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Objective: To determine and compare the fixation strength of conjunctival pedicle flaps to cornea achieved via conventional ophthalmic suture and three different adhesive compounds., Animals Studied: Ex vivo porcine globes., Procedures: Following a 6 mm wide 500-micron-restricted depth lamellar keratectomy, conjunctival pedicle flaps were secured to the keratectomy site with either 8-0 VICRYL® suture or one of three adhesive products, including Tisseel® bioadhesive, ReSure® synthetic adhesive, or ethyl cyanoacrylate adhesive (n = 10 per surgical group). Adhesive application protocol varied by product based upon adhesive biocompatibility. Corneoconjunctival tissues were then harvested, clamped in a tensile testing device, and loaded at a rate of 1 mm/s under video surveillance until the point of failure. Peak load was determined for each test and used to compare fixation strength between samples., Results: Forty conjunctival flaps were performed, with 6 omitted from evaluation due to dehiscence prior to tensile testing. Of the 34 flaps analyzed, 10 were secured with suture, 10 with cyanoacrylate, 8 with ReSure®, and 6 with Tisseel®. Flaps secured with suture withstood significantly higher applied tensile force compared with cyanoacrylate (p = .02474), ReSure® (p = .00000), and Tisseel® (p = .00002). Flaps secured with cyanoacrylate withstood significantly greater force than those secured with ReSure® and Tisseel® (p = .01194 and 0.01798, respectively). There was no significant difference in fixation strength between ReSure® and Tisseel® glue (p = .95675)., Conclusions: Conjunctival pedicle flap fixation using 8-0 VICRYL® suture fixation was able to withstand significantly greater maximum tensile force compared to ReSure®, Tisseel®, or cyanoacrylate adhesives. Fixation strength achieved with cyanoacrylate adhesive was significantly greater than that achieved with ReSure® or Tisseel®., (© 2024 The Authors. Veterinary Ophthalmology published by Wiley Periodicals LLC on behalf of American College of Veterinary Ophthalmologists.)

INTRODUCTION: Military personnel extensively use night vision goggles (NVGs) in contemporary scenarios. Since NVGs may induce or increase injuries from falls or vehicular accidents, biomechanical risk assessments would aid design goal or mitigation strategy development. METHODS: This study assesses injury risks from NVG impact on cadaver heads using impactors modeled on the PVS-14 NVG. Impacts to the zygoma and maxilla were performed at 20° or 40° angles. Risks of facial fracture, neurotrauma, and neck injury were assessed. Acoustic sensors and accelerometers assessed time of fracture and provided input variables for injury risk functions. Injuries were assessed using the Abbreviated Injury Scale (AIS); injury severity was assessed using the Rhee and Donat scales. Risk functions were developed for the input variables using censored survival analyses. RESULTS: The effects of impact angle and bone geometry on injury characteristics were determined with loading area, axial force, energy attenuation, and stress at fracture. Probabilities of facial fracture were quantified through survival analysis and injury risk functions. These risk functions determined a 50% risk of facial bone fracture at 1148 N (axial force) at a 20° maxillary impact, 588 N at a 40° maxillary impact, and 677 N at a 20° zygomatic impact. A cumulative distribution function indicates 769 N corresponds to 50% risk of fracture overall. DISCUSSION: Results found smaller impact areas on the maxilla are correlated with higher angles of impact increasing risk of facial fracture, neck injuries are unlikely to occur before fracture or neurotrauma, and a potential trade-off mechanism between fracture and brain injury. Davis MB, Pang DY, Herring IP, Bass CR. Facial fracture injury criteria from night vision goggle impact . Aerosp Med Hum Perform. 2023; 94(11):827-834.

Purpose: Although congenital stationary night blindness (CSNB) has been described in a Japanese beagle dog research colony, certain clinical correlates with human CSNB have not yet been described, nor has an estimate of frequency of the condition been made in inbred and outbred beagle populations., Methods: A beagle with CSNB obtained from a commercial research dog supplier in the USA and matched control dogs (n = 3) underwent examination, refraction, ocular imaging, assessment of visual navigation ability and detailed electroretinography (ERG). Retrospective review of ERGs in two independent groups of inbred (n = 15 and 537, respectively) and one group of outbred dogs (n = 36) was used to estimate CSNB frequency in these populations., Results: In the affected dog, there were absent dark-adapted b-waves in response to dim-light flashes, severely reduced dark-adapted b-waves in response to bright-light flashes, and normal light-adapted b-waves with a-waves that had broadened troughs. Long-flash ERGs confirmed a markedly reduced b-wave with a preserved d-wave, consistent with cone ON-bipolar cell dysfunction. There was evidence of normal rod photoreceptor a-wave dark adaptation, and rapid light adaptation. In the wider beagle populations, five inbred beagles had a b/a wave ratio of < 1 in dark-adapted bright-flash ERG, whereas no outbred beagles had ERGs consistent with CSNB., Conclusions: The identified dog had clinical findings consistent with complete type CSNB, similar to that described in the Japanese colony. CSNB appears to be a rare disorder in the wider beagle population, although its detection could confound studies that use retinal function as an outcome measure in research dogs, necessitating careful baseline studies to be performed prior to experimentation.

