Optic neuritis in children.

PURPOSE: To describe the clinical characteristics of optic neuritis in children, including final visual acuity and development of multiple sclerosis (MS). METHODS: Charts were reviewed of all patients < 15 years of age who presented with optic neuritis to the Bascom Palmer Eye Institute or the Miami Children's Hospital between 1986 and 1998. RESULTS: Fifteen patients were identified. There was a slight female predilection in the study group (60%), with a mean age of 9.8 years at presentation. A preceding febrile illness within 2 weeks of visual symptoms was reported in 66% of patients. Initial visual acuity ranged from 20/15 to no light perception. Involvement was bilateral in 66% of patients, and disc swelling was present in 64% of involved eyes. Of the patients who underwent magnetic resonance imaging, 33% had focal demyelinating lesions in the brain, and 63% of affected nerves were enlarged or enhanced with gadolinium. Eleven patients were treated with intravenous steroids. Final visual acuity was > or = 20/40 in 58.3% of eyes. Thirty percent of the patients had vision of finger counting or worse. Four (26%) patients developed MS. The mean age of patients with MS was 12 years, compared with 9 years in children who did not develop MS. Patients with unilateral involvement had an excellent visual prognosis (100% > 20/40), but a higher rate of development of MS (75%). Two patients had positive serology for Lyme disease. CONCLUSIONS: Optic neuritis presents differently in children than in adults. Children typically have bilateral involvement with papillitis following an antecedent viral illness. Although visual prognosis is poorer in children than adults, the development of MS is less common in children. Children who present with unilateral involvement have a better visual prognosis; however, they also develop MS at a greater frequency than children with bilateral involvement. Patients who developed MS were, on average, older at presentation with optic neuritis than those who did not develop MS.

Optic nerve avulsion from a golfing injury.

PURPOSE: To describe a patient with optic nerve avulsion after being struck in the eye with a golf club. METHODS: A 10-year-old male was hit in the left eye by a golf club. The patient underwent full ophthalmoscopic evaluation and neuroimaging. RESULTS: The patient had no light perception in the left eye when first seen. Avulsion of the optic nerve with vitreous hemorrhage was apparent on examination. Computed tomographic imaging of the brain and orbits revealed no abnormalities. CONCLUSIONS: Optic nerve avulsion from golf-related injury is more likely to occur when the impact site is between the globe and the orbital rim. Rupture of the globe is more likely to occur with direct impact to it.

Clinical practice guidelines for the management of orbital cellulitis.

PURPOSE: A retrospective study was performed to review the management of periorbital and orbital cellulitis at Miami Children's Hospital, between January 1, 1993 and February 15, 1996. RESULTS: One hundred and one patients were included in this study. The variables analyzed in this study included age, sex, length of hospital stay, imaging studies, laboratory tests, and microbiology specimens collected. Patients were classified according to the modified Chandler classification. Average length of stay for our patient population was 4.5 days. Data regarding the radiologic studies, laboratory tests, and microbiology yield of specimens were analyzed. CONCLUSIONS: The incidence of orbital infection, manifested by lid swelling alone is much more common (stages I and II) than orbital infection involving postseptal findings (stages III, IV, and V); 84.16% compared with 15.84%, respectively. An updated approach and a general guideline for the management of periorbital and orbital cellulitis according to the clinical staging of the process is presented.

Bilateral aplasia of the optic nerves, chiasm, and tracts in an otherwise healthy infant.

PURPOSE: To report bilateral aplasia of the optic nerves, chiasm, and tracts in an otherwise healthy infant. METHOD: Case report. RESULTS: Ophthalmologic examination disclosed bilateral microphthalmos and optic nerve aplasia. Physical, neurologic, and genetic evaluations were otherwise normal. Magnetic resonance imaging of the brain and orbits disclosed bilateral aplasia of the optic nerves, chiasm, and tracts. CONCLUSION: Bilateral aplasia of the optic nerves, chiasm, and tracts may occur in an otherwise healthy infant.

Ocular manifestations in pediatric patients with acquired immunodeficiency syndrome.

