Australian and New Zealand journal of ophthalmology最新文献

Thyroid orbital disease may threaten sight when acute proptosis causes corneal exposure or when enlarged extraocular muscles cause compressive optic neuropathy. The early clinical signs of thyroid optic neuropathy include loss of colour perception and visual field defects. The onset of thyroid optic neuropathy is difficult to predict and these clinical tests should be included in the routine examination of patients with thyroid orbital disease.

Facial palsy is cosmetically unacceptable, whether affecting eyes or mouth. It endangers the vision. Both upper and lower facial paralysis can be surgically dealt with, using the temporal muscle and fascia. This produces satisfactory results in a relatively short period of time.

Graves' ophthalmopathy occurs in 2% to 7% of patients with Graves' disease with the major manifestations being proptosis, ophthalmoplegia, optic neuropathy and/or eyelid retraction. Although autoimmune in nature, the precise pathophysiology is unknown. The course of the ophthalmopathy is not influenced by the mode of treatment of the hyperthyroidism. In addition to restoration of the euthyroid state, the aims of treatment include relief of eye pain, correction of extraocular muscle dysfunction, protection of visual acuity and improvement of appearance. Specific therapy depends on the severity of the ophthalmopathy and varies from lubricating eye drops in mild disease to high-dose steroids and radiotherapy or decompressive surgery in severe cases.

Orbital myositis is an idiopathic inflammatory condition involving the extraocular muscles. A case of presumed orbital myositis is presented, displaying typical features on orbital computed tomography, and a dramatic response to corticosteroid therapy. Atypical features of acute-on-chronic course, and concomitant sinus disease are discussed. A differential diagnosis of enlarged extraocular muscles is also discussed, and the benefits of corticosteroid trial before formal biopsy in the appropriate clinical setting is emphasised.

The author's experience, limited to some twenty operations, mirrors the great experience of other clinics. The need to be aware of compressive optic neuropathy (CON) in endocrine-related orbital disease (EROD) is outlined. The value of orbital decompression in CON, severe corneal exposure and cosmetically unacceptable proptosis is mentioned. The author's technique is outlined. Three illustrative cases are briefly described.

Lateral orbitotomy is the standard surgical approach to lesions in the middle third of the orbit, to many lesions in the posterior third of the orbit and to benign lacrimal gland tumours. The indications, surgical technique and complications are discussed.

Most ophthalmic zoster occurs in healthy people and ocular complications occur in 50%. The mainstay of ocular therapy is topical steroid, but careful follow-up and withdrawal are essential. The place of systemic steroid therapy and acyclovir in immunocompetent patients with zoster is uncertain.

Two cases of acute non-haemorrhagic conjunctivitis due to coxsackievirus A24 (CA24) are described. These are the first Australian isolates. The presentation was as a severe conjunctivitis in otherwise healthy adults who had not travelled outside Australia. The course was of short duration and self-limiting with no long-term sequelae. The isolates could not be neutralised by antiserum prepared against prototype CA24 but were identified by immune electron microscopy and complement fixation.

The corneal endothelium was assessed following penetrating keratoplasty in a series of 50 patients and eight illustrative cases are described. Assessment disclosed a wide variation in the endothelial cell count and morphology following keratoplasty. In some patients the endothelial cell count was so low and the morphology so abnormal that long-term survival of the graft was doubtful. In cases with such a low count it is very doubtful whether the graft will survive a secondary procedure such as cataract extraction or intraocular lens implantation. Some donor material may carry corneal guttae and the use of such material should be avoided. If the material is good it will withstand inflammatory episodes including graft rejection if treatment is prompt and appropriate. Satisfactory material may be obtained from elderly donors while a young donor does not guarantee suitable material. It is desirable to assess the corneal endothelium of donor material carefully before use.