OBJECTIVE To assess the effects of topically applied 2% dorzolamide hydrochloride-0.5% timolol maleate ophthalmic solution (DHTM) on incidence and severity of postoperative ocular hypertension (POH; ie, intraocular pressure [IOP] > 25 mm Hg) in dogs undergoing cataract extraction by phacoemulsification. DESIGN Randomized, masked, controlled study. ANIMALS 103 dogs (180 eyes). PROCEDURES Pertinent history, signalment, and ophthalmic examination findings were recorded. Dogs received 1 drop of DHTM or sham treatment solution (sterile, buffered, isotonic eye drops) in both eyes 14 hours and 2 hours before anesthetic induction and at the time of corneal incision closure (ie, end of surgery); IOPs were assessed by rebound tonometry 2, 4, 6, and 8 hours after surgery and between 7:30 and 8:00 am on the following day. Dogs with IOPs of 26 to 45 mm Hg received 1 drop of 0.005% latanoprost solution topically; the surgeon's treatment of choice was used for dogs with IOPs > 45 mm Hg. Incidence of POH and postoperative IOPs were compared between treatment groups. RESULTS DHTM treatment resulted in significantly lower incidence of POH than did sham treatment at the level of the dog (18/53 [34%] vs 31/50 [62%]) and the eye (24/94 [26%] vs 42/86 [48%]). Mean IOP did not differ between groups at the time of POH detection. The DHTM-treated eyes that developed POH were significantly more likely to have a 1-hour follow-up IOP < 25 mm Hg after latanoprost administration than were sham-treated eyes (19/25 [76%] vs 18/35 [51%]; OR, 3.87). CONCLUSIONS AND CLINICAL RELEVANCE Multidose perioperative administration of DHTM in dogs undergoing phacoemulsification reduced the incidence of POH and improved responsiveness of POH to latanoprost treatment.

Intracranial astrocytomas are relatively uncommon in dogs and optic nerve astrocytomas even more so. This neoplasm should be considered as differential in canine patients with vision loss, retinal detachment, ocular mass, and histopathologic findings of infiltrative fusiform to polygonal glial cells possibly associated with glomeruloid vascular proliferation.

Background: The prevalence and progression of vascular complications of spontaneous diabetes mellitus (DM) in dogs have not been described., Objectives: To investigate the effects of duration of disease, as estimated by time since DM diagnosis, and glycemic control on prevalence of systemic hypertension, proteinuria, and diabetic retinopathy in dogs with spontaneous DM., Animals: Seventeen client-owned dogs with spontaneous DM., Methods: Prospective, longitudinal observational study. Dogs with DM of less than 1 year's duration were recruited and evaluated once every 6 months for 24 months. Recorded measures included indirect BP, urine albumin, protein and creatinine concentrations, serial blood glucose and serum fructosamine concentrations, ophthalmic examination, and a standardized behavioral questionnaire., Results: Eleven dogs completed the 2-year follow-up period, during which the highest recorded prevalence of systolic and diastolic hypertension was 55 and 64%, respectively. Prevalence of microalbuminuria and elevated urine protein:creatinine ratio (UPC) ranged up to 73 and 55%, respectively. Prevalence of retinopathy ranged up to 20%. No significant effect of time since DM diagnosis or glycemic control was detected for any of the measures examined. Additionally, no significant associations between BP, urine albumin concentration, UPC and retinopathy were detected., Conclusions and Clinical Relevance: With the exception of proteinuria, which was substantial in some cases, clinically deleterious diabetic vascular complications were not identified in dogs in this study., (Copyright © 2014 by the American College of Veterinary Internal Medicine.)

Objective:   To immunohistochemically evaluate expression of vascular endothelial growth factor receptor-1 (VEGFR1) and -2 (VEGFR2) in ocular tissue of healthy dogs and dogs affected with primary glaucoma, uveitic glaucoma, and intraocular neoplasia., Sample Population:   Enucleated globes from five dogs with primary glaucoma, five dogs with uveitic glaucoma, six dogs with intraocular neoplasms and three ophthalmically normal control dogs., Procedure:   Ocular tissues were obtained from enucleated globes of clinical cases or immediately following euthanasia for control dogs. Tissue sections were stained immunohistochemically for VEGFR1 and VEGFR2 via standard techniques and vascular tissue was qualitatively evaluated. Vascular endothelial VEGFR1 and VEGFR2 expression patterns are reported for normal and diseased ocular tissues. In addition, VEGFR1 and VEGFR2 expression patterns are reported for all normal ocular tissues., Results:   A constitutive expression pattern was detected for VEGFR1 by ocular vascular endothelial cells as well as nonvascular cells in the cornea, uvea, lens, and retina. VEGFR2 demonstrated limited expression in normal ocular tissue, but was widely expressed in vascular endothelium of diseased eyes, particularly in pre-iridal fibrovascular membranes., Conclusions:   The results of this study suggest a role for VEGF receptors in both physiologic and pathologic angiogenesis in canine ocular tissue. Manipulation of this pathway may be a rational consideration for therapeutic intervention in canine ocular disease exhibiting pathologic neovascularization., (© 2011 American College of Veterinary Ophthalmologists.)

Objective: To examine the concentrations of vascular endothelial growth factor (VEGF) in aqueous humor of dogs with intraocular disease and to evaluate the association of aqueous humor VEGF with pre-iridal fibrovascular membrane (PIFM) formation., Procedures: Two hundred and twenty six aqueous humor samples and 101 plasma samples were collected from 178 dogs with a variety of intraocular diseases (including cataract, primary glaucoma, uveitic glaucoma, aphakic/pseudophakic glaucoma, retinal detachment, lens luxation, and intraocular neoplasia), and aqueous humor was collected from 13 ophthalmically normal control dogs. Systemic disease status and administration of select medications were recorded. Aqueous and plasma VEGF was assayed via enzyme-linked immunosorbant assay validated for canine VEGF. Available histopathology samples were examined for the presence of PIFM. Where present, PIFMs were categorized as none, cellular, vascular or fibrous, and fibrovascular. Data were evaluated by mixed model anova, with application of Tukey-Kramer adjustment for multiple comparisons., Results: There was no association between aqueous humor and plasma VEGF levels. Compared with normal controls, aqueous humor VEGF was significantly elevated for all intraocular diseases (P < 0.05) except for primary and diabetic cataracts. Systemic disease and administered medications had no significant effect on aqueous humor VEGF concentration. Compared to dogs without PIFM, aqueous humor VEGF was significantly higher in dogs with fibrovascular PIFM (P = 0.001), but not cellular (P = 0.1704) or fibrous/vascular PIFM (P = 0.0667)., Conclusions: These findings confirm that VEGF is commonly elevated in aqueous humor of dogs with intraocular disease and likely plays a role in the causation or progression of a variety of intraocular disorders, including the development of PIFM., (© 2012 American College of Veterinary Ophthalmologists.)

