N. Calixto

Marcus Gunn Phenomenon: differential diagnosis of palpebral ptoses in children

OBJECTIVE The aim of this paper is to review existing literature on the subject and to report on and discuss a case of Marcus Gunn Phenomenon. DESCRIPTION A five year-old female, otherwise a healthy patient, while still a few months old, was seen by a pediatrician who detected a disorder of the right eye, initially believed to be strabismus, at a follow-up childcare consultation. Several ophthalmologists failed to establish a precise diagnosis. After a pediatric ophthalmologist had examined the child at four years of age, a diagnosis of Marcus Gunn Phenomenon, otherwise known as jaw-winking phenomenon, was confirmed. Apart from this anomaly, physical, ophthalmological, and neurological examinations were normal. Since ptosis was mild and no association with strabismus, amblyopia or other conditions was established, no surgical procedures were necessary. COMMENTS This report is an alert to pediatricians regarding the presence of this largely unknown phenomenon, making it possible for pediatricians to identify the phenomenon, refer the patient to an ophthalmologist, and establish differential diagnosis from other, more severe forms of ptosis, requiring more aggressive treatment.

Estudo comparativo das diferenças entre as estratégias dinâmica e normal com o perímetro Octopus 1-2-3

Purpose: To show the results of a comparative study between dynamic and normal strategies with Octopus 1-2-3. Methods: Automatic perimetry using the Octopus 1-2-3 with dynamic and normal strategies was performed on 24 glaucomatous patients (eight males and 16 females) within an average interval of six months between the two exams. All patients had previously submitted to at least one automatic perimetry with the Octopus 1-2-3. The data compared, for both eyes, were: the patients age, number of questions, mean sensitivity (MS), mean defect (MD), loss variance (LV), short-term fluctuation (SF) and the reliability factor (RF). In the statistical analyses through the paired t test, only the visual fields with RF less than 10 were included. The level of significance was equal to 5% (p < 0.05). Results: There was no statistically significant difference between the two strategies in relation to age, LV, SF and RF. However, there was statistically significant differences in the duration of the test, number of questions, MS and MD. The dynamic strategy showed a higher diffuse sensitivity and a lower mean defect than the normal strategy. Conclusions: Our results show that the threshold values measured by the dynamic strategy were in close agreement with the values obtained using the normal strategy in patients who have, or are suspected of having, glaucoma and whose visual fields are normal or borderline. They also confirm the claimed reduction in testing time. These results also suggest that, when comparing a visual field exam performed with the dynamic strategy to one performed with a normal strategy, it is necessary to be cautious in regard to MS and MD values.