Fine structural defects in a case of congenital microcoria.

A case of congenital miosis associated with myopia and cataract is described. Tissue obtained at iridectomy was examined with the electron microscope and compared with a specimen of normal iris. The miotic iris was found to be hypoplastic and to display differences in the cellular density of the stroma. The contractile processes of the dilator myoepithelium were conspicuously absent from the underlying stroma, and the existing myofibrils were much disarranged.

Ocular toxicity following ethambutol in standard dosage.

We describe a patient who developed rapid irreversible blindness following treatment with ethambutol in the recommended dose of 15 mg/kg body weight which in clinical practice is widely considered to be safe. This case exemplifies the potential risks of ethambutol and re-emphasizes the importance of instructing patients to stop the drug at once if they develop visual symptoms.

Comparison of the pupillary, refractive, and hypotensive effects of Ocusert-40 and pilocarpine eyedrops in the treatment of chronic simple glaucoma.

Twelve patients with chronic simple glaucoma were treated for 1 week with Ocusert-40, and the effects on the pupil, intraocular pressure, and refraction were measured. A comparison was made with the effects of pilocarpine eyedrop therapy in 8 of these patients. Both forms of pilocarpine treatment gave satisfactory control of intraocular pressure and both constricted the pupil to a similar degree shortly after initiation of treatment. During the week on Ocusert-40 the pupils redilated, so that 54% of the initial miosis remained after 7 days' wear. There was, however, considerable variability in the pupillary sensitivity to Ocusert-40 within and between eyes, and it is suggested that this may have been partly due to variable release rates of pilocarpine. Only minor decreases in visual acuity and refraction resulted from pilocarpine in either form. Seven of the 12 patients rejected Ocusert-40 because of discomfort or inability to retain the device.

Ethambutol and intra-ocular pressure.

Two groups of Korean patients with tuberculosis, matched in pairs for age and duration of chemotherapy, have been studied. One group had received ethambutol in a mean dosage of 14.4 mg/kg and the other antituberculosis chemotherapy not including ethambutol for at least 3 months. All patients had routine ophthalmological assessments on admission to the study, including examination of the fundi, visual fields and macular thresholds. Intra-ocular pressures were measured and a water-drinking test was then carried out. All the assessments were made by the same ophthalmologist who was at all times kept unaware of the treatment which each patient was receiving or which patients were paired. There was no evidence of ocular toxicity or that ethambutol in the dosages studied has an effect on intra-ocular pressure.

Scleritis and temporal arteritis.

Thirty consecutive patients with severe scleritis or episcleritis were admitted as in-patients to the Medical Ophthalmology Unit and assessed for systemic disease. There were seventeen women and thirteen men. The mean age was 53 with a median of 57 (range 23-83). Eighteen of the patients had scleritis: eleven of these had evidence of connective tissue disease and three of them had temporal arteritis. Twelve patients had episcleritis: six of them had a collagen disease and one of them developed temporal arteritis. This high incidence of temporal arteritis in association with scleritis has not been previously reported. It is important to diagnose and treat overt temporal arteritis early with parenteral steroids so that ischaemic papillopathy can be avoided. A higher incidence of collagen diseases than previously described is reported in episcleritis. It is thought that this is secondary to selection since patients with the usual self-limiting episcleritis are not normally referred for further in-patient investigation. In no patient was more than one significant diagnosis made. There was no significant medical illness in only 11% of patients with scleritis and 33% of patients with episcleritis. The majority of the non-collagen diseases (e.g. hypertension) were not previously recognized. In none of the patients with temporal arteritis was the diagnosis made before admission. It is concluded that full examination and investigation for underlying disease is indicated in both scleritis and severe episcleritis.

Uveitis. A series of 368 patients.

During the first 10 years (1963-74) of a new Medical Ophthalmology Unit, 368 of 3,930 admissions had endogenous uveitis, anterior in 215 (58 per cent.), posterior in 65 (18 per cent.), and generalized in 88 (24 per cent.). Acute uveitis in 153 patients tended to have a short course counted in months, whereas in 215 with chronic uveitis the condition was measured over years, punctuated by relapses. Sex distribution was equal. At the time of initial presentation, 60 per cent. of patients were aged 20 to 40 years, 8 per cent. were under 20, and 10 per cent. were over 60 years of age.

Neuro-ophthalmic sarcoidosis.

Sarcoidosis is a multisystem disorder in which ocular involvement occurs in about one-quarter and neurosarcoidosis in 7 per cent of patients. When the retina is involved, the reported incidence of central nervous system sarcoidosis is 37 per cent. The patient described had a transient papular eruption of the legs, bilateral hilar lymphadenopathy, polyarthralgia with knee effusions, and bilateral facial and peripheral neuropathy. Ocular involvement was characterized by anterior uveitis (in the initial stages), vitreous flare, bilateral disc oedema, macular oedema, streak haemorrhages, peripheral periphlebitis, nerve fibre bundle defects, and candle-wax spots. Fluorescein angiography showed no fluorescence of the candle-wax spots nor of the adjacent vessels. However, there was hyperfluorescence of two retinal lesions. This patient had unilateral internal ophthalmoplegia, only three cases of which have been reported in the literature. Her health was restored by heavy, prolonged corticosteroid therapy. Her family history revealed that an uncle died of sarcoidosis complicated by cryptococcal meningitis. The literature on retinopathy in sarcoidosis is reviewed and the lesions noted in the posterior segment are listed.

A trial of corticotrophin gelatin injection in acute optic neuritis.

The effect of a 30 day course of corticotrophin gelatin injections on the natural history of acute unilateral optic neuritis in 27 patients is reported. A further 27 patients received inert injections in a double-blind control. Measurements were made on visual acuity, visual field, macular threshold, and colour vision, and the development of optic atrophy and other neurological episodes was recorded. No significant differences were found between treated and control groups at intervals up to two years from the start of the trial. The criteria for inclusion of patients are given and it is concluded that corticotrophin has no effect on the natural history of the condition as defined.