A 14-year-old, female spayed Domestic Short-haired cat was presented for evaluation of progressive superficial corneal ulceration with mucoid ocular discharge, blepharospasm, and conjunctival hyperemia OD. Upon examination, ulcerative keratitis with stromal loss, chemosis, corneal edema, miosis, aqueous flare, and hyphema were noted. Corneal cytology revealed branching, septate fungal hyphae with bulbous terminations and associated ovoid structures, with suppurative inflammation. Fungal culture of corneal swabs confirmed the presence of Acremonium, although PCR of the cytology sample was negative. Ten days of treatment with topical 1% miconazole resulted in clinical deterioration before switching to topical 1% voriconazole solution, which was successful in resolving the infection. The apparent clinical efficacy of the topical antifungals used contrasted with the in vitro susceptibility profile., (© 2011 American College of Veterinary Ophthalmologists.)

Objective: To evaluate fluorescein nasolacrimal transit (NLT) times in ophthalmically normal dogs and nonbrachycephalic cats by use of 2 methods of the Jones test., Animals: 73 dogs and 36 cats., Procedures: Fluorescein dye was applied to the ocular surface of both eyes by means of a wetted fluorescein strip and, in a subsequent test, by administration of a drop of 0.2% fluorescein solution. During each test, the nares were monitored for the appearance of fluorescein for up to 30 minutes after application. Time of fluorescein appearance at the nares was recorded as NLT time. Recorded variables for all study animals included age, reproductive status, body weight, and Schirmer tear test values. For dogs, skull index, snout length, and cephalic conformation were also recorded. Data were grouped for statistical comparisons according to test results., Results: In both dogs and cats, NLT was faster when the fluorescein solution versus fluorescein strip was used. In cats, none of the recorded variables had a significant effect on NLT, irrespective of the testing method used. In dogs, several variables had a significant effect on NLT, including cephalic conformation, snout length, age, and reproductive status, but these findings varied with testing method and testing group., Conclusions and Clinical Relevance: NLT was highly variable in dogs and cats, regardless of testing method used. Assessment of nasolacrimal patency in brachycephalic dogs by use of either method evaluated here is not likely to be clinically useful. In cats, assessment of nasolacrimal patency with the fluorescein drop method was faster and more conclusive than with the fluorescein strip method.

Objective: To report ophthalmic findings in the Screech owl (Megascops asio). Sample population Twenty-three, apparently healthy adult captive Screech owls in Maryland., Procedures: OU of all owls underwent complete ophthalmic examination. One randomly assigned eye of each bird was measured by phenol red thread tear test (PRT), and the other eye by Schirmer tear test (STT). TonoVet rebound tonometry and TonoPen-XL applanation tonometry were performed in each eye to measure IOP. Conjunctival swabs were cultured from one eye of 10 birds, corneal diameter was measured in OU of eight birds, and streak retinoscopy was performed on OU of seven birds. Ten birds were anesthetized, and A-scan ultrasonography using a 15-MHz probe was performed to obtain axial intraocular measurements., Results: Ophthalmic abnormalities were noted in 24/46 (52%) of eyes. Median STT result was < or = 2 mm/min, ranging < or = 2-6 mm/min, and mean +/- SD PRT was 15 +/- 4.3 mm/15 s. Mean +/- SD IOP were 9 +/- 1.8 mmHg TonoVet-P, 14 +/- 2.4 mmHg TonoVet-D, and 11 +/- 1.9 mmHg TonoPen-XL. Coagulase negative staphylococcal organisms were cultured from all conjunctival swabs. Mean +/- SD corneal dimensions were 14.5 +/- 0.5 mm vertically and 15.25 +/- 0.5 mm horizontally. All refracted birds were within one diopter of emmetropia. Mean +/- SD axial distance from the cornea to the anterior lens capsule was 4.03 +/- 0.3 mm, from cornea to the posterior lens capsule was 10.8 +/- 0.5 mm, and from cornea to sclera was 20.33 +/- 0.6 mm., Conclusions: This study reports ophthalmic examination findings in Screech owls, and provide means and ranges for various ocular measurements. This is the first report of rebound tonometry and PRT in owls.

Objective: To determine the effects of body position on intraocular pressure (IOP) in dogs without glaucoma., Animals: 24 healthy dogs with no evidence of glaucoma., Procedures: Dogs underwent ophthalmic examinations to ensure that no IOP-affecting ocular diseases were present. Each dog was sequentially placed in dorsal recumbency, sternal recumbency, and sitting position. For each of the 3 positions, IOP in the right eye was measured by use of an applanation tonometer immediately after positioning (0 minutes) and after 3 and 5 minutes had elapsed. The initial body position was randomly assigned; each position followed the other positions an equal number of times, and IOP measurements were initiated immediately after moving from one body position to the next. Proparacaine hydrochloride (0.5%) was applied to the right eye immediately prior to IOP measurements., Results: Intraocular pressure was affected by body position. During the 5-minute examination, IOP decreased significantly in dogs that were dorsally recumbent or sitting but did not change significantly in dogs that were sternally recumbent. For the 3 positions, overall mean IOP differed significantly at each time point (0, 3, and 5 minutes). Mean IOP in dorsal recumbency was significantly higher than that in sternal recumbency at 0 and at 3 minutes; although the former was also higher than that in sitting position at 3 minutes, that difference was not significant., Conclusions and Clinical Relevance: Body position affects IOP in dogs. When IOP is measured in dogs, body position should be recorded and consistent among repeat evaluations.

