Unraveling congenital ptosis with the aid of the pediatric perimeter device

Background: Ocular morbidity with an early onset can have a significant impact on the long-term development of an individual. Hence, careful assessment of visual functions early on is very important. However, testing infants always poses a challenge. Standard tools to assess infants’ visual acuity, ocular motility, and so on rely on the clinician’s quick subjective judgments of an infant’s looking behavior. Eye movements are usually observed from head rotations or spontaneous eye movements in infants. Judging eye movements in the presence of strabismus is even more challenging. Purpose: This video shows a 4-month-old infant’s viewing behavior captured during a visual field screening study. The recorded video aided in the examination of this infant that was referred to a tertiary eye care clinic. The additional information captured through the perimeter testing is discussed. Synopsis: The Pediatric Perimeter device was developed to address visual field extent and gaze reaction time assessment in the pediatric population. As a part of a large-scale screening study, infants’ visual fields were tested. During this screening, a 4-month-old infant presented with a ptosis in the left eye. The infant was consistently missing the light stimuli presented in the left upper quadrant in the binocular visual field testing. The infant was referred to a tertiary eye care center to a pediatric ophthalmologist for further examination. During clinical examination, the infant was suspected to either have congenital ptosis or monocular elevation deficit. But the diagnosis of the eye condition was unsure owing to the poor cooperation of the infant. With the aid of Pediatric Perimeter, the ocular motility was consistent with limitation of elevation in abduction, indicating a possible monocular elevation deficit with congenital ptosis. The infant was also noted to have Marcus Gunn jaw-winking phenomenon. The parents were assured and asked for a review in 3 months. In the subsequent follow-up, the Pediatric Perimeter testing was performed, and the recording showed a full extraocular motility in both eyes. Hence, the diagnosis was changed to only congenital ptosis. The probable explanation for missing the target in the left upper quadrant in the first visit is postulated further. The left upper quadrant is the superotemporal visual field of the left eye and the superonasal visual field of the right eye. As the left eye had ptosis, the superotemporal visual field could have been obstructed and hence the stimuli missed. The normative extent for the nasal and superior visual field is just about 30° for a 4-month-old infant. Hence, the right eye also perhaps missed the stimuli in its superonasal visual field extent. This video highlights the utility of the Pediatric Perimeter device in providing a magnified view of the infant’s face along with greater visibility of ocular features from the infrared video imaging. This can potentially help the clinician to easily observe different ocular/facial abnormalities such as extraocular motility disorders, lid functions, and in identifying unequal pupil size, media opacities, and nystagmus. Highlights: The presence of congenital ptosis in younger infants might predispose as superior visual field defect and could also masquerade as a limitation in elevation.

Uso de modelo de olho não biológico na simulação de cirurgia de estrabismo: relato de experiência / Use of non-biological eye model in strabismus surgery simulation: experience report

Resumo: Introdução: Estrabismo é uma doença ocular caracterizada pelo desvio dos olhos cujo tratamento pode ser clínico ou cirúrgico. O ensino da cirurgia de estrabismo faz parte do programa de residência médica de oftalmologia, e seu treinamento é realizado mais frequentemente em sala de cirurgia, em situações reais. A aprendizagem ativa por experimentação ou simulação é cada vez mais utilizada na educação em saúde. Relato de experiência: O objetivo deste trabalho é descrever o relato de experiência da utilização de simulação como método de ensino de cirurgia de estrabismo para os médicos residentes do programa de residência de oftalmologia de um hospital universitário. Discussão: A simulação é um tipo de metodologia ativa que permite ao residente conquistar habilidades cirúrgicas por meio da repetição em ambiente seguro, de modo a diminuir as taxas de complicações cirúrgicas. Diferentemente de outros simuladores com tecnologia avançada para treinamento de cirurgia intraocular, nosso modelo de olho é uma ferramenta simples, de baixo custo e de fácil acesso e manuseio. A portabilidade e facilidade no manuseio permitem que o residente pratique as etapas com mais frequência desenvolvendo a memória com as etapas cirúrgicas. Conclusão: O ensino da cirurgia oftalmológica é uma tarefa desafiadora, e a utilização de métodos de aprendizagem ativa, como a simulação, é uma alternativa para o treinamento de habilidades cirúrgicas, com o propósito de diminuir as taxas de complicações.

