Læknablaðið - 15.06.1997, Blaðsíða 81

LÆKNABLAÐIÐ 1997; 83
433
A-18. The eye and I: or psychological as-
pects of blindness
ReidAH
From The Royal Dundee Liff Hospital, by Dundee,
Scotland
The eye has a significance reaching back into
mythology and the roots of the collective human
unconscious. Concepts of the eye as a magical pro-
tective force contrast with age old beliefs in the “evil
eye" and blindness as a biblical punishment. Tliese
ancient themes influence our patients in the way
they respond to, and cope with, blindness. In this
response there are components of bereavement,
loss of confidence and of self-esteem.
Where blindness has occurred acutely following
trauma or explosion, for example, there may be the
phenomena of post-traumatic stress disorder to re-
solve. Patients may deal with blindness unsatis-
factorily through projective mechanisms such as
anger and grievance, or equally unsatisfactorily
through denial.
Blindness brings with it a loss of control over the
environment and impinges on family dynamics,
sexual relationships and choice of partner. There
are certain intriguing relationships with such specif-
ic psychiatric syndromes as anorexia nervosa, sleep
disorder and the Charles Bonnet Syndrome of com-
plex visual hallucinations in elderly patients in the
setting of clear consciousness and minimal or ab-
sent cognitive impairment.
As compared to deafness there has been very
little systematic study of the psychiatric conse-
quences of blindness and more needs to be known.
A-19. Tarantula ophthalmia nodosa
Blaikie A, Ellis J, Sanders R, McEwen C
From The Departments of Ophthalmology Nine-
wells Hospital Dundee and Queen Margaret Hospi-
tal Dunfermline, Scotland
Introduction: The shedding of urticarious hairs is
the main defensive mechanism of the New World
Tarantulas. They are generally less venomous than
African tarantulas and are consequently more pop-
ular as pets. We present three cases of eye disease
from the East of Scotland due to tarantula hair
contact.
Material and methods: Three patients who sus-
tained ocular injury from urticarious hairs of taran-
tula spiders were followed up over a several year
period. Tarantula hairs were examined using a
Scanning Electron Microscope.
Results: One patient developed a short, self limit-
ing keratoconjunctivitis. Two of the patients al-
though initially presenting with a similar clinical
picture have entered a long period of symptomatic
panuveitis. One of these patients has developed
reduced visual acuity and raised intra-ocular pres-
sure. The other patient even at seven years follow
up still has a residual grumbling pan-uveitis with
chorioretinal inflammatory lesions. Hairs from an
Asian Black tarantula were involved with the short,
self-limiting case while Chilean Rose tarantuia hairs
caused the two long, complicated cases.
Scanning Electron Micrograph analysis of the
Chilean Rose tarantula hairs revealed very similar
morphology to hairs of the Lymantriidae species of
Caterpillar.
Discussion: Caterpillar Hair Ophthalmia Nodosa is
a well described condition with over 50 cases in the
literature. The clinical course of ocular injury from
caterpillar hairs of the Lymantriidae group is similar
in natural history to the two long, complicated cases
we describe due to Chilean Rose tarantula hairs.
Scanning electron analysis of the Chilean Rose
tarantula hairs suggests a very similar morphol-
ogy to the Lymantriidae caterpillar hairs and sig-
nificantly different from hairs of other tarantula
species. This suggests that the morphology of ur-
ticarious hairs may dictate the clinical outcome of
ocular injury.
Removal of the hairs at the earliest opportunity
would appear to be an important intervention,
hopefully avoiding long term complications.
A-20. The use of hydroxyapatite spheres
in Iceland
Haraldur Sigurðsson, Eyþór Björgvinsson
From The Department of Ophthalmology, Uni-
versity oflceland, Reykjavík, lceland
Purpose: To review the use of hydroxyapatite
spheres following enucleation in Iceland, espe-
cially using mersilene mesh as a cover.
Material and methods: The first 20 consecutive
patients done in Iceland are described. The first
had donor sclera as a cover. Since then 15 patients
have had mersilene mesh covering the sphere. In
all the patients a 20mm hydroxyapatite sphere
were used. All the patients except two have had
bone scan to demonstrate vascularity.
Results: All the spheres have been tolerated
nicely, no exposure or rejection has occurred.
The follow up period is 6-50 months. Bone scan
has demonstrated a fully vascular sphere, two
months following enucleation for the mersilene
mesh and six months for sclera. Just seven of
these 20 patients have had a peg inserted.
Conclusion: Mersilene mesh covering hydrox-
yapatite sphere is nicely tolerated and becomes
rapidly vascularised. Just few of the patients want
have had peg inserted.