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The clinical approach to the diagnosis of abusive head trauma involves many medical specialties. Careful history, which includes an understanding of pediatric development, differential diagnosis of medical conditions and the types of injuries that can result in head trauma is necessary. The collaboration with radiologists, neuroradiologists, ophthalmologists, neurosurgeons and many other specialists provides informative insight into a child’s presentation of head trauma, whether accidental or inflicted through an abusive act. This chapter informs the clinical and biomechanical evidence associated with injuries often seen in cases of abusive head trauma, and highlights how collaboration between researchers in both fields can enhance the safety and protection of children.
Eyes function as organs of both perception and expression: they can see, but they can also show. Challenging a long-running scholarly bias in favour of their visual function, Weeping Eyes foregrounds the organ's major role in affect and emotion, probing the different ways that tears are conceptualised in both sentimental and scientific literature. Centred around the rise of ophthalmology as a discipline in Britain at the turn of the nineteenth century, it considers how historical developments in ocular science shaped literary depictions of seeing and feeling. By rethinking what it can mean to cry, Megan Nash overturns critical paradigms that have long dominated ideas of the eyes and vision, and tackles some of the most pressing conceptual questions of affect studies.
Chapter 5 examines how certain conventions of the sentimental genre – like the tear and the man of feeling archetype – are taken up in the sensation fiction of Wilkie Collins. Focusing primarily on The Woman in White (1860), it suggests that Collins uses the tear as a staging point from which to mount an argument about the limits of materialism. With characters such as the infamous villain Count Fosco, he highlights the dangers involved in completely conflating emotion and physiology. With this in view, while it has become customary to see the sensation novel as a genre that addresses itself specifically to the nerves, The Woman in White pre-emptively warns its readers not to strip bodily responses of their potential for meaning.
The Introduction maps out the historical and theoretical context of Weeping Eyes, and is organised into three parts that each focus on a different ocular function. The first concentrates on crying eyes, comparing literary and scientific conceptions of tears in the late eighteenth and early nineteenth centuries, and unpacking these through the contemporary theoretical lens of affect studies. The second part focuses on seeing eyes, outlining the key theoretical foundations of vision studies, and problematising long-standing associations that persist between seeing and knowing, and seeing and power. The final section takes up reading eyes, asking what sentimental texts and tears can teach us about the role feeling plays in our engagement with books. Taken together, these sections sketch out the alternative epistemologies and agencies of the eye that are elaborated throughout the rest of the study.
In this chapter, we review the neuro-ophthalmologic history and examination, and provide frameworks for their assessment. We summarize the neuro-ophthalmologic manifestations in common movement disorders. Attention to the neuro-ophthalmologic system can assist with the differential diagnosis of these conditions.
An adult Indian buffalo (Bubalus bubalis) presented with corneal opacity, irritation, and excessive lacrimation from the left eye in the Referral Veterinary Polyclinic-Teaching Veterinary Clinical Complex (RVC-TVCC), Indian Veterinary Research Institute, Izatnagar. Clinical examination revealed a whitish thread-like worm in the left eye’s anterior chamber. The worm was surgically removed from the eye with supportive nerve blocks. Light microscopy was used for parasite morphological identification, which provided insight into the worm as female Setaria sp. Genomic DNA was isolated, and polymerase chain reaction amplification of 12S rRNA was conducted for molecular confirmation of the parasite. The amplicon was sequenced and analysed by bioinformatics software. Sequence data showed an amplicon size of 243 bp. Phylogenetic analysis with reference data from the NCBI Genbank database revealed the worm was S. digitata, with a similarity of 99.17%. The common predilection site of S. digitata is in the peritoneal cavity of natural hosts like cattle and buffalo and is mostly non-pathogenic. The aberrant migration of the parasite larva to the brain and eye commonly occurs in goats, sheep, and horses, causing clinical conditions like cerebrospinal nematodiasis (lumbar paralysis) and ocular setariasis, respectively. Nevertheless, until now, there have been no reports of ocular setariasis in buffalo. This report is the first unusual occurrence of ocular setariasis in buffalo and its molecular confirmation and phylogenetic analysis using 12S rRNA.