Abstract: Introduction: Strabismus is an ocular condition characterized by eye misalignment. Its treatment can be clinical or surgical. The teaching of strabismus surgery is part of the medical residency program in ophthalmology. Its training is most often carried out in the operating theatre, in real situations. However, active learning through experimentation or simulation has been increasingly applied in health education. Experience Report: This study describes the use of simulation as a teaching method of strabismus surgery to ophthalmology residents. Discussion: Simulation is a type of active methodology that allows the resident to gain surgical skills through repetition in a safe environment. This can help reduce the risk of surgical complications. Unlike other simulators with advanced technology for intraocular surgery training, our model eye is a simple low-cost tool. It is easy to access and handle. The portability and ease of use allow the residents to practice the steps more frequently. Conclusion: The teaching of ophthalmic surgery is a challenging task and the use of active learning methods such as simulation is an alternative for training surgical skills.

Alterações oculares em escolares e adolescentes após início da pandemia por COVID-19 / Acute eye symptoms in schoolchildren and adolescents after the onset of COVID-19 pandemic

RESUMO Objetivo Identificar as alterações oculares em crianças e adolescentes secundárias ao fator do isolamento social e ao consequente aumento do uso de telas. Métodos Estudo observacional, descritivo e analítico, do tipo transversal realizado no período de julho a agosto de 2021, por meio da aplicação de questionários. Resultados Apresentaram cefaleia associada ao uso excessivo de tela 26,51% dos estudantes e 38,8% relataram suspeita de insuficiência de convergência. Em relação ao questionário de olho seco, 18,8% foram sintomáticos e 7,5% sintomáticos de difícil manejo. O computador foi o dispositivo mais utilizado em atividades escolares (71,5%), e, em segundo lugar, esteve o celular (66,3%). Casos sintomáticos de olho seco foram mais relatados em participantes que não faziam uso de computador (36,4%). Não foi possível identificar relação entre insuficiência de convergência e tempo de uso de dispositivos. Em relação ao olho seco, aqueles que passaram mais tempo em frente a tela relataram maior porcentagem de sintomas de difícil manejo (42,9%). Conclusão Foram mais prevalentes olho seco e sintomas de insuficiência de convergência na população estudada.

ABSTRACT Objective To identify eye conditions associated to social distancing and related increase in screen time exposure on children and teenagers. Methods Observational, descriptive and analytical study, with a cross-section design, carried out between July and August 2021, by questionnaire survey. Results Headaches related to excessive screen time exposure were reported by 26.51% of the students surveyed, while 38.8% reported suspect convergence insufficiency. Regarding the questionnaire about dry eye, 18.8% were symptomatic and 7.5% reported hard-to-manage symptoms. Computers were the devices most used for schoolwork (71.5%), followed by cellphones on second place (66.3%). Symptomatic cases of dry eye were mostly reported by participants that did not make use of computers (36.4%). It was not possible to establish a connection between convergence insufficiency and device usage time. Those participants that reported more screen time exposure also reported an increased percentage of hard-to-manage symptoms (42.9%), regarding dry eye. Conclusion Dry eye and convergence insufficiency symptoms were more prevalent in the surveyed population.