Over 1.9 million people suffer from eye injuries in the United States, occurring from automobile accidents, sports related impacts, and military combat. The purpose of the current study is to analyze the rupture pressure of human eyes using a high rate pressurization system. Internal pressure was dynamically induced into the eye with a drop tower pressurization system. The rupture pressure was measured with a small pressure sensor inserted into the optic nerve. A total of 10 human eye dynamic pressure tests were performed to determine rupture pressure and to compare the results with previous data. It was found that the average high rate rupture pressure of human eyes is 0.89+/- 0.25 MPa. In comparing these data with previous studies, it is concluded that as the loading rate increases the rupture pressure also increases.

Objective: To document normal ophthalmic findings and ocular abnormalities in captive adult pygmy goats., Animals Studied: Ten healthy adult pygmy goats (five male, five female; 5-11 years of age; 26-45 kg body mass) underwent complete ophthalmic examinations., Procedure: Direct illumination, diffuse and slit-beam biomicroscopy, indirect ophthalmoscopy, IOP measurements and Schirmer tear tests were performed. TonoVet rebound tonometry, followed by topical application of 0.5% ophthalmic proparacaine, and Tono-Pen XL applanation tonometry were performed in each eye to obtain estimates of IOP., Results: Ophthalmic abnormalities included corneal scars and pigmentation, incipient cataracts, lenticular sclerosis, and vitreal veiling. Mean STT values were 15.8 mm/min, with a range of 10-30 mm/min. Mean IOP values were 11.8 mmHg for TonoVet-D, with a range of 9-14 mmHg; 7.9 mmHg for TonoVet-P, with a range of 6-12 mmHg; and 10.8 mmHg for Tono-Pen XL, with a range of 8-14 mmHg., Conclusions: Ophthalmic examination findings in adult pygmy goats, including normal means and ranges for STT and IOP measurements, using applanation and rebound tonometry, are provided.

Objective: To determine outcome of initial conservative management for primary lens luxation and evaluate topically administered demecarium bromide miotic treatment for prevention of anterior lens luxation, glaucoma, and vision loss in dogs., Design: Retrospective case series., Animals: 34 dogs with primary lens luxation., Procedures: Medical records of affected dogs were reviewed for times to anterior luxation, luxation of the lens in the opposite eye, development of glaucoma, and vision loss., Results: At 4 to 6 weeks and at 3 months after diagnosis of lens instability (subluxation or posterior luxation), 100% (34/34 and 29/29, respectively) of conservatively managed eyes retained vision. At 1 year after diagnosis of lens instability, 80% (16/20) of conservatively managed eyes retained vision, and at 2 years after diagnosis of lens instability, 11 of 19 conservatively treated eyes retained vision. The only significant effect of miotic treatment was to delay anterior lens luxation in eyes with lens instability. Miotic treatment did not significantly affect the time from anterior lens luxation in 1 eye to anterior luxation in the other eye, time to onset of glaucoma, or time to loss of vision in eyes with an unstable lens., Conclusions and Clinical Relevance: Prophylactic topically administered miotic treatment may be effective at delaying anterior luxation of an unstable lens in eyes affected by primary lens instability. Conservative medical management of dogs with primary lens instability is a reasonable alternative to surgical removal of a subluxated or posteriorly luxated lens via intracapsular lens extraction.

Objective: To describe the clinical and diagnostic features of the canine sensorimotor syndrome caused by striatocapsular brain infarctions (SCI)., Animals Studied: Six dogs with diagnostic imaging or postmortem evidence of SCI., Procedures: Medical records of dogs with SCI were retrospectively reviewed and the signalment, history, clinical signs, antemortem clinicopathologic test results, diagnostic imaging findings, case outcomes, and pathologic findings recorded., Results: All dogs had an acute onset of nonprogressive homonymous visual field deficits and contralateral general proprioceptive (GP) deficits. Contralateral hemiparesis and facial hypalgesia were noted in 5/6 dogs. CT scans were normal in 2/4 dogs, and revealed poorly defined hypoattenuating lesions in the subcortical white matter in two dogs. MRI exams were performed in 5/6 dogs and revealed unilateral, variably sized, striatocapsular lesions consistent with nonhemorrhagic infarctions. Diagnostic imaging (6/6) and postmortem examinations (2/6) suggested that SCI resulted from lesions in the vascular territories of the rostral choriodal (6/6) and lenticulostriate arteries (2/6). Diseases predisposing to infarction were not identified in 5/6 dogs. Improvements in mentation, behavior, proprioceptive deficits, and hemiparesis were seen in surviving dogs, but persistent, symptomatic sensory deficits were noted during the follow-up period., Conclusions: SCI should be considered as a differential diagnosis for dogs with acute onset, nonprogressive homonymous hemianopia, contralateral GP deficits or hemiparesis, and facial hypalgesia. MRI is the preferred modality for the antemortem imaging diagnosis of SCI. Although partial recovery occurred in all surviving dogs, visual and facial sensory disturbances persisted.