Forty pediatric patients seropositive for human immunodeficiency virus antibody and conforming to Centers for Disease Control, Atlanta, Ga, case definition of acquired immunodeficiency syndrome underwent ophthalmic examinations to evaluate prospectively the incidence, type, and natural history of ocular involvement in pediatric acquired immunodeficiency syndrome. A total of 87 examinations were performed on the patient population throughout the course of the study. Twenty percent had ocular findings, including two cases of cytomegalovirus retinitis, one case of isolated retinal cotton-wool spots, one case of toxoplasmosis retinochoroiditis, and three cases of external infections of adnexal structures. One patient had unusual peripheral retinal findings. The incidence of ocular manifestations in pediatric acquired immunodeficiency syndrome is considerably less than reported in several adult series. However, we recommend ophthalmic screening in all pediatric patients with acquired immunodeficiency syndrome with encephalopathy or disseminated opportunistic infections, or when symptoms suggest ophthalmic involvement.

Efficacy and safety of topical oxymetazoline in treating allergic and environmental conjunctivitis.

This randomized, double-masked study evaluated the safety and efficacy of oxymetazoline 0.025% topical ophthalmic solution compared with its vehicle when used to treat allergic or environmental conjunctivitis. Thirty-nine patients with moderate bilateral conjunctival hyperemia instilled one drop of either oxymetazoline 0.025% solution or its vehicle twice daily for one week. At each evaluation the signs and symptoms of conjunctivitis were evaluated, complete eye examinations were performed, and heart rate and blood pressure were measured. An overall assessment of treatment efficacy was made at each follow-up evaluation. The signs and symptoms of conjunctivitis had significantly improved in the oxymetazoline-treated group when compared with those of the vehicle-treated group, and the ocular and systemic safety of each treatment was comparable.

Evaluacion de embarazo y parto en adolescentes de temprana edad ginecologica. / Evaluation of pregnancy and labor in adolescents of early gynecologic age

Se estudiaron 178 adolescentes embarazadas menores de 16 anos de edad. Se analizaron detalladamente por EG independiente de la EC 94 pacientes que embarazaron con una EG < a 3 anos. Se detecto una incidencia de gestosis de 4.2% y pre-termino de 17.20%. Se registro un 22.22% de RN de menos de 2.500 gr. y un Score de Apgar de 1-3 en el 7.40% de los casos de adolescentes de 3 anos de EG: datos no esperados.Se destaca como factor de riesgo de intervencion cesarea 1 ano de EG y como factor de riesgo de aplicacion de forceps 2 anos de EG

Evaluacion de embarazo y parto en adolescentes de temprana edad ginecologica. / Evaluation of pregnancy and labor in adolescents of early gynecologic age

Se estudiaron 178 adolescentes embarazadas menores de 16 anos de edad. Se analizaron detalladamente por EG independiente de la EC 94 pacientes que embarazaron con una EG < a 3 anos. Se detecto una incidencia de gestosis de 4.2% y pre-termino de 17.20%. Se registro un 22.22% de RN de menos de 2.500 gr. y un Score de Apgar de 1-3 en el 7.40% de los casos de adolescentes de 3 anos de EG: datos no esperados.Se destaca como factor de riesgo de intervencion cesarea 1 ano de EG y como factor de riesgo de aplicacion de forceps 2 anos de EG

One-month crossover trial comparing the intraocular pressure control of 3.4% Piloplex twice daily with 2.0% pilocarpine four times daily.

A one-month crossover trial comparing Piloplex 3.4% b.i.d. with pilocarpine 2.0% q.i.d. was conducted to compare the effectiveness of the 2 drugs in reducing the intraocular pressure of ocular hypertensive and open-angle glaucoma in subjects previously controlled with pilocarpine 2.0%. For both groups the mean IOP increased slightly from baseline with pilocarpine and decreased significantly from baseline with Piloplex. The side effects of both treatments were minor. Piloplex and pilocarpine treatment were both associated with eye dryness; Piloplex was associated with lacrimation in 2 subjects. This controlled study showed that Piloplex 3.4% b.i.d. was more effective than pilocarpine 2% q.i.d. in lowering intraocular pressure.

Evaluation of pregnancy and delivery in low gynecologic age adolescents.

178 pregnant adolescents of under 16 years of age were studied. 94 patients who conceived at a gynecologic age (G.A.) less than or equal to 3 years were studied independently of their chronological age (C.A.). The incidence of gestosis and pre-term delivery was 4.2% and 17.20%, respectively. 22.22% of the infants born to patients with G.A. = 3 years, weighed less than 2,500 g . ; and 7.4% of these newborns had Apgar Scores of 1-3: these results were unexpected. Patients with G.A. = 1 are at increased risk of cesarean section, while those with G.A. = 2 are at a high risk of forceps delivery.