A rare case of acquired ptosis in a child secondary to Pituitary macroadenoma

Pituitary adenomas are rare neoplasms with a propensity for unusual presentations and an aggressive clinical course. An 8 years old female child presented to Department of Ophthalmology at SVS Medical College and Hospital Mahabubnagar with the chief complaints of mild ptosis of RE since 1month, associated with fever, headache, vomiting and diplopia since 2 days. On ocular examination, BCVA in BE - 6/9 and anterior segment examination suggested RE mild ptosis with hypotropia and adduction restriction. Fundus examination was normal. There was no palpable mass/ bruit in the orbit. MRI revealed lobulated enhancing soft tissue lesion in sella and parasellar region extending into basifrontal region causing pressure over optic chiasm, 3rd ventricle and cavernous sinuses suggestive of pituitary macroadenoma. Hormonal essays revealed elevated prolactin, beta HCG levels and abnormal thyroid profile. On the basis of clinical examination and investigations a clinical diagnosis of pituitary macroadenoma was made. Then the case was referred to department of neurosurgery where transphenoidal resection under GA was planned and after 2days of admission she had a respiratory arrest and could not be resuscitated.

Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up / Paresia isolada do nervo abducente associada ao COVID-19: 8 meses de seguimento

ABSTRACT We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.

RESUMO Reportamos o caso de homem previamente hígido, 48 anos, com paralisia isolada do nervo abducente 18 dias após infecção pelo novo coronavírus (COVID-19) confirmada por reação cadeia polimerase de transcriptase reversa. A principal queixa do paciente na admissão era diplopia. O exame ocular revelou paralisia do sexto nervo craniano do olho esquerdo. Esotropia incomitante no exame inicial media 30 dioptrias prismáticas. Abdução estava limitada com adução completa no olho esquerdo. O paciente foi submetido a investigação clínica e neurológica com exame de neuroimagem, incluindo análise de amostra do líquido cefalorraquidiano para descartar causas infecciosas. Optou-se por abordagem conservadora com terapia ortóptica e prisma de Fresnel. Oito meses após a infecção pelo COVID-19, o paciente evoluiu com regressão do estrabismo e informou recuperação completa do quadro. Este relato sugere que paralisia isolada do nervo abducente causada por SARS-CoV-2 pode melhorar com abordagem conservadora.

Clinical diagnosis and treatment of 9 childhood opsoclonus-myoclonus syndrome patients and application of standard rating scale / 中华神经科杂志

Objective:To summarize the clinical features of childhood opsoclonus-myoclonus syndrome (OMS), evaluate severity degree and prognosis using OMS Symptom Severity Standard Rating Scale.Methods:The clinical features,diagnosis, therapeutic regimen and follow-up of 9 children with OMS in Department of Neurology and Oncology Department of Children's Hospital of Fudan University between 2011 and 2019 were retrospectively reviewed. Severity degree and prognosis were evaluated using OMS Symptom Severity Standard Rating Scale.Results:Among the 9 children with OMS, 4 were males and 5 were females. The onset age ranged from 14 months to 5 years, with a median of 17 months. Main symptoms were opsoclonus, myoclonus, ataxia, motor function regression, behavior and mood changes and sleep disorders. Eghit patients were combined with tumor. Seven of them with neuroblastoma were confirmed by surgical pathology, the other one showed spontaneous regression and symptom remission without treatment. Eight patients received hormone combined with intravenous immunoglobulin, of which 3 cases received adrenocorticotropic hormone, while 5 cases received methylprednisolone pulse therapy, with prednisone sequential therapy, decreasing dose gradually. Rituximab was administrated in 3 patients whose annual recurrent time was≥2. Nine patients were divided into 3 groups according to OMS Symptom Severity Standard Rating Scale, 1 of mild degree, 3 of moderate degree, 5 of severe degree. There was no recurrence and sequelae in the mild-degree patient after 3 years follow-up. There was no recurrence and sequelae in 2 of the moderate-degree patients after 1-2 years follow-up. Different degrees of motor, cognitive sequelae were found in 1 of moderate-degree patients and all of severe-degree patients after 1-8 years follow-up.Conclusions:Childhood OMS patients have early onset age. Bad symptom severity before treatment and multiphase course are associated with poor prognosis. OMS Symptom Severity Standard Rating Scale is suitable for estimations of long-term prognosis.

