양안에서 발생한 양성 간헐동공산대 1예

안예림,김한얼,김예림,최연주 대한안과학회 2019 대한안과학회지 Vol.60 No.9

Purpose: Although benign episodic mydriasis has been rarely reported worldwide, most of the reports so far have occurred in unilaterally. To report an unusual case of benign episodic bilateral mydriasis. Case summary: Nineteen-year-old woman who presented with intermittent dilation of both pupils two months ago. She had difficulty on reading and doing tasks because of her visual blur. This symptom usually lasted for 1-2 hours, occurred once every 2-3 days, most frequently during stressful situations. Headaches and dizziness accompanied the eye symptoms, and her pupils were both 5 mm in a lighted room and both 7 mm in a dark room. All tests, including brain magnetic resonance imaging, showed no abnormal findings. We diagnosed her as benign episodic bilateral mydriasis. The frequency of her symptoms decreased during the university vacation period. Conclusions: In the absence of ophthalmologic or neurologic abnormalities other than headaches in patients with transient mydriasis, benign episodic mydriasis should be considered as a differential diagnosis. Although benign episodic bilateral mydriasis has a unilateral predominance, for the first time the authors report that benign episodic mydriasis may occur in both eyes during same episode. 목적: 양성 간헐동공산대가 전 세계적으로 드물게 보고되고 있으나, 지금까지의 보고는 대부분 단안에 발생하였다. 양안에서 동시에발생한 양성 간헐동공산대를 경험하였기에 이를 보고하고자 한다. 증례요약: 19세 여자 환자가 간헐적으로 양안 동공이 확장되어 독서하기 어려움을 주 증상으로 본원에 방문했다. 대개 2-3일에 한번, 1-2시간 정도 지속되는 양상을 보였으나 스트레스를 받는 상황에서 더 빈번하게 일어난다고 하였으며, 증상이 발생할 때 두통, 어지러움이 동반되었다고 했다. 밝은 조명에서 5 mm/5 mm, 어두운 조명에서 7 mm/7 mm로 동공이 확장된 상태였다. 뇌 자기공명영상을 비롯한 전신 소견과 안과적 검사는 정상이었다. 양안에서 발생한 양성 간헐동공산대로 진단하였고, 이후에도 증상은 반복되었으나, 방학 기간이 되면서 증상이 발생하는 빈도가 감소하는 양상을 보였다. 결론: 일시적인 동공산대를 보이는 환자에서 두통 이외에 다른 안과적, 신경학적 이상 소견이 없다면, 양성 간헐동공산대도 감별진단으로 고려해야 하겠다. 주로 편측성으로 발생하는 것으로 알려져 있지만 양안에 동시에 발생할 수도 있다는 점을 최초로 보고하는바이다.

약물에 의한 동공 확장이 안구, 각막 및 안내 수차에 미치는 영향

유은주,강수연,김효명,송종석,Eun Joo Yoo,Su Yeon Kang,Hyo Myung Kim,Jong Suk Song 대한안과학회 2013 대한안과학회지 Vol.54 No.4

aberrations. Methods: Sixty-two right eyes of 62 healthy participants were included in the present study. Ocular, corneal and internal aberrations were measured with a KR-1W wavefront aberrometer (Topcon Corp., Tokyo, Japan) before mydriasis in mesopic conditions. After pupil dilatation with a mydriatic drug (phenylephrine chloride 0.5% + tropicamide 0.5%) (Mydrin-P, Santen, Osaka, Japan), the measurements were repeated. The wavefront data of 4-mm and 6-mm diameter zones were analyzed. The changes of aberrations before and after mydriasis were evaluated by paired t-test. Results: The values of ocular, corneal and internal spherical aberrations before and after mydriasis on the 4-mm diameter pupil zone were not statistically significantly different. On the 6-mm diameter zone, the ocular and internal spherical aberrations were statistically significantly different (p = 0.025, p = 0.002, respectively, paired t-test). However, the corneal aberrations did not show significant changes. The internal aberrations average before mydriasis was -0.043 (±0.21) μm and was shifted in a negative direction to -0.093 (±0.17) μm after mydriasis. The ocular aberrations average also changed toward negative after mydriasis. The high-order aberrations and astigmatism did not change significantly. Conclusions: The ocular and internal spherical aberrations changed toward negative with mydriasis in the participants’ eyes suggesting the change of the ocular spherical aberration to be attributed to internal changes.

