Lacrimal-duct-probing-induced bacteremia: should children with congenital heart defects receive antibiotic prophylaxis?

PURPOSE: To determine the incidence of bacteremia following lacrimal-duct probing in children, and to evaluate the potential need for antibiotic prophylaxis in children who are at an increased risk of infectious endocarditis (IE). METHODS: In a prospective study beginning in October 1994, 40 consecutive children requiring lacrimal-duct probing performed by a single pediatric ophthalmologist received preoperative lacrimal and blood cultures followed by postoperative probe-induced transient bacteremia that was defined as a negative preoperative blood culture, followed by a positive postoperative blood culture of the same bacteria identified in the positive lacrimal culture. RESULTS: The overall infection rate as described above was 7 of 40 children (17.5%) with a 95% confidence interval of 7.3% to 32.8%. Of these, four children had positive postoperative cultures for Haemophilus influenzae (10.0%) and 3 were positive for Streptococcus pneumoniae (7.5%) One child had a negative preoperative blood and lacrimal culture with a postoperative blood culture positive for Streptococcus viridans. CONCLUSIONS: This study shows a significant incidence of lacrimal-probe-induced bacteremia with organisms that have been documented as etiological agents for IE in children. IE, although less common in children, remains a serious, potentially life threatening infection with high mortality. Although lacrimal-duct probing has never been clearly associated with documented endocarditis, it is the authors' recommendation that it be prudent for patients who are at known high risk for endocarditis to receive SBE prophylaxis considering the low cost/benefit ratio.

Leukemic relapse presenting as acute unilateral hypopyon in acute lymphocytic leukemia.

A 16-year-old girl with acute lymphocytic leukemia in hematologic remission and no evidence of active central nervous system disease had a unilateral hypopyon as her sole site of relapse. She underwent diagnostic paracentesis and was treated with topical corticosteroids, chemotherapy, and radiotherapy to the central nervous system. Ocular involvement of the iris and anterior chamber as the site of primary disease or a relapse is a rare event. The anterior chamber serves as a sanctuary for cancer cells, and treatment protocols, including better anterior chamber prophylaxis, are warranted.

Management of strabismus with botulinum A toxin.

Three hundred eight patients with strabismus were treated with botulinum A toxin (Oculinum) chemodenervation; 153 were followed by the authors for at least 6 months. In this study group, 97 received botulinum A toxin injections as the primary method of treatment of their ocular deviation. Fifty-six received injections after traditional extraocular muscle surgery. Botulinum A toxin was useful for management of patients with recent surgical overcorrections and for management of some patients with sixth cranial nerve palsy. Chemodenervation of an extraocular muscle was not as successful as traditional strabismus surgery for treatment of infantile esotropia and other comitant deviations. Botulinum A toxin injection was ineffective in patients who had restrictive strabismus. This drug has limited application in the management of patients with strabismus.

Rapid, simplified diagnosis of cystinosis in conjunctival biopsies.

Assessment of the markedly elevated concentration of free cystine in conjunctival tissue from patients with cystinosis permits a rapid, simple, and unequivocal diagnosis of this disorder of amino acid metabolism.