Microtropia: clinical findings and management for the primary eye care practitioner.

BACKGROUND: Microtropia is a small-angle strabismus with a highly developed degree of binocular cooperation. It is a unilateral comitant horizontal deviation less than 5 prism diopters (PD) in the presence of anomalous retinal correspondence (ARC), amblyopia, some motor fusion, and reduced stereoacuity. CASE REPORT: A 7-year-old white girl presented for a second opinion concerning unexplained vision loss in the left eye. Visual acuities were 20/20 in the right eye and 20/200 in the left eye. Ocular evaluation found normal eye health with a 4-PD constant left esotropia at near and a 3-PD constant left esotropia at distance on unilateral cover test. A diagnosis of steady nasal eccentric fixation microtropia without identity with strabismic amblyopia in the left eye was made. Over the follow-up period, visual acuity improved but the alignment did not. CONCLUSION: Microtropia can defy detection, resulting in a reduced chance of achieving near-normal visual potential in children. It is important for clinicians to understand the possible etiologies, related entities, proper testing, differential diagnoses, and the goals of treatment. This case report reviews the clinical findings, diagnoses, and management of patients with microtropia.

Child development and refractive errors in preschool children.

PURPOSE: Many parents are concerned about their child's development. The purpose of this study is to determine whether parental concerns about overall development are associated with significant refractive errors among urban preschool children. METHODS: A cross-sectional population-based study was conducted to evaluate the prevalence of ocular disorders in white and African American children aged 6 through 71 months in Baltimore, Maryland. A comprehensive eye examination with cycloplegic refraction was performed. Parental concerns about development were measured with the Parents' Evaluation of Developmental Status screening tool. Of 2546 eligible children 2381 (93.5%), completed the refraction and the parental interview. RESULTS: Parental concerns about development were present in 510 of the 2381 children evaluated [21.4%; 95% confidence intervals (CI): 9.8 to 23.1]. The adjusted odds ratios [OR] of parental concerns with hyperopia [≥3.00 diopters (D)] was 1.26 (95% CI: 0.90 to 1.74), with myopia (≥1.00 D) was 1.29 (95% CI: 0.83 to 2.03), with astigmatism (≥1.50 D) was 1.44 (95% CI: 1.08 to 1.93) irrespective of the type of astigmatism, and with anisometropia (≥2.00 D) was 2.61 (95% CI: 1.07 to 6.34). The odds of parental concerns about development significantly increased in children older than 36 months with hyperopia ≥3.00 D, astigmatism ≥1.50 D, or anisometropia ≥2.00 D. CONCLUSIONS: Parental concerns about general developmental problems were associated with some types of refractive error, astigmatism ≥1.50 D and anisometropia ≥2.00 D, in children aged 6 to 71 months. Parental concerns were also more likely in children older than 36 months with hypermetropia, astigmatism, or anisometropia. Parental concerns were not associated with myopia. Because of the potential consequences of uncorrected refractive errors, children whose parents have expressed concerns regarding development should be referred for an eye examination with cycloplegic refraction to rule out significant refractive errors.

Acute zonal occult outer retinopathy: a case report.

BACKGROUND: Acute zonal occult outer retinopathy (AZOOR) is a disorder of unknown etiology with a predilection for young women. AZOOR is characterized by an acute loss of one or more zones of outer retinal function with a corresponding loss of visual field in one or both eyes. Patients present with photopsia, variable funduscopic changes, and abnormal electroretinogram (ERG) findings. There are no proven treatments. Diagnosed cases have a reasonable prognosis because central vision is often spared. CASE REPORT: A 24-year-old white woman presented with acute photopsia with clouded temporal vision in the right eye (O.D.). Initial evaluation found a slightly swollen nerve fiber layer with no other outstanding lesions O.D. Over a 7-week follow-up period, there was significant progression into the deep chorioretinal tissues O.D. with an anterior chamber response. At 3 months, an afferent pupillary defect (APD) developed with significant retinal pigment epithelium (RPE) changes. After extensive testing, the consulting retinal specialist identified AZOOR as the etiology. At 21 and 31 months, the process remained in remission. Although primary symptoms subsided, the dense inferior-temporal field defect remained O.D. CONCLUSION: AZOOR is a rare condition with subtle and often vague signs and symptoms making diagnosis difficult. The course of AZOOR, its clinical presentations, hypothesis of etiology, differential diagnosis, workup, management, and prognosis are reviewed.