면봉을 이용한 산동제 결막 도포법의 효용성

변용수,김수영,박영훈,이영춘,Yong Soo Byun,M,D,Su Young Kim,M,D,Young Hoon Park,M,D,Young Chun Lee,M,D 대한안과학회 2008 대한안과학회지 Vol.49 No.4

Purpose: We compared the efficacy of applying mydriatics to the conjunctiva of the lower eyelid by using a cotton-tipped applicator with an eye-dropping method. Methods: Thirty children under 16 years of age (60 eyes) and 30 adults more than 20 years old (60 eyes) were randomly chosen. Mydriatics were applied to each eye using an eye-dropping method for one eye and a conjunctival application method using a cotton-tipped applicator for the other eye. Pupil size was measured before applying mydriatics, immediately and at 30 and 60 minutes after application. Also, we investigated the degree of discomfort. Results: In the children, the pupil size in the eye dropping group and the conjunctival application group were each 8.01±0.57 mm and 7.97±0.57 mm at 60 minutes after applying mydriatics (P=0.07). In the adults, the pupil size was 7.94±0.59 mm in the eye-dropping group and 7.89±0.55 mm in the conjunctival application group at 60 minutes after applying mydriatics (P=0.074). In terms of degree of discomfort, the adults found the conjunctival application method to be significantly more unpleasant than the eye-dropping method at each three applications (P=0.001, 0.001, 0.001). Conclusions: The conjunctival application method using a cotton-tipped applicator has an equal effect in terms of mydriasis compared to the eye-dropping method. It is convenient to use in children and in the elderly who show less compliance. Also, this new method reduces systemic absorption of the medication. Therefore, the conjunctival application method is a good substitute for the conventional methods for mydriasis.

천사의 나팔의 접촉에 의한 편측 동공 산대 1예

이영섭,서경훈,박인기,Young Seob Lee,MD,Kyung Hoon Seo,MD,In Ki Park,MD 대한안과학회 2011 대한안과학회지 Vol.52 No.10

Purpose: To report a case of unilateral mydriasis after accidental exposure to an Angel’s trumpet leaf. Case summary: A 53-year-old woman visited the Eye Department complaining of blurred vision and difficulty in light adaptation in the left eye of 1-week duration. The best corrected visual acuity was 20/20 in both eyes and other ophthalmological findings were considered normal except for dilation of the left pupil and a decrease in light reflex. The patient was initially unaware of any cause of her eye problems, but when asked specifically, the patient remembered an Angel’s trumpet leaf brushing against her left eye when she carried the plants. There were no other previous medical or drug histories, thus the Angel’s trumpet was considered as the cause for the unilateral mydriasis. The patient’s progress was followed for a week, her symptoms improved and the pupil size and reflex returned to normal. Conclusions: The cultivation of Angel’s trumpet has become increasingly popular in Korea in recent years. The present case emphasizes the importance of an accurate and detailed history regarding specific contact history with plants like Angel’s trumpet in otherwise healthy patients affected by unilateral mydriasis. J Korean Ophthalmol Soc 2011;52(10):1259-1261

Pupil Size in Relation to Cortical States during Isoflurane Anesthesia

Kum, Jeung Eun,Han, Hio-Been,Choi, Jee Hyun The Korean Society for Brain and Neural Science 2016 Experimental Neurobiology Vol.25 No.2

<P>In neuronal recording studies on anesthetized animals, reliable measures for the transitional moment of consciousness are frequently required. Previous findings suggest that pupil fluctuations reflect the neuronal states during quiet wakefulness, whose correlation was unknown for the anesthetized condition. Here, we investigated the pupillary changes under isoflurane anesthesia simultaneously with the electroencephalogram (EEG) and electromyogram (EMG). The pupil was tracked by using a region-based active contour model. The dose was given to the animal in a stepwise increasing mode (simulating induction of anesthesia) or in a stepwise decreasing mode (simulating emergence of anesthesia). We found that the quickly widening pupil action (mydriasis) characterizes the transitional state in anesthesia. Mydriasis occurred only in the light dose in the emergence phase, and the events were accompanied by an increase of burst activity in the EEG followed by EMG activity in 47% of the mydriasis events. Our findings suggest that recording such pupil changes may offer a noncontact monitoring tool for indexing the transitional state of the brain, particularly when a lower threshold dose is applied.</P>