Varied presentations of congenital ocular synkinesis: do they all fit congenital cranial dysinnervation disorder spectrum? / Apresentações variadas de sincinesias oculares congênitas: todas elas se enquadram ao espectro das desordens congênitas da desnervação craniana?

ABSTRACT Purpose: Synkinesis results from nerve miswirings and causes aberrant movements of the affected muscles. We present a series of cases of rare congenital ocular synkinesis involving the extraocular muscles and the levator palpebrae superioris and speculate the possibility of classifying these entities in the spectrum of congenital cranial dysinnervation disorder. Methods: Records of patients with the diagnosis of congenital ocular synkinesis were analyzed retrospectively. We analyzed the sex, laterality, and complete features of the ocular motility of each patient. Results: Nine patients with congenital ocular synkinesis were included. A slight predominance of women was noted. In terms of laterality, four patients had only the right eye involved, four had only the left eye, and one had both eyes involved. Notably, 55.5% were orthotropic in the primary position. The third, fourth, and sixth cranial nerves were involved in the miswiring in 100%, 44.4%, and 11.1% of the cases, respectively. Conclusions: Congenital synkinesis might present in a very eclectic and uncommon fashion. The aberrant innervation in these cases classifies them into the group of congenital cranial dysinnervation disorders.

RESUMO Objetivo: Sincinesias são resultado de inervações anômalas e ocasionam movimentos aberrantes dos músculos envolvidos. Apresentamos uma série com casos raros de sincinesias oculares congênitas dos músculos extraoculares e do levantador da pálpebra superior e especulamos a possibilidade de classificá-las dentro do espectro das desordens congênitas da desnervação cranianana. Métodos: Prontuários de pacientes com diagnóstico de sincinesia ocular congênita foram estudados retrospectivamente. Analisamos sexo, lateralidade e as características completas do exame de motilidade de cada paciente. Resultados: Nove pacientes com sincinesias oculares congênitas foram incluídos. Houve discreta predominância no sexo feminino. Em termos de lateralidade, o olho direito foi o único envolvido em 4 casos, o olho esquerdo também em 4 casos e 1 caso apresentou acometimento bilateral. 55,5% dos pacientes eram ortotrópicos na posição primária. Os III, VI e IV nervos participaram da sincinesia em 100%, 44,4% e 11,1% dos casos, respectivamente. Conclusões: Sincinesias oculares congênitas podem se apresentar de modo bastante eclético e incomum. A inervação aberrante presente em cada um desses casos os coloca na lista de candidatos a integrar o grupo das desordens congênitas da desenervação craniana.

Síndrome de flutter ocular e ataxia de tronco pós-infecciosa / The post-infectious ocular flutter syndrome and truncal ataxia

OBJETIVO: Descrever um quadro clínico subagudo pós-infeccioso caracterizado por ataxia de tronco e flutter ocular. RELATO DE CASO: Um homem de 37 anos previamente hígido, pouco após um quadro sistêmico inespecífico que se resolveu espontaneamente, deu início a movimentos involuntários hipercinéticos dos olhos, da cabeça e desequilíbrio importante. Os sintomas evoluíram em poucos dias. Ao exame, apresentava ataxia de tronco e presença de flutter ocular. O líquor mostrou pleocitose discreta. Ressonância magnética (RM) de crânio e exames laboratoriais normais. Houve melhora espontânea e total dos sintomas em cerca de três semanas. CONCLUSÃO: A síndrome de flutter ocular e ataxia de tronco é rara e é destacado a benignidade do quadro.

