t hereportoftheepidemiologySubcommit - teeofthe � 2007� dryeyeWorkShopsummarizescurrent� knowledgeontheepidemiologyofdryeyedisease, �providing� prevalenceandincidencedatafromvariouspopulations.� It� stressestheneedtoexpandepidemiologicalstudiestoad- ditionalgeographicregions, � toincorporatemultipleraces� andethnicitiesinfuturestudies, �andtobuildaconsensus� ondryeyediagnosticcriteriaforepidemiologicalstudies.� recommendationsaremaderegardingseveralcharacteristics� ofdryeyequestionnairesthatmightbesuitableforusein� epidemiologicalstudiesandrandomizedcontrolledclinical� trials.�riskfactorsfordryeyeandmorbidityofthedisease� areidentified, �andtheimpactofdryeyediseaseonqualityof� lifeandvisualfunctionareoutlined. �Suggestionsaremadefor� furtherprospectiveresearchthatwouldleadtoimprovement� ofbotheyeandgeneralpublichealth.

The epidemiology of dry eye disease: Report of the epidemiology subcommittee of the international Dry Eye WorkShop (2007)

ContextSpontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid (CSF) leaks and is known for causing orthostatic headaches. It is an important cause of new headaches in young and middle-aged individuals, but initial misdiagnosis is common.ObjectiveTo summarize existing evidence regarding the epidemiology, pathophysiology, diagnosis, and management of spontaneous spinal CSF leaks and intracranial hypotension.Evidence AcquisitionMEDLINE (1966-2005) and OLDMEDLINE (1950-1965) were searched using the terms intracranial hypotension, CSF leak, low pressure headache, and CSF hypovolemia. Reference lists of these articles and ongoing investigations in this area were used as well.Evidence SynthesisSpontaneous intracranial hypotension is caused by single or multiple spinal CSF leaks. The incidence has been estimated at 5 per 100 000 per year, with a peak around age 40 years. Women are affected more commonly than men. Mechanical factors combine with an underlying connective tissue disorder to cause the CSF leaks. An orthostatic headache is the prototypical manifestation but other headache patterns occur as well, and associated symptoms are common. Typical magnetic resonance imaging findings include subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain (mnemonic: SEEPS). Myelography is the study of choice to identify the spinal CSF leak. Treatments include bed rest, epidural blood patching, percutaneous placement of fibrin sealant, and surgical CSF leak repair, but outcomes have been poorly studied and no management strategies have been studied in properly controlled randomized trials.ConclusionsSpontaneous intracranial hypotension is not rare but it remains underdiagnosed. The spectrum of clinical and radiographic manifestations is varied, with diagnosis largely based on clinical suspicion, cranial magnetic resonance imaging, and myelography. Numerous treatment options are available, but much remains to be learned about this disorder.

https://jamanetwork.com/journals/jama/articlepdf/202849/JCR60004.pdf

Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension

Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observations in four of the patients. The mean age of the six women and five men included in the study was 38 years (range 22-51 years). All patients presented with a postural headache; however, most had additional symptoms, including nausea, emesis, sixth cranial-nerve paresis, or local back pain at the level of the CSF leak. All patients underwent indium-111 radionucleotide cisternography or computerized tomographic (CT) myelography. The location of the spontaneous CSF leak was in the cervical spine in two patients, the cervicothoracic junction in three patients, the thoracic spine in five patients, and the lumbar spine in one patient. The false negative rate for radionucleotide cisternography was high (30%). Subdural fluid collections, meningeal enhancement, and downward displacement of the cerebellum, resembling a Chiari I malformation, were commonly found on cranial imaging studies. In most patients, the symptoms resolved in response to supportive measures or an epidural blood patch. Leaking meningeal diverticula were found to be the cause of the CSF leak in four patients who underwent surgery. In three patients these diverticula could be ligated with good result but in one patient an extensive complex of meningeal diverticula was found to be inoperable. Two patients had an unusual body habitus and joint hypermobility, and two other patients had suffered a spontaneous retinal detachment at a young age. In conclusion, spontaneous spinal CSF leaks are uncommon, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most spinal CSF leaks are located at the cervicothoracic junction or in the thoracic spine, and they may be associated with meningeal diverticula. The radiographic study of choice is CT myelography. The disease is usually self-limiting, but in selected cases our experience with surgical ligation of leaking meningeal diverticula has been satisfactory. An underlying connective tissue disorder may be present in some patients with a spontaneous spinal CSF leak.

Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.

Syndrome of Orthostatic Headaches and Diffuse Pachymeningeal Gadolinium Enhancement

http://www.pesudovs.com/konrad/Docs/Solomon2009.pdf

LASIK world literature review: quality of life and patient satisfaction.

Refractive surgery in the United States Army, 2000–2003

Intraocular foreign body injuries during Operation Iraqi Freedom.

Retinal detachment in osteogenesis imperfecta

Objective measurement of the optic nerve head (ONH)-foveal angle, representing the torsional status of 40 eyes in 20 normal patients, was performed by fundus photography and compared to a method utilizing an indirect ophthalmoscope and protractor described herein. Photography established a mean ONH-foveal angle of 7.03 degrees (SD 2.94 degrees). Comparison with the indirect/protractor method revealed a mean difference of 1.10 degrees (SD 0.99) with a range of 0 degrees to 4 degrees between methods. The indirect/protractor method seems to provide a rapid, inexpensive, and accurate method of determining the degree of ocular torsion when compared to the fundus photograph method which requires greater patient cooperation and investment in time and equipment. The ONH-foveal angle varies widely among normal individuals (0 degrees to 16 degrees). Variation between left and right eyes of the same individual was not significant (1.15 degrees, SD 1.39 degrees), and if greater than 4 degrees, probably represents cyclovertical muscle dysfunction or restrictive orbitopathy. The converse, however, may not always be true as individuals with less than 4 degrees difference between eyes may have cyclovertical muscle imbalance.

William P. Madigan

Papers

Refractive surgery in the United States Army, 2000–2003

Intraocular foreign body injuries during Operation Iraqi Freedom.

Retinal detachment in osteogenesis imperfecta

Ocular torsion-direct measurement with indirect ophthalmoscope and protractor.

Ocular complications in the Department of Defense Smallpox Vaccination Program.