Comparison of conjunctival pedicle flap to corneal fixation strength achieved by Tisseel® fibrin glue, ethyl cyanoacrylate adhesive, ReSure® hydrogel sealant, and conventional suturing with 8-0 VICRYL® ophthalmic suture.

OBJECTIVE: To determine and compare the fixation strength of conjunctival pedicle flaps to cornea achieved via conventional ophthalmic suture and three different adhesive compounds. ANIMALS STUDIED: Ex vivo porcine globes. PROCEDURES: Following a 6 mm wide 500-micron-restricted depth lamellar keratectomy, conjunctival pedicle flaps were secured to the keratectomy site with either 8-0 VICRYL® suture or one of three adhesive products, including Tisseel® bioadhesive, ReSure® synthetic adhesive, or ethyl cyanoacrylate adhesive (n = 10 per surgical group). Adhesive application protocol varied by product based upon adhesive biocompatibility. Corneoconjunctival tissues were then harvested, clamped in a tensile testing device, and loaded at a rate of 1 mm/s under video surveillance until the point of failure. Peak load was determined for each test and used to compare fixation strength between samples. RESULTS: Forty conjunctival flaps were performed, with 6 omitted from evaluation due to dehiscence prior to tensile testing. Of the 34 flaps analyzed, 10 were secured with suture, 10 with cyanoacrylate, 8 with ReSure®, and 6 with Tisseel®. Flaps secured with suture withstood significantly higher applied tensile force compared with cyanoacrylate (p = .02474), ReSure® (p = .00000), and Tisseel® (p = .00002). Flaps secured with cyanoacrylate withstood significantly greater force than those secured with ReSure® and Tisseel® (p = .01194 and 0.01798, respectively). There was no significant difference in fixation strength between ReSure® and Tisseel® glue (p = .95675). CONCLUSIONS: Conjunctival pedicle flap fixation using 8-0 VICRYL® suture fixation was able to withstand significantly greater maximum tensile force compared to ReSure®, Tisseel®, or cyanoacrylate adhesives. Fixation strength achieved with cyanoacrylate adhesive was significantly greater than that achieved with ReSure® or Tisseel®.

Facial Fracture Injury Criteria from Night Vision Goggle Impact.

INTRODUCTION: Military personnel extensively use night vision goggles (NVGs) in contemporary scenarios. Since NVGs may induce or increase injuries from falls or vehicular accidents, biomechanical risk assessments would aid design goal or mitigation strategy development.METHODS: This study assesses injury risks from NVG impact on cadaver heads using impactors modeled on the PVS-14 NVG. Impacts to the zygoma and maxilla were performed at 20° or 40° angles. Risks of facial fracture, neurotrauma, and neck injury were assessed. Acoustic sensors and accelerometers assessed time of fracture and provided input variables for injury risk functions. Injuries were assessed using the Abbreviated Injury Scale (AIS); injury severity was assessed using the Rhee and Donat scales. Risk functions were developed for the input variables using censored survival analyses.RESULTS: The effects of impact angle and bone geometry on injury characteristics were determined with loading area, axial force, energy attenuation, and stress at fracture. Probabilities of facial fracture were quantified through survival analysis and injury risk functions. These risk functions determined a 50% risk of facial bone fracture at 1148 N (axial force) at a 20° maxillary impact, 588 N at a 40° maxillary impact, and 677 N at a 20° zygomatic impact. A cumulative distribution function indicates 769 N corresponds to 50% risk of fracture overall.DISCUSSION: Results found smaller impact areas on the maxilla are correlated with higher angles of impact increasing risk of facial fracture, neck injuries are unlikely to occur before fracture or neurotrauma, and a potential trade-off mechanism between fracture and brain injury.Davis MB, Pang DY, Herring IP, Bass CR. Facial fracture injury criteria from night vision goggle impact. Aerosp Med Hum Perform. 2023; 94(11):827-834.

Phenotypic characterization of complete CSNB in the inbred research beagle: how common is CSNB in research and companion dogs?

