Acute angle-closure in juvenile X-linked retinoschisis.

Juvenile X-linked retinoschisis (JXR), the most common inherited retinal disorder in young males, presents with a wide range of phenotypic variations. Acute angle closure in children with JXR has been reported in the literature only once before. We present a case of acute-angle closure, temporally associated with pharmacologic dilation, in a 12-year-old boy with JXR.

When Pediatric Headaches Are Not Benign-Eye Findings.

Headache is the most common neurologic complaint that presents to the pediatrician. While most headaches are benign in nature, patients must be carefully evaluated to rule out life- or vision-threatening causes. Non-benign etiologies of headache may exhibit ophthalmologic signs and symptoms that can help narrow the differential diagnosis. It is also important for physicians to know in what situations appropriate ophthalmologic evaluation is necessary, such as evaluating for papilledema in the setting of elevated intracranial pressure. In this article we discuss life- and/or vision-threatening etiologies of headache, including infection, autoimmune disease, cerebrovascular pathologies, hydrocephalus, intracranial neoplasia, and idiopathic intracranial hypertension, and their associated ophthalmologic manifestations. Due to less familiarity of the disease amongst primary care providers, we discuss pediatric idiopathic intracranial hypertension in more comprehensive detail.

The Effect of Horizontal Rectus Muscle Surgery on Distance-Near Incomitance.

PURPOSE: To determine the effect of horizontal rectus muscle surgery on distance-near incomitance. DESIGN: Prospective, comparative, interventional case series. METHODS: Prospective evaluation of patients >7 years old who had medial or lateral rectus muscle surgery at the University of Arkansas Medical Center or Arkansas Children's Hospital between December 2009 and January 2012. Prism and alternate cover testing was performed at distance (6 m) and near (0.3 m) fixation after >1 hour of monocular occlusion at preoperative and postoperative examinations within 1 week, and closest to 1 year after surgery. The change in distance-near incomitance was calculated. Patients with extraocular muscle fibrosis or paralysis were excluded. RESULTS: Forty-five patients met inclusion criteria. Twenty-five patients had medial rectus muscle surgery, and 20 patients had lateral rectus muscle surgery. Postoperative examinations showed a change in distance-near incomitance ≤10 prism diopters (PD) in 42 of 44 patients evaluated within 1 week after surgery and in all 28 patients evaluated 6-24 months after surgery. Horizontal rectus muscle surgery did not induce a clinically significant change in distance-near incomitance (±2 PD equivalence, TOST confidence interval, -1.8 +1.6 PD, P value = 0.014). Contrary to traditional teaching, medial rectus muscle surgery was not more likely to induce a greater effect at near fixation (P = 0.80) and lateral rectus muscle surgery was not more likely to induce a greater effect at distance fixation (P > 0.99). CONCLUSION: Horizontal rectus muscle surgery does not induce a clinically significant effect on distance-near incomitance. Contrary to traditional teaching, medial rectus muscle surgery does not induce a greater effect on ocular alignment at near fixation and lateral rectus muscle surgery does not induce a greater effect on ocular alignment at distance fixation. It is not necessary to consider distance-near incomitance when choosing between medial rectus and lateral rectus muscle surgery.

Pediatric pseudotumor cerebri.

PURPOSE OF REVIEW: Recent findings in the literature regarding the epidemiology, diagnosis, and treatment of pediatric pseudotumor cerebri (PTC) are described. In the past, children with PTC have been treated like adult cases; however, the literature highlights important differences between children and adults with PTC. RECENT FINDINGS: Revised diagnostic criteria define an opening cerebrospinal fluid pressure greater than 28 cm water as elevated in the pediatric population. Obesity is an important risk factor for primary and secondary PTC in post-pubertal children. Magnetic resonance imaging shows findings suggestive of elevated intracranial pressure in children with PTC, similar to those of adults with PTC. Diamox and weight loss are effective treatments for PTC patients with mild visual field loss. Severe papilledema, decreased vision, and optical coherence tomography measures at presentation identify patients at increased risk for subsequent visual loss. SUMMARY: Findings summarized in the recent literature may change practice patterns in the diagnosis and treatment of pediatric PTC. Although there are many similarities between the adult and pediatric populations, the differences should be considered when managing children with PTC.