Search

The association of early‐onset non‐progressive ataxia and miosis is an extremely rare phenotypic entity occasionally reported in the literature. To date, only one family (two siblings and their mother) has benefited from a genetic diagnosis by the identification of a missense heterozygous variant (p.Arg36Cys) in the ITPR1 gene. This gene encodes the inositol 1,4,5‐trisphosphate receptor type 1, an intracellular channel that mediates calcium release from the endoplasmic reticulum. Deleterious variants in this gene are known to be associated with two types of spinocerebellar ataxia, SCA15 and SCA29, and with Gillespie syndrome that is associated with ataxia, partial iris hypoplasia, and intellectual disability. In this work, we describe a novel individual carrying a heterozygous missense variant (p.Arg36Pro) at the same position in the N‐terminal suppressor domain of ITPR1 as the family previously reported, with the same phenotype associating early‐onset non‐progressive ataxia and miosis. This second report confirms the implication of ITPR1 in the miosis–ataxia syndrome and therefore broadens the clinical spectrum of the gene. Moreover, the high specificity of the phenotype makes it a recognizable syndrome of genetic origin. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion To compare pain perception, pupil behaviours, and cytokine levels during first‐eye and second‐eye femtosecond laser‐assisted cataract surgery (FLACS) and determine which is better regarding a short or long interval for bilateral FLACS.Notably, 96 eyes of 48 patients with bilateral cataracts underwent the first surgeries in the left or right eye, according to a random sequence. They were further randomised into 2‐ and 6‐week subgroups based on surgery intervals. Pupil size was measured from captured images, and pain perception was assessed using a visual analog scale (VAS). Aqueous humour prostaglandin E2 (PGE2), monocyte chemoattractant protein‐1 (MCP‐1), interleukin (IL)‐6, and IL‐8 levels were also quantitatively analysed. All patients were followed for 1 week to evaluate changes in endothelial cell density (ECD), central corneal thickness (CCT), and macular central subfield thickness (CST).Ocular pain was significantly higher in patients who underwent second‐eye FLACS. First tear break‐up time was negatively correlated with VAS score. MCP‐1 levels were significantly higher in patients who underwent second‐eye FLACS, and VAS scores were positively correlated with MCP‐1 levels across all patients. There were no differences between sequential FLACS in miosis, PGE2, IL‐6, IL‐8 levels and changes in postoperative ECD, CCT, and CST. Patients who underwent second‐eye FLACS after 6 weeks showed more CCT, CST, and MCP‐1 changes than baseline.Second‐eye FLACS causes more pain and upregulated MCP‐1. There was no difference between sequential FLACS in PGE2 levels, miosis, and postoperative inflammation. Furthermore, first‐eye FLACS triggered a sympathetic irritation, particularly after a 6‐week interval. [ABSTRACT FROM AUTHOR]

We describe and assess the efficiency of a novel technique of placing implantable collamer lens (ICL) footplates in the sulcus in poorly dilated pupils utilizing perioptic holes and two instruments simultaneously (Sinskey hook and ICL manipulator). Twelve eyes of 10 patients underwent ICL implantation through this technique. The technique employs a bimanual approach engaging perioptic holes in the eyes with intraoperative miosis. Perioptic holes were engaged with a Sinskey hook and pulled slightly back, while the footplates were tucked under the iris by using an ICL manipulator. All patients had uneventful surgery. At 1 week follow-up, uncorrected distance visual acuity (UCDVA) was −0.01 ± 0.04 logMAR with a mean vault of 606.17 ± 108.33 microns. No complications were noted. However, too small a pupil is a limiting factor; this technique can be of use in up to mid-dilated pupils. Bimanual placement of haptics of ICL may represent a safe and effective technique in insufficient mydriasis or intraoperative pupillary miosis.

BackgroundThere is an urgent need for easy-to-perform bedside measures to detect residual consciousness in clinically unresponsive patients with acute brain injury. Interestingly, the sympathetic control of pupil size is thought to be lost in states of unconsciousness. We therefore hypothesized that administration of brimonidine (an alpha-2-adrenergic agonist) eye drops into one eye should produce a pharmacologic Horner's syndrome if the clinically unresponsive patient is conscious, but not if the patient is unconscious. Here, in a first step to explore this hypothesis, we investigated the potential of brimonidine eye drops to distinguish preserved sympathetic pupillary function in awake volunteers from impairment of sympathetic tone in patients in a coma.MethodsWe enrolled comatose patients admitted for acute brain injury to one of the intensive care units (ICU) of a tertiary referral center, in whom EEG and/or neuroimaging for all practical purposes had ruled out residual consciousness. Exclusion criteria were deep sedation, medications with known drug interactions with brimonidine, and a history of eye disease. Age- and sex-matched healthy and awake volunteers served as controls. We measured pupils of both eyes, under scotopic conditions, at baseline and five times 5-120 min after administering brimonidine into the right eye, using automated pupillometry. Primary outcomes were miosis and anisocoria at the individual and group levels.ResultsWe included 15 comatose ICU patients (seven women, mean age 59 ± 13.8 years) and 15 controls (seven women, mean age 55 ± 16.3 years). At 30 min, miosis and anisocoria were seen in all 15 controls (mean difference between the brimonidine-treated pupil and the control pupil: - 1.31 mm, 95% CI [- 1.51; - 1.11], p  0.99). This effect was unchanged after 120 min and remained robust in sensitivity analyses correcting for baseline pupil size, age, and room illuminance.ConclusionIn this proof-of-principle study, brimonidine eye drops produced anisocoria in awake volunteers but not in comatose patients with brain injury. This suggests that automated pupillometry after administration of brimonidine can distinguish between the extremes of the spectrum of consciousness (i.e., fully conscious vs. deeply comatose). A larger study testing the "intermediate zone" of disorders of consciousness in the ICU seems warranted.

Background: Presbyopia is an age-related ocular condition, typically affecting individuals aged over 40 years, characterized by a gradual and irreversible decline in the eye's ability to focus on nearby objects. Correction methods for presbyopia encompass the use of corrective lenses, surgical interventions (corneal or lens based), and, more recently, the FDA-approved topical administration of 1.25% pilocarpine. While prior research has demonstrated the efficacy of daily pilocarpine eye drop application in enhancing near visual acuity by increasing the depth of focus leveraging the pinhole effect, limited knowledge exists regarding its influence on visual acuity under varying conditions of contrast and ambient luminance. Methods: This study aims to investigate the impact of these variables on visual acuity, employing the VA-CAL test, among 11 emmetropic and 11 presbyopic volunteers who reported subjective difficulties with near vision. This study includes evaluations under natural conditions with a pinhole occluder (diameter of 2 mm), and subsequent administration of 1% pilocarpine (Pilomann, Bausch + Lomb, Laval, Canada). Results: The VA-CAL results demonstrate the expected, statistically significant effects of contrast and ambient luminance on visual acuity in both emmetropic and presbyopic volunteers. Furthermore, in emmetropic individuals, the application of pilocarpine resulted in a statistically significant reduction in visual acuity. In contrast, presbyopes did not exhibit statistically significant differences in the visual acuity space under either the pinhole or pilocarpine conditions when compared to natural conditions. Conclusions: The pharmacological treatment of presbyopia with pilocarpine eye drops, intended to enhance near vision, does not adversely affect visual acuity in presbyopes. This suggests that pilocarpine may offer a viable alternative for individuals averse to wearing corrective eyewear. [ABSTRACT FROM AUTHOR]