Decreased vision in the aged population poses significant morbidity and decreases quality of life. At least one third of the American population over age 65 has significant vision compromise due to ophthalmic disease. Decreased vision limits independence and poses significant economic and societal burdens. Ophthalmic disease in the elderly poses significant challenges to patients and providers due to the vast and diverse spectrum of ophthalmic conditions, and therefore requires specialized care by optometrists and ophthalmologists.
Ophthalmic diseases are seen at a higher frequency in aged patients and include structural changes, malignancies, and infections of the eyelids and orbit. In addition, diseases such as cataracts, age-related macular degeneration (ARMD), glaucoma, and ischemic optic neuropathy are seen at a significantly higher incidence in elderly patients and can result in severe vision loss. Routine ophthalmic care is required to identify, manage, and treat such diseases in order to prevent sequelae, optimize independence, and preserve vision. Medical therapies, surgical intervention, low-vision aids, and social support systems can be utilized to aid in treatment.
Paediatric otogenic cerebral venous sinus thrombosis is a rare, heterogeneous and life-threatening condition, with possible otological, neurological and ophthalmological sequelae. Its course and outcomes can be widely variable. The publications available often consider individual aspects of paediatric otogenic cerebral venous sinus thrombosis management. The condition itself and the nature of the currently available guidance can lead to uncertainties when holistically managing patients with paediatric otogenic cerebral venous sinus thrombosis.
Objectives
Clear recommendations for the comprehensive assessment and management of paediatric otogenic cerebral venous sinus thrombosis are presented, along with the literature review upon which they are based. Its clinical and radiological assessment are discussed.
Conclusion
A multidisciplinary approach to assessment and management is recommended, inclusive of infectious diseases, ENT surgery, neurology, ophthalmology and haematology. On balance, anticoagulation is recommended for three months. Follow-up imaging is not recommended in the absence of clinical concern. Follow up by ENT surgery, neurology and ophthalmology departments is recommended.
Eye health is an integral part of well-being that may be at increased risk when health service delivery is affected by sudden-onset disasters, complex humanitarian events, or conflict in resource-scarce environments. This study proposes a design plan for a mobile eye hospital to support health systems between the initial emergency response and recovery of health infrastructure in resource-scarce environments of low- and middle-income countries. The facility benefits from high mobility and modularity, it can be assembled and operated by minimal personnel, and easily expanded as necessary. It has capacity to host high-volume ophthalmological services without the logistical complexity of large-scale emergency medical team responses or military operations. The design provides a medium-term service that can either operate from a fixed location or be redeployed in-country with ease. Mobile eye hospitals may provide a useful facility for local governments suffering damaged health systems, or as a way to complement current eye health provision. The design may also be used by charitable nongovernmental organizations during an initial emergency response, with the ability to quickly deploy to a target location and establish eye services.
This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year.
Methods:
A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county.
Results:
Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infectious ophthalmology diagnoses increased (P < 0.001), percentage of patients on immunosuppression increased (P < 0.001), and the number of private insurance payers increased while the number of county-funded insurance payers decreased (P = 0.003).
Conclusions:
The risk of infectious eye diagnosis was double the risk of traumatic eye diagnosis from Hurricane Harvey flooding. During public disaster planning, different ophthalmological medical resources and responses should be considered for flooding versus high-wind events.
The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration (AMD).
The second chapter studies the efforts of the Christian Ḥunayn ibn Isḥāq, whose workshop in ʿAbbāsid Baghdad translated the Galenic sources considered in this book, to enhance the respectability of the specialism of ophthalmology in his Ten Treatises on the Eye. I show that, even more so than medicine, ophthalmology was at a disadvantage in its pursuit for epistemic authority because Galen himself had attacked the sub-field as an exemplar of the worrying tendency among doctors in Rome and other cities towards specialization, which threatened the unity of the discipline and the health of patients. Concerned with his own intellectual status at court, Ḥunayn, I argue, subversively uses Galen's explanation of the Timaeus' description of the eyes' service to the rational soul to give ophthalmologists a stake in medico-philosophical controversies relating to sensation. I also expose how Ḥunayn modifies Galen’s interpretation of Plato’s teleological ocular anatomy and visual theory in order to privilege the eye over all other organs as a window to cosmic knowledge.