OBJECTIVE: To describe a post-infectious subacute clinical picture characterized by truncal ataxia and ocular flutter. CASE REPORT: A healthy 37-year-old man, a few days after spontaneously resolved nonspecific systemic disease, initiated involuntary hyperkinetic movements of the eyes, head, and major imbalance. The symptoms progressed within a few days. He presented ataxia of the trunk and presence of ocular flutter. CSF showed pleocytosis. Magnetic resonance of the skull and laboratory tests were normal. There was spontaneous and total improvement of symptoms in about three weeks. CONCLUSION: The ocular flutter syndrome and truncal ataxia is rare and the benignity of the condition is highlighted.

Esporotricose ocular: manifestações atípicas / Ocular sporotrichosis: atypical manifestations

Resumo A esporotricose humana e animal é uma infecção subaguda a crônica causada pelo fungo dimórfico Sporothrix schenckii. A esporotricose ocular tem ganhado destaque em função da epidemia de esporotricose urbana enfrentada pelo estado do Rio de Janeiro na última década e se apresenta classicamente como conjuntivite granulomatosa, mas formas atípicas podem ocorrer. Este artigo tem por objetivo relatar 2 casos atípicos de esporotricose ocular em pacientes imunocompetentes, ambos apresentando quadro clínico compatível com a síndrome oculoglandular de Parinaud associada à dacriocistite em um caso e presumivelmente à coroidite no outro caso.

Abstract Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case.

Regeneración aberrante del III nervio craneal por aneurisma cerebral bilateral. Reporte de caso / Aberrant regeneration of the III cranial nerve due to bilateral cerebral aneurism

RESUMEN Los trastornos de la motilidad ocular constituyen motivo de consulta periódica en Oftalmología. La regeneración aberrante, trastorno muy poco reportado, es considerada la sincinesia oculomotora de mayor invalidez y complejidad. Diversas condiciones neuroftalmológicas están implicadas en la etiopatogenia de la enfermedad, la mayoría de las cuales puede ocasionar la muerte. El manejo de los síntomas y signos provocados por paradójicos movimientos oculares conjugados es difícil. Se reportó un caso con remisión tardía a neuroftalmología por diagnóstico inicial y evolución desfavorable. La historia psicofísica arrojó diagnóstico definitivo de regeneración aberrante del III nervio craneal secundario, a aneurisma cerebral de la carótida interna bilateral, agravado por reanastomosis quirúrgica. Una rigurosa, obligatoria e impostergable historia neuroftalmológica, se impone ante toda parálisis del III nervio craneal para brindar un diagnóstico etiológico preciso y de esta forma proteger la vida.

ABSTRACT The disturbances in ocular motility are the cause of periodical consultation in Ophthalmology. The aberrant regeneration, a scarcely reported disturbance, is considered the oculomotor synkinesis of highest disability and complexness. Several neuro-ophthalmologic conditions are implicated in the disease ethiopathogeny, and most of them could lead to death. The management of the symptoms and signs caused by paradoxical conjugated ocular movements is difficult. A case is reported of late remission to Neuro-ophthalmology due to unfavorable diagnosis and evolution. The psycho-physical history led to a definitive diagnosis of aberrant regeneration of the III secondary cranial nerve, to cerebral aneurism of the bilateral internal carotid, worsened by surgical re-anastomosis. In front of any paralysis of the III cranial nerve, it is necessary a rigorous, obligatory and immediate neuro-ophthalmological history to arrive to a precise etiological diagnosis, protecting life in that way.

Trochlear-oculomotor synkinesis: another congenital cranial dysinnervation disorder? / Sincinesia troclear-oculomotora: outro distúrbio congênito de denervação craniana?

ABSTRACT This report documents an unusual phenomenon. A 6-year-old girl with trochlear-oculomotor synkinesis presented with superior oblique and palpebral levator co-contraction. The literature was reviewed and the possibility of classifying this entity as a congenital cranial dysinnervation disorder was speculated.

