ABSTRACT
PURPOSE: Carotid cavernous sinus ectasia is a rare cause of abducens nerve palsy. OBSERVATION: We present a case of severe unilateral progressive esotropia resulting from cavernous sinus carotid vascular ectasia in a 67 y/o female. She had progressive esotropia over the years with no neuroimaging despite having regular ophthalmic care. Magnetic resonance imaging determined the etiology of her chronic severe esotropia. CONCLUSION AND IMPORTANCE: Carotid cavernous sinus ectasia should be considered in the differential of severe progressive unilateral abducens nerve palsy. Magnetic resonance imaging with magnetic resonance angiography is important to determine etiology of severe progressive esotropia.
ABSTRACT
Congenital anomalous orbital structures are rare and associated with strabismus, globe retraction, and dystopia. The authors present a case of congenital paradoxical right lower eyelid retraction with upgaze due to an anomalous extraocular muscle in a 17-year-old, healthy, female patient. Orbital computed tomography showed an intraconal, inferolateral soft-tissue band extending from the orbital apex to the inferior oblique muscle and lower eyelid. There was resolution of lower eyelid retraction and exposure symptoms after resection of the anterior portion of the fibromuscular band from the lower eyelid retractors and eyelid elevation with ear cartilage. To the authors' knowledge, this case is the first to report anomalous orbital structure as a rare cause of congenital paradoxical lower eyelid retraction, which can be improved with resection.
Subject(s)
Eye Movements/physiology , Eyelid Diseases/congenital , Eyelids/abnormalities , Oculomotor Muscles/abnormalities , Adolescent , Eyelid Diseases/diagnosis , Female , Humans , Oculomotor Muscles/physiopathology , Tomography, X-Ray ComputedABSTRACT
The American Academy of Pediatrics advocates efforts to minimize discomfort and systemic effect of retinopathy of prematurity (ROP) examinations. Although many ophthalmologists use topical anesthetics, many do not believe them necessary. We present the results of the first survey to quantify the use of topical anesthetics in ROP examinations by clinicians who screen for ROP. The results show that although use of topical anesthetic is common, it is not universal.
Subject(s)
Anesthetics, Local/administration & dosage , Neonatal Screening , Ophthalmology/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Retinopathy of Prematurity/diagnosis , Administration, Topical , Gestational Age , Guidelines as Topic , Health Care Surveys , Humans , Infant, Newborn , Infant, Very Low Birth Weight , Neonatal Screening/methods , Ophthalmology/organization & administration , Procaine/administration & dosage , Procaine/analogs & derivatives , Propoxycaine/administration & dosage , Societies, Medical , Tetracaine/administration & dosageABSTRACT
We report a case of toxoplasmosis with bilateral maculopathy in a 7-year-old boy diagnosed with ataxia telangiectasia (AT) at age 6. AT manifests as ataxia, apraxia, telangiectasia, and dysarthria. Common ophthalmologic findings in AT include fine conjunctival telangiectasia. Patients also suffer from recurrent sinopulmonary infections; however, serious opportunistic infection is rarely diagnosed. At 8 years of age he developed disseminated Toxoplasma gondii (toxoplasmosis) infection and meningoencephalitis. This ophthalmologic finding and the subsequent toxoplasmosis meningoencephalitis have not been previously reported in AT.
Subject(s)
Ataxia Telangiectasia/diagnosis , Conjunctival Diseases/diagnosis , Eye Infections, Parasitic/diagnosis , Retinal Diseases/diagnosis , Toxoplasmosis, Ocular/diagnosis , Anti-Infective Agents/therapeutic use , Ataxia Telangiectasia/drug therapy , Ataxia Telangiectasia/parasitology , Cerebrospinal Fluid/parasitology , Child , Conjunctival Diseases/drug therapy , Conjunctival Diseases/parasitology , Eye Infections, Parasitic/drug therapy , Eye Infections, Parasitic/parasitology , Humans , Magnetic Resonance Imaging , Male , Polymerase Chain Reaction , Retinal Diseases/drug therapy , Retinal Diseases/parasitology , Tomography, Optical Coherence , Toxoplasma/isolation & purification , Toxoplasmosis, Ocular/drug therapy , Toxoplasmosis, Ocular/parasitology , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic useABSTRACT
PURPOSE: To study the intra- and inter-observer reliability of pediatric ophthalmologists in grading retinal hemorrhages in abusive head trauma. METHODS: Pediatric ophthalmologists attending the 2009 annual meeting of the American Association for Pediatric Ophthalmology and Strabismus participated in an onsite survey. The participants were required to compare a collection of fundus photographs of patients with abusive head trauma to two standardized photographs, A and B. Participants graded photographs as normal (no retinal hemorrhages), better than A but not normal, same as A, between A and B, same as B, or worse than B. The survey was divided into four parts: part 1 consisted of 20 photographs to be graded; part 2 was a questionnaire about participant's professional experience; part 3 consisted of 20 photographs to be graded (including 15 graded in part 1 but reordered); and part 4 asked about the criteria used to grade the photographs. RESULTS: Of the 95 participants, 92 (97%) were licensed physicians with a mean of 14 years in practice. The intra-rater reliability was found to be high, with overall average of 85% pre- and post-agreement on the common pictures. Kendall's coefficient of concordance was used as the statistical measure of inter-rater reliability and had a high value (0.82). CONCLUSIONS: Pediatric ophthalmologists showed high intra- and inter-observer reliability in grading retinal hemorrhages in abusive head trauma.
