Gregg T. Lueder

Air bag-associated ocular trauma in children

OBJECTIVEnTo describe a series of children with ocular injuries related to air bag deployment.nnnDESIGNnRetrospective, observational case series.nnnPARTICIPANTSnSeven patients with ocular injuries sustained in motor vehicle accidents in which air bags were deployed.nnnMETHODSnReview of medical records.nnnRESULTSnAll patients had periocular contusions. Minor injuries included corneal abrasions (n = 5), superficial eyelid laceration (n = 1), and traumatic iritis (n = 2). Serious injuries included corneal edema (n = 1) and a traumatic hyphema with secondary glaucoma and cataract (n = 1). The latter patient required surgery. All other injuries resolved with medical therapy. All patients recovered normal visual acuity.nnnCONCLUSIONSnSerious ocular injuries in children may result from air bag deployment. Most such injuries are minor and resolve without sequela. It is recommended that infants and children travel in the rear seat of automobiles to minimize their risk of injury.

Anomalous Orbital Structures Resulting in Unusual Strabismus

Anomalous orbital structures are a rare cause of strabismus. These structures attach to the globe and produce a mechanical restriction, resulting in incommitant motility disorders. Three types of anomalous structures have been described. The first arise from the extraocular muscles themselves and insert in abnormal locations. The second are fibrous bands located beneath the rectus muscles. The third are discrete anomalous muscles that originate in the posterior orbit and insert in abnormal locations on the globe. These structures have been associated with unusual patterns of strabismus. Clinical findings that suggest the presence of anomalous orbital structures include globe retraction not associated with Duane retraction syndrome, very large vertical strabismus, and an elevation deficit that is worse in abduction. When looking for anomalous orbital structures in patients with atypical strabismus, imaging studies should be considered.

Corneal opacities associated with NTBC treatment

PURPOSEnTo describe a patient with hereditary tyrosinemia type I (HHT-I) treated with 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3-cyclohexanedione (NTBC) who developed corneal opacities.nnnMETHODSnA 14-month-old patient was diagnosed with HHT-I and began treatment with NTBC. Her serial ocular examinations were normal until age 4 years, when she developed ocular discomfort and was found to have bilateral, linear, branching subepithelial corneal opacities.nnnRESULTSnOver the next 3 years, the extent of the opacities fluctuated, and increased opacities correlated with periods of poor compliance with a restricted protein diet. Serum tyrosine levels remained elevated at 238 to 602 umol/L (normal 26 to 83) throughout the duration of NTBC treatment.nnnCONCLUSIONnCorneal opacities are a potential consequence of NTBC treatment for HHT-I. The lesions probably result from elevated serum and ocular tyrosine levels due to inhibition of the tyrosine catabolic pathway and poor dietary compliance.

Visual Function After Laser Hyperthermia and Chemotherapy for Macular Retinoblastoma

PURPOSEnTo determine whether treatment of macular retinoblastoma with chemotherapy and laser hyperthermia can lead to satisfactory visual acuity.nnnMETHODSnA child with unilateral macular retinoblastoma was treated with chemotherapy and laser hyperthermia. Visual function was assessed one year after treatment.nnnRESULTSnAt age 25 months, the patient had normal visual behavior and a normal spatial-sweep visual-evoked potential.nnnCONCLUSIONnTreatment of macular retinoblastoma with chemotherapy and laser hyperthermia may enable recovery of satisfactory visual acuity.

The effect of an eyelid speculum on intraocular pressure measurement in children

PURPOSEnTo assess the effect of a pediatric eyelid speculum on the measurement of intraocular pressure (IOP) in children.nnnDESIGNnObservational case series.nnnMETHODSnIntraocular pressure measurements were performed during examination under anesthesia immediately after induction. The measurements were made with and without a pediatric eyelid speculum in place.nnnRESULTSnIntraocular pressure measurements were made in 77 eyes of 45 consecutive children. The mean IOP without the speculum was 16.33 mm Hg in the right eye and 16.55 mm Hg in the left eye. With the lid speculum in place the mean IOP was 20.26 mm Hg in the right eye and 20.05 mm Hg in the left eye (P <.05).nnnCONCLUSIONSnThe presence of an eyelid speculum raised IOP an average of 4 mm Hg. This effect should be considered when interpreting IOP measurements in children.

Vertical Strabismus Resulting From an Anomalous Extraocular Muscle

Unusual ocular motility abnormalities have been rarely reported to result from anomalous extraocular structures. These structures, which may be either muscular or fibrotic, attach to the globe and produce a mechanical restriction resulting in incomitant strabismus. To our knowledge, we report the first patient with an anomalous extraocular muscle in whom the clinical, radiologic, surgical, and histopathologic findings are described.

Intraoperative dehiscence of a rectus muscle: report of two cases.

i ntraoperative dehiscence of a rectus muscle is an unusual complication of strabismus and retinal surgery) -3 It results from separation of an extraocular muscle at the muscle-tendon junction during surgical manipulation. Prompt recog-nition and management of this complication is necessary to minimize the risk of serious ocular motility disturbances. We report two patients with this complication.

Corneal Abnormalities in a Mother and Daughter With Focal Dermal Hypoplasia (Goltz-Gorlin Syndrome)

PURPOSE/METHODSnFocal dermal hypoplasia is an inherited dermatologic disorder commonly associated with skeletal and dental abnormalities. Ocular abnormalities frequently found in patients with focal dermal hypoplasia include microphthalmos, anophthalmos, and colobomas. Corneal abnormalities rarely have been described in patients with focal dermal hypoplasia. We examined a mother and daughter with focal dermal hypoplasia with distinctive corneal lesions.nnnRESULTS/CONCLUSIONnSeveral discrete vascularized peripheral subepithelial corneal opacifications were present bilaterally in both patients with focal dermal hypoplasia. No ocular abnormalities that would predispose to these abnormalities were found. These corneal lesions appear to represent an unusual manifestation of focal dermal hypoplasia.

Comparison of Visual Acuity Measured with Allen Figures and Snellen Letters Using the B-VAT II Monitor

OBJECTIVEnAllen figure optotypes commonly are used to measure visual acuity in young children. Children with normal acuity measured with Allen figures sometimes are found to have unsuspected amblyopia that is detected when they are tested with Snellen letters. The correlation between visual acuities measured with these two optotype charts has not been well studied. The authors compared visual acuities measured with Allen figure and Snellen letter optotypes using the Mentor B-VAT II monitor.nnnDESIGNnThe study design was a nonrandomized, comparative clinical trial.nnnPARTICIPANTSnThe study was composed of 12 adult subjects.nnnINTERVENTIONnVisual acuities were measured using both Allen figure and Snellen letter optotypes using the B-VAT II monitor. The images were progressively blurred using plus lenses.nnnMAIN OUTCOME MEASURESnVisual acuity was measured.nnnRESULTSnAt visual acuity levels of 20/60 or better, Allen figure testing averaged 1.5 lines better than Snellen letter testing; between 20/70 and 20/200 visual acuities, the difference was 2.5 lines.nnnCONCLUSIONSnAllen figure testing with the B-VAT II monitor overestimates visual acuity compared with testing with Snellen letters. This appears to result primarily from the construction of the optotypes. This discrepancy should be considered when visual acuity is measured in young children.

Bilateral macular lesions in incontinentia pigmenti. Bloch-Sulzberger syndrome.

Background Incontinentia pigmenti (IP) is an inherited disorder with many systemic and ocular manifestations. Abnormalities of trie retinal pigment epithelium, including peripheral hypopigmented areas, have been reported occasionally in patients with IP. These have not been symmetric, and they have not involved the fovea. The visual function in affected areas has not been described. Methods The ophthalmic examination and results of fluorescein angiography are described in a patient with IP and bilateral discrete hypopigmented macular lesions. Results The patient had normal vision. Fluorescein angiography of the macular lesions revealed transmission of fluorescence in the early phase and staining in the late phase. Conclusion The authors believe that this is the first report of bilateral macular hypopigmented lesions in a patient with IP, and it is the first to document normal vision in an affected area.