PURPOSE: Although congenital stationary night blindness (CSNB) has been described in a Japanese beagle dog research colony, certain clinical correlates with human CSNB have not yet been described, nor has an estimate of frequency of the condition been made in inbred and outbred beagle populations. METHODS: A beagle with CSNB obtained from a commercial research dog supplier in the USA and matched control dogs (n = 3) underwent examination, refraction, ocular imaging, assessment of visual navigation ability and detailed electroretinography (ERG). Retrospective review of ERGs in two independent groups of inbred (n = 15 and 537, respectively) and one group of outbred dogs (n = 36) was used to estimate CSNB frequency in these populations. RESULTS: In the affected dog, there were absent dark-adapted b-waves in response to dim-light flashes, severely reduced dark-adapted b-waves in response to bright-light flashes, and normal light-adapted b-waves with a-waves that had broadened troughs. Long-flash ERGs confirmed a markedly reduced b-wave with a preserved d-wave, consistent with cone ON-bipolar cell dysfunction. There was evidence of normal rod photoreceptor a-wave dark adaptation, and rapid light adaptation. In the wider beagle populations, five inbred beagles had a b/a wave ratio of < 1 in dark-adapted bright-flash ERG, whereas no outbred beagles had ERGs consistent with CSNB. CONCLUSIONS: The identified dog had clinical findings consistent with complete type CSNB, similar to that described in the Japanese colony. CSNB appears to be a rare disorder in the wider beagle population, although its detection could confound studies that use retinal function as an outcome measure in research dogs, necessitating careful baseline studies to be performed prior to experimentation.

Effects of perioperative topical dorzolamide hydrochloride-timolol maleate administration on incidence and severity of postoperative ocular hypertension in dogs undergoing cataract extraction by phacoemulsification.

OBJECTIVE To assess the effects of topically applied 2% dorzolamide hydrochloride-0.5% timolol maleate ophthalmic solution (DHTM) on incidence and severity of postoperative ocular hypertension (POH; ie, intraocular pressure [IOP] > 25 mm Hg) in dogs undergoing cataract extraction by phacoemulsification. DESIGN Randomized, masked, controlled study. ANIMALS 103 dogs (180 eyes). PROCEDURES Pertinent history, signalment, and ophthalmic examination findings were recorded. Dogs received 1 drop of DHTM or sham treatment solution (sterile, buffered, isotonic eye drops) in both eyes 14 hours and 2 hours before anesthetic induction and at the time of corneal incision closure (ie, end of surgery); IOPs were assessed by rebound tonometry 2, 4, 6, and 8 hours after surgery and between 7:30 and 8:00 am on the following day. Dogs with IOPs of 26 to 45 mm Hg received 1 drop of 0.005% latanoprost solution topically; the surgeon's treatment of choice was used for dogs with IOPs > 45 mm Hg. Incidence of POH and postoperative IOPs were compared between treatment groups. RESULTS DHTM treatment resulted in significantly lower incidence of POH than did sham treatment at the level of the dog (18/53 [34%] vs 31/50 [62%]) and the eye (24/94 [26%] vs 42/86 [48%]). Mean IOP did not differ between groups at the time of POH detection. The DHTM-treated eyes that developed POH were significantly more likely to have a 1-hour follow-up IOP < 25 mm Hg after latanoprost administration than were sham-treated eyes (19/25 [76%] vs 18/35 [51%]; OR, 3.87). CONCLUSIONS AND CLINICAL RELEVANCE Multidose perioperative administration of DHTM in dogs undergoing phacoemulsification reduced the incidence of POH and improved responsiveness of POH to latanoprost treatment.

Optic nerve astrocytoma in a dog.

Intracranial astrocytomas are relatively uncommon in dogs and optic nerve astrocytomas even more so. This neoplasm should be considered as differential in canine patients with vision loss, retinal detachment, ocular mass, and histopathologic findings of infiltrative fusiform to polygonal glial cells possibly associated with glomeruloid vascular proliferation.

Expression of vascular endothelial growth factor receptor-1 and -2 in normal and diseased canine eyes.

