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Cranial Neuropathies II, III, IV, and VI
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Tanyatuth Padungkiatsagul, Heather E. Moss
The CN III innervates the medial, inferior, and superior recti muscles as well as the inferior oblique, along with the levator muscle of the eyelid, and the pupillary sphincter. Therefore, a complete CN III palsy causes limitation in ipsilateral elevation, adduction, and depression. The eye classically appears ‘down and out’, with ipsilateral ptosis and mydriasis (Figure 22.17). Diplopia is oblique and resolves in ipsilateral gaze. Patients may not complain of diplopia if the ptosis blocks vision in one eye. The mydriasis can cause blurry vision at near if accommodation is also impaired.
Pathological Processes of the Eye Related to Chemical Exposure
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
For examination of the lens and iris and for closer examination of the cornea and the adnexa, the use of a slit-lamp biomicroscope is indicated. Slit-lamp examination can be performed with a mydriatic if good visualization of the lens is desired, or without a mydriatic if the iris is of concern. The slit-lamp biomicroscope is a necessity in performing eye irritation evaluations (e.g., the Draize test).
L-5-Hydroxytryptophan
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Melvin H. Van Woert, Eunyong Chung
The most common adverse effects of L-5HTP/carbidopa are anorexia, nausea, diarrhea, and vomiting, which usually decrease or disappear within several months after initiating therapy. If significant gastrointestinal adverse effects develop, while initiating treatment, the rate of L-5HTP increase can be slowed to every 1 to 2 weeks. Prochlorperazine or trimethobenzamide may be added for severe nausea and/or vomiting and diphenoxylate for diarrhea; these drugs can be discontinued after several weeks to a few months after a tolerance to these adverse effects develops. Some patients on L-5HTP/carbidopa manifest behavioral changes, which consist of euphoria, disinhibition, increased alertness, and impaired judgment (24,25). With further increases in L-5HTP, hypomania, restlessness, rapid speech, anxiety, insomnia, agitation, and aggressiveness can evolve. Mydriasis, blurring of vision, abdominal pain, and lightheadedness may also occur. Two patients with myoclonus have developed a sclerodermalike skin reaction, without evidence of systemic involvement, during chronic therapy with L-5HTP/carbidopa (26). Dyspnea with hyperventilation, hypotension, and sleepiness have been observed with doses of L-5HTP greater than 2000 mg/day. The only changes in routine laboratory tests have been a 20% decrease in plasma cholesterol level (24).
Evaluation of Pupillometric Parameters in Patients with COVID-19
Published in Ocular Immunology and Inflammation, 2023
Yücel Öztürk, Merve Beyza Yıldız, Rüveyde Bolaç
The autonomic nervous system affects multiple ocular functions, including pupillary reflexes. Mydriasis and miosis occur in response to sympathetic and parasympathetic stimulation, respectively. The afferent pathway of the pupillary light reflex is carried by the second cranial nerve, while the efferent pathway is carried by the third cranial nerve.12 Pupillometry analysis provides useful information in the diagnosis and follow-up of many neurological and ophthalmological diseases.13 The identification of the differentiation in autonomic nervous system function presented by pupillometric measurements may contribute to the understanding of the neurological effects of COVID-19 and may become a useful clinical biomarker to detect autonomic nervous system differences. We aimed to investigate the pupil diameter and the pupillary light response in patients with a history of COVID-19 accompanied by neurological manifestations compared with the age- and gender-matched healthy controls.
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
An acute angle closure with pupil block can result from drug-induced mydriasis in patients with anatomically narrow angles. Any psychiatric medication with anticholinergic effects, including TCAs, SSRIs, SNRIs, and others, can cause mydriasis.71–73 Appropriate treatment includes reversal of the mydriasis and discontinuation of the medication. Therefore, communication with primary care physicians of these at-risk patients is important. Secondary angle closure may also occur with topiramate use, although the mechanism of action differs. Researchers suspect that choroidal effusion causes forward displacement of the lens, resulting in angle closure. Treatment includes aggressive cycloplegia in order to reopen the closed angle.54,74 Optometrists can evaluate the angle with gonioscopy and slitlamp examination. The astute clinician should be able to distinguish between an angle closure necessitating cycloplegia as treatment, and angle closure where cycloplegia would further exacerbate the problem.
A systematic evidence-based review of treatments for primary hyperhidrosis
Published in Journal of Drug Assessment, 2021
Michael E. Stuart, Sheri A. Strite, Kristin Khalaf Gillard
Although there were only two studies investigating topical glycopyrronium cloth for the treatment of axillary hyperhidrosis, they were of “moderate” quality with large groups, good designs and execution for both efficacy and safety, and reported consistent results. In these two key clinical trials for glycopyrronium cloth, most treatment-emergent adverse events were transient and reversible. Anticholinergic side effects are a potential risk with glycopyrronium cloth treatment, and Glaser et al.16 noted that patients who do not wash their hands following application may inadvertently transfer the drug to another body area such as the eyes. Authors concluded that unilateral ophthalmologic events of mydriasis and blurred vision were most likely due to local exposure, whereas anticholinergic side effects such as dry mouth and urinary hesitation were likely a result of systemic exposure.