Acute phthisis bulbi and external ophthalmoplegia in herpes zoster ophthalmicus.

A patient developed acute phthisis bulbi and external ophthalmoplegia with herpes zoster ophthalmicus (HZO). The clinical course and ocular complications of HZO are described briefly and the cause of phthisis bulbi and external ophthalmoplegia in zoster ophthalmicus is discussed. It is suggested that the acute hypotonia in HZO is due to an ischemic necrosis of the ciliary body, resulting from an occlusive vasculitis which may also be responsible for the external ophthalmolplegia.

Lacrimal scintigraphy. I. Compartmental analysis of data.

Linear compartmental analysis was applied to lacrimal scintigraphy data from asymptomatic and obstructed lacrimal systems. Failure to achieve satisfactory results in most of the asymptomatic systems studied suggests that variable tear flow is a feature of normal lacrimal drainage which precludes linear analysis. However, in cases where the analysis was successful the results were consistent with the occurrence of reflux between the conjunctival and lacrimal sacs, and between the lacrimal sac and nasolacrimal duct. Further support for the existence of reflux between compartments was provided by the analysis of obstructed systems, particularly those with obstruction at the upper end of the nasolacrimal duct. In such cases there was rapid equilibrium of the tracer between the conjunctival and lacrimal sacs, which in the absence of tear flow could be explained by reflux between these 2 compartments.

Lacrimal scintigraphy. III. Physiological aspects of lacrimal drainage.

Lacrimal scintigraphy (LS) was performed on asymptomatic lacrimal drainage systems and the results were evaluated to understand the physiology of lacrimal drainage. It was found that a physiological obstruction can exist at the level of the nasolacrimal duct in normal asymptomatic individuals, and it is suggested that this obstruction is due to the resistance offered by the valve of Hasner, which in turn is dependent on (a) the volume of fluid in the lacrimal sac and the nasolacrimal duct, and (b) the anatomical integrity of the valve. The LS observations are taken into account to postulate a mechanism of drainage from the lacrimal sac into the nose, which hitherto has not been very clear. It is also suggested that reflux can occur between the various compartments of the lacrimal drainage system and that the various valves in the membranous passageway can become incompetent in an obstructed system.

Lacrimal scintigraphy. II. Its role in the diagnosis of epiphora.

Lacrimal scintigraphy (LS) was performed in 860 lacrimal drainage systems (LDS) in 188 patients with bilateral epiphora and 226 patients with unilateral epiphora. A very high incidence of canalicular obstruction was found in these patients, the incidence being higher in the group with unilateral epiphora. It is suggested that a canalicular block is a commoner cause of obstructive epiphora than has been recognised previously and that LS is a reliable method of studying the canalicular function. A significant number (42%) of the opposite asymptomatic eyes of patients with unilateral epiphora were found to have an abnormality in the LDS, which supports the view that abnormalities in the LDS tend to be bilateral. Only 25% of these asymptomatic systems showed a normal drainage, confirming that physiological obstruction can exist below the lacrimal sac in normal lacrimal drainage systems.

Role of lacrimal scintigraphy and subtraction macrodacryocystography in the management of epiphora.

Fifty-one patients were investigated by subtraction macrodacryocystography (SMDCG, 103 systems) and by lacrimal scintigraphy (LS, 105 systems). It was found that these investigations complemented each other and between them the precise site of obstruction in the lacrimal drainage apparatus could be determined in 80%. The radiation dosage to the lens in SMDCG significant, and it is therefore recommended that the patients with lacrimal obstruction should: (1) have lacrimal puncta dilated with a probe to No. 1 diameter and be forbstruction is still uncertain, then and only then should SMDCG be performed.