Vision is mediated by light passing through the pupil, which changes in diameter from approximately 2 to 8 mm between bright and dark illumination. With age, mean pupil size declines. In laboratory experiments, factors affecting pupil size can be experimentally controlled. How the pupil reflects the change in retinal input from the visual environment under natural viewing conditions is unclear. We address this question in a field experiment (N = 83, 43 female, 18–87 years) using a custom-made wearable video-based eye tracker with a spectroradiometer measuring near-corneal spectral irradiance. Participants moved in and between indoor and outdoor environments varying in spectrum and engaged in a range of everyday tasks. Our data confirm that light-adapted pupil size is determined by light level, with a better model fit of melanopic over photopic units, and that it decreased with increasing age, yielding steeper slopes at lower light levels. We found no indication that sex, iris colour or reported caffeine consumption affects pupil size. Our exploratory results point to a role of photoreceptor integration in controlling steady-state pupil size. The data provide evidence for considering age in personalized lighting solutions and against the use of photopic illuminance alone to assess the impact of real-world lighting conditions.

Background: To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs. Methods: We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition. Results: We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations. Conclusions: Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended. [ABSTRACT FROM AUTHOR]

One of the most important characteristics, which determine facial appearance, is eye colour. Among the different conditions that causes an alteration in the normal iris pigmentation is congenital Horner Syndrome. Here we describe a case of right unilateral segmental heterochromia iridum in the historical portrait “Portrait of an unknown soldier” displayed at the Ferdinandeum Tyrolean State Museum (Innsbruck, Austria). Along with heterochromia, the sitter also displays right anisocoria, miosis, and mild ptosis of the upper and lower lids. This case highlights the interest of artists for modification of facial appearance in order to represent the sitter in the most possible realistic way. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 6-year-old intact male Golden Retriever exhibiting bilateral miosis, third eyelid protrusion, and lateralizing forebrain signs, emphasizing the diagnostic process involving neurological examination, anatomic and etiologic diagnoses, and MRI findings revealing a smaller right prosencephalon with irregular gyri and ventricular enlargement.

Exposure to environmental stressors is known to increase disease susceptibility in unexposed descendants in the absence of detectable genetic mutations. The mechanisms mediating environmentally-induced transgenerational disease susceptibility are poorly understood. We showed that great-great-grandsons of female mice exposed to tributyltin (TBT) throughout pregnancy and lactation were predisposed to obesity due to altered chromatin organization that subsequently biased DNA methylation and gene expression. Here we analyzed DNA methylomes and transcriptomes from tissues of animals ancestrally exposed to TBT spanning generations, sexes, ontogeny, and cell differentiation state. We found that TBT elicited concerted alterations in the expression of "chromatin organization" genes and inferred that TBT-disrupted chromatin organization might be able to self-reconstruct transgenerationally. We also found that the location of "chromatin organization" and "metabolic" genes is biased similarly in mouse and human genomes, suggesting that exposure to environmental stressors in different species could elicit similar phenotypic effects via self-reconstruction of disrupted chromatin organization.

Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40–50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field. [ABSTRACT FROM AUTHOR]

Background: Horner's syndrome (HS) classically consists of the symptom triad of miosis, ptosis, and anhidrosis. It is caused by impairment of a certain pathway in the sympathetic nervous system. It may also appear as part of the clinical signs of other diseases and syndromes, including Pancoast tumors, intradural and/or epidural tumors, thoracic outlet syndrome, syringomyelia, brachial plexus injury, and aortic dissection. Here, we report a very rare complication of vertebral column resection in children, and we present the clinical findings of a case of Horner's syndrome with a current literature review. Case presentation: A five-year-old child with severe congenital kyphoscoliosis qualified for surgical treatment of the spinal deformity via a posterior approach, with three-column osteotomy and fusion. Results: After successful surgery, the patient presented with HS due to distraction of the sympathetic nerve trunk and, thus, innervation to the left eye. At the 4-year follow-up, the child had fully recovered. Conclusions: Pediatric HS after posterior instrumented scoliosis correction surgery with posterior vertebral column resection of the thoracic spine is very rare. This is the first reported case of HS after posterior vertebral column resection and spinal fusion for congenital kyphoscoliosis without the use of epidural analgesia. Symptom resolution may be variable and, in some cases, delayed. [ABSTRACT FROM AUTHOR]

Background: To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs. Methods: We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition. Results: We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations. Conclusions: Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended.

Continuous circular capsulorhexis (CCC) was demonstrated independently by Thomas Neuhann, Kimiya Shimizu, and Howard Gimbel in the 1980s and it finds mention in the landmark paper by Gimbel and Neuhann. The authors describe a technique of achieving the rhexis in a stable, viscoelastic-filled anterior chamber using the tunnel floor as the entry. This gets covered by the roof of the tunnel postoperatively and, therefore, does not leak. There is no oar-locking or striae even when cystitome goes beyond the edge of the tunnel. As there is no escape of the viscoelastic substance, there is no change in the pressure or shallowing of the anterior chamber. It is a useful technique for beginners. It is of great help in difficult cases like intumescent cataracts, shallow anterior chambers, hyperopes, nanophthalmos, pseudoexfoliation, small non-dilating pupils, intraoperative floppy iris syndrome (IFIS), and phacomorphic glaucoma. [ABSTRACT FROM AUTHOR]

Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) have not been evaluated sufficiently due to limited data, particularly in China. Methods: Patients with SUNCT or SUNA treated in a tertiary headache centre or seven other headache clinics of China between April 2009 and July 2022 were studied; we compared their demographics and clinical phenotypes. Results: The 45 patients with SUNCT and 31 patients with SUNA had mean ages at onset of 37.22 ± 14.54 years and 42.45 ± 14.72 years, respectively. The mean ages at diagnosis of SUNCT and SUNA were 41.62 ± 12.70 years and 48.68 ± 13.80 years, respectively (p = 0.024). The correct diagnosis of SUNCT or SUNA was made after an average of 2.5 (0–20.5) years or 3.0 (0–20.7) years, respectively. Both diseases had a female predominance (SUNCT: 1.14:1; SUNA: 2.10:1). The two diseases differed in the most common attack site (temporal area in SUNCT, p = 0.017; parietal area in SUNA, p = 0.002). Qualitative descriptions of the attacks included stabbing pain (44.7%), electric-shock-like pain (36.8%), shooting pain (25.0%), and slashing pain (18.4%). Lacrimation was the most common autonomic symptom in both SUNCT and SUNA patients, while eyelid oedema, ptosis, and miosis were less frequent. Triggers such as cold air and face washing were shared by the two diseases, and they were consistently ipsilateral to the attack site. Conclusions: In contrast to Western countries, SUNCT and SUNA in China have a greater female predominance and an earlier onset. The shared core phenotype of SUNCT and SUNA, despite their partial differences, suggests that they are the same clinical entity. [ABSTRACT FROM AUTHOR]

Background Amitraz is a formamidine insecticide and acaricide that acts on α2 adrenergic receptors. There is limited information in the literature regarding the toxicity of this compound and treatment of poisoning. Here, we have studied the epidemiology, symptoms, signs, complications, abnormalities in the tests, management, and prognosis of individuals who were admitted to a tertiary care hospital with acute amitraz intoxication. Methods This retrospective study was conducted at a tertiary care facility, Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, India. A total of 76 laboratory-confirmed cases of amitraz poisoning admitted to our hospital between January 2014 and March 2024 were included. All patients were analysed for symptoms, signs, laboratory abnormalities, complications, and management protocols. The data was analysed for frequency, percentage, mean, median, mode, standard deviation, and minimum and maximum values using IBM SPSS Statistics, version 26. Results Amitraz poisoning was most commonly observed in patients aged 20-29 years (36.8%); approximately 23.7% were younger than 20 years. The incidence was the lowest (9.2%) in people who were older than 60 years. A total of 97.4% of patients were from rural areas; out of 76, 50% were male patients and the remaining female patients. The most common presentation was vomiting (90.8%), followed by loss of consciousness (31.6%) and drowsiness (23.7%). Miosis was the most common sign seen in 73.7% of patients, 3.9% had mid-dilated pupils, 5.2% had mydriasis, and 17.1% had normal pupils. In total, 32.9% had hypotension, 10.5% had hypertension and 15.8% had hypothermia; 7.9% of patients had pneumonitis as found on chest X-rays, whereas X-rays of 1.3% patients showed pulmonary edema. ECG findings showed sinus tachycardia in 32.8% of patients, sinus bradycardia in 18.4%, and tall T-waves in only 1.3%, whereas 47.4% had a normal sinus rhythm. Around 39.5% had metabolic acidosis, and 9.2% had metabolic alkalosis based on arterial blood gas analysis. A total of 28.9% of patients needed mechanical ventilation. It was found that 96% of the patients recovered and 2.6% succumbed to death. Also, a patient's average stay in the hospital was 4.83±2.4 days. Conclusion The research emphasizes the importance of prompt gastric lavage to mitigate the hazardous effects of amitraz. Despite the lack of an antidote, supportive treatment is necessary to address cardiac effects like bradycardia and hypotension, as well as central nervous system depression and respiratory failure. Even though amitraz intoxication has a benign prognosis, these cases are to be closely observed and monitored in intensive care units., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee of Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura issued approval BLDE (DU)/IEC/ 1078/ 2023-24. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jalawadi et al.)

Presbyopia is a progressive, age-related condition that reduces the eye's ability to focus on near objects. If uncorrected or undercorrected, presbyopia can negatively impact people's daily activities and quality of life. Until recently, standard treatments comprised corrective glasses or contact lenses and surgical procedures, all of which fail to restore natural accommodation of the lens and are associated with inconvenience and/or potential ocular complications. Pilocarpine hydrochloride (HCl) ophthalmic solution 1.25% (Vuity™; Allergan, an AbbVie Company, North Chicago, IL, USA) is the first and, at the time of writing, only topical agent approved by the United States Food and Drug Administration to treat presbyopia. Pilocarpine HCl ophthalmic solution 1.25% is formulated in a proprietary vehicle using pHast™ technology, which allows rapid equilibration to the physiological pH of the tear film to enhance bioavailability and reduce side effects such as ocular discomfort and vision blur. Clinical trials in individuals with presbyopia have demonstrated that pilocarpine HCl 1.25% is well tolerated and leads to rapid improvements in near and intermediate vision, without impacting distance vision. In this article, we discuss the mechanism of action of pilocarpine HCl 1.25%, preclinical and clinical evidence supporting its use in presbyopia, and its value in providing a non-invasive, reversible, glasses-free alternative for managing presbyopia. [ABSTRACT FROM AUTHOR]

Abstract Objective: To assess the efficacy of prophylactic administration of 0.1% nepafenac in the maintenance of trans-operative mydriasis following cataract surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Oct 2018 to Mar 2019. Methodology: A total of 70 patients undergoing cataract surgery phacoemulsification were randomly placed in either the control group or the nepafenac group. Nepafenac eye drops were administered as one drop 8 hourly, 3 days before surgery. Control group didn’t receive any medication preoperatively Mydriasis was measured trans-operatively before surgery, after aspiration of the cortex, and then at the end of surgery. Patients of both groups received tobradex 2 weeks post-surgery. Results: Post-surgery statistically significant (0.001) difference was observed in the mean pupil size between the nepafenac group (7.88 ± 0.49) and the control group (6.57 ± 0.92 mm). Conclusion: Use of nepafenac prophylactically was very effective in maintenance of trans-operative mydriasis in cataract surgery.

