Glaucoma in a case of Hurler disease.

The electron microscopic appearances of the corneoscleral and iris tissue removed at operation from a child with Hurler disease and glaucoma showed distinctive swollen cells with intracellular inclusions similar to those which are observed in other tissues in these patients and which are due to abnormal lysosomal storages of mucopolysaccharides. Some recent observations on the possible relationship between mucopolysaccharides and the drainage of fluid from the anterior chamber are briefly reviewed and correlated with the present observations. The development of glaucoma in this patient is thought to be associated with the presence of the mucopolysaccharide-containing cells in the region of the aqueous drainage channels.     

Spherophakia: a case report.

A case of spherophakia with unilateral traumatic phacometecesis is presented and the treatment of the postextraction sequelae by contact-lens therapy is described.     

Glaucoma case finding: a cluster-randomised intervention trial

PURPOSE: To assess the effect of an intervention comprising training in optic disc assessment, explicit referral criteria and ophthalmologist feedback on referred patients, on the number of optometrist referrals for suspected glaucoma seen at a referral site and the positive predictive value of those referrals. METHODS: Optometric practices routinely referring to the Ealing Hospital Eye Clinic were randomly divided into two groups taking into consideration those practices, which shared an optometrist (a cluster) and the number of optometrist days worked per week.One group of practices acted as controls, while the other practices were invited to receive the intervention. Data on 397 new patients referred and presenting to Ealing Hospital with suspected glaucoma were collected over a 20-month period. The data on patients who had failed to attend their appointment were collected over 7 months of this period. The number of referrals seen, the positive predictive value of those referrals, and the attendance rate were calculated. Optometrist's opinions of the intervention were assessed qualitatively. Data relating to optometrist compliance with the intervention were also collected. RESULTS: The number of glaucoma referrals presenting to Ealing Hospital from the intervention practices was almost double that from the control practices (210 vs 119). When cluster randomisation, the number of optometrist days per cluster and the number of assessed referrals in the preintervention period are taken into consideration, it is estimated that the intervention is associated with a 52% increase in the number of referrals reaching Ealing Hospital. However, the design effect resulting from the cluster randomisation was unexpectedly high (of the order of 13-14)and so the confidence intervals around the estimate of 52% are very wide (95% c.i. 35% decrease to 253% increase, P = 0.34). There was no evidence of an association between optometrist compliance with the intervention and the number of referrals seen at Ealing Hospital. The positive predictive value (PPV)of referrals was similar for the intervention(0.49 (95% c.i. 0.42, 0.55)) and control groups(0.46 (95% c.i. 0.33, 0.60)). Optometrist opinions of the intervention were largely favourable. All expressed a willingness to participate in future programmes. CONCLUSION: A large difference in the number of referrals between the practice groups was observed. Since the PPV of referral was unchanged, the potential impact of the intervention in terms of numbers of new cases of glaucoma detected in the community is substantial. However, because of its large design effect, this trial does not provide conclusive evidence of an impact of the intervention on referral numbers. A considerably larger trial will be required to produce conclusive evidence of an effect.     

Conjunctival myxoma: a case report.

A rare case of conjunctival myxoma in an 18-year-old female is reported. Clinically it presented as a painless mass located in the nasal bulbar conjunctiva. It was composed of spindle and stellate shaped cells in a loose mucoid stroma. Some of the cells had intracytoplasmic vacuoles consistent with dilated rough endoplasmic reticulum and/or intranuclear vacuoles of nuclear membrane invaginations. Mast cells were also seen in the stroma. No recurrence has been reported eight months postoperatively.     

Cone-rod dystrophy: a case report.

Cone-rod dystrophy is considered one of the rarer hereditary retinal degenerations. This disease can be easily mistaken for a number of other conditions because of its unusual characteristics. This paper discusses these characteristics and presents a case report to illustrate how the optometrist can effectively manage patients with this disease.     

Primary epitarsus: a case report.

Epitarsus is a rare congenital anomaly or may be acquired following severe conjunctivitis, usually of a cicatrising nature. The terms primary and secondary epitarsus are suggested to denote the two different aetiological varieties. On its clinical and histopathological features the present case conforms to the interfornix variety of primary epitarsus.     

Cryptococcal chorioretinitis: a case report.

Chorioretinitis occurred in a young man whose long-standing cryptococcal meningitis had been identified and treated. In one eye spontaneous resolution had occurred. His case history and fluorescein angiograms are presented.     

