The hoatzin (watt-ZEEN) is a medium-size bird measuring 24.5 to 27.5 inches (62 to 70 centimeters) and weighing 1.4 to 1.9 pounds (650 to 850 grams). Its face is bright blue and without feathers. It has thick eyelashes above bright red eyes. The bill is short and gray. The head is topped by a fan-shaped crest of long feathers that resembles a punk haircut. Neck is long and buff colored, as is the tip of the tail. Underparts are chestnut colored, upperparts are bronze and olive.
Trichodontids, the sandfishes, are superficially similar to trachinids. They reach 11.8 in (30 cm), but they are scaleless and have spines on the preopercle rather than the opercle and a longer first dorsal fin with 10-15 spines. Their lips are fringed. Trichonotids, the sanddivers, have a scientific name similar to that of the previous family, which might cause confusion. They are very different fishes, in that they are very elongate and cylindrical, growing to only about 6 in (16 cm). They have a dorsal iris flap with narrow extensions resembling eyelashes, a lower jaw with a fleshy extension beyond the upper jaw, a single long dorsal fin with three to eight anterior spines that are elongate and filamentous in males of some species, fanlike pelvic fins that are larger than the pectoral fins, and a scaled body.
The need for ocular safety testing became clear early in the 1930s when an untested eyelash product containing p-phenylene diamine was marketed in the United States. Use of this and similar products led to sensitization of the external ocular structures, corneal ulceration, vision loss, and at least one fatality 12 . These events resulted in passage in the United States of the Food, Drug and Cosmetic Act of 1938, which required that materials sold to consumers be safe.
The FD&C Act exempts so-called ''coal-tar'' hair-dyes from the adulteration provision at Section 601 (a), if they bear the cautionary statement prescribed by law on the label and give ''patch test'' instructions, even if they are irritating to the skin or are otherwise harmful to the human body. The ''coal-tar hair-dye exemption,'' named for the synthetic organic colors originally derived from the coal tar derivative, aniline, to which the exemption was initially applied 9 , does not include eyelash and eyebrow dyes since coal-tar derived color additives may cause blindness when used for dyeing the eyelashes or eyebrows (9c). The exemption also does not apply to non-coal tar color additives in hair dyes (9c).
Effects.12 As an adjunctive therapy, latanoprost was well tolerated for a year with good IOP response.13 Although the response rate is low in the pediatric population, in those that do respond it is very effective and offers good 24-hour control.14 The once-daily dosing is convenient for parents, and the local systemic effects are manageable, although parents do need to be warned because they will likely note iris pigment changes, eyelash growth, and hyperemia. If used only to manage IOP prior to a definitive surgical procedure, then local side effects are seldom a problem. The frequency of these side effects in children on long-term therapy is not known.
Figure 8-2 shows three common mistakes in eliciting the corneal reflex (a) The stimulus is touching the eyelash. This will always provoke a blink, so you do not know whether the corneal reflex is present, (b) The stimulus is touching the sclera. This is less sensitive than the cornea and is not the area from which the reflex initiates, (c) The stimulus is in front of the pupil, so Figure 8-2. Three common errors in eliciting the corneal reflex. The stimulus touches the eyelash or the sclera or is in front of the pupil. In the lower right it is placed correctly on the cornea. Figure 8-2. Three common errors in eliciting the corneal reflex. The stimulus touches the eyelash or the sclera or is in front of the pupil. In the lower right it is placed correctly on the cornea.
Testing the frontalis muscle and seventh nerve function by asking the patient to repeatedly wrinkle and relax the forehead in the direction of the arrows. B. Forceful eye closing reveals the symmetry of eyelash tucking, wrinkling around the eyes, depth of the nasolabial folds, and retraction of the corners of the mouth. (Continued) Figure 8-6. A. Testing the frontalis muscle and seventh nerve function by asking the patient to repeatedly wrinkle and relax the forehead in the direction of the arrows. B. Forceful eye closing reveals the symmetry of eyelash tucking, wrinkling around the eyes, depth of the nasolabial folds, and retraction of the corners of the mouth. (Continued)
Monosomy of the long arm of chromosome 10 causes low birth weight, hypotonia, and microcephaly. Affected individuals may have brachycephaly, a broad and prominent nasal bridge, a small nose with anteverted nostrils, low-set and large ears, a prominent upper lip, and short neck cleft lip palate and micrognathia may be evident. Additional features include growth retardation, skeletal anomalies including clinodactyly, syndactyly, an abnormal chest with wide-spaced nipples, and delayed bone age. Ophthalmic features include hypertelorism, up- or downward slanting and narrowing of the palpebral fissures, scant lashes, strabismus,
Long eyelashes, hypogenitalism in both males and females, and cardiac malformations. Ophthalmic manifestations are common and include hypertelorism, epicanthus, up- or downward slanting of the palpebral fissures, synophrys, strabismus, nasolacrimal duct obstruction, cataract, corneal opacities, congenital glaucoma, nystagmus, and colobomatous