RESUMO Este relato descreve um fenômeno incomum. Uma menina de 6 anos com sincinesia troclear-oculomotora apresentou co-contração do oblíquo superior e do levantador da pálpebra. A literatura foi revisada e especulou-se a possibilidade de classificar essa desordem como um distúrbio da congenital cranial dysinnervation disorder.

Research progress of oculomotor disorder in Parkinson's disease / 中华神经科杂志

Parkinson's disease (PD) is a common neurodegenerative disease characterized by bradykinesia,resting tremor,muscle rigidity,and abnormal gait posture.Ocular motor function test plays an important part in neurological examinations.It has been widely accepted that specific ocular motor patterns contribute to diagnosis of Parkinsonian syndrome including progressive supranuclear palsy and multiple system atrophy.However,recent studies have shown that patients of PD may also exhibit specific eye movement disorders,which will be helpful in the early diagnosis,evaluation and differential diagnosis of PD.In 2015,the Movement Disorder Society clinical diagnostic criteria for Parkinson's disease suggested that sustained staring evoked nystagmus could be used as an exclusive criterion for PD.The clinical features,detection methods and clinical significance of oculomotor dysfunction in PD are reviewed in this article.

Posterior internuclear ophthalmoplegia as a sign of pons infarction: a case report / 中华神经科杂志

Posterior internuclear ophthalmoplegia is a rare sign of pons infarction.Due to its mild clinical symptoms,it is easily misdiagnosed.In this article,we report a case of posterior internuclear ophthalmoplegia caused by pons infarction,discuss the causes of misdiagnosis and hope to attract the attention of doctors.By analyzing the clinical features of the case and reviewing the literatures,we try to differentiate the disease from multiple sclerosis,pons tumors and other diseases.The diagnosis was confirmed with thorough physical examination,laboratory test and imaging examination.Posterior internuclear ophthalmoplegia is a sign of pons infarction.

Presenting Internuclear Ophthalmoplegia with Peripheral Type Facial Palsy: Seven-and-a-Half Syndrome

A 49-year-old male presented with horizontal binocular diplopia without facial pain or skin lesion. Limitation of medial gaze in the left eye was revealed on neurological examination, which is accompanied by peripheral facial nerve palsy ipsilaterally. The diagnosis had been made based on the diffusion restriction lesion of left pontine tegmentum. We may denominate a “seven-and-a-half syndrome” and clinician should maintain a high level of awareness of the various syndromes associated with pontine lesions.

Long-term Results of Slanted Recession of Bilateral Lateral Rectus Muscle for Intermittent Exotropia with Convergence Insufficiency

PURPOSE: To evaluate the long-term efficacy of slanted lateral rectus recession in children for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency. METHODS: The medical records of 53 patients with convergence insufficiency intermittent exotropia who underwent slanted bilateral lateral rectus recession performed by a single surgeon and received follow-up for more than 12 months were retrospectively analyzed. Deviation angles at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively and on the last visit were reviewed. Surgical success was defined as postoperative residual distance and near deviation angles ≤8 prism diopters and a difference between the near and distance angles ≤8 prism diopters. RESULTS: The mean duration of follow-up was 24 months (range, 12 to 61 months). On the last visit, the residual deviation angles were ≤8 prism diopters in 75.5% for distance, 62.3% for near, and 81.1% for the near-distance difference. Surgical success was achieved in 31 (58.5%) patients, and none of them manifested limitations in eye movements or diplopia at the last follow-up visit. CONCLUSIONS: Slanted lateral rectus recession is an effective surgical method for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency.