Intraocular coenurosis: a case report.

A case of intraocular coenurosis was clinically diagnosed and treated with praziquantel. The drug destroyed the coenurus, but vision was lost through toxic endophthalmitis and retinal detachment. There were no systemic side effects.     

Glaucoma case detection

In Dalby more than 1,000 residents have been followed for a decade (1977-1987) with periodic comprehensive eye examinations including family history, ophthalmoscopy, slit-lamp examination, applanation tonometry, and computerized perimetry. The large majority were followed at long intervals (2.75 and 5.65 years). Ophthalmoscopy and tonometry were used to select a minor part of the population to be followed at shorter intervals. In this way 16 out of 24 manifest glaucomas detected after the first survey were found among patients followed at shorter intervals. A closer look at the data suggested that the selection could have been further improved if the slit-lamp examination and the family history had been used in much the same way as ophthalmoscopy and tonometry. On this basis new criteria to select persons said to have 'presumptive glaucoma' are proposed.     

Mycobacterium chelonei keratitis: a case report.

The case is reported of a patient who initially presented with a dendritiform corneal ulcer that ultimately failed to heal and in which Mycobacterium chelonei was repeatedly cultured. The organism was sensitive only to kanamycin and amikacin; however, topical administration of these antibiotics failed to achieve a complete cure. Penetrating keratoplasty was ultimately required to eradicate the organism from the cornea.     

Progressive hemifacial atrophy: a case report.

A case of a 28-year-old Caucasian female with progressive hemifacial atrophy and atrophy of the rhomboid muscles on the ipsilateral side is reported. The literature on this condition and its treatment is reviewed.     

Central gyrate atrophy: a case report.

Central gyrate atrophy is a rare ocular finding with a unique pathogenesis and fundus appearance. This entity results in total atrophy of the large and small vessels of the choroid and concomitant changes in the outer layers of the retina. A case report is presented to demonstrate the clinical appearance of this lesion and its relationship to the pathogenesis.     

Amoebic keratitis: a clinicopathological case report.

A 22-year-old farmer with recurrent corneal erosions and keratoiritis underwent a penetrating keratoplasty. Investigations carried out on the corneal disc revealed an amoebic keratitis, which is considered to be a very rare condition.     

Rhinoscleroma with exophthalmos: a case report.

This is a report of a 20-year-old Nigerian man with a 15-year history of exophthalmos and nasal blockage caused by rhinoscleromatous. The diagnosis was made by histopathological examination of a biopsy specimen taken from the nasal passages. Despite protracted antibiotic therapy the patient experienced recurrent exophthalmos. Computerised axial tomography and sinus films showed the lesion to have invaded through the sinus passage into the orbit. Further histopathological examination of tissue removed at the time of surgical decompression also revealed rhinoscleroma. This appears to be the third report of rhinoscleromatous spread to the orbit.     

Fronto-ethmoid sinus mucocele: a case report.

BACKGROUND: Mucoceles are epithelium-lined cavities in the paranasal sinuses filled with mucus. They develop because of scarring and obstruction of the sinus ostium, whether from chronic sinusitis, trauma, or surgery. They commonly erode the bony sinus wall and can have serious complications of brain and orbital invasion, with potential for abscess and rupture. CASE REPORT: A 39-year-old woman had diplopia in left gaze and a hard nodule above the right eye for 1 year. She recently noted a bulging right eye, nasal congestion, and occasional headaches. She was 9 years post-sinus surgery. All aspects of the afferent optic nerve function were intact. Right-sided proptosis was evident as was a right adduction and supraduction deficit, prompting immediate imaging, both with a computed tomography scan and magnetic resonance imaging of the orbits. These results showed a large right ethmoid sinus mucocele, with bony erosion and orbital invasion, prompting an immediate surgical referral. CONCLUSION: Mucoceles may arise from any of the paranasal sinuses and, because of the close proximity of these spaces to the orbit, may initially manifest with visual and ocular signs and symptoms. Therefore, eye care providers need to be aware of this entity and the need for immediate referral or workup if a mucocele is suspected.     

Ocular larva migrans: a case report.

A case of intraocular toxocara larva migrans occurring in a 12-year-old boy is presented. Motility is inferred from the nature of multiple intraocular lesions observed. Possible mechanisms preventing a conclusive immunological response to the organism are discussed.