Subject(s)
Child Abuse/diagnosis , Head Injuries, Closed/complications , Retinal Hemorrhage/diagnosis , Child , Head Injuries, Closed/diagnosis , Humans , Observer Variation , Photography , Reproducibility of Results , Retinal Hemorrhage/etiologyABSTRACT
BACKGROUND: Sildenafil is a phosphodiesterase type 5 inhibitor used as a therapeutic adjunct in critically ill neonates with persistent pulmonary hypertension. Sildenafil is associated with several ocular complications in adults and is suspected to exacerbate retinopathy of prematurity (ROP). The risk of ocular complication in sildenafil-treated newborns, not otherwise at risk for the development of ROP, is unknown. METHODS: Twenty-two neonates with birth gestational age greater than 34 weeks and birth weight over 2,100 g who received oral sildenafil for more than 2 weeks were assessed by a pediatric ophthalmologist for potential ocular complications. RESULTS: Four patients had ocular findings: 2 had bacterial conjunctivitis; 1 had optic nerve hypoplasia, choroidal coloboma, and nystagmus; 1 had previously suffered from a hypotensive episode and had a documented cortical injury accompanied by bilateral optic disk atrophy and nystagmus. All cases seemed unrelated to sildenafil use and improved despite continued use of the drug. CONCLUSIONS: Our results do not support the need for a routine ophthalmologic examination in term and near-term neonates receiving sildenafil.
Subject(s)
3',5'-Cyclic-GMP Phosphodiesterases/antagonists & inhibitors , Eye/drug effects , Hypertension, Pulmonary/drug therapy , Phosphodiesterase Inhibitors/administration & dosage , Piperazines/administration & dosage , Sulfones/administration & dosage , Administration, Oral , Birth Weight , Female , Gestational Age , Humans , Infant , Infant, Newborn , Male , Phosphodiesterase Inhibitors/adverse effects , Piperazines/adverse effects , Purines/administration & dosage , Purines/adverse effects , Risk Assessment , Sildenafil Citrate , Sulfones/adverse effectsABSTRACT
OBJECTIVE: To determine whether visual acuity improvement with Bangerter filters is similar to improvement with patching as initial therapy for children with moderate amblyopia. DESIGN: Randomized, clinical trial. PARTICIPANTS: We enrolled 186 children, 3 to <10 years old, with moderate amblyopia (20/40-20/80). METHODS: Children were randomly assigned to receive either daily patching or to use a Bangerter filter on the spectacle lens in front of the fellow eye. Study visits were scheduled at 6, 12, 18, and 24 weeks. MAIN OUTCOME MEASURES: Visual acuity in amblyopic eyes at 24 weeks. RESULTS: At 24 weeks, amblyopic eye improvement averaged 1.9 lines in the Bangerter group and 2.3 lines in the patching group (difference in mean visual acuities between groups adjusted for baseline acuity = 0.38 line). The upper limit of a 1-sided 95% confidence interval was 0.76 line, which slightly exceeded a prespecified noninferiority limit of <0.75 line. Similar percentages of subjects in each group improved > or =3 lines (Bangerter group 38% vs patching group 35%; P = 0.61) or had > or =20/25 amblyopic eye acuity (36% vs 31%, respectively; P = 0.86). There was a lower treatment burden in the Bangerter group as measured with the Amblyopia Treatment Index. With Bangerter filters, neither a fixation switch to the amblyopic eye nor induced blurring in the fellow eye to worse than that of the amblyopic eye was required for visual acuity improvement. CONCLUSIONS: Because the average difference in visual acuity improvement between Bangerter filters and patching was less than half a line, and there was lower burden of treatment on the child and family, Bangerter filter treatment is a reasonable option to consider for initial treatment of moderate amblyopia.
