Toxic anterior segment syndrome (TASS) is a sterile postoperative inflammatory reaction that can develop after anterior segment surgery. It generally has its onset 12 to 48 hours after surgery. The most common finding associated with TASS is diffuse limbus-to-limbus corneal edema secondary to a toxic insult to the corneal endothelium. It is also commonly associated with a dilated, irregular pupil, fibrin in the anterior chamber, a hypopyon, and the late onset of glaucoma secondary to damage to the trabecular meshwork. It is most commonly caused by inadequate flushing of phacoemulsification and irrigation/aspiration handpieces and reusable cannulas. When these handpieces and cannulas are cleaned with detergents, the detergents adhere to any residual viscoelastic agent. Because autoclaving does not denature most detergents, when the handpieces and cannulas are next used, the residual detergent is flushed into the anterior segment of the eye. Because even minute quantities of detergents can be toxic to the anterior segment of the eye, this can result in TASS. Other common causes of TASS include use of the wrong concentration of detergents and enzymatic cleaners, use of medications with preservatives in the eye, or accidentally introducing ointment into the eye.

anterior segment detergents tass handpieces cannulas toxic secondary residual surgery onset common commonly associate corneal limbus syndrome insult wrong diffuse

Background: Preschool children often present for ophthalmologic examination because of eye pain. Although the differential diagnosis includes serious conditions, the diagnostic and prognostic importance of apparently isolated eye pain are unknown.Methods: We reviewed records of 80 consecutive patients presenting between 2 and 6 years of age with eye pain but without a red eye or a history of an obvious cause of pain. Families of children seen in the office only once were contacted by phone to obtain follow-up information.Results: Functional eye pain was diagnosed in 73 of 80 patients (91%). Of the 64 patients with follow-up between 1 week to 4 years (mean, 21 months), 56 (88%) had no other cause of eye pain. Dry eyes, allergic conjunctivitis, blepharitis, corneal foreign body, sinusitis, and trichiasis were diagnosed in 7 patients. Other children were found to have refractive error, amblyopia, blepharospasm, and nystagmus?all considered unlikely to cause eye pain.Conclusions: Absent a preexisting or obvious cause of eye pain, the symptom is usually functional in preschool children who may have difficulty communicating vague visual symptoms to caregivers. However, such children deserve examination, not only so that unapparent causes can be excluded but also because unrelated conditions may require further evaluation and treatment. Parents can be reassured that if no abnormality is found on initial ophthalmologic examination, children with eye pain are unlikely to have subsequent diagnoses.

pain children cause patients preschool examination between diagnos conditions functional prognostic years obvious diagnostic follow ophthalmologic unlikely includes deserve apparently

Purpose: To determine whether children who present to an ophthalmology practice for nasolacrimal duct obstruction are more likely to have risk factors for amblyopia.Methods: A retrospective chart review was conducted on all patients presenting to a pediatric oculoplastic specialist between January 1, 2001, and August 8, 2009. The review yielded 402 pediatric patients diagnosed with nasolacrimal duct obstruction. Children were classified as having amblyopia risk factors on the basis of the American Association for Pediatric Ophthalmology and Strabismus referral criteria.Results: Of 402 patients with nasolacrimal duct obstruction, 100% received a cyclopegic refraction. Of these, 88 patients (22%) were found to have amblyogenic risk factors; 65 of these patients had amblyogenic refractive errors, 9 had strabismus, and 14 had a combination of the two. Of the 88 patients with amblyopia risk factors, 11% had a family history of strabismus compared with 9% of patients without amblyopia risk factors, which was not a statistically significant difference. There was no other significant pathology found on the dilated fundus examinations except for one child known to have persistent hyperplastic primary vitreous and a congenital cataract and one child with previously known CHARGE syndrome before the examination for nasolacrimal duct obstruction.Conclusions: Children who present with nