Compensatory head posture and neck problems: is there an association? A cohort study of nystagmus patients.

PURPOSE: The aims of this study were twofold: to investigate if a compensatory head posture due to nystagmus causes long-term neck problems or adversely effects quality of life and to survey ophthalmologists on their opinions and management of these patients. METHODS: A case-controlled study was carried out to assess the range of neck movements in patients with compensatory head posture due to congenital nystagmus. Exclusion criteria included known neck problems, vertebrobasilar insufficiency, and age less than 16 years. Neck movements were assessed using an inclinometer. Quality of life and disability was assessed using the American Academy of Orthopaedic Surgeons' Cervical Spine Questionnaire. One hundred and fifty consultant ophthalmologists throughout the United Kingdom were surveyed via a postal questionnaire. RESULTS: The range of motion in these patients (n=20) was limited when compared to matched controls especially for lateral flexion (P=0.001) and extension (P=0.003). However, despite limited movement, patients did not perceive a disability and there was no adverse effect on quality of life. In all 55% of ophthalmologists believed compensatory head posture due to nystagmus leads to long-term neck problems. About 46% had personal experience of patients with long-term neck problems due to nystagmus. Eighty-four per cent were influenced in their decision to operate by the presence of a head posture. CONCLUSIONS: Significant restriction in neck movements exists in nystagmus patients with compensatory head posture, although this does not appear to adversely affect quality of life.

Childhood amblyopia treatment: psychosocial implications for patients and primary carers.

PURPOSE: To investigate the psychosocial impact of amblyopia therapy on children and their carers. METHOD: The study was prospective and incorporated a repeated-measures design. A total of 59 carers were classified into occluded (n=31) or nonoccluded group (n=28). A questionnaire consisting of the Perceived Stress Index (PSI) and the Perceived Psychosocial Questionnaire (PPQ) was used to measure carer's perception of stress and psychosocial well-being of the child respectively prior to and following commencement of treatment. Parametric and nonparametric tests were used to analyse the data. RESULTS: No significant difference in carer's stress (P>0.05) and child's psychosocial well-being (P>0.05) was observed between occluded and nonoccluded groups. Within occluded group, carer's stress (P>0.05) and child's psychosocial well-being (P>0.05) did not differ significantly before and following commencement of treatment. Within the occluded group, carers felt more negative towards their child following onset of glasses therapy (P<0.01) and became more positive when occlusion was introduced in the subsequent follow-up (P<0.01). CONCLUSIONS: When compared to carers in the nonoccluded group, those with children undergoing occlusion therapy did not experience significantly more stress or perceived their child as exhibiting less psychosocial well-being. Within the occluded group, carers' stress level and child's psychosocial well-being did not significantly change following onset of occlusion therapy. Carers felt temporarily more negative towards the child following onset of treatment with glasses. In this study, there is no evidence to indicate that occlusion therapy has negative psychosocial impact on carers and children alike.

Post-traumatic orbital cellulitis.

Orbital cellulitis is uncommon. It may arise as a sequel to eyelid infection, or from direct spread of infection from the paranasal sinuses; it may be of odontogenic origin and has been reported after meningitis and after nasoorbital fractures with pre-existing sinusitis. Clinically, orbital cellulitis is of great importance, as it is a severe disease with potentially disastrous consequences. It may lead to optic neuritis, optic atrophy, blindness, cavernous sinus thrombosis, superior orbital fissure syndrome, meningitis, subdural empyema, and even death. We report two cases of severe post-traumatic orbital cellulitis with subperiosteal abscesses. These were managed surgically and vision was preserved. We describe the anatomy, a classification of orbital infection, and the importance of multidisciplinary management of these cases.

Systemic effects of screening for retinopathy of prematurity.

AIMS: To detect systemic complications of screening for retinopathy of prematurity (ROP), paying particular attention to the physical examination. METHODS: Oxygen saturation, pulse rate, and blood pressure were monitored before, during, and after 110 ROP screening examinations. RESULTS: Following topical mydriatics diastolic blood pressure was elevated by a mean of 6 (SD 7.2) mm Hg. Immediately after the examination there was a further rise in both systolic and diastolic pressure of 4.3 (14.5) mm Hg and 3.3 (11.6) mm Hg, respectively. Oxygen saturation and pulse rate remained stable during the control period and administration of eyedrops. Saturation fell by a median of 3% (95% confidence interval plus or minus 1.2%) after the examination while there was rise in pulse rate of 7 (SD 23.1) beats per minute. This change in pulse rate was not observed in infants on concurrent methylxanthine therapy. No infant had clinically significant changes at the end of the study. CONCLUSION: The initial changes in blood pressure may represent side effects of topical mydriatics but the later changes following the physical examination may be an additional response to the stress of ROP screening.

