment and personnel familiar with its use are essential. Monitoring of the blood pressure, electrocardiography and pulse oximetry should be routine. Having the globe in primary gaze renders the optic nerve less vulnerable, and avoidance of deep penetration of the orbit is of great importance.
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Intraocular BB pellet injuries are a devastating form of ocular trauma with a poor prognosis. The penetration of the eye by the pellet causes a marked disruption of the intraocular contents that in most cases leads to enucleation. ⋯ Eighteen months after the injury the acuity in the affected eye was 20/30 with a contact lens. To our knowledge this is the first case in which useful vision has been recovered in this type of injury.
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We describe 12 patients with endogenous endophthalmitis caused by Klebsiella pneumoniae seen between 1983 and 1988. Three patients had bilateral involvement. ⋯ In all eyes the outcome was light perception or worse; nine eyes had no light perception. Six eyes were enucleated or eviscerated.