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Show !oumal of ClilliCiJ/ Neuro-ophlhallllology 8(4); 277-280, 1988. « 1988 Raven Press, Ltd., New York Letters to the Editor Magnifying Loupe Shunt-Dependent Hydrocephalus To the Editor: To the Editor: Abraham Rapoport, M.D. Department of Neurology Edith Wolfson Hospital PO Box 5 Holon-58100, Israel I should like to bring to the attention of the readers a small gadget that I have found helpful in examining the pupils of my patients, It is a loupe with a magnification of x 2 with a built-in beam of light. It weighs 150 g, The long axis is 17 ern, It works with two small (1.5-V) batteries, I have recently encountered two cases of longstanding shunt-dependent hydrocephalus in adults, without local eye disease dating back to childhood, in which photophobia was very prominent symptom, Both patients exhibited headache, vomiting, and photophobia relieved by shunt revision, Review of my records in one case showed relatively severe photophobia was also present 5 years before prior to another shunt revision, In the second patient his mother recounted photophobias also being fairly intense prior to his shunt revision by another surgeon 15 years earlier, In both cases one could predict the patient's preoperative symptomatic condition by just going to the darkened hospital room, Photophobia as a manifestation of intracranial hypertension is reported by Huber (1) who felt that it was a common symptom in brain tumor and subdural hematoma, Photophobia, of course, is also very commonly seen in migraine subarachnoid hemorrhage-two conditions in which authors have discussed or speculated about concomitant presence of intracranial hypertension (2,3), I would like to know if anyone else has been impressed with photophobia as a possible manifestation of intracranial hypertension, Vincent L. Ferrara, M.D. 931 Huntingdon Pike Huntingdon Valley, PA FIG. 1 FIG. 2 The gadget is seen in Fig, 1 and is shown In action" in Fig, 2, showing the magnification of the examined eye, The flash reflex makes it difficult to observe the pupil in this photo, but in a dimmed room it is very useful. The cost, in Israel is $20,00. It is made in Japan but I could not find a patent number. It can be purchased in most opticsoptometrist shops, Editorial Comment REFERENCES I have no personal experience with this small loupe, but if the reader is interested in obtaining one, he or she should write to Dr. Rapoport for further information, J. L. Smith, M. D. 1. Huber A. Eye symptoms ill braill tumor, St. Louis: Mosby, 1971 2. Adams HP Jr.. Jergennsen DO. Kassel NF. Sales AL. Pitfalls in the recognition of subarachnoid hemorrhage. lAMA 1980;224:94-6. 3. Van Olphen HAN. Migraine a result of increased pressure: A new pathophysiological concept. (preliminary report). Neurosurg Rev.• 1986;9(1-2):121-4. 277 |