장벽광응고레이저술 이후 발생한 동공확장 2예

박보현,장수경,이종수 대한안과학회 2020 대한안과학회지 Vol.61 No.7

Purpose: To report two cases of pupil dilatation that occurred after laser treatment at the peripheral lattice degeneration or retinal hole. Case summary: A 28-year-old male was treated with a Pascal laser for barrier photocoagulation at 10-12 and 6 o'clock retinal holes and a lattice degeneration. He complained of decreased visual activity at near distance. The right pupil size was 5 mm and the left pupil size was 3 mm. The right eye was more dilatated. The relative afferent pupillary defect test of the right eye was normal and the direct light reflex was slightly decreased in the same eye. A 35-year-old female patient was treated with a barrier grid photocoagulation with an argon laser for peripheral retinal degeneration, which occurred 1 month prior. The right eye dilatation was 4 mm pupil size. Both the pupillary light reflex and the relative afferent pupillary defect test showed normal results. Conclusions: Because mydriasis can occur as an uncommon complication following barrier photocoagulation at the peripheral retinal degeneration and hole, mydriasis before the peripheral retinal treatmen should be fully explained to the patient. In addition, every effort should be made to minimize damage to the distribution of the short ciliary nerve, especially superior and inferior to the peripheral retinal lesion. 목적: 주변부 장벽광응고레이저술 시행 후 발생한 동공확장 2예를 보고하고자 한다. 증례요약: 28세 남자 환자가 우안 6시, 10-12시 방향 망막원공 및 격자 모양 망막변성으로 우안 주변부 장벽광응고레이저술을 시행받았으며, 이후 발생한 우안의 근거리 시력저하를 주소로 내원하였다. 세극등검사에서 우안 5 mm, 좌안 3 mm로 우안 동공확장을 보였고, 상대구심성동공결손검사에서 정상 소견을 보였으나 동공반응검사에서 우안은 빛에 대한 반응이 감소해 있었다. 35세 여자 환자가 한 달 전 우안 격자모양 망막변성으로 우안 주변부 장벽광응고레이저술을 시행 받았으며, 이후 발생한 우안 눈부심 및 사물이 흐려보임을 주소로 내원하였다. 우안 4 mm, 좌안 2 mm로 우안 동공확장을 보였고, 동공반응검사 및 상대구심성동공결손검사에서는 모두 정상 소견을 보였다. 결론: 장벽광응고레이저술 시행 후 드물게 짧은 섬모체 신경 손상으로 인한 동공부등이 발생할 수 있기에, 레이저 시술 전 환자에게 이에 대한 내용을 충분히 설명해야 한다. 특히, 광응고레이저술 시행 시에도 망막주변부 상부와 하부에 넓게 분포하는 짧은 섬모체신경의 손상이 최소화될 수 있도록 주의해야 한다.

일반 시청 조건에서의 색상 성분과 동공 반응

이두환,장만호,백두진 한국안광학회 2017 한국안광학회지 Vol.22 No.3

목적: 본 연구는 일반 시청 조건하에서 색상 성분과 동공 반응과의 기능적 관계를 알아보고자 시행되었다. 방법: 정상 시력을 가진 12명의 피험자들의 동공 데이터는 45분간 뮤직비디오를 시청하는 동안에 아이트래커를 통해 수집되었고, 이 데이터는 색상, 채도 및 명도와 같은 색상 성분들과 함께 분석하였다. 결과: 동공 분석 결과 산동과 축동은 반응 횟수와 반응량이 유사하였다. 색상들의 총 노출 횟수는 동공 반응량과 정적 상관관계를 보였고, 이러한관계는 6가지 대표 색상들 중에서 빨강과 노랑에서 보편적 특징으로 나타났다. 축동 횟수와 축동량은 채도와 명도수준과 유의한 관계를 보이지는 않았지만, 산동 횟수와 산동량은 채도와는 정적 상관관계를 가졌고 명도와는 부적상관관계를 보였다. 결론: 색상 성분들은 기능적으로 축동 보다는 산동과 더 밀접한 관계가 있는 것으로 사료된다. Purpose: This study aimed to provide a basis for the functional relationship between chrominance components and pupillary responses under natural viewing conditions. Methods: The pupil data for twelve subjects with normal vision were collected by an eye-tracker when they were watching a 45-minute music video, and analyzed with respect to its chrominance components such as hue, saturation and lightness. Results: The pupillometric results show that mydriasis and miosis had similar frequency and amplitude. The count of hues had positive relationships between the amplitude of pupillary responses, and such relationships are universal features of red and yellow amongst the hues. While the frequency and amplitude of miosis did not show any significant relationships with both levels of saturation and lightness, those of mydriasis were positively and negatively related to saturation and lightness respectively. Conclusion: Chrominance components are functionally more related to mydriasis than to miosis.

Application of Topical Rocuronium Bromide Dosing by Ocular Size in Four Species of Wild Birds

Haerin Rhim,Sunjun Jung,Namsoo Kim,Jae-Ik Han 대한수의학회 2023 Journal of Veterinary Science Vol.24 No.4

Background: Rocuronium bromide has been evaluated as a mydriatic agent in birds, but the species applied were limited and the dose and effect were variable. Objective: This study aims to evaluate the efficacy of topical rocuronium bromide as mydriatics in 4 species according to horizontal palpebral fissure length: Feral pigeon (Columba livia), Common kestrel (Falco tinnunculus), Northern boobook (Ninox japonica), and Eurasian eagle owl (Bubo bubo). Methods: A total of 32 birds (8 for each species) were included as pre-releasing examination. Rocuronium bromide was instilled in one randomly selected eye of each bird based on palpebral fissure length criteria (0.5 mg/50 μL for pigeons, 1 mg/100 μL for kestrels and boobook owls, and 2 mg/200 μL for eagle owls). The contralateral eye was used as control and treated with normal saline. After instillation of the drug, pupil diameter, pupillary light reflex, intraocular pressure, heart rate, and respiratory rate were evaluated at 10 min intervals up to 180 min and at 30 min intervals up to 360 min. Results: Statistically significant mydriasis was obtained in all birds (p < 0.001). However, in boobook and eagle owls, marked mydriasis persisted until 360 min. Side effects including corneal erosion and lower eyelid paralysis were common, which was observed in 26/32 birds. Blepharospasm was also noted during this study. No systemic adverse signs were observed. Conclusions: Rocuronium bromide could be a good mydriatics option for 4 species of birds, however, further studies are needed to find lowest effective dose to reduce drug-related side effects.

Transient Anisocoria during Medial Blowout Fracture Surgery

이재일,강석주,전성빈,선훅 대한두개안면성형외과학회 2016 Archives of Craniofacial Surgery Vol.17 No.3

Transient anisocoria is rare during blowout fracture reconstruction. We report a case of transient anisocoria occurring during medial blowout fracture reconstruction and review the relevant literature. A 54-year-old woman was struck in the face and was admitted for a medial blowout fracture of the left eye. During the operation, persistent bleeding occurred. To control this bleeding, a 1% lidocaine solution with 1:200,000 epinephrine was applied to the orbital wall with cotton pledgets. In total, 40 mL of local anesthetic was used for the duration of the operation. After approximately three hours of the surgery, the ipsilateral pupil was observed to be dilated, with sluggish response to light. By 3 hours after the operation, the mydriasis had resolved with normal light reflex. In conclusion, neurological and ophthalmologic evaluation must be performed prior to blowout fracture surgery. Preoperative ophthalmic evaluation is simple and essential in ruling out any preexisting neurologic condition. Moreover, surgeons must be aware of the fact that excessive injection of lidocaine with epinephrine for hemostasis during orbital wall surgery can result in intraoperative anisocoria. Anisocoria-related situations must be addressed in a proficient manner through sufficient understanding of the mechanism controlling the pupillary response to various stimuli.

밀러피셔 증후군 환자에 대한 한방 치험 1례

이현규,서원주,김재학,조기호,문상관,정우상,권승원,진철,Lee, Hyunku,Suh, Won-joo,Kim, Jae hak,Cho, Ki-Ho,Moon, Sang-Kwan,Jung, Woo-Sang,Kwon, Seungwon,Jin, Chul 대한중풍순환신경학회 2019 대한중풍학회지 Vol.20 No.1

■ Objectives The purpose of this case report is to show the effect of Traditional Korean Medicine(TKM) on a patient with Miller Fisher Syndrome. ■ Methods A patient with Ataxia, Diplopia, Mydriasis diagnosed as Miller Fisher Syndrome was treated with herbal medication, acupuncture, electro-acupuncture, and press needles. Then we evaluated the improvement with the size of pupil, NRS(Numeral Rating Scale) of Diplopia, Assessment for Gait disturbance. ■ Results We could observe decrease in pupil size and NRS of Diplopia and improve in assessment for gait disturbance after the TKM treatment. ■ Conclusion This case showed the effect of TKM treatment on Miller Fisher syndrome.