Axial length biometry in infants with retinopathy of prematurity.

Ultrasound axial length measurements were obtained on infants under a birthweight of 1500 g or 32 weeks gestation undergoing screening for retinopathy of prematurity (ROP). A total of 496 readings were obtained on 171 infants between 32 and 41 weeks post-conceptual age. Other details recorded were maximum stage of acute ROP, birthweight, gestational age, sex, and biparietal and occipitofrontal head diameters. The relationship of these variables to axial growth of the eye was examined using analysis of covariance with a repeated measures approach. Mean axial length increased from 15.27 mm to 16.65 mm in the left eye during this period. Following adjustment for repeated readings a growth rate of 0.18 mm/week was obtained for both eyes. Male infants were found to have longer axial lengths despite correction for birthweight, gestation and head size (p < 0.0001 right and left). Higher stages of acute ROP were also associated with shorter axial length (p < 0.05 for all stages of both eyes) but the rate of growth during the study period did not demonstrate significant differences between stages. Stage 3 infants reaching the threshold for cryotherapy had shorter axial length than stage 3 infants not receiving treatment. The effect of prematurity on the growth of the eye and the significance of these findings with respect to the subsequent development of refractive errors in premature infants are discussed.

Ocular manifestations of classical and limited Wegener's granulomatosis.

Wegener's granulomatosis (WG) may be subdivided into two forms, classical and limited. The latter specifically excludes renal disease and carries a better prognosis. Both forms have sight-threatening complications, but the relative incidence of ocular manifestations in each is not well documented. Patients with limited (n = 15) and classical (n = 16) WG were ophthalmologically examined. Ocular abnormalities found included orbital and nasolacrimal disease, corneo-scleral inflammation, dry eyes and retinal vein occlusion. In four patients (two from each group), no ocular disease was detected. The limited group included four potentially sight-threatening complications, compared to eight in the classical group. Overall, there was no statistically significant difference in any of the ocular manifestations between the two groups. Although treatment with corticosteroid and immunosuppressive agents has dramatically improved the prognosis of the disease, ocular morbidity is still well recognized. A combined medical and ophthalmological approach with prompt therapeutic intervention is recommended in these patients.

The pharmacokinetics and biodistribution of technetium-99m(V)dimercaptosuccinic acid in an animal tumor model.

This study used an established rabbit tumor model with squamous carcinoma to evaluate the pharmacokinetics and biodistribution of technetium-99m-(V)dimercaptosuccinic acid. A total of 54 rabbits were studied (25 with no tumor; 29 with tumor). Technetium-99m(V)dimercaptosuccinic acid had a bi-exponential blood clearance in rabbits with no tumors (28 and 325 min) and in rabbits with tumors (27 and 352 min). There was no significant difference (p greater than 0.05) in mean clearance times between the two groups and clearance appeared unaffected by tumor mass. Technetium-99m(V)dimercaptosuccinic acid had a bi-exponential cumulative urine excretion with no apparent difference in half-times between non-tumor and tumor rabbit groups (200 and 240 min, respectively). Technetium-99m(V)dimercaptosuccinic acid had a major organ biodistribution in rabbits which included bone, kidneys, bladder and the blood pool. The major route of excretion was via the urine. There was no significant difference (p greater than 0.05) in organ biodistribution between rabbits with no tumors and rabbits with tumors and there was no evidence of active uptake of technetium-99m(V)dimercaptosuccinic acid by either squamous carcinoma or inflammatory tissue.

Tonic pupils and human parvovirus (B19) infection.

We document the case of a young woman with bilateral internal ophthalmoplegia and subsequently tonic (Adie's) pupils, corneal epitheliopathy, and uveitis due to human parvovirus B19 infection. To our knowledge, this is the first reported case of ocular complications of this virus.

Is padding necessary after cataract extraction?

The results of a prospective study to assess the value of padding eyes following cataract surgery are reported. A group of eyes dressed with a petroleum jelly mesh, gauze pad, and cartella shield were compared with a group dressed only with a cartella shield. Study of the eyes and lids before and after operation, including the taking of lid margin and fornix swabs for culture, suggested that there was no significant difference in the bacterial presence between the two groups. The eyes dressed with a cartella shield alone appeared less prone to discharge. The relative merits of different types of dressing are discussed.