OBJECTIVE: To immunohistochemically evaluate expression of vascular endothelial growth factor receptor-1 (VEGFR1) and -2 (VEGFR2) in ocular tissue of healthy dogs and dogs affected with primary glaucoma, uveitic glaucoma, and intraocular neoplasia. SAMPLE POPULATION: Enucleated globes from five dogs with primary glaucoma, five dogs with uveitic glaucoma, six dogs with intraocular neoplasms and three ophthalmically normal control dogs. PROCEDURE: Ocular tissues were obtained from enucleated globes of clinical cases or immediately following euthanasia for control dogs. Tissue sections were stained immunohistochemically for VEGFR1 and VEGFR2 via standard techniques and vascular tissue was qualitatively evaluated. Vascular endothelial VEGFR1 and VEGFR2 expression patterns are reported for normal and diseased ocular tissues. In addition, VEGFR1 and VEGFR2 expression patterns are reported for all normal ocular tissues. RESULTS: A constitutive expression pattern was detected for VEGFR1 by ocular vascular endothelial cells as well as nonvascular cells in the cornea, uvea, lens, and retina. VEGFR2 demonstrated limited expression in normal ocular tissue, but was widely expressed in vascular endothelium of diseased eyes, particularly in pre-iridal fibrovascular membranes. CONCLUSIONS: The results of this study suggest a role for VEGF receptors in both physiologic and pathologic angiogenesis in canine ocular tissue. Manipulation of this pathway may be a rational consideration for therapeutic intervention in canine ocular disease exhibiting pathologic neovascularization.

Aqueous humor vascular endothelial growth factor in dogs: association with intraocular disease and the development of pre-iridal fibrovascular membrane.

OBJECTIVE: To examine the concentrations of vascular endothelial growth factor (VEGF) in aqueous humor of dogs with intraocular disease and to evaluate the association of aqueous humor VEGF with pre-iridal fibrovascular membrane (PIFM) formation. PROCEDURES: Two hundred and twenty six aqueous humor samples and 101 plasma samples were collected from 178 dogs with a variety of intraocular diseases (including cataract, primary glaucoma, uveitic glaucoma, aphakic/pseudophakic glaucoma, retinal detachment, lens luxation, and intraocular neoplasia), and aqueous humor was collected from 13 ophthalmically normal control dogs. Systemic disease status and administration of select medications were recorded. Aqueous and plasma VEGF was assayed via enzyme-linked immunosorbant assay validated for canine VEGF. Available histopathology samples were examined for the presence of PIFM. Where present, PIFMs were categorized as none, cellular, vascular or fibrous, and fibrovascular. Data were evaluated by mixed model anova, with application of Tukey-Kramer adjustment for multiple comparisons. RESULTS: There was no association between aqueous humor and plasma VEGF levels. Compared with normal controls, aqueous humor VEGF was significantly elevated for all intraocular diseases (P < 0.05) except for primary and diabetic cataracts. Systemic disease and administered medications had no significant effect on aqueous humor VEGF concentration. Compared to dogs without PIFM, aqueous humor VEGF was significantly higher in dogs with fibrovascular PIFM (P = 0.001), but not cellular (P = 0.1704) or fibrous/vascular PIFM (P = 0.0667). CONCLUSIONS: These findings confirm that VEGF is commonly elevated in aqueous humor of dogs with intraocular disease and likely plays a role in the causation or progression of a variety of intraocular disorders, including the development of PIFM.

Acremonium keratomycosis in a cat.

A 14-year-old, female spayed Domestic Short-haired cat was presented for evaluation of progressive superficial corneal ulceration with mucoid ocular discharge, blepharospasm, and conjunctival hyperemia OD. Upon examination, ulcerative keratitis with stromal loss, chemosis, corneal edema, miosis, aqueous flare, and hyphema were noted. Corneal cytology revealed branching, septate fungal hyphae with bulbous terminations and associated ovoid structures, with suppurative inflammation. Fungal culture of corneal swabs confirmed the presence of Acremonium, although PCR of the cytology sample was negative. Ten days of treatment with topical 1% miconazole resulted in clinical deterioration before switching to topical 1% voriconazole solution, which was successful in resolving the infection. The apparent clinical efficacy of the topical antifungals used contrasted with the in vitro susceptibility profile.