TwinsUK is the largest cohort of community-dwelling adult twins in the UK. The registry comprises over 14,000 volunteer twins (14,838 including mixed, single and triplets); it is predominantly female (82%) and middle-aged (mean age 59). In addition, over 1800 parents and siblings of twins are registered volunteers. During the last 27 years, TwinsUK has collected numerous questionnaire responses, physical/cognitive measures and biological measures on over 8500 subjects. Data were collected alongside four comprehensive phenotyping clinical visits to the Department of Twin Research and Genetic Epidemiology, King’s College London. Such collection methods have resulted in very detailed longitudinal clinical, biochemical, behavioral, dietary and socioeconomic cohort characterization; it provides a multidisciplinary platform for the study of complex disease during the adult life course, including the process of healthy aging. The major strength of TwinsUK is the availability of several ‘omic’ technologies for a range of sample types from participants, which includes genomewide scans of single-nucleotide variants, next-generation sequencing, metabolomic profiles, microbiomics, exome sequencing, epigenetic markers, gene expression arrays, RNA sequencing and telomere length measures. TwinsUK facilitates and actively encourages sharing the ‘TwinsUK’ resource with the scientific community — interested researchers may request data via the TwinsUK website (http://twinsuk.ac.uk/resources-for-researchers/access-our-data/) for their own use or future collaboration with the study team. In addition, further cohort data collection is planned via the Wellcome Open Research gateway (https://wellcomeopenresearch.org/gateways). The current article presents an up-to-date report on the application of technological advances, new study procedures in the cohort and future direction of TwinsUK.
Visual alterations, peripheral light loss (PLL) and blackout (BO), are componentsof acceleration (+Gz) induced loss of consciousness (LOC) andrecovery of consciousness (ROC). The kinetics of loss of vision (LOV) andrecovery of vision (ROV) were determined utilizing ocular pressure inducedretinal ischemia and compared to the kinetics of LOC and ROC resulting from+Gz-induced cephalic nervous system (CPNS) ischemia. The time fromself-induced retinal ischemia in completely healthy subjects (N= 104) to the onset of PLL and complete BO was measured. The timefrom release of ocular pressure, with return of normal retinal circulation, tothe time for complete recovery of visual fields was also measured. The kineticsof pressure induced LOV and ROV was compared with previously developed kineticsof +Gz-induced LOC and ROC focusing on the rapid onset, vertical arm,of the +Gz-induced LOC and ROC curves. The time from onset ofincreased ocular pressure, immediately inducing retinal ischemia, to PLL was5.04 s with the time to BO being 8.73 s. Complete recovery of the visual fieldfrom BO following release of ocular pressure, immediately abolishing retinalischemia, was 2.74 s. These results confirm experimental findings that visualloss is frequently not experienced prior to LOC during exposure to rapid onset,high levels of +Gz-stress above tolerance. Offset of pressure inducedretinal ischemia to ROV was 2.74 s, while the time from offset of+Gz-induced CPNS ischemia to ROC was 5.29 s. Recovery of retinalfunction would be predicted to be complete before consciousness is regainedfollowing +Gz-induced LOC. Ischemia onset time normalization inneurologic tissues permits comparison between different stress-induced times toaltered function. The +Gz-time tolerance curves for LOV and LOCprovide comparison and integration of neurologic state transition kinetics inthe retina and CPNS.
Ophthalmologic complaints represent approximately 2% of emergency department (ED) visits. Acute vision loss is the most serious of such presentations and requires prompt assessment for a treatable cause. The differential diagnosis for acute vision loss includes retinal detachment, macular disorders, vaso-occlusive disorders, temporal arteritis, neuro-ophthalmologic disorders, and functional disorders. We report the case of a previously healthy 33-year-old man who presented to the ED with acute bilateral vision loss that was ultimately diagnosed as central serous retinopathy (CSR), an idiopathic, self-limited condition that typically affects males age 20 to 50 years. This condition is not mentioned in standard emergency medicine textbooks or the emergency medicine literature, and our hope is that our report will serve to illustrate a typical case of CSR and help prompt emergency physicians to consider this diagnosis in the appropriate circumstances.