ABSTRACT
STUDY DESIGN: A case report of a clinical observation. OBJECTIVES: To present the clinical findings of an unusual complication of spinal fusion and epidural analgesia. SUMMARY OF BACKGROUND DATA: A 13-year-old girl developed Horner's syndrome after posterior thoracic spinal fusion and epidural analgesia. METHODS: By clinical examination and pupillary pharmacologic testing, the diagnosis of Horner's syndrome was confirmed. RESULTS: Examination and testing confirmed the presence of central or preganglionic Horner's syndrome. The specific cause of the Horner's syndrome was not determined. Horner's syndrome persisted, and the blepharoptosis was corrected surgically. CONCLUSIONS: This is the first reported case of Horner's syndrome occurring after posterior spinal fusion and epidural analgesia.
Subject(s)
Anesthesia, Epidural/adverse effects , Horner Syndrome/etiology , Spinal Fusion/adverse effects , Thoracic Vertebrae/surgery , Anesthetics, Inhalation , Blepharoptosis/etiology , Blepharoptosis/surgery , Child , Female , Horner Syndrome/pathology , Humans , Radiography , Thoracic Vertebrae/diagnostic imagingABSTRACT
PURPOSE: Two preliterate acuity charts, the Lea Symbol chart and the HOTV chart, were compared prospectively in an established preschool vision screening program. The charts were compared by measuring time required to test, reliability coefficients, and the percentage of children testable with each chart. METHODS AND MATERIALS: Seven hundred and seventy-seven 3- to 5-year-old children were randomized to four screening sequences that determined the order of chart use. Each child was screened on two occasions within 6 weeks. Testing was performed at 10 feet, and optotypes were not isolated for testing. RESULTS: Mean test time was significantly less for older children, but was not related to the chart used. Reliability coefficients were similar for the Lea Symbols and the HOTV charts. The percentage of children testable by each chart improved with increased age of the child. More 3 year olds were testable with the Lea Symbols chart compared to the HOTV chart (92% versus 85%, P = .05). CONCLUSIONS: Vision screening with either chart was more rapid and more frequently achieved with 4- and 5-year-old children compared with the 3 year olds. For the population as a whole, each chart gave similar results. Among the 3 year olds, however, testability rates were better for the Lea Symbols chart. The Lea Symbols chart is an acceptable option for preschool vision screening, and may be more efficacious than the HOTV chart for screening 3-year-old children.
Subject(s)
Vision Disorders/diagnosis , Vision Screening , Vision Tests/instrumentation , Child, Preschool , Female , Humans , Male , Prospective Studies , Reproducibility of Results , Visual AcuityABSTRACT
Retinal hemorrhage is a frequent finding in child abuse, but may also be associated with cardiopulmonary resuscitation, accidental trauma, and a variety of illnesses such as blood dyscrasias and infections. Although it is imperative that child abuse be considered in all children who present with retinal hemorrhages, whether retinal hemorrhages can be attributed to cardiopulmonary resuscitation in suspected cases of abuse poses a dilemma. The etiologies of retinal hemorrhage as well as the literature presently available to support or refute the various diagnoses are discussed. Guidelines for funduscopic examination in the Emergency Department as well as a clinical classification of retinal hemorrhage are provided. In addition, guidelines are suggested for the appropriate clinical investigations in children with retinal hemorrhages.
Subject(s)
Child Abuse , Retinal Hemorrhage/etiology , Cardiopulmonary Resuscitation/adverse effects , Child , Child, Preschool , Eye Injuries/complications , Humans , Infant , Ophthalmoscopy , Retinal Hemorrhage/classification , Retinal Hemorrhage/diagnosisABSTRACT
Forty-six patients with Prader-Willi syndrome were examined to determine the incidence and character of ocular abnormalities. All patients met clinical criteria for this syndrome including infantile hypotonia, hypogonadism, truncal obesity, intellectual impairment, dysmorphic facies, and short stature. Thirty-two patients had best corrected visual acuities between 6/6 and 6/9 in each eye. Seven patients (15%) had myopia greater than -3.75 diopters. Nineteen (41%) patients had astigmatism of 1.25 diopters or greater. Amblyopia of strabismic, anisometropic, or ametropic etiology was present in 11 (24%) of the patients. Strabismus was present in 25 (54%) patients: 22 (48%) patients had esotropia and three (7%) had exotropia. Nine patients either received or required strabismus surgery. Thirty-three percent of the patients examined for iris transillumination defects had this finding. This study represents the first large series of patients with Prader-Willi syndrome to undergo detailed ophthalmologic evaluation. Recognition of this syndrome is important because of the high incidence of potentially treatable ocular problems.
Subject(s)
Eye Diseases/complications , Prader-Willi Syndrome/complications , Adolescent , Esotropia/complications , Eye Diseases/physiopathology , Female , Fixation, Ocular , Humans , Male , Optic Nerve/abnormalities , Strabismus/complications , Strabismus/surgeryABSTRACT
A young woman presented with ocular discomfort after handling her pet tarantula. Multiple fine hairs were detected on the eyelids, in the palpebral and bulbar conjunctiva, and in the corneal epithelium and stroma. In addition, foreign body granulomas were found in the conjunctiva. Six months later, peripheral chorioretinal lesions were seen. The clinical and histologic findings in this case closely resemble the findings in ophthalmia nodosa caused by caterpillar hairs.
Subject(s)
Animals, Domestic , Endophthalmitis/etiology , Eye Foreign Bodies/etiology , Hair , Spiders , Adolescent , Animals , Conjunctivitis/etiology , Cornea/pathology , Eyelids/pathology , Female , HumansABSTRACT
Seventy-three children received modern designs of posterior and flexible anterior chamber intraocular lenses. Twenty-eight (38%) had anterior chamber and 45 (62%) had posterior chamber lenses implanted. Postoperative implant complications occurred in 38 (54%) eyes; the most frequent was secondary membrane formation. Six eyes (22%) with anterior chamber lenses and 25 eyes (58%) with posterior chamber lenses required posterior capsulotomies. Seventy percent of the posterior chamber lens recipients less than six years of age developed secondary membranes. All of these eyes had a discission except one Nd:YAG laser patient. Forty-eight percent of the patients with posterior chamber lenses over six years of age required posterior capsulotomies: 55% had Nd:YAG laser capsulotomies and 45% had discissions. Based upon these observations, we now recommend primary implantation of flexible anterior chamber lenses in three- to six-year old children who have tissue-free visual axes and for all secondary implantations. Primary posterior chamber lenses are recommended for children six years of age and older and for younger children who will tolerate a Nd:YAG laser capsulotomy.
Subject(s)
Age Factors , Lenses, Intraocular , Anterior Chamber , Child , Child, Preschool , Female , Humans , Laser Therapy , Lens Capsule, Crystalline/surgery , Male , Postoperative Complications/surgeryABSTRACT
A 6-month-old girl underwent surgical excision of an epibulbar mass which had the clinical appearance of a dermolipoma. Intraoperatively, a separate underlying mass was uncovered which was firmly adherent to the sclera. Histopathologic examination confirmed the superficial lesion to be a typical dermolipoma, and the underlying lesion to be an epibulbar osseous choristoma with associated adherent ectopic lacrimal gland tissue. The clinical features, management, and histopathology of this new association are reviewed.