Evaluation of nasolacrimal fluorescein transit time in ophthalmically normal dogs and nonbrachycephalic cats.

OBJECTIVE: To evaluate fluorescein nasolacrimal transit (NLT) times in ophthalmically normal dogs and nonbrachycephalic cats by use of 2 methods of the Jones test. ANIMALS: 73 dogs and 36 cats. PROCEDURES: Fluorescein dye was applied to the ocular surface of both eyes by means of a wetted fluorescein strip and, in a subsequent test, by administration of a drop of 0.2% fluorescein solution. During each test, the nares were monitored for the appearance of fluorescein for up to 30 minutes after application. Time of fluorescein appearance at the nares was recorded as NLT time. Recorded variables for all study animals included age, reproductive status, body weight, and Schirmer tear test values. For dogs, skull index, snout length, and cephalic conformation were also recorded. Data were grouped for statistical comparisons according to test results. RESULTS: In both dogs and cats, NLT was faster when the fluorescein solution versus fluorescein strip was used. In cats, none of the recorded variables had a significant effect on NLT, irrespective of the testing method used. In dogs, several variables had a significant effect on NLT, including cephalic conformation, snout length, age, and reproductive status, but these findings varied with testing method and testing group. CONCLUSIONS AND CLINICAL RELEVANCE: NLT was highly variable in dogs and cats, regardless of testing method used. Assessment of nasolacrimal patency in brachycephalic dogs by use of either method evaluated here is not likely to be clinically useful. In cats, assessment of nasolacrimal patency with the fluorescein drop method was faster and more conclusive than with the fluorescein strip method.

Effect of body position on intraocular pressure in dogs without glaucoma.

OBJECTIVE: To determine the effects of body position on intraocular pressure (IOP) in dogs without glaucoma. ANIMALS: 24 healthy dogs with no evidence of glaucoma. PROCEDURES: Dogs underwent ophthalmic examinations to ensure that no IOP-affecting ocular diseases were present. Each dog was sequentially placed in dorsal recumbency, sternal recumbency, and sitting position. For each of the 3 positions, IOP in the right eye was measured by use of an applanation tonometer immediately after positioning (0 minutes) and after 3 and 5 minutes had elapsed. The initial body position was randomly assigned; each position followed the other positions an equal number of times, and IOP measurements were initiated immediately after moving from one body position to the next. Proparacaine hydrochloride (0.5%) was applied to the right eye immediately prior to IOP measurements. RESULTS: Intraocular pressure was affected by body position. During the 5-minute examination, IOP decreased significantly in dogs that were dorsally recumbent or sitting but did not change significantly in dogs that were sternally recumbent. For the 3 positions, overall mean IOP differed significantly at each time point (0, 3, and 5 minutes). Mean IOP in dorsal recumbency was significantly higher than that in sternal recumbency at 0 and at 3 minutes; although the former was also higher than that in sitting position at 3 minutes, that difference was not significant. CONCLUSIONS AND CLINICAL RELEVANCE: Body position affects IOP in dogs. When IOP is measured in dogs, body position should be recorded and consistent among repeat evaluations.

High rate internal pressurization of the human eye to determine dynamic rupture pressure.

Over 1.9 million people suffer from eye injuries in the United States, occurring from automobile accidents, sports related impacts, and military combat. The purpose of the current study is to analyze the rupture pressure of human eyes using a high rate pressurization system. Internal pressure was dynamically induced into the eye with a drop tower pressurization system. The rupture pressure was measured with a small pressure sensor inserted into the optic nerve. A total of 10 human eye dynamic pressure tests were performed to determine rupture pressure and to compare the results with previous data. It was found that the average high rate rupture pressure of human eyes is 0.89+/- 0.25 MPa. In comparing these data with previous studies, it is concluded that as the loading rate increases the rupture pressure also increases.

Ophthalmic examination findings in adult pygmy goats (Capra hicus).