Sintomas visuais e insuficiência de convergência em docentes universitários / Visual symptoms and convergence insufficiency in university teachers

Resumo Objetivo: Investigar a prevalência de desconforto visual e insuficiência de convergência (IC) em docentes universitários. Métodos: Tratar-se de um estudo transversal, com 60 docentes de ambos os sexos, tendo sido utilizado o questionário Convergence Insufficiency Symptom Survey, validado para a população brasileira. Resultados: Dos docentes entrevistados 55,0% eram do sexo feminino. 48,3% responderam dedicar menos que duas horas por dia à leitura, sendo que 40,0% dos entrevistados disseram que fazem pausas de 30 minutos à uma hora durante a leitura e 63,3% afirmaram passar entre 2 a 5 horas por dia em frente ao computador. Em relação à investigação sobre as doenças do sistema visual, 25,0% relataram apresentar miopia, sendo que 55,0% dos indivíduos usam óculos e destes 41,7% o usam com frequência. Quanto à investigação da prevalência de insuficiência de convergência, obteve-se frequência de (1,8) %. Conclusão: Constatou-se que a maioria dos entrevistados se apresentou com desconforto visual e uma pequena porcentagem foram acometidos pela IC.

Abstract Objective: To investigate the prevalence of visual discomfort and convergence failure in professors. Methods: A cross-sectional study was done, consisting of 60 teachers of both sexes, of the Centro Universitário FAG, which used the Convergence Insufficiency Symptom Survey, validated for the Brazilian population. Results: Of those surveyed 55.0% are female. 48.3% respondents spend less than two hours a day reading, with 40.0% of respondents said they do 30-minute breaks for one hour during reading and 63.3% said they spend between 2-5 hours a day in front of the computer. With regard to research on diseases of the visual system, 25.0% reported having myopia, with 55.0% of individuals use these glasses and 41.7% use it frequently. The research of the prevalence of convergence insufficiency, gave an average of 12.4(1.8) %. Conclusion: It was found that most respondents presented with visual discomfort and small percentages were affected by CI.

Metástasis intraorbitárias de cáncer de mama / Breast cancer orbital metastasis

Objetivo: Describir un caso raro de una paciente previamente diagnosticada con cáncer de mama que evolucionó después de algunos años con metástasis intraorbitaria. Métodos: Relato del caso y revisión de literatura. Resultados: La correlación del diagnóstico previo de neoplasia de mama y la presencia de múltiples lesiones en la órbita y regiones adjacentes ha permitido concluir que la paciente presentaba enfermedad metastásica. Las metástasis se presentan como manifestaciones cada vez más frecuentes en enfermos oncológicos. La órbita y estruturas próximas constituyen topografías poco usuales de diseminaciónde células neoplásicas y manifestaciones iniciales pueden mimetizar otras condiciones, retrasando el diagnóstico. Como se trataban de pequeñas lesiones, se ha optado por radioterapia como tratamiento único. Después del término la paciente evolucionó con regresión de sintomatología. Conclusiones: Aunque infrecuentes, manifestaciones oculares pueden ocurrir en enfermos oncológicos y la investigación de enfermedad metastático de la órbita es esencial para el seguimiento adecuado.

Objective: Description a rare case of a patient with previous diagnosis of breast cancer that evolved years after with orbital metastasis. Method: Case report and literature review. Results: The relation between the previous diagnosis of breast cancer and the presence of multiple orbital and adjacent lesions allowed concluding that the patient presented metastatic disease. Metastasis presented as a common manifestation in oncological patients. Orbit and neighboring structures constitute unusualsite of neoplastic cells dissemination and initial manifestations could mimic other conditions, which can slow diagnosis. As they were small lesions that are close to noble structures, it was opted by performing exclusive radiotherapy. After the end of treatment, the patient referred improvement of her symptoms. Conclusions: Although unusual, ocular manifestations could occur in oncological patients and orbit metastatic disease investigation is essential to the proper follow.

Inferior rectus muscle rupture due to orbital trauma / Ruptura de músculo reto inferior por trauma orbitário

ABSTRACT A 48-year-old patient with blunt periorbital trauma presented with vertical strabismus and diplopia secondary to inferior rectus muscle avulsion. After ophthalmologic and CT scan evaluation, early surgical treatment with anatomical restoration led to improvement in motility deficits with resolution of diplopia.

