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Query: UMLS:C0022568 (keratitis)
 5,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A corneal abrasion is the most common eye complication during general anesthesia and recovery. It is painful, may progress to inflammation of the uveal tract, and in the presence of contamination may lead to a serious infection. Both eyes may be involved, as the two reported cases show. Possible causes include mask friction on the open eye or other careless technics. Treatment includes local application of an antibiotic ointment and an eye pressure patch. In addition, a cycloplegic and mydriatic solution is instilled to prevent synechiae (in the presence of a secondary iridocyclitis) and to relieve the pain associated with spasm of the iris and ciliary muscle. Topical application of local anesthetics should be avoided, as they delay regeneration of corneal epithelium and may promote keratitis.
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PMID:Corneal injuries during general anesthesia. 117 Jul 81

Botulinum A exotoxin was recently approved for use in Canada. We describe the efficacy of botulinum toxin in the management of 235 patients with blepharospasm (mean age 64.3 years) and 130 patients with hemifacial spasm (mean age 60.4 years) treated at three Canadian ophthalmologic centres between 1984 and 1989. A total of 98% of the patients with blepharospasm and 100% of the patients with hemifacial spasm had significant relief of their symptoms; however, 11% of the former and 2% of the latter did not respond to the usual starting concentrations of the drug and needed stronger dosages for relief. The duration of relief varied widely in both groups. Up to 7% of patients had ineffective treatments but responded to subsequent injections. Analysis of variance and linear trend statistics showed that there were no changes in the mean duration of relief over the first several treatments for individual patients in either group. Side effects were transient and included ptosis, exposure keratitis, epiphora and strabismus.
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PMID:Treatment of blepharospasm and hemifacial spasm with botulinum A toxin: a Canadian multicentre study. 205 23

A total of 39 patients with essential blepharospasm and 2 patients with hemifacial spasm were treated with one or more forms of therapy. All patients underwent neurologic and ophthalmic assessment to rule out ocular causes of blepharospasm. Thirty-six patients were given a trial of various medications. Only one patient was successfully treated: her condition was markedly improved with pimozide after benztropine mesylate, clonazepam and amantadine hydrochloride had failed to help. Patients who did not respond to drug therapy were offered the option of undergoing eyebrow-eyelid muscle stripping surgery. The six patients who underwent surgery showed considerable improvement; however, side effects such as frontal anesthesia, exposure keratitis, lagophthalmus, scarring and eyelid malposition occurred, and three of the six had residual spasm. At this point type A botulinum toxin became available. A total of 27 patients (26 who did not respond to drug therapy, including the 3 with residual spasm after surgery, and 1 previously untreated patient) received type A botulinum toxin injections. Most experienced rapid relief from their spasms. The beneficial effects lasted weeks to months, and there were no major side effects. Treatment with type A botulinum toxin appears to be a safe and effective means of temporarily relieving blepharospasm. The long-term results with repeated injections are yet to be determined.
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PMID:Treatment of blepharospasm with medication, surgery and type A botulinum toxin. 381 52

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin is presented. Pertinent research relating to the causes of these complications is also reviewed. The most common complications of treatment with botulinum toxin are related to acute local effects resulting from chemodenervation. The most important clinical effect in this group is weakening of the levator muscle resulting in ptosis, and the corneal consequences of lagophthalmos. The latter includes exposure keratitis, dry eyes, blurred vision, and hypersecretion epiphora. Less common local effects include facial numbness, diplopia, and ectropion. Some distant effects are being observed with increasing frequency. These include pruritus, dysphagia, nausea, and a flu-like syndrome. Most significant, however, are the rare reports of generalized weakness and the documentation of EMG abnormalities distant to the site of toxin injection. This has been seen with injections for both blepharospasm and torticollis. Until further studies on the long-term distant complications of botulinum toxin are available, it is recommended that patients receive as few life-time doses of toxin as possible, consistent with adequate management of their spasms. The practice of reinjecting patients routinely every three months, or at the first return of mild spasms should be discouraged.
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PMID:Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and long-term, local and systemic effects. 882 30

This article analyzes various types of ocular disorders associated with the use of oral contraceptives (OCs) as well as the ocular risks of pregnancy in diabetic women. Numerous publications have described the secondary ophthalmologic effects of OCs since they have entered into widespread use. Such effects or complications are rare, nonspecific, occur after a short or long duration of use, and may be serious or minor. Among less serious reported effects are modifications of refraction or ocular tension, intolerance of contact lenses, keratitis, and alterations of color vision. Vascular complications are the most serious effect tentatively identified, but few prospective and comparative studies have been conducted to confirm the relationship. The role of OCs is assumed from observation of a few cases, and is disturbing because vascular accidents are rare in women under age 40. The vascular effects may include venous or arterial occlusion of the retina, isolated bleeding, retinal edema, vascular pseudo-papillitis, or visual problems resulting from transient cerebral ischemic accidents and ophthalmic migraines. Such effects may threaten the eyesight, but an American study recently found 82 cases among 10-15 million OC users. Occlusion of the main retinal artery usually results in loss of sight and functional recuperation is unusual. Spasm of the central retinal artery may precede occlusion and requires immediate ophthalmologic examination and discontinuation of OCs. Venous occlusion occurs less suddenly and involves a less extensive loss of sight. The prognosis depends on the affected area. Some effects, such as isolated retinal bleeding and vascular pseudo-papillitis, are reversed on termination of OC use. The risk of ocular vascular accidents is affected by smoking, irregular lipid and glucose metabolism, and hypertension. A history of vascular problems, visual problems, or migraines should be excluded before OCs are prescribed, and an initial ophthalmologic examination can explore retinal vascular anomalies and follow high risk patients with fluorescent angiography. Migraines should be considered a warning signal; if they appear premenstrually or persist despite use of low-dose pills, another method of contraception should be used. The considerable elevation of levels of estrogen and progesterone that occurs in pregnancy has no major ocular consequences for normal women but may cause or aggravate retinopathy in diabetic women. Few prospective studies have been done, but it appears that 80% of retinopathies that originate in pregnancy remain uncomplicated. Preexisting conditions are likely to become more serious. The most serious are associated with elevated rates of spontaneous abortion and neonatal complications. A diabetic woman desiring to have children should be advised to do so as early as possible and should be screened for retinal disease and treated before becomig pregnant.
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PMID:[The eye and hormones: vascular disorders associated with combined oral contraceptives and pregnancy]. 1228 Feb 1