OBJECTIVE: To document normal ophthalmic findings and ocular abnormalities in captive adult pygmy goats. ANIMALS STUDIED: Ten healthy adult pygmy goats (five male, five female; 5-11 years of age; 26-45 kg body mass) underwent complete ophthalmic examinations. PROCEDURE: Direct illumination, diffuse and slit-beam biomicroscopy, indirect ophthalmoscopy, IOP measurements and Schirmer tear tests were performed. TonoVet rebound tonometry, followed by topical application of 0.5% ophthalmic proparacaine, and Tono-Pen XL applanation tonometry were performed in each eye to obtain estimates of IOP. RESULTS: Ophthalmic abnormalities included corneal scars and pigmentation, incipient cataracts, lenticular sclerosis, and vitreal veiling. Mean STT values were 15.8 mm/min, with a range of 10-30 mm/min. Mean IOP values were 11.8 mmHg for TonoVet-D, with a range of 9-14 mmHg; 7.9 mmHg for TonoVet-P, with a range of 6-12 mmHg; and 10.8 mmHg for Tono-Pen XL, with a range of 8-14 mmHg. CONCLUSIONS: Ophthalmic examination findings in adult pygmy goats, including normal means and ranges for STT and IOP measurements, using applanation and rebound tonometry, are provided.

Outcomes of nonsurgical management and efficacy of demecarium bromide treatment for primary lens instability in dogs: 34 cases (1990-2004).

OBJECTIVE: To determine outcome of initial conservative management for primary lens luxation and evaluate topically administered demecarium bromide miotic treatment for prevention of anterior lens luxation, glaucoma, and vision loss in dogs. DESIGN: Retrospective case series. ANIMALS: 34 dogs with primary lens luxation. PROCEDURES: Medical records of affected dogs were reviewed for times to anterior luxation, luxation of the lens in the opposite eye, development of glaucoma, and vision loss. RESULTS: At 4 to 6 weeks and at 3 months after diagnosis of lens instability (subluxation or posterior luxation), 100% (34/34 and 29/29, respectively) of conservatively managed eyes retained vision. At 1 year after diagnosis of lens instability, 80% (16/20) of conservatively managed eyes retained vision, and at 2 years after diagnosis of lens instability, 11 of 19 conservatively treated eyes retained vision. The only significant effect of miotic treatment was to delay anterior lens luxation in eyes with lens instability. Miotic treatment did not significantly affect the time from anterior lens luxation in 1 eye to anterior luxation in the other eye, time to onset of glaucoma, or time to loss of vision in eyes with an unstable lens. CONCLUSIONS AND CLINICAL RELEVANCE: Prophylactic topically administered miotic treatment may be effective at delaying anterior luxation of an unstable lens in eyes affected by primary lens instability. Conservative medical management of dogs with primary lens instability is a reasonable alternative to surgical removal of a subluxated or posteriorly luxated lens via intracapsular lens extraction.

Presumed and confirmed striatocapsular brain infarctions in six dogs.

OBJECTIVE: To describe the clinical and diagnostic features of the canine sensorimotor syndrome caused by striatocapsular brain infarctions (SCI). ANIMALS STUDIED: Six dogs with diagnostic imaging or postmortem evidence of SCI. PROCEDURES: Medical records of dogs with SCI were retrospectively reviewed and the signalment, history, clinical signs, antemortem clinicopathologic test results, diagnostic imaging findings, case outcomes, and pathologic findings recorded. RESULTS: All dogs had an acute onset of nonprogressive homonymous visual field deficits and contralateral general proprioceptive (GP) deficits. Contralateral hemiparesis and facial hypalgesia were noted in 5/6 dogs. CT scans were normal in 2/4 dogs, and revealed poorly defined hypoattenuating lesions in the subcortical white matter in two dogs. MRI exams were performed in 5/6 dogs and revealed unilateral, variably sized, striatocapsular lesions consistent with nonhemorrhagic infarctions. Diagnostic imaging (6/6) and postmortem examinations (2/6) suggested that SCI resulted from lesions in the vascular territories of the rostral choriodal (6/6) and lenticulostriate arteries (2/6). Diseases predisposing to infarction were not identified in 5/6 dogs. Improvements in mentation, behavior, proprioceptive deficits, and hemiparesis were seen in surviving dogs, but persistent, symptomatic sensory deficits were noted during the follow-up period. CONCLUSIONS: SCI should be considered as a differential diagnosis for dogs with acute onset, nonprogressive homonymous hemianopia, contralateral GP deficits or hemiparesis, and facial hypalgesia. MRI is the preferred modality for the antemortem imaging diagnosis of SCI. Although partial recovery occurred in all surviving dogs, visual and facial sensory disturbances persisted.