Objective: To determine duration of corneal anesthesia following topical administration of 0.5% proparacaine hydrochloride solution in domestic shorthair (DSH) cats., Animals: 20 clinically normal DSH cats., Procedures: Baseline corneal touch threshold (CCT) was established by use of a Cochet-Bonnet aesthesiometer. Treatment consisted of a single 50-microL topical application of an ophthalmic preparation of 0.5% proparacaine solution to a randomly selected eye of each cat. The corneal touch threshold was assessed 1 and 5 minutes after application to the cornea and at 5- minute intervals thereafter for 60 minutes., Results: Corneal sensitivity, as determined by Cochet-Bonnet aesthesiometry, was significantly reduced from baseline for 25 minutes following topical administration of ophthalmic proparacaine. Maximal anesthetic effect lasted 5 minutes., Conclusions and Clinical Relevance: As determined by Cochet-Bonnet aesthesiometry, duration of anesthetic effects on the cornea induced by a single topical application of an ophthalmic preparation of 0.5% proparacaine solution in DSH cats is considerably shorter than the reported duration of corneal anesthesia in dogs.

Objective: To assess the efficacy and kinetics of a continuous infusion modality for topical ophthalmic drug delivery via subpalpebral lavage in horses., Animals Studied: Five ophthalmically normal horses, Procedures: A constant-rate continuous delivery pump was used to apply 0.01% fluorescein solution to the eyes of five ophthalmically normal horses via subpalpebral lavage. Fluorescein was applied at a rate of 0.14 mL/h for 72 h. Tear samples were collected from the ventral conjunctival fornix at regular intervals via capillary tube and tear fluorescein concentrations were determined via spectral assay. Laboratory studies to evaluate the procedures used in the study also were performed., Results: Overall mean tear film fluorescein concentration was approximately 20% of the applied concentration of fluorescein. However, tear film fluorescein concentrations varied considerably between horses and over time. Dilution varied from 0.62% to 60% of the applied concentration. Air pockets sporadically appeared in subpalpebral lavage tubing lines, resulting in discontinuous topical application of fluorescein., Conclusions: Constant-rate delivery of ophthalmic medications using a continuous infusion pump may provide a valuable method of topical drug delivery if tear film dilution of drugs is taken into account.

More than 30,000 people lose sight in at least one eye every year in the United States. Globe rupture is one of the most severe injuries and can often result in the loss of an eye. Previous studies to determine the injury tolerance of the human eye to globe rupture have not investigated the effects of extraocular muscles on the response of the eye. The purpose of the current study is to quantify the effects of the extraocular muscles using quasistatic displacement tests of the human eye in situ. A total of three post-mortem human heads were used for the matched pair tests designed to elucidate any differences in the force-deflection response of the human eye with the extraocular muscles intact and transected. Computed tomography imaging was utilized to observe the deformation of the eye within the orbit for each displacement, from 0 mm to 30 mm. Slight differences in the force-deflection response are observed; however, it is not clear how these differences will influence impact response at a dynamic rate. It was also observed that under quasistatic displacements that the eye is able to translate out of the way of the impactor assembly, even under large deflections, and without globe rupture. Additional dynamic tests are recommended to determine the effects of the extraocular muscles on eye impact response.

Background: Eye injuries affect a large proportion of the population and are expensive to treat. This article presents a parametric analysis of experimental data to determine the most significant factors for predicting ocular injuries or tissue lesions., Methods: Using logistic regression, statistical values were generated to determine significant projectile characteristics for predicting ocular injury in published studies. Projectiles included BBs, metal rods, and foam particles with velocities ranging from 2 m/s to 122 m/s., Results: A normalized energy (energy per projected area) value was found as the best predictor for ocular injury. Using this predictor, a 50% injury risk of corneal abrasion, lens dislocation, hyphema, retinal damage, and globe rupture was found to be 1,503 kg/s(2), 19,194 kg/s(2), 20,188 kg/s(2), 30,351 kg/s(2), and 23,771 kg/s(2), respectively., Conclusion: Normalized energy was the most significant predictor of injury type and tissue lesion. This finding is of great value for history-taking management triaging and as a design aid to minimize the risk of ocular injury for consumer products.

Objective: To investigate possible injury mechanisms in the eyes of elderly individuals and the effects of lens stiffness on model outputs indicative of injury as a function of age., Methods: Three separate frontal impact scenarios, a foam particle (30 m/s), steering wheel (15 m/s), and air bag (67 m/s), were simulated with a validated finite-element model to determine the effects of changing lens stiffness on the eye when subjected to blunt trauma. The lens stiffness of the model was increased with increasing age using stiffness values determined from the literature for 3 age groups., Results: The computational eye model demonstrated increasing peak stress in the posterior portion of the ciliary body and decreasing peak stress in the posterior portion of the zonules with increasing lens stiffness for the 2 most severe impact types, the air bag and steering wheel. Peak deformation of the lens decreased with increasing lens stiffness., Conclusions: On the basis of the computational modeling analysis, the risk of eye injury increases with age; as a result, the eyes of elderly patients may be more susceptible to ciliary body-related eye injuries in traumatic-impact situations. Clinical Relevance These data support the contention that trauma-induced damage to the lens, ciliary body, and zonules may be related to increased stiffness of the lens. The data indicate that all people, especially elderly individuals, should use safety systems while driving an automobile and sit as far from the air bag as is comfortable. Those in sports or work environments requiring protective lenses should wear them. Designers of air bags and automobile companies should continue to work to reduce the potential that the air bag will contact the eye.

Objective: To determine clinical features, diagnostic imaging abnormalities, underlying disease, disease progression, and outcome in dogs with bilateral cavernous sinus syndrome., Design: Retrospective study., Animals: 6 dogs., Procedure: Dogs were included if clinical signs consistent with bilateral cavernous sinus syndrome (i.e., deficits of the third, fourth, and sixth cranial nerves and at least 1 of the first 2 branches of the fifth cranial nerve) were present and a lesion of the cavernous sinus was identified by means of diagnostic imaging or postmortem examination., Results: 5 dogs were evaluated because of problems referable to abnormal ocular motility or pupillomotor dysfunction, and 1 dog was evaluated because of partial motor seizures involving the face and bilateral mydriasis. Four dogs had neurologic signs referable to an extrasinusoidal lesion at the time of initial examination, and the remaining 2 dogs eventually developed extrasinusoidal signs. Besides neuroanatomic location, the only consistent neuroimaging feature was variably intense, heterogeneous enhancement of cavernous sinus lesions. Neoplasia was histologically confirmed as the underlying cause in 5 of the dogs and was suspected in the remaining dog. Median survival time for the 4 dogs that were treated was 199 days (range, 16 to 392 days)., Conclusions and Clinical Relevance: Results suggest that bilateral cavernous sinus syndrome is rare in dogs but should be suspected in dogs with compatible clinical signs. Affected dogs have a poor prognosis, and dogs with clinical signs of bilateral cavernous sinus syndrome should be systematically evaluated for neoplastic disease.

