A clinical study on the detection of strabismus, anisometropia or ametropia of children by simultaneous photography of the corneal and the fundus reflexes.

Twenty two strabismus and 106 straight eyed patients with anatomically normal eyes were first photographed with a conventional camera equipped with a weak 100 mm teleobjective and coaxial flashlight and then examined clinically. The possibility of detecting strabismus, anisometropias and ametropias in the photographs by noting the localisation of the corneal reflexes and examining the appearance and lightness of the fundus reflexes and their possible asymmetry were tested in a double blind study. Even small angled strabismus cases could be found because of the asymmetrical localisation of the corneal reflexes. In 18 of the 22 strabismus cases (82%) there was asymmetrical lightness of the fundus reflexes and the fundus reflex of the deviating eye was lighter than that of the fixating eye. All the straight eyed anisometropias of 3.0 diopters or more (five cases) were observed in the photographs because of the asymmetrical appearance of the fundus reflexes. In straight eyed anisometropias of under 3.0 diopters, the fundus reflexes were symmetrical in 90 cases and asymmetrical in 11 cases (11%). Only three out of eight hyperopias of fomr +4.5 to +6.0 diopters were found because of the light crescent in the low part of the pupil. All myopias of over -4.0 diopters (14 cases) were observed because of the light crescent appearance in the upper part of the pupil. No pupillary crescents appeared with refractions of less than -1.75 diopters myopia or less than +4.5 diopters hyperopia; 172 eyes came within this range. Even a technician can perform, without premedication, the method tested here for rapid and simple screening to detect strabismus and straight eyed anisometropias of 3.0 diopters or more in small children or other patients who do not co-operate well in normal clinical examination. Over -4.0 diopters myopias can also be found. The method was rather unreliable for finding hyperopias, presumably because no cycloplegic drops were used.

[Reversible visual impairment caused by leukemic fundus changes (author's transl)]. / Reversibler Visusabfall durch Fundusveränderungen bei Leukämie.

Monocular impaired visual acuity was the initial symptom of chronic myeloic leukemia in a 41 year old man. A subretinal infiltration had caused foveal retinal thinning. 3 1/2 months after the onset of therapy retinal thickness had normalized and the vision was fully restored.

[Visual field in the Cushing syndrome (author's transl)]. / Gesichtsfeldbefund beim Cushing-Syndrom.

According to traditional opinion the basophile adenoma, in contrast to the eosinophile or chromophobe tumours of the hypophyse, practically never causes lesion of the chiasm. However, the case of a 16-year-old girl suffering from adiposis, hypertonia, striae distensae and a "full moon face" is used to demonstrate that through the precis examination of the visual field on the Goldmann perimeter even with normal disque of the optic nerve, normal sella turcica established by X-ray, and uncharacteristic hormon condition, a slight chiasmal lesion caused by pressure from below can be established.

Nanophthalmos with uveal effusion. A new clinical entity.

Five patients exhibited the association of nanophthalmos and uveal effusion, apparently on a familial basis. Glaucoma, occurring in the fourth to sixth decades of life, required surgical intervention that was followed by the development of secondary retinal and choroidal detachment. Recognition of this syndrome is important because: (1) surgical procedures for glaucoma should be avoided, if possible, in order to prevent the development of uveal effusion; (2) retinal detachment surgical procedures are ineffective in uveal effusion and should be avoided, and (3) choroidal elevation occurring in the uveal effusion phase may be erroneously diagnosed as an intraocular tumor and unnecessary enucleation may follow.