Subject(s)
Amblyopia/therapy , Eyeglasses , Occlusive Dressings , Sensory Deprivation , Visual Acuity/physiology , Amblyopia/physiopathology , Child , Child, Preschool , Female , Humans , Male , Treatment OutcomeABSTRACT
Corneal metallic foreign body is a common condition in working-age adults due to occupational exposure, such as grinding, welding, and hammering. Ocular trauma is a leading cause of vision loss in children; however, corneal metallic foreign bodies are rare in the pediatric population. Here we describe 2 children suffering from autism spectrum disorders presenting with recurrent corneal metallic foreign bodies. Meticulous history revealed that both children extensively used a therapeutic home swing with metallic suspensions, suggesting the potential mechanism for the recurrent corneal metallic foreign bodies. Furthermore, the use of protective eyewear during swinging prevented further recurrences. Awareness of this potential danger is particularly important in children with disabilities, who may have difficulty communicating their concerns and cooperating during examination and treatment.
Subject(s)
Child Development Disorders, Pervasive/complications , Corneal Injuries , Eye Foreign Bodies/etiology , Eye Injuries, Penetrating/etiology , Metals , Child , Eye Foreign Bodies/prevention & control , Eye Foreign Bodies/surgery , Eye Injuries, Penetrating/prevention & control , Eye Injuries, Penetrating/surgery , Eye Protective Devices , Humans , Male , RecurrenceABSTRACT
An 8-month-old boy presented with anisocoria, a sluggishly reactive right pupil, and cholinergic supersensitivity as the only signs of what proved months later to be compressive third cranial nerve palsy due to an arachnoid cyst. Tonic constriction and dilation, segmental iris sphincter palsy, aberrant regeneration phenomena, ductional deficits, and ptosis were absent. The initial diagnosis was postganglionic internal ophthalmoplegia attributed to a viral ciliary ganglionopathy. Nineteen months later, he had developed an incomitant exodeviation and a supraduction deficit. Brain MRI revealed a mass consistent with an arachnoid cyst compressing the third cranial nerve in the right interpeduncular cistern. Resection of the cyst led to a persistent complete third cranial nerve palsy. This is the second reported case of prolonged internal ophthalmoplegia in a young child as a manifestation of a compressive third cranial nerve palsy. Our patient serves as a reminder that isolated internal ophthalmoplegia with cholinergic supersensitivity is compatible with a preganglionic compressive third nerve lesion, particularly in a young child.
Subject(s)
Arachnoid Cysts/complications , Arachnoid Cysts/pathology , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve Diseases/pathology , Pupil Disorders/etiology , Pupil Disorders/pathology , Acetylcholine/metabolism , Age Factors , Arachnoid Cysts/surgery , Cholinergic Fibers/metabolism , Decompression, Surgical , Humans , Infant , Iris/innervation , Iris/physiopathology , Magnetic Resonance Imaging , Male , Muscarinic Agonists , Mydriasis/etiology , Mydriasis/pathology , Mydriasis/physiopathology , Neurosurgical Procedures , Oculomotor Muscles/innervation , Oculomotor Muscles/physiopathology , Oculomotor Nerve/pathology , Oculomotor Nerve/physiopathology , Oculomotor Nerve Diseases/physiopathology , Oculomotor Nerve Injuries , Ophthalmoplegia/etiology , Ophthalmoplegia/pathology , Ophthalmoplegia/physiopathology , Parasympathetic Fibers, Postganglionic/injuries , Parasympathetic Fibers, Postganglionic/metabolism , Parasympathetic Fibers, Postganglionic/physiopathology , Pilocarpine , Pupil Disorders/physiopathology , Treatment OutcomeABSTRACT
PURPOSE: To present a detailed series of patients with unilateral retinal hemorrhages in shaken baby syndrome. METHODS: Patients with a diagnosis of Shaken Baby Syndrome evaluated by the Ophthalmology Department at Penn State University between January 1999 and January 2004 were reviewed. Patients were identified and their medical records, photographs, and computed tomographic scans were reviewed. Additional records were obtained from the Children's Hospital of Philadelphia. RESULTS: Of the 12 patients evaluated at Penn State University, the age at presentation ranged from 6 weeks to 15 months, with an average age of 4.3 months. Six (50%) had bilateral intracranial hemorrhage, while 6 (50%) had unilateral intracranial hemorrhage. The six patients with unilateral intracranial hemorrhage all had ipsilateral retinal hemorrhages. The perpetrators were male (100%) and 11 (92%) were the babies' fathers. For the five patients evaluated at Children's Hospital of Philadelphia, the age at presentation ranged from 4 weeks to 1 year, with an average of 4.35 months. Three (60%) had bilateral intracranial hemorrhage and two (40%) had unilateral intracranial hemorrhage. The perpetrators were male in four (80%) cases and three (60%) were the babies' fathers. CONCLUSIONS: These patients demonstrate the varied presentations of shaken baby syndrome. Unilateral retinal hemorrhages do not rule out the diagnosis of shaken baby syndrome.