The purpose of this study was to investigate eye injuries resulting from frontal automobile crashes and to determine the effects of depowered airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a 3-part investigation of 22 236 individual crashes. Of the 2 103 308 occupants exposed to a full powered deployment, 3.7% sustained an eye injury compared to 1.7% of the 310 039 occupants exposed to a depowered airbag deployment. Occupants were at a significantly higher risk to sustain an airbag-induced eye injury when exposed to a full powered airbag compared with occupants exposed to a depowered airbag deployment ( P = .04). Approximately, 90% of the eye injuries in full powered airbag deployments were caused by the airbag, compared to only 35% of the depowered airbag eye injuries.

Objective: To determine the duration of effect and the effect of multiple doses of topical ophthalmic application of 0.5% proparacaine hydrochloride on corneal sensitivity in clinically normal dogs., Animals: 8 clinically normal dogs., Procedure: Dogs were randomly allocated to treatment order in a 2 x 2 (period X treatment) crossover study. Treatments consisted of topical application of ophthalmic 0.5% proparacaine (1 drop or 2 drops at a 1-minute interval); treatments were applied to both eyes. A Cochet-Bonnet aesthesiometer was used to determine corneal touch threshold (CTT) before corneal application, 1 and 5 minutes after corneal application, and at 5-minute intervals thereafter for 90 minutes., Results: The CTT value before treatment differed significantly from CTT values after treatment until 45 minutes after application in the 1-drop group and until 55 minutes after application in the 2-drop group. As determined by use of the Cochet-Bonnet aesthesiometer, a significantly greater anesthetic effect was detected for the 2-drop treatment, compared with the effect for the 1-drop treatment, at 30, 35, 40, 45, 50, and 55 minutes after application. Maximal anesthetic effect lasted for 15 minutes for the 1-drop treatment and 25 minutes for the 2-drop treatment., Conclusions and Clinical Relevance: Duration of corneal anesthetic effect induced by topical ophthalmic application of 0.5% proparacaine in dogs of this study is considerably longer than that reported elsewhere. Serial application of doses of 0.5% proparacaine increases the duration and magnitude of corneal anesthetic effects.

Objective: To determine the effect of oral hydrocortisone on intraocular pressure (IOP) in ocular normotensive dogs., Animals Studied: Seventeen ocular normotensive dogs. Procedures Dogs were randomly assigned to treatment (n = 9) and control (n = 8) groups. Dogs in the treatment group received hydrocortisone, 3.3 mg/kg PO every 8 h, and dogs in the control group received gelatin capsule placebo PO every 8 h for 5 weeks. Applanation tonometry was performed on both eyes of all dogs prior to treatment and then once weekly for 5 weeks during hydrocortisone treatment., Results: No significant effect of treatment was noted for right (P = 0.1013) or left (P = 0.1157) eyes during the treatment period, nor was there significant interaction of treatment by week for the right (P = 0.9456) or left (P = 0.3577) eyes. A significant rise in IOP over the treatment period was noted in both right (P < 0.0001) and left (P = 0.0006) eyes of both groups, but was unrelated to treatment., Conclusion: Orally administered hydrocortisone does not significantly increase IOP in nonglaucomatous dogs when administered over a 5-week period.

Objective: To determine prevalence of retinal hemorrhages and microaneurysms in dogs with diabetes mellitus following cataract extraction by means of phacoemulsification and identify potential risk factors., Design: Retrospective study., Procedure: Medical records of dogs undergoing phacoemulsification between 1993 and 2003 were reviewed, and information was recorded on signalment, history, physical examination findings, ophthalmic examination findings, results of laboratory testing, electroretinographic findings, and surgical findings. Glycemic control was classified as poor, intermediate, or good on the basis of baseline blood glucose concentration, perioperative body weight loss, daily insulin dosage, and presence of glucosuria and ketonuria. Data from diabetic and nondiabetic dogs were analyzed to determine prevalence and risk factors for development of retinal hemorrhages or microaneurysms following phacoemulsification., Results: 11 of the 52 (21%) dogs with diabetes mellitus developed ophthalmoscopic signs of retinal hemorrhages or microaneurysms, compared with 1 of the 174 (0.6%) nondiabetic dogs. Median time from onset of diabetes mellitus to diagnosis of retinopathy was 1.4 years (range, 0.5 to 3.2 years). No risk factors for development of retinopathy were identified., Conclusions and Clinical Relevance: Results suggest that retinal hemorrhages and microaneurysms may be more common and develop earlier in diabetic dogs than previously reported. This may affect treatment, as diabetic dogs survive longer with improved glycemic control.

The purpose of this paper is to determine the static and dynamic rupture pressures of 20 human and 20 porcine eyes. This study found the static test results show an average rupture pressure for porcine eyes of 1.00 +/- 0.18 MPa while the average rupture pressure for human eyes was 0.36 +/- 0.20 MPa. For dynamic loading, the average porcine rupture pressure was 1.64 +/- 0.32 MPa, and the average rupture pressure for human eyes was 0.91 +/- 0.29 MPa. Significant differences are found between average rupture pressures from all four groups of tests (p = 0.01). A risk function has been developed and predicts a 50% risk of globe rupture at 1.02 MPa, 1.66 MPa, 0.35 MPa, and 0.90 MPa internal pressure for porcine static, porcine dynamic, human static, and human dynamic loading conditions, respectively.