Purpose: To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification.Methods: This was a prospective case-control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups(20 eyes each group), and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V), B-HEX Pupil Expander (Med Invent Devics, India)(group VI),respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity (BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared.Results: One same doctor finished all cataract surgeries successfully. The eyes' condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. The ECDs were better at 6 months postoperatively in group III and V, median values: 2114/mm2, 1961/mm2. PD was largest in group II (median value: 5.5 mm), which was significantly larger than other groups (Padjusted < 0.05).Conclusions: All 6 methods used in this study were effective for the mechanical dilatation of small pupils and didn't affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification. Iris-retractor hooks and the Malyugin Ring can reduce intraoperative corneal endothelium cell loss. Postoperative PD is larger when the iris was cut open radially. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to demonstrate the patient demographics, etiologies and apraclonidine test results in adult Horner's syndrome. Methods: This retrospective study was performed by the analysis of medical data of patients who were given 0.5% apraclonidine test. Patients' past medical history, demographic data, etiologies, accompanying neurological findings and pharmacological test results were assessed. Results: Forty patients (21 females and 19 males) with a mean age of 50.3 ± 11.6 years were evaluated. Apraclonidine 0.5% test was positive in 37 patients (92.5%). An etiology could be identified in 20 patients (central [9 patients, 45%], preganglionic [9 patients, 45%] and postganglionic [2 patients, 10%]). Neurological findings accompanying Horner's syndrome were present in 8 patients. Conclusion: Despite detailed investigations, in a significant number of patients with Horner's syndrome an underlying cause may not be detected. Among the identifiable lesions, central and preganglionic involvements are still the first leading causes of Horner's syndrome. In addition, apraclonidine test may not be positive in all patients and a negative response does not exclude Horner's syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of cataract extraction through small pupil with the help of a specially designed instrument called club. Study Design: Interventional case series. Place and Duration of Study: Euro eye clinic from January 2019 to December 2019. Methods: Seventeen consecutive patients with pupil diameter of <4mm after maximal pharmacological dilatation were recruited for study. Inclusion criteria was patients with less than 4mm pupil size after maximum pharmacological dilation. Patient with previous anterior segment surgery and small pupil with posterior synechea were excluded. The instrument (club) was originally designed for breaking posterior synechae. Sutureless Manual Extracapsular Cataract Extraction (SMECE), more commonly known as MSICS, was performed in all cases. After tunnel formation and capsulotomy, club was used to bring lens edge out in pupillary margin. Lens was then maneuvered into anterior chamber and expressed out. Results: All 17 patients had successful SMECE. In one patient pupil was stretched before applying instrument. None of the patients had posterior capsular rupture or hyphaema. Conclusion: This instrument designed in Center of Ophthalmic Instrument and Equipment Designing (COIED) is very useful, safe and cost effective. In Extra Capsular Cataract Extraction (ECCE) or SMECE, surgeons usually do keyhole iridotomy, mechanical stretching or multiple sphincterotomies for managing small pupil. With this new instrument, cataract extraction can be done without surgical trauma to the pupil, thus preserving pupil shape. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Horner’s syndrome (HS) is characterized by unilateral ptosis, ipsilateral miosis with normally reactive pupil, and in some cases, ipsilateral facial anhidrosis. Case presentation We report an adult male presenting with ptosis. Neurological examination revealed ptosis and miosis in the right eye. Anhidrosis was not observed, and the patient did not complain about it. Laboratory tests were within normal limits. He had searched a general practitioner because of purulent nasal discharge, nasal obstruction, and anosmia. He was diagnosed with acute rhinosinusitis. Symptomatic treatment was started. The subject had full recovery of the nasal symptoms, but his right upper eyelid was drooping progressively. In the follow-up, after the third month, the patient was recovering from ptosis and miosis. In 1 year, the ptosis was minor with less than 1 mm and miosis was no more observed. Discussion A few cases of HS secondary to a sinus infection have been reported in the literature. To the authors’ knowledge, there are only two case reports of individuals who developed sinusitis and Horner’s syndrome. The present case is the first to present isolated HS features. Our report suggests that sinusitis should be listed as a probable cause of isolated Horner’s syndrome. Moreover, patients presenting with this presentation probably have a good prognosis.

