The effect of positional changes on intraocular pressure during sleep in patients with and without glaucoma.

PURPOSE: To determine whether sleeping at a 20-degree head-up position decreases nocturnal intraocular pressure (IOP) compared with lying supine (flat) in patients with and without glaucoma. DESIGN: Prospective, nonrandomized comparative case series. MATERIALS AND METHODS: Thirty patients were recruited based on self-reported disease status with 15 glaucoma and 15 nonglaucoma patients; a total of 60 eyes were tested. Patients were evaluated in a sleep laboratory on 2 separate nights, lying flat 1 night and lying on a wedge pillow at a 20-degree head-up position another night. Baseline IOP was measured during the awake period (10 PM), then measured at 2-hour intervals during the sleep period (12, 2, 4, and 6 AM). RESULTS: IOP measurements during the 10 PM awake period did not significantly differ between the 2 positions (P=0.55). During the sleep period (12 to 6 AM), the mean IOP was 1.51 mm Hg lower in the 20-degree head-up position when compared with the flat position (95% confidence interval, 0.99 to 2.04 mm Hg), with an average drop of 1.56 and 1.47 mm Hg in glaucoma and nonglaucoma patients, respectively. This corresponds to a 9.33% and 8.67% IOP reduction in glaucoma and nonglaucoma patients, respectively. Twenty-five of 30 patients (83.3%) had lower mean IOPs in the 20-degree head-up position. Mean IOP reduction was >10% for 11 of 30 patients (36.7%) when sleeping in the head-up position. CONCLUSIONS: The 20-degree head-up position correlates with lower nocturnal IOP as compared with the supine position in glaucoma and nonglaucoma patients. No significant difference in IOP reduction was observed in glaucoma patients when compared with nonglaucoma patients.

Central retinal artery occlusion in a patient with tetralogy of Fallot.

A 17-year-old Caribbean male presented with painless acute vision loss in the left eye. The patient was found to have a central retinal artery occlusion and an underlying uncorrected tetralogy of Fallot. To our knowledge, this is the first such reported case. One week after presentation visual acuity in the left eye spontaneously improved to 20/200.

Linear IgA dermatosis mimicking ocular cicatricial pemphigoid.

PURPOSE: To describe an unusual case of cicatrizing conjunctivitis. METHODS AND RESULTS: A 59 year old male presented in July 1997 with a complaint of intermittent redness and discharge of the right eye. Medical history was significant for a buccal mucosal lesion biopsy taken two years earlier that revealed subepidermal fibrosis. Conjunctival biopsy, performed to rule out ocular cicatricial pemphigoid, yielded a diagnosis of linear IgA dermatosis, an unusual diagnosis not often considered by ophthalmologists. CONCLUSIONS: The diagnosis of cicatrizing conjunctivitis is often overlooked. Its importance as it pertains to the life threatening disease of ocular cicatricial pemphigoid is clear.

Retinal-vein occlusions: carotid artery evaluation indicated.

In patients presenting with retinal-vein occlusion there is a 50% likelihood that there is concomitant carotid artery disease. Six of 12 patients originally presenting with retinal vein disease were subsequently diagnosed as having carotid artery disease. The implication is clear: Patients with retinal vein occlusions merit careful carotid artery evaluation.

Mucormycosis: case presentation and discussion.

Mucormycosis is encountered in patients with diabetes mellitus, as well as other debilitating diseases. The fungus is ubiquitous, but only certain types of patients become afflicted with this disease. Early diagnosis, control of the underlying disease, drug therapy, and surgical treatment can save the lives of patients with this infection. One should not be reluctant to think of mucormycosis in a differential diagnosis. Mucormycosis is becoming more frequently diagnosed.

Central retinal vein occlusion: life and sight implications.

Central retinal vein occlusion is an ophthalmic disease with both life and sight threatening implications. Treatment should be aimed at the underlying ophthalmic or systemic disease. Questionable modes of therapy (ie, anticoagulation) may injure the patient as a whole without offering any really better results for the ophthalmic condition.