Objective: To evaluate the effect of topical ophthalmic 10% phenylephrine on systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), pulse rate (PR) and electrocardiogram (ECG) in dogs., Animals Studied: Nine clinically normal dogs., Procedure: Arterial catheters were placed in the dorsal pedal artery of awake dogs and ECG leads were attached. After a 15-min acclimatization period, baseline PR, SAP, DAP and MAP were recorded every 5 min for 20 min. Two treatment groups (eight dogs each) were studied. Group I: one drop of phenylephrine was placed in each eye once. Group II: one drop of phenylephrine was placed in each eye three times at 5-min intervals. Following treatment, PR, SAP, DAP and MAP were recorded every 5 min for 90 min. The mixed procedure of the SAS system was used to perform a repeated measures analysis of variance to test for linear and quadratic trends across time., Results: Group I: There was a significant quadratic decrease in PR across time (P = 0.0051). Systolic arterial pressure increased linearly with time (P = 0.0002), MAP increased linearly with time (P = 0.0131), and DAP increased linearly with time (P = 0.0001). Group II: There was a significant quadratic decrease in PR across time (P = 0.0023). There was a significant quadratic increase in SAP (P = 0.0324), MAP (P = 0.0103) and DAP (P = 0.0131) across time., Conclusions: Topical ophthalmic application of 10% phenylephrine in normal dogs results in elevation of arterial blood pressure and reflex bradycardia.

Surgical management of corneal disease can be a challenging undertaking. Some corneal surgical procedures require specialized microsurgical training, whereas individuals with general surgical training, written guidance, and proper instrumentation can successfully perform others. A prerequisite to success is familiarity with several unique features of corneal microsurgery. The purpose of this article is to provide an overview of applicable microsurgical instruments and their proper use, to provide guidelines for appropriate suture choice and application, and to present pre- and postoperative surgical considerations particular to corneal surgical procedures. Specific surgical procedures are beyond the scope of this article, but the fundamentals of corneal surgical manipulations applicable to the specific surgeries covered in other articles in this issue are described. Finally, because an understanding of corneal function, anatomy, and physiology is essential to the corneal surgeon, a brief review of these topics with an emphasis on surgical application is provided.

Objective: To investigate eye injuries resulting from frontal automobile crashes and to determine the effects of frontal air bags., Methods: The National Automotive Sampling System database files from January 1, 1993, through December 31, 1999, were examined in a 3-part study that included an investigation of 22 236 individual crashes that occurred in the United States. A new 4-level eye injury severity scale that quantifies injuries based on recovery time, need for surgery, and possible loss of sight was developed., Results: Of all occupants who were exposed to an air bag deployment, 3% sustained an eye injury. In contrast, 2% of occupants not exposed to an air bag deployment sustained an eye injury. A closer examination of the type of eye injuries showed that there was a statistically significant increase in the risk of corneal abrasions for occupants who were exposed to an air bag compared with those who were not (P =.03). Of occupants exposed to an air bag deployment, 0.5% sustained a corneal abrasion compared with 0.04% of occupants who were not exposed to an air bag., Conclusions: Using the new injury levels, it was shown that although occupants exposed to an air bag deployment had a higher risk of sustaining minor eye injuries, the air bag appears to have provided a beneficial exchange by reducing the number of severe eye injuries.

Over 2.4 million eye injuries occur each year in the US, with over 30,000 patients left blind as a result of the trauma. The majority of these injuries occur in automobile crashes, military operations and sporting activities. This paper presents a nonlinear finite element model of the eye and the results of 22 experiments using human eyes to validate for globe rupture injury prediction. The model of the human eye consists of the cornea, sclera, lens, ciliary body, zonules, aqueous humor and vitreous body. Lagrangian membrane elements are used for the cornea and sclera, Lagrangian bricks for the lens, ciliary, and zonules, and Eulerian brick elements comprise the aqueous and vitreous. Nonlinear, isotropic material properties of the sclera and cornea were gathered from uniaxial tensile strip tests performed up to rupture. Dynamic modeling was performed using LS-Dyna. Experimental validation tests consisted of 22 tests using three scenarios: impacts from foam particles, BB's, and baseballs onto fresh eyes used within 24 hours postmortem. The energies of the projectiles were chosen so as to provide both globe rupture and no rupture tests. Displacements of the eye were recorded using high speed color video at 7100 frames per second. The matched simulations predicted rupture of the eye when rupture was seen in the BB and baseball tests, and closely predicted displacements of the eye for the foam tests. Globe rupture has previously been shown to occur at peak stresses of 9.4 MPa using the material properties included in the model. Because of dynamic effects and improvements in boundary conditions resulting from a more realistic modeling of the fluid in the anterior and posterior chambers, the stresses can be much higher than those previously predicted, with the globe remaining intact. The model is empirically verified to predict globe rupture for stresses in the corneoscleral shell exceeding 23 MPa, and local dynamic pressures exceeding 2.1 MPa. The model can be used as a predictive aid to reduce the burden of eye injury, and can serve as a validated model to predict globe rupture.