Duration of corneal anesthesia following topical administration of 0.5% proparacaine hydrochloride solution in clinically normal cats.

OBJECTIVE: To determine duration of corneal anesthesia following topical administration of 0.5% proparacaine hydrochloride solution in domestic shorthair (DSH) cats. ANIMALS: 20 clinically normal DSH cats. PROCEDURES: Baseline corneal touch threshold (CCT) was established by use of a Cochet-Bonnet aesthesiometer. Treatment consisted of a single 50-microL topical application of an ophthalmic preparation of 0.5% proparacaine solution to a randomly selected eye of each cat. The corneal touch threshold was assessed 1 and 5 minutes after application to the cornea and at 5- minute intervals thereafter for 60 minutes. RESULTS: Corneal sensitivity, as determined by Cochet-Bonnet aesthesiometry, was significantly reduced from baseline for 25 minutes following topical administration of ophthalmic proparacaine. Maximal anesthetic effect lasted 5 minutes. CONCLUSIONS AND CLINICAL RELEVANCE: As determined by Cochet-Bonnet aesthesiometry, duration of anesthetic effects on the cornea induced by a single topical application of an ophthalmic preparation of 0.5% proparacaine solution in DSH cats is considerably shorter than the reported duration of corneal anesthesia in dogs.

The effects of extraocular muscles on static displacements of the human eye.

More than 30,000 people lose sight in at least one eye every year in the United States. Globe rupture is one of the most severe injuries and can often result in the loss of an eye. Previous studies to determine the injury tolerance of the human eye to globe rupture have not investigated the effects of extraocular muscles on the response of the eye. The purpose of the current study is to quantify the effects of the extraocular muscles using quasistatic displacement tests of the human eye in situ. A total of three post-mortem human heads were used for the matched pair tests designed to elucidate any differences in the force-deflection response of the human eye with the extraocular muscles intact and transected. Computed tomography imaging was utilized to observe the deformation of the eye within the orbit for each displacement, from 0 mm to 30 mm. Slight differences in the force-deflection response are observed; however, it is not clear how these differences will influence impact response at a dynamic rate. It was also observed that under quasistatic displacements that the eye is able to translate out of the way of the impactor assembly, even under large deflections, and without globe rupture. Additional dynamic tests are recommended to determine the effects of the extraocular muscles on eye impact response.

Constant rate infusion for topical ocular delivery in horses: a pilot study.

OBJECTIVE: To assess the efficacy and kinetics of a continuous infusion modality for topical ophthalmic drug delivery via subpalpebral lavage in horses. ANIMALS STUDIED: Five ophthalmically normal horses PROCEDURES: A constant-rate continuous delivery pump was used to apply 0.01% fluorescein solution to the eyes of five ophthalmically normal horses via subpalpebral lavage. Fluorescein was applied at a rate of 0.14 mL/h for 72 h. Tear samples were collected from the ventral conjunctival fornix at regular intervals via capillary tube and tear fluorescein concentrations were determined via spectral assay. Laboratory studies to evaluate the procedures used in the study also were performed. RESULTS: Overall mean tear film fluorescein concentration was approximately 20% of the applied concentration of fluorescein. However, tear film fluorescein concentrations varied considerably between horses and over time. Dilution varied from 0.62% to 60% of the applied concentration. Air pockets sporadically appeared in subpalpebral lavage tubing lines, resulting in discontinuous topical application of fluorescein. CONCLUSIONS: Constant-rate delivery of ophthalmic medications using a continuous infusion pump may provide a valuable method of topical drug delivery if tear film dilution of drugs is taken into account.

Determination of significant parameters for eye injury risk from projectiles.

