Exercise induced esotropia.

A case of unusual intermittent esotropia and diplopia is reported. A 13-year-old boy experienced diplopia during vigorous exercise that resolved within 30 minutes after stopping the exercise. The symptoms had been present unchanged since age 6. Examination revealed orthophoria. After vigorous exercise an esotropia of 14 prism diopters in the distance developed, which gradually resolved over 30 minutes. Neurologic evaluation, CT scan, and magnetic resonance imaging scan have been normal. The symptoms have continued unchanged for 11 years. To my knowledge, no other similar case of exercise induced esotropia has been reported.

Traumatic retinoschisis in battered babies.

Five infants who were victims of physical abuse had extensive bilateral retinal hemorrhages on initial evaluation and subsequently developed signs of permanent retinal damage. None showed external evidence of trauma to the eyes. Vitreous hemorrhage developed after a delay of several days or more in three cases that were followed closely from the time of the traumatic incident. In several eyes, apparent intraretinal blood-filled cavities were seen acutely in the macular region and elsewhere. Late scarring of the macula typically had a cystic or crater-like configuration. Electroretinography showed loss or reduction of the positive B-wave with preservation of the negative A-wave in every case. We propose that splitting of the retina resulting from the direct mechanical effects of violent shaking was responsible for all of these findings.

Eye bobbing associated with jaw movement.

Two patients were treated for a previously unreported disorder believed to be related to Marcus Gunn jaw-winking. The first, a 9-month-old infant with left congenital blepharoptosis without jaw-winking and with normal ocular motility had an up and down movement of the left globe synchronous with nursing movements of the jaw. The second was a 5-year-old girl with left blepharoptosis, jaw-winking, and left double elevator palsy who had up and down movements of both the left upper lid and the left globe synchronous with chewing. The left globe movements were most prominent in the field of vertical action of the superior rectus muscle and persisted after levator excision and fascia lata sling procedures. The possible etiology of the Marcus Gunn jaw-winking phenomenon is discussed and related to our cases of eye bobbing. The eye bobbing probably is caused by abnormal innervation to the superior rectus muscle produced by jaw movements in a manner analogous to the abnormal stimulation of the levator muscle in jaw-winking. The similar embryologic development and innervation of the levator and superior rectus muscles add credence to this theory.

Endophthalmitis caused by an Erwinia species.

A 14-year-old boy developed exogenous endophthalmitis presumably caused by an Erwinia species. To our knowledge, this is the firs reported case of endophthalmitis caused by an Erwinia species, which has been considered pathogenic for only the last ten years. The endophthalmitis developed after a piece of wood penetrated the patient's sclera. After removal of the foreign body, the patient received intravitreally and subconjunctivally administered gentamicin sulfate, intramuscularly administered cephaloridine, and a short course of orally administered prednisone. The patient had clinical and visual improvement.