Background: Airbags have saved lives in automobile crashes for many years and are now planned for use in helicopters. The purpose of this study was to investigate the potential for ocular injuries to helicopter pilots wearing night vision goggles when the airbag is deployed., Methods: A nonlinear finite element model of the human eye was created. Ocular structures such as the fatty tissue, extraocular muscles, and bony orbit were included. The model was imported into Madymo (Mathematical Dynamical Models) and used to determine the worst-case position of a helicopter pilot wearing night vision goggles. This was evaluated as the greatest Von Mises stress in the eye when the airbag was deployed., Results: The worst-case position was achieved by minimizing the distance between the eyes and goggles, having the occupant look directly into the airbag, and making initial contact with the airbag halfway through its full deployment. Simulations with the goggles both remaining fastened to and breaking away from the aviator helmet were performed. Finally, placing a protective lens in front of the eyes was found to reduce the stress to the eye but increase the force experienced by the surrounding orbital bones., Conclusion: The finite element model of the eye proved effective for evaluating the experimental parameters.

Objective: To determine effects of cyclophotocoagulation via administration of 100 J with a neodymium:yttrium aluminum garnet (Nd:YAG) laser on corneal touch threshold (CTT), intraocular pressure (IOP), aqueous tear production, and corneal nerve morphology in eyes of dogs., Animals: 15 dogs., Procedure: Noncontact Nd:YAG laser was transsclerally applied (10 applications; 25 W for 0.1 seconds for each application to each of 4 quadrants) to the ciliary body of the left eye of 15 dogs; the right eye was the control eye. Corneal integrity, CTT, tear production as measured by the Schirmer tear test (STT), and IOP were evaluated for 14 days following laser treatment. On day 14, dogs were euthanatized, eyes harvested, and corneas stained with gold chloride. Major nerve bundles were analyzed by use of a drawing tube attached to a light microscope, and maximum diameters were measured by use of image analysis software., Results: All laser-treated eyes had significantly higher CTT values, compared with control eyes. Six of 15 laser-treated eyes developed ulcerative keratitis. On most days, IOP was significantly lower in laser-treated eyes in both morning and evening. Laser-treated eyes had a significant decrease of approximately 1 nerve bundle/corneal quadrant. Values for STT or nerve bundle diameters did not differ significantly., Conclusions and Clinical Relevance: Administration of 100 J with a Nd:YAG laser effectively reduced IOP while increasing CTT and caused a significant decrease in number, but not diameter, of major corneal nerve bundles. Nerve damage and corneal hypoesthesia are etiologic factors in ulcerative keratitis following Nd:YAG cyclophotocoagulation.

Objectives: To determine the presence of feline leukemia virus (FeLV) in the corneas of FeLV-infected cats., Animals Studied: Thirty-four random source cats., Procedures: Seventeen cats were found positive for FeLV serum p27 antigen by enzyme-linked immunosorbent assay (ELISA). Twelve ELISA positive cats were also positive on peripheral blood samples by immunofluorescent antibody (IFA) testing. Seventeen ELISA negative cats served as negative controls. Full thickness corneal specimens were collected from the left cornea of all cats and analyzed for FeLV proviral DNA and gp70 antigen by polymerase chain reaction (PCR) and immunohistochemical (IHC) testing, respectively., Results: Eleven (64.7%) positive corneal PCR results were obtained from 17 ELISA positive cats. Of 12 cats that were both ELISA and IFA positive on peripheral blood, 10 (83.3%) had positive corneal PCR results. All corneal tissues from ELISA negative cats were PCR negative. IHC staining of corneal sections revealed the presence of FeLV gp70 in corneal tissues of nine (52.9%) ELISA positive cats. Of the 12 cats that were both ELISA and IFA positive on peripheral blood, eight (66.7%) had positive corneal IHC results. Positive IHC staining was localized to the corneal epithelium. Corneal tissues of all ELISA negative cats and all IFA negative cats were negative on IHC testing., Conclusions: FeLV antigens and proviral DNA are present in corneal tissues of some FeLV-infected cats. Screening corneal donors for FeLV infection is warranted.

Pre- and postanesthetic Schirmer tear test (STT) values were measured in 46 dogs. All subjects had normal preanesthetic STT values (18.3 +/- 2.8 mm per min in the left eye [OS] and 18.3 +/- 3.0 mm per min in the right eye [OD]). Significant differences were found between pre- and postanesthetic STT values. Significant decreases in tear production were evident for up to 24 hours following the anesthetic event. Subject age did not significantly influence the results. Duration of anesthesia significantly affected the rate of return to preanesthetic STT values, with anesthetic events greater than two hours in duration having a prolonged effect as compared to anesthetic events less than two hours in duration. Anticholinergic administration prior to or during anesthesia further lowered postanesthetic STT values.

OBJECTIVE: To determine the effect of topical 1% ophthalmic atropine sulfate on intraocular pressure (IOP) in ocular normotensive horses. Animals Studied Eleven clinically healthy horses. Procedures IOP was measured bilaterally twice daily, at 8 AM and 4 PM, for 5 days. No medication was applied for the first 2 days of the study. Thereafter, one eye of each horse was treated with 0.1 mL of topical 1% atropine sulfate ointment twice daily (7 AM and 7 PM) for 3 days. The contralateral eye served as a control. In eight of the horses, an additional IOP reading was taken 3 days following cessation of the atropine treatment. RESULTS: There was no significant difference in the IOP of control vs. treatment eyes in the pretreatment period, days 1 and 2 (P = 0.97 and 0.55, respectively). During the treatment period, treated eyes of 10 of the horses had significantly lower IOP than control eyes (P = 0.03). The mean IOP reduction in treated eyes, relative to untreated eyes, was 11.2%. One horse had a significant rise in IOP in the treated eye compared to the remaining study animals. The IOP of control eyes did not vary significantly over the observation period (P = 0.27). There was no significant variation in IOP between the 8 AM and 4 PM measurement (P = 0.9). CONCLUSIONS: Topical 1% atropine sulfate causes a small, but significant decline in IOP in most ocular normotensive horses. Because topical atropine may elevate IOP in some horses, it should be used with caution in the treatment of glaucoma in this species.