ABSTRACT
Direct traumatic optic neuropathy is a rare complication of endoscopic sinus surgery and can result in irreversible damage to the optic nerve. We report a case of direct traumatic optic neuropathy after transnasal endoscopic orbital decompression for Graves's disease in a patient who experienced near-complete recovery of vision. We discuss possible mechanisms.
Subject(s)
Decompression, Surgical/adverse effects , Endoscopy/adverse effects , Optic Nerve Injuries/etiology , Paranasal Sinuses/surgery , Blindness/etiology , Female , Humans , Methylprednisolone , Optic Nerve Injuries/diagnosis , Optic Nerve Injuries/diagnostic imaging , Recovery of Function , Tomography, X-Ray Computed , Treatment Outcome , Visual Acuity , Visual Fields , Young AdultABSTRACT
PURPOSE: Papilledema is considered one of the cardinal ophthalmologic signs of shunt failure. However, the prevalence of papilledema in children with shunt malfunction has not been systematically investigated. The purpose of this study is to determine the sensitivity of papilledema as a sign of shunt failure in children. METHODS: A prospective evaluation was undertaken of all children (n = 29; <19 years of age) with surgically confirmed shunt malfunction who were treated at Arkansas Children's Hospital between July 2007 and April 2008. Each child had a dilated fundus examination and/or RetCam photograph while under anesthesia immediately before shunt repair. The optic disk was evaluated for the presence of papilledema and pallor. Intracranial pressure was measured during surgical shunt repair at the discretion of the neurosurgeon. RESULTS: Twenty-nine patients had surgically confirmed shunt failure. Patient's age ranged from 36 days to 18 years, 8 months. Four patients (14%) had papilledema, and 1 patient had severe optic disk pallor. The remaining 24 patients had flat optic disks. Five patients had flat optic disks despite an intracranial pressure >/=300 mm H(2)O. CONCLUSIONS: Papilledema is not a sensitive sign of shunt failure. Even children with severe elevations in intracranial pressure from shunt malfunction may have flat optic disks. Therefore, physicians that evaluate children with shunts should be aware that a normal optic disk does not preclude shunt malfunction.
Subject(s)
Cerebrospinal Fluid Shunts/adverse effects , Intracranial Hypertension/diagnosis , Intracranial Hypertension/etiology , Papilledema/diagnosis , Papilledema/etiology , Adolescent , Child , Child, Preschool , Equipment Failure , Female , Humans , Hydrocephalus/surgery , Infant , Male , Ophthalmoscopy , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Sensitivity and SpecificityABSTRACT
Dyskeratosis congenita, also referred to as Zinsser-Cole-Engman syndrome, is characterized by reticular skin pigmentation, dystrophic nail changes, and mucosal leukoplakia. Other findings include carious teeth, premature graying of hair, and osteoporosis. Approximately 50% of patients develop pancytopenia. Ophthalmologic manifestations include blepharitis, conjunctivitis, obliteration of the lacrimal puncta, nasolacrimal duct obstruction, ectropion, and loss of eyelashes. We report bilateral retinal hemorrhages from pancytopenia in a patient with dyskeratosis congenita.
Subject(s)
Dyskeratosis Congenita/complications , Retinal Hemorrhage/etiology , Blood Transfusion , Dyskeratosis Congenita/diagnosis , Dyskeratosis Congenita/therapy , Follow-Up Studies , Humans , Male , Retinal Hemorrhage/diagnosis , Retinal Hemorrhage/therapy , Visual Acuity , Young AdultABSTRACT
PURPOSE: We sought to determine whether visual field abnormalities occur in infants with deformational posterior plagiocephaly and to assess whether there is a relationship between the severity and laterality of visual field abnormalities with the severity and laterality of skull deformity. METHODS: A retrospective chart review was performed on 40 consecutive infants with deformational posterior plagiocephaly. Each was tested with standardized binocular arc perimetry in the horizontal plane. Sixteen patients also had 3-dimensional computed tomography of the skull. Hemifield asymmetry of >/=20 degrees and/or a decrease in hemifield values by >/=20 degrees from established normal patients was considered abnormal. Visual field data from study patients was plotted against previously published normative data. Graphs comparing visual field defects and laterality to cranial asymmetry also were generated. RESULTS: Thirty-five percent of infants with deformational posterior plagiocephaly had constriction of one or both hemifields by at least 20 degrees from established normal patients. Hemifield asymmetry of 20 degrees or more was found in 17.5% of infants tested. There was a significant difference in the worse hemifield values measured in each patient and the standard visual fields obtained from normative data ( P = 0.036). There was no correlation between the laterality of the visual fields to the laterality of the defects. A correlation between severity of hemifield constriction and % asymmetry on computed tomography was noted ( P = 0.209). CONCLUSIONS: Deformational posterior plagiocephaly may affect visual field development but neither the laterality nor the severity of skull deformity is predictive of the severity of visual field defects.
Subject(s)
Plagiocephaly, Nonsynostotic/complications , Vision Disorders/etiology , Visual Fields , Humans , Image Processing, Computer-Assisted , Infant , Plagiocephaly, Nonsynostotic/diagnostic imaging , Severity of Illness Index , Tomography, X-Ray Computed , Vision Disorders/physiopathologyABSTRACT
PURPOSE: To describe the clinical characteristics and treatment response of ocular rosacea in the pediatric population. DESIGN: Retrospective case series. METHODS: The clinic charts of consecutive pediatric cases of ocular rosacea were evaluated over a 34-month period. Minimal diagnostic inclusion criteria were the presence of posterior eyelid inflammation including meibomian gland inspissation and lid margin telangiectasis, in conjunction with conjunctival injection or episcleritis. RESULTS: Six patients ranged from 3 to 12 years of age at presentation. All shared a long history of ocular irritation and photophobia. Five patients (83%) were female and had bilateral involvement. Eyelid telangiectases and meibomian gland disease were present in all cases. Three patients (50%) had sterile corneal ulcers. Only two patients (33%) had cutaneous involvement at the time of diagnosis. All patients experienced significant improvement with a combination of oral antibiotics (doxycycline or erythromycin), with or without topical antibiotics (erythromycin or bacitracin) or topical steroids (fluorometholone). CONCLUSION: Ocular rosacea in children may be misdiagnosed as viral or bacterial infections. Unlike in adults, associated cutaneous changes are uncommon. Most disease is bilateral, although involvement may be asymmetric. Response to conventional treatment is excellent, although long-term treatment may be necessary to prevent relapses.
Subject(s)
Corneal Ulcer/complications , Eyelid Diseases/complications , Meibomian Glands/pathology , Rosacea/complications , Telangiectasis/complications , Anti-Bacterial Agents , Child , Child, Preschool , Corneal Ulcer/diagnosis , Corneal Ulcer/drug therapy , Drug Therapy, Combination/therapeutic use , Eyelid Diseases/diagnosis , Eyelid Diseases/drug therapy , Female , Fluorometholone/therapeutic use , Glucocorticoids/therapeutic use , Humans , Male , Retrospective Studies , Rosacea/diagnosis , Rosacea/drug therapy , Telangiectasis/diagnosis , Telangiectasis/drug therapyABSTRACT
Idiopathic intracranial hypertension, also referred to as pseudotumor cerebri (PTC), is characterized by high intracranial pressure, normal cerebral ventricles,and cerebrospinal fluid. Although papilledema is described in various anemias, only one case of PTC with idiopathic aplastic anemia has been reported in the English literature. We report a case of papilledema in an adolescent with aplastic anemia and propose its mechanism.