Gaze direction and pupil dilation play a critical role in communication and social interaction due to their ability to redirect and capture our attention and their relevance for emotional information. The present study aimed to explore whether the pupil size and gaze direction of the speaker affect language comprehension. Participants listened to sentences that could be correct or contain a syntactic anomaly, while the static face of a speaker was manipulated in terms of gaze direction (direct, averted) and pupil size (mydriasis, miosis). Left anterior negativity (LAN) and P600 linguistic event-related potential components were observed in response to syntactic anomalies across all conditions. The speaker's gaze did not impact syntactic comprehension. However, the amplitude of the LAN component for mydriasis (dilated pupil) was larger than for miosis (constricted pupil) condition. Larger pupils are generally associated with care, trust, interest, and attention, which might facilitate syntactic processing at early automatic stages. The result also supports the permeable and context-dependent nature of syntax. Previous studies also support an automatic nature of syntax (fast and efficient), which combined with the permeability to relevant sources of communicative information, such as pupil size and emotions, is highly adaptive for language comprehension and social interaction., (© The Author(s) 2024. Published by Oxford University Press.)

Purpose: To evaluate the efficacy and safety of a hinged pupil expansion device (PED) in eyes with small pupils undergoing phacoemulsification.Methods: In this prospective, multicenter, interventional case series of 57 eyes with suboptimal pharmacologic pupil dilation (<5 mm diameter), a hinged PED (I-Ring, Beaver-Visitec International, Waltham, MA) was applied to facilitate surgical visualization during cataract surgery. The pupil diameters (PD) were measured at different stages of the procedure and at the 1-month follow-up visit. Rate of successful intraoperative PED deployment, pupil size, and shape were assessed.Results: The mean patient age was 70.5 ± 12.1 years. The I-Ring PED was successfully applied in all eyes. The mean PD at various stages were 4.1 ± 1.1 mm (dilation with eye drops only preoperatively), 4.3 ± 1.1 mm (dilation after intracameral epinephrine and ophthalmic viscoelastic device), 6.80 ± 0.00 mm (with PED applied), and 5.7 ± 1.1 mm (end of surgery). A statistically significant difference (P < 0.001) was observed between the mean PD with intracameral medications and with PED application. Postoperative circular pupil was observed in 54 of 57 eyes (94.7%) and the mean eccentricity index (n = 57 eyes) was 0.11 ± 0.22. No significant adverse events were observed.Conclusion: The I-Ring PED safely and effectively provided and maintained adequate pupil expansion and surgical visualization in eyes with small pupils undergoing cataract surgery. Postoperatively 95% of eyes attained circular pupils. This hinged PED is an additional instrumentation option for the safe and effective expansion of inadequately sized pupils during cataract surgery. [ABSTRACT FROM AUTHOR]

Background: Physicians currently measure the pupil diameter and the pupillary light reflex with visual observations using a ruler and a traditional penlight, leading to possibly inaccurate and subjective assessments. Although a mobile pupillometer has been developed and is available in clinical settings, this device can only assess one pupil at a time. Hence, an indirect pupillary light reflex, including those under irradiation to the opposite side of pupil, cannot be evaluated. Consequently, we have developed a new automatic mobile pupilometer, the Hitomiru®, with Hitomiru Co., Ltd. (Tokyo, Japan). This device is a two-glass type pupilometer with a video recording system. The pupil diameter and light reflex of both pupils can be measured simultaneously; therefore, both indirect and direct light reflexes can be assessed.Purpose: To evaluate the clinical ability of the Hitomiru® pupilometer to assess the pupil diameter and the pupillary light reflex of healthy volunteers and patients with intracranial lesions in an intensive care unit (ICU).Methods: Twenty-five healthy volunteers and five ICU patients with intracranial lesions on only the left side were assessed using the Hitomiru® pupilometer. The protocol was as follows: infrared light was applied to both pupils, followed by visible light to the right pupil, infrared light to both pupils, visible light to the left pupil, and then infrared light to both pupils. All the intervals were 2 s, and the dynamics of pupil diameters on both sides were continuously recorded.Results: The healthy adults had approximately 0.5 mm anisocoria, miosis was harder, and mydriasis was less with increased age. There were several differences in miosis rates, miosis times, and mydriasis rates between the healthy adults and the patients with intracranial lesions with both direct irradiation and indirect irradiation.Conclusions: The initial trial estimated and digitally recorded direct and indirect light reflexes, including rapidity of miosis after direct and indirect lights on, and mydriasis after direct and indirect lights off. The Hitomiru® pupilometer was a useful device to digitally record and investigate the relationship between pupil reflexes and intracranial diseases.