BACKGROUND: Eye injuries affect a large proportion of the population and are expensive to treat. This article presents a parametric analysis of experimental data to determine the most significant factors for predicting ocular injuries or tissue lesions. METHODS: Using logistic regression, statistical values were generated to determine significant projectile characteristics for predicting ocular injury in published studies. Projectiles included BBs, metal rods, and foam particles with velocities ranging from 2 m/s to 122 m/s. RESULTS: A normalized energy (energy per projected area) value was found as the best predictor for ocular injury. Using this predictor, a 50% injury risk of corneal abrasion, lens dislocation, hyphema, retinal damage, and globe rupture was found to be 1,503 kg/s(2), 19,194 kg/s(2), 20,188 kg/s(2), 30,351 kg/s(2), and 23,771 kg/s(2), respectively. CONCLUSION: Normalized energy was the most significant predictor of injury type and tissue lesion. This finding is of great value for history-taking management triaging and as a design aid to minimize the risk of ocular injury for consumer products.

Blunt trauma of the aging eye: injury mechanisms and increasing lens stiffness.

OBJECTIVE: To investigate possible injury mechanisms in the eyes of elderly individuals and the effects of lens stiffness on model outputs indicative of injury as a function of age. METHODS: Three separate frontal impact scenarios, a foam particle (30 m/s), steering wheel (15 m/s), and air bag (67 m/s), were simulated with a validated finite-element model to determine the effects of changing lens stiffness on the eye when subjected to blunt trauma. The lens stiffness of the model was increased with increasing age using stiffness values determined from the literature for 3 age groups. RESULTS: The computational eye model demonstrated increasing peak stress in the posterior portion of the ciliary body and decreasing peak stress in the posterior portion of the zonules with increasing lens stiffness for the 2 most severe impact types, the air bag and steering wheel. Peak deformation of the lens decreased with increasing lens stiffness. CONCLUSIONS: On the basis of the computational modeling analysis, the risk of eye injury increases with age; as a result, the eyes of elderly patients may be more susceptible to ciliary body-related eye injuries in traumatic-impact situations. Clinical Relevance These data support the contention that trauma-induced damage to the lens, ciliary body, and zonules may be related to increased stiffness of the lens. The data indicate that all people, especially elderly individuals, should use safety systems while driving an automobile and sit as far from the air bag as is comfortable. Those in sports or work environments requiring protective lenses should wear them. Designers of air bags and automobile companies should continue to work to reduce the potential that the air bag will contact the eye.

Bilateral cavernous sinus syndrome in dogs: 6 cases (1999-2004).

OBJECTIVE: To determine clinical features, diagnostic imaging abnormalities, underlying disease, disease progression, and outcome in dogs with bilateral cavernous sinus syndrome. DESIGN: Retrospective study. ANIMALS: 6 dogs. PROCEDURE: Dogs were included if clinical signs consistent with bilateral cavernous sinus syndrome (i.e., deficits of the third, fourth, and sixth cranial nerves and at least 1 of the first 2 branches of the fifth cranial nerve) were present and a lesion of the cavernous sinus was identified by means of diagnostic imaging or postmortem examination. RESULTS: 5 dogs were evaluated because of problems referable to abnormal ocular motility or pupillomotor dysfunction, and 1 dog was evaluated because of partial motor seizures involving the face and bilateral mydriasis. Four dogs had neurologic signs referable to an extrasinusoidal lesion at the time of initial examination, and the remaining 2 dogs eventually developed extrasinusoidal signs. Besides neuroanatomic location, the only consistent neuroimaging feature was variably intense, heterogeneous enhancement of cavernous sinus lesions. Neoplasia was histologically confirmed as the underlying cause in 5 of the dogs and was suspected in the remaining dog. Median survival time for the 4 dogs that were treated was 199 days (range, 16 to 392 days). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that bilateral cavernous sinus syndrome is rare in dogs but should be suspected in dogs with compatible clinical signs. Affected dogs have a poor prognosis, and dogs with clinical signs of bilateral cavernous sinus syndrome should be systematically evaluated for neoplastic disease.