RESUMO Paciente de 48 anos com história de trauma periorbitário contuso apresentou estrabismo vertical e diplopia secundários à avulsão de músculo reto inferior. Após avaliação oftalmológica e tomográfica, o tratamento precoce cirúrgico das lesões com reparo anatômico permitiu melhora nos deficits de motilidade com resolução da diplopia.

Validez del cuestionario CISS-V15 para el diagnóstico de la insuficiencia de convergencia / Validity of the CISS-V15 questionnaire for diagnosisof the convergence insufficiency

Introducción. El cuestionario Convergence Insufficiency Symptoms Survey, (CISS-V15) es una herramienta para el diagnóstico y seguimiento del tratamiento de pacientes con insuficiencia de convergencia. Objetivo. Determinar la validez del cuestionario CISS-V15 para el diagnóstico de la insuficiencia de convergencia, frente a las pruebas clínicas con que se evalúa el estado motor ocular de los pacientes atendidos en consulta optométrica, en las ciudades de Recife y Salvador, Brasil. Métodos. Se llevó a cabo un estudio con enfoque cuantitativo, de tipo transversal y descriptivo, con 50 pacientes de dos instituciones educativas en Brasil. Se seleccionaron aquellos que cumplían con los criterios de inclusión para aplicar el cuestionario, y se identificaron los pacientes con insuficiencia de convergencia y aquellos con visión binocular normal. Se analizaron los resultados del cuestionario y las pruebas de motilidad ocular, para estimar medidas de tendencia central, y analizar los valores de sensibilidad y especificidad del cuestionario. Resultados. La prueba alcanzó una sensibilidad de 0,83 y una especificidad de 0,81. Conclusiones. Frente a las pruebas clínicas, el cuestionario CISS-V15 demostró tener validez diag-nóstica para las personas con insuficiencia de convergencia y aquellas con visión binocular normal, lo que lo convierte en una herramienta valiosa para el diagnóstico y seguimiento del tratamiento de los pacientes con insuficiencia de convergencia

Introduction: The Convergence Insufficiency Symptom Survey Questionnaire (CISS-V15) is a tool for diagnosis and monitoring of treatment of patients with convergence insufficiency. Objective: To determine the validity of the questionnaire CISS-V15 for the diagnosis of convergence insufficiency against clinical tests assessing the oculomotor state in optometric patients seen in con-sultation in the cities of Recife and Salvador, Brazil. Methods: A descriptive transversal study with a quantitative approach was conducted with 50 patients from two educational institutions in Brazil. Patients were selected from those that met the inclusion criteria for applying the questionnaire. Patients with convergence insufficiency and those with normal binocular vision were identified. The results of the questionnaire and ocular motility tests were analyzed to estimate central tendency measures and to analyze the sensitivity and specificity of the questionnaire. Results: The test had a sensitivity of 0.83 and a specificity of 0.81. Conclusions: Given the clinical test, the CISS-V15 questionnaire proved to be valid to classify individuals with convergence insufficiency, and those with normal binocular vision, which makes it a valuable tool for the diagnosis and monitoring of the treatment of patients with convergence insufficiency.

Three Cases of Acquired Simulated Brown Syndrome after Blowout Fracture Operations

Brown syndrome is known as limited elevation of the affected eye during adduction. It is caused by a disorder of the superior oblique tendon, which makes it difficult for the eyeball to look upward, especially during adduction. It is classified into congenital true sheath Brown syndrome and acquired simulated Brown syndrome. Acquired simulated Brown syndrome can be caused by trauma, infection, or inflammatory conditions. The surgical restoration of blowout fractures can also lead to limitations of ocular motility, including Brown syndrome. We report on three patients with acquired simulated Brown syndrome, who complained of diplopia and limitation of ocular motility after operations to treat blowout fractures.