Objective: To assess the efficacy of prophylactic administration of 0.1% nepafenac in the maintenance of trans-operative mydriasis following cataract surgery. Study Design: Comparative prospective study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Oct 2018 to Mar 2019. Methodology: A total of 70 patients ndergoing cataract surgery phacoemulsification were randomly placed in either the control group or the nepafenac group. Nepafenac eye drops were administered as one drop 8 hourly, 3 days before surgery. Control group didn't receive any medication preoperatively Mydriasis was measured trans-operatively before surgery, after aspiration of the cortex, and then at the end of surgery. Patients of both groups received tobradex 2 weeks post-surgery. Results: Post-surgery statistically significant (0.001) difference was observed in the mean pupil size between the nepafenac group (7.88 ± 0.49) and the control group (6.57 ± 0.92 mm). Conclusion: Use of nepafenac prophylactically was very effective in maintenance of trans-operative mydriasis in cataract surgery. [ABSTRACT FROM AUTHOR]

A 57-year-old female presented with headache, miosis, and ptosis diagnosed as Horner syndrome (HS). After delaying the recommended diagnostic imaging, she experienced transient, unilateral visual impairment in bright light. The patient was subsequently determined to have a spontaneous internal carotid artery dissection (ICAD) and secondary retinal ischemia with minimal cardiovascular risk factors and no history of preceding trauma. She wore dark glasses, received gabapentin for pain control, and was anticoagulated for a total of 4 months at which time the ICAD resolved despite a residual blepharoptosis and anisocoria.

Stephen A LoBue,1,2 Prashant Tailor,3 Thomas D LoBue1 1Department of Ophthalmology, LoBue Laser and Eye Medical Center Inc, Murrieta, CA, USA; 2Lincoln Medical Center, Affiliated to Weill Cornell Medical College, Bronx, NY, USA; 3Medical College of Georgia, Augusta, GA, USACorrespondence: Thomas D LoBueLoBue Laser and Eye Medical Center Inc, 40700 California Oaks Road, Ste 106, Murrieta, CA 92562, USATel +1 951-696-1135Email Thomas.lobue@lobueeyecenters.comPurpose: To report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract.Methods: A single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion.Results: Nine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal.Conclusion: Dense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.Keywords: dense cataract, miosis, IFIS, dementia, novice surgeon, pupil ring

To evaluate post-miosis changes in the anterior chamber structures in various angle-closure glaucomas (ACG). Totally 14 eyes of primary chronic angle-closure glaucoma (PCACG), 12 eyes of lens-induced secondary chronic angle-closure glaucoma (LSACG) and 14 healthy eyes were recruited. After miosis, for PCACG group, intraocular pressure (IOP) and anterior chamber depth (ACD) changed not significantly, while anterior chamber angle widened significantly. LSACG group showed a significant increase in IOP, decrease in ACD, and narrowing in anterior chamber angle. Healthy eyes showed significant decreases in IOP and anterior chamber parameters. Thus, miosis could widen the anterior chamber angle of patients with PCACG, while increase the narrowing of anterior chamber angle and IOP of patients with LSACG. We should pay attention to the distinction between PCACG and LSACG patients and the proper administration of pilocarpine in the treatment of patients with chronic ACG.

Purpose: To present a work related penetrating neck injury that was refered to our department for Horner`s Syndrome (HS). Case Presentation: A 48-year-old male was referred to Ophthalmology department due to blurred vision in his left eye. In his medical history, he had a work related penetrating neck injury by a four cm metal of diamond cutting piece one year ago. On physical and ophthalmologic examination, ptosis and miosis were detected on his left eye. Conclusion: Artery injuries should be kept in mind, if HS accompany a neck injury. To best of our knowledge our case report is the first occupational HS with a projectile object.