Partial trisomy of the short arm of chromosome 4 is a rare abnormality associated with dysmorphic facial features, malformed ears, depressed nasal bridge, short neck, prominent glabella and chin, abnormal genitalia in males, and skeletal anomalies growth and mental retardation are consistent features. Ophthalmic features include hypertelorism, epicanthus, down-slanting of the palpebral fissures, deeply set eyes, strabismus, blepharophimosis, bushy eyelashes, synophrys, nystagmus, and microphthalmia.64 136 145 163
Trisomy of the short arm of chromosome 6 is characterized by pre- and postnatal growth retardation. Affected individuals have a characteristic craniofacial dysmorphism with dolichocephaly, a high forehead with a high and broad nasal bridge, bulbous nose with hyperplastic nares, short philtrum, small mouth with thin lips, and micrognathia choanal atresia, camptodactyly, syndactyly, and genitourinary malformations may be evident. Ophthalmic features include hypertelorism, strabismus, long lashes, blepharophimosis, blepharoptosis, optic atrophy, and microphthalmia.112,329
Partial trisomy of the long arm of chromosome 7 in bands 2 to 3 causes pre- and postnatal growth retardation, delayed skeletal maturation including closure of the fontanelles, hypotonia, seizures, central nervous system malformations including hydrocephalus, hypoplasia of the corpus callosum, cerebral and cerebellar atrophy, and hypoplasia of the cerebellar vermis. Facial features include frontal bossing, depression of the nasal bridge, upturned nares, long philtrum, cleft palate, small mandible, dysplastic ears, and short neck and skeletal anomalies include scoliosis, hemivertebrae, absent ribs, joint laxity or stiffness, hip dislocation, camptodactyly, short midhands with a single transverse palmar crease, and long fingers and toes. Oph-thalmologic features include hypertelorism, downward slanting and or narrow palpebral fissures, epicanthus, strabismus, absent lateral rectus muscles, prominent eyes, long lashes, optic nerve hypoplasia, and colobomatous microphthalmia anoph-
Attached to the margins of the orbit, in front of the eyeball, are the upper and lower eyelids (palpebra (Latin), blepharon (Greek)). These have muscles for opening and closing the eyelids. The eyelashes (cilia) are special hairs of the eyelids which help protect the eyeball. The margins of the eyelids have special oil to prevent the loss of fluids from the area. The inner lining of the eyelids is continuous with the conjunctiva, a membrane over the anterior surface of the eyeball.
Partial duplication of the long arm of chromosome 13 causes mental and growth retardation with microcephaly facial features include frontal bossing, long philtrum, dysplastic ears, stubby nose, and high arched palate additional features include polydactyly, and genital abnormalities in males. Ophthalmic manifestations include hypo- or hypertelorism, epicanthus, up- or downward slanting of the palpebral fissures, strabismus, blepharoptosis, long lashes, synophrys, sphero-phakia, and colobomatous microphthalmia. The frequency of the specific anomalies is a function of the trisomic region 30,85,132,233,244,261,310,349,397
Absent, hypoplastic, or malpositioned thumbs cardiac malformations and inguinal hernia in males. Ophthalmic features include hypertelorism, sparse lashes, blepharoptosis, and up- or downward slanting of the palpebral fissures, narrowing of the palpebral fissures, and nystagmus.134,198,223,293
Duplication of the long arm of chromosome 16 causes postnatal growth retardation with hypotonia and characteristic craniofacial features including asymmetry with bitemporal narrowing, a high forehead, large metopic suture, prominent nose with a broad tip, thin upper lip, cleft palate, micrognathia, low-set, dysplastic ears, and a short neck. Other features include an imperforate or abnormally positioned anus skeletal, gastrointestinal, and cardiac malformations and dermatological abnormalities. Ophthalmic features include hypertelorism, epicanthus, up- and downward slanting and or narrowing of the palpebral fissures, strabismus, decreased or long lashes, lid entropion, periorbital edema, deep-set globes, and strabismus.17,39,146,313,338,406
Trichotillomania involves hair-pulling episodes that result in noticeable hair loss. Although any area of the body can be a target, the most common areas are the scalp, followed by the eyelashes, eyebrows, and pubic region. Hair-pulling can occur without the individual's awareness, but is frequently preceded by a sense of increasing tension and followed by a sense of relief or
The side effect profiles of the various PG analogs are compared in table 2.1. Eye irritation, conjunctival hyperemia, and eyelash changes are the most frequently reported side effects. Eye irritation, burning, and pain are reported with variable frequency in the various studies, and the rates of these symptoms with the various PG analogs are not substantially different from each other or from timolol. A wide range of other signs or symptoms such as superficial punctate keratitis, blurred vision, cataract, and headache have been reported at low rates in various clinical studies. The side effects of iris color changes, eyelash changes, and periocular skin color changes are specifically associated with the PG analogs. Bimatoprost and travoprost have been reported to give a higher incidence of hyperemia and eyelash changes compared to latanoprost,2,3,45,46 and package insert labeling reflects this difference. There is no clear evidence that the incidence or severity of other side effects...