[Paresis of the superior oblique eye muscle]. / Parese av øvre skrå øyemuskel.

Congenital or acquired palsy of the superior oblique eye muscle presents a clinical picture which is consistent and recognizable. The diagnosis is based upon two clinical findings: hypertropia of the affected eye with a greater than normal vertical deviation in adduction, and an increase of the hypertropia when tilting the head towards the affected side (positive Bielschowsky test). In the majority of cases the dominant feature of the clinical picture is overreaction of the ipsilateral inferior oblique. We have retrospectively examined 22 patients with superior oblique palsy who underwent surgery. Median follow-up time was three months. 20 (91%) of the patients were operated primarily by performing a recession of the ipsilateral inferior oblique muscle. Additional surgery had to be performed on five patients. The final postoperative examination showed the result to be a success in 19 (86%) of the patients, judged on relief of symptoms and objective measurements. We conclude that in the majority of cases surgical treatment of superior oblique palsy by recession of the ipsilateral inferior oblique gives good results.

Ophthalmia neonatorum in northern Norway. I: Epidemiology and risk factors.

During one year, 1928 of all 1958 neonates born in the county of Troms in Northern Norway were followed until 6 weeks of age, regarding the development of ophthalmia neonatorum. Conjunctivitis was found in 364 cases (189 per 1000 neonates), including mild and self-limiting cases. In 14.5 cases per 1000 neonates the ophthalmia neonatorum was recorded as severe. Boys were more often affected than girls (P = 0.001). The age of the mother and obstetric events did not significantly influence the occurrence of conjunctivitis. 31.4% of the neonates received silver nitrate instillation. The frequency of conjunctivitis in the group with and without prophylaxis was 15.9 and 20.3%, respectively (P = 0.023). The incidence of chlamydial ophthalmia was 8 per 1000 neonates. At present, chlamydial ophthalmia is a common disease in neonates. Efforts should be made to screen fertile women for chlamydial genital infection and to encourage prompt microbiological examination in cases of ophthalmia neonatorum.

Ophthalmia neonatorum in northern Norway. II. Microbiology with emphasis on Chlamydia trachomatis.

In a population of 1928 neonates in Northern Norway, ophthalmia neonatorum was diagnosed in 18.9%, including mild and self-limiting cases. Sixteen out of 269 (6.0%) cultured cases were positive for Chlamydia trachomatis. No gonococcal ophthalmia was seen. In neonates whose symptoms began in the maternity wards, the distribution of the isolated microorganisms (mainly Staphylococcus aureus) was different from those in whom symptoms began after discharge (mainly S. aureus, Staphylococcus species (coagulase-negative), Streptococcus viridans and C. trachomatis). Growth of C. trachomatis was significantly associated with the intensity of conjunctivitis (P less than 0.001). However, no sequelae could be demonstrated in the eyes at the age of 6 months. 60% of the neonates with chlamydial ophthalmia also suffered from rhinitis. 31.4% of the neonates received silver nitrate instillation, which had no significant influence on the frequency of chlamydial ophthalmia. General practitioners are often faced with chlamydial ophthalmia. In cases of ophthalmia neonatorum, a microbiological examination is recommended, as a guide to appropriate antibiotic treatment. The result of microbiological examination may also indicate other infections in mother and child. In areas with a readily available health service, including an adequate microbiological laboratory service, prophylaxis in the eyes does not seem to be necessary.

Perinatal transmission of Chlamydia trachomatis. The use of serological tests in detecting infected women.

A study is presented on the use of serological tests for the detection of Chlamydia trachomatis in 273 pregnant women. 166 were cultured for C. trachomatis and nine (5.4%) were positive. Three culture-positive babies, all born to culture-positive women, had conjunctivitis. Elevated IgG and IgA antibody levels were seen in six (67%) and three (33%) of the infected women, respectively. Three (2.4%) of IgG antibody-negative mothers (n = 126) were positive by culture. Compared to serology culture of the microorganism appears as the most reliable way of detecting infected women.

Ophthalmomyiasis caused by the reindeer warble fly larva.

Two boys with ophthalmomyiasis caused by the first instar larva of the reindeer warble fly Hypoderma tarandi are reported. Both were 9 years old and came from the coast of northern Norway. One had ophthalmomyiasis interna posterior and one eye had been removed because of progressive pain and blindness. Histological examination showed the remains of a fly larva. The second boy had ophthalmomyiasis externa with a tumour in the upper eyelid, and histological examination showed a warble with a well preserved larva. Identification of the parasite in the histological material was based on the finding of cuticular spines and parts of the cephalopharyngeal skeleton identical with those of the first instar larva of H tarandi.

Cultivation of Chlamydia trachomatis. Different methods of treating the specimens.

Specimens of Chlamydia trachomatis were treated either by five different detergents, by ultrasound sonication or by four different buffers before cultivation in cycloheximide-treated McCoy cells. The chlamydial yield by cultivation and the variance of the yield were compared to a standard method using 0.2 molar sucrose in phosphate buffered saline (2SP) without application of detergents or sonication. 2SP was superior to the other buffers. None of the detergents increased the chlamydial yield. Sonication at energy-levels above approximately 1200 Ws/ml reduced the chlamydial yield significantly. Sonication just below this threshold doubled the yield. None of the methods reduced the variance of the yield.

Culture, ELISA and immunofluorescence tests for the diagnosis of conjunctivitis caused by Chlamydia trachomatis in neonates and adults.

The relative value of culture, direct specimen antigen detection tests, i.e., enzyme-linked immunosorbent assay (ELISA) and immunofluorescence (IF) tests in the diagnosis of Chlamydia trachomatis infection was studied in 125 newborns and 121 adults with signs of conjunctivitis. Eye and nasopharyngeal samples were tested by culture using cycloheximide-treated or irradiated McCoy cells, ELISA (i.e., Chlamydiazyme, Abbott) and IF tests (i.e., Chlamyset, Orion and MicroTrak, Syva). Of the neonates, 70 (35 boys and 35 girls) and 54 (33 males and 21 females) of the adults were positive in one or both eyes in one or more tests: 191 (39%) in cultures, 173 (35%) in ELISA and 160 (33%), 176 (36%) in each of the IF tests. Using culture as standard reference, the sensitivities of ELISA and the IF tests were 88%, 81% and 87%, while the corresponding specificities were 99%, 98% and 97%, respectively. The predictive values for a negative test (PVN) were 93%, 89% and 92% and for a positive test (PVP) 98%, 96% and 94%. Of the 124 cases chlamydia-positive in the eyes, 67 (54%), 76 (61%), 64 (52%) and 70 (57%) were positive in nasopharyngeal samples in one or more of culture, ELISA and the two IF tests, respectively. The sensitivities of ELISA and the IF tests in nasopharyngeal samples were 87%, 78% and 81%, while the corresponding specificities were 90%, 93% and 91%, respectively. The predictive values for a negative (PVN) test were 95%, 92% and 93%, and for a positive test (PVP) 76%, 81%, and 77%. Nasopharyngeal swabs were more often positive in cases with 2 or more weeks' duration of symptoms than in those with shorter duration.

Chlamydia trachomatis: in vitro susceptibility of genital and ocular isolates to some quinolones, amoxicillin and azithromycin.

The minimum inhibitory concentration (MIC) of ofloxacin, ciprofloxacin, norfloxacin, amoxicillin and a new erythromycin analogue (azithromycin or CP 62993) against Chlamydia trachomatis was determined. There was a large difference between the MICs (microgram/ml) of different quinolones (median of 3 independent measurements; range): ofloxacin (0.5; 0.5-1) less than ciprofloxacin (1; 1-2) less than norfloxacin (16; 16-32). The MIC of amoxicillin varied from 0.25 to 1 (median 0.5) in different experiments. The MIC of azithromycin (0.125; 0.063-0.25) was lower than that of erythromycin (0.25; 0.125-0.5). The minimum lethal concentration (MLC) of ofloxacin and azithromycin was determined with and without passage of the McCoy cells. Both methods gave the same results. Ofloxacin seemed to have a lethal effect on C. trachomatis, as the MIC and MLC were equal. In contrast, the effect of the MIC of azithromycin on C. trachomatis was bacteriostatic. The MLC of azithromycin was 2-4 times higher than the MIC (p less than 0.001).