Joseph H. Calhoun

Medical Management of Congenital Nasolacrimal Duct Obstruction

A consecutive series of 113 infants seen with congenital nasolacrimal duct obstruction were treated with local massage and topical antibiotic ointment. In 107 of the infants the obstruction was resolved within 8 months of initiation of this form of management. Nearly all of the infants were spared a surgical procedure that probably would have been performed if early probing of the nasolacrimal system had been advocated.

RESULTS OF LATE PROBING FOR CONGENITAL NASOLACRIMAL DUCT OBSTRUCTION

One hundred four consecutive patients (138 eyes) with congenital nasolacrimal duct obstruction were probed after the age of 13 months. One hundred twenty-nine eyes (93.5) were cured after the first probing. Based on this study and others showing the effectiveness of medical management, it is the current practice of the authors to delay probing until the patient is at least 13 months of age.

Persistent strabismus presenting after cataract surgery.

To determine causative factors of persistent strabismus presenting after cataract surgery, the surgical techniques and subsequent motility findings of eight patients who had persistent postoperative strabismus were studied. In two of the eight patients, complications related to the placement of the bridle suture were believed causative based on subsequent surgical findings. A similar etiology could be speculated in an additional three patients. An isolated vascular accident coincident to the cataract operation could account for a sixth case. The final two patients were believed to have a decompensated congenital fourth nerve palsy. In no patients could the myotoxic effect of a local anesthetic or the hypoxic effect of an ocular pressure-reduction device plausibly account for the deviation.

Silsoft Extended Wear Contact Lenses in Pediatric Aphakia

Fifty pediatric aphakic patients, ranging in age from 7 days to 11 years, were fitted with the Silsoft extended wear contact lens. Compared to other extended wear lenses, the Silsoft lens has several advantages. These include easier handling, a less traumatic fitting procedure for the child, the use of fluorescein for evaluation of the lens-cornea relationship and a low loss rate. This lens appears to be safe, with no permanent adverse effects on the cornea.

Treatment of Manifest Latent Nystagmus

Eight patients with manifest latent nystagmus, as noted by ocular movement recordings, were examined for nystagmus reduction after surgical or optical treatment. Seven of the patients had strabismus. Five patients underwent strabismus surgery, had no tropia postoperatively, and the manifest latent nystagmus converted to latent nystagmus. Four of these five patients subsequently showed improvement in binocular visual acuity. Three patients received optical treatment; one had accommodative esotropia and, with appropriate spectacle correction, the manifest latent nystagmus was converted to latent nystagmus with improved vision. In the other two patients the manifest latent nystagmus lessened after correction with appropriate spectacles; binocular visual acuity of one of these patients improved. The possibility of converting manifest latent nystagmus to latent nystagmus by strabismus surgery is a reasonable surgical goal. In patients with manifest latent nystagmus and strabismus, surgical or optical alignment of the eyes decreases the nystagmus intensity and may also improve binocular visual acuity.

Extended-wear Contact Lenses for the Treatment of Pediatric Aphakia

The practicality of extended-wear contact lenses in the refractive correction of pediatric aphakia was assessed with 240 eyes in 184 patients. Patient ages at the time of contact lens fitting ranged from 18 days to 9.8 years. One hundred forty-one eyes were fit from 1 day to 55 months postoperatively and then followed for 6 months to 5.7 years (average, 29 months). Only five patients lost more than five lenses. The overall loss rate was less than one lens per year of follow-up. No patient had contact lens-related complications with permanent visual sequelae. Only 14% of patients had contact lens problems or factors related to parental inability to care for the lens which resulted in discontinuation of contact lens therapy. The authors were unable to identify any subset of patients who should be considered for primary surgical optical correction of their aphakia.

Problems of the Lacrimal System in Children

The lacrimal system is composed of various glands to produce tears and a drainage system for tear removal. The most common abnormality is a defect or blockage in the drainage system, a blocked nasolacrimal duct. Most of the evidence favors conservative management of this condition, reserving probing for those that fail to resolve by one year of age.

Ocular manifestations of pediatric disease.

A review of the ocular manifestations of pediatric disease is in some ways a review of pediatrics itself. A paper this size cannot hope to be comprehensive in scope or encyclopedic in detail. Instead, we have chosen to touch on recent developments in pediatrics that we feel may be of particular interest to the ophthalmologist, as well as certain areas of pediatric ophthalmology that make it clear that a childs ocular disease takes place in the larger context of the growing child.

Cataracts in Children

As in so many ocular disorders, early detection and treatment is of great importance in the visual prognosis of children with cataracts. To this end, the author discusses the signs and symptoms of cataracts, the evaluation of the child with cataracts, the treatment, management, prognosis of cataracts, and the complications of cataract surgery.