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New eyelid clamp
VOL. 70. NO. 5
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859
CORRESPONDENCE
family should be accompanied by an exami nation for myopathy. If either a positive his tory or myopathy are found, then a CPK level should be determined. Unfortunately, most abnormalities of muscle and even strenuous exercise raise the CPK level so that its reliability leaves much to be desired. An elevated CPK in an otherwise normal patient, could be due to a subclinical myopa thy, although this has not been conclusively demonstrated. In any event, the finding of elevated CPK should alert the physician to the potential complications of malignant hyperthermia during anesthesia. If general anesthesia is administered to a patient who is suspected of developing hyperpyrexia, it is mandatory that the patient's temperature be carefully monitored for up to 24 hours after the anesthesia. A frequent clue to the early onset of the malignant hyperpyrexia is the tightening of the jaws. In creased resistance to positive pressure respi ration will be noted as the respiratory mus cles tighten. If the increasing fever is not found and successfully treated during the first signs, cyanosis, further respiratory dif ficulty, tachycardia, metabolic acidosis, and falling blood pressure will develop. Ener getic treatment with hypopyrexic measures, with concommitant attention to the blood chemistries, will save many patients even af ter the onset of severe hyperpyrexia. Ophthalmologists will be glad to hear that patients susceptibility to hyperpyrexia from general anesthesia do well with local anes thetics. Robert D. Reinecke REFERENCES
1. Guedal, A. E. : Inhalation Anesthesia : A Fun damental Guide, 2nd ed. New York, Macmillan Co., 1951. 2. Ryan, J. F., and Papper, E. M. : Malignant fe ver during and following anesthesia. Anesthesiology 32: 196, 1970. 3. Snow, J. C. : Proceedings of the New England Ophthalmological Society. Ann. J. Ophth. 70: 1970. 4. Isaacs, H., and Barlow, M. B. : Malignant hy perpyrexia during anesthesia: Possible association
with the subclinical myopathy. Brit. Med. J. 1:275, 1970. 5. Denborough, M. A., Ebeling, P., King, J. O., and Zapf, P. : Myopathy and malignant hyperpy rexia. Lancet 1:1138, 1970.
CORRESPONDENCE N E W EYELID CLAMP
Editor American Journal of Ophthalmology: A new eyelid clamp (Fig. 1) provides the following features: hemostasis of the entire eyelid and application to the upper or lower, right or left eyelids. This clamp is
Fig. 1 (Anwar). Photograph of new eyelid clamp. particularly useful in operations for multiple meibomian cysts, entropion, ectropion, and tarsorrhaphy. One may expose the external or conjunctival surface of the eyelid with out removing the clamp. M. Anwar Uxbridge Middlesex, England
BANKNOTES AND THE BLIND
Editor, American Journal of Ophthalmology : The sighted traveler is often puzzled by the variations in the physical properties and monetary values of foreign currencies (Fig. 1). Soon, however, he can tell at a glance the value of the money in his purse. Not so the blind tourist. To handle foreign money confidently, he must rely on his sense of touch—or the help of others. Some countries (Austria, Belgium, Den mark, England, France, Norway, Spain,
-
:/-
859
CORRESPONDENCE
family should be accompanied by an exami nation for myopathy. If either a positive his tory or myopathy are found, then a CPK level should be determined. Unfortunately, most abnormalities of muscle and even strenuous exercise raise the CPK level so that its reliability leaves much to be desired. An elevated CPK in an otherwise normal patient, could be due to a subclinical myopa thy, although this has not been conclusively demonstrated. In any event, the finding of elevated CPK should alert the physician to the potential complications of malignant hyperthermia during anesthesia. If general anesthesia is administered to a patient who is suspected of developing hyperpyrexia, it is mandatory that the patient's temperature be carefully monitored for up to 24 hours after the anesthesia. A frequent clue to the early onset of the malignant hyperpyrexia is the tightening of the jaws. In creased resistance to positive pressure respi ration will be noted as the respiratory mus cles tighten. If the increasing fever is not found and successfully treated during the first signs, cyanosis, further respiratory dif ficulty, tachycardia, metabolic acidosis, and falling blood pressure will develop. Ener getic treatment with hypopyrexic measures, with concommitant attention to the blood chemistries, will save many patients even af ter the onset of severe hyperpyrexia. Ophthalmologists will be glad to hear that patients susceptibility to hyperpyrexia from general anesthesia do well with local anes thetics. Robert D. Reinecke REFERENCES
1. Guedal, A. E. : Inhalation Anesthesia : A Fun damental Guide, 2nd ed. New York, Macmillan Co., 1951. 2. Ryan, J. F., and Papper, E. M. : Malignant fe ver during and following anesthesia. Anesthesiology 32: 196, 1970. 3. Snow, J. C. : Proceedings of the New England Ophthalmological Society. Ann. J. Ophth. 70: 1970. 4. Isaacs, H., and Barlow, M. B. : Malignant hy perpyrexia during anesthesia: Possible association
with the subclinical myopathy. Brit. Med. J. 1:275, 1970. 5. Denborough, M. A., Ebeling, P., King, J. O., and Zapf, P. : Myopathy and malignant hyperpy rexia. Lancet 1:1138, 1970.
CORRESPONDENCE N E W EYELID CLAMP
Editor American Journal of Ophthalmology: A new eyelid clamp (Fig. 1) provides the following features: hemostasis of the entire eyelid and application to the upper or lower, right or left eyelids. This clamp is
Fig. 1 (Anwar). Photograph of new eyelid clamp. particularly useful in operations for multiple meibomian cysts, entropion, ectropion, and tarsorrhaphy. One may expose the external or conjunctival surface of the eyelid with out removing the clamp. M. Anwar Uxbridge Middlesex, England
BANKNOTES AND THE BLIND
Editor, American Journal of Ophthalmology : The sighted traveler is often puzzled by the variations in the physical properties and monetary values of foreign currencies (Fig. 1). Soon, however, he can tell at a glance the value of the money in his purse. Not so the blind tourist. To handle foreign money confidently, he must rely on his sense of touch—or the help of others. Some countries (Austria, Belgium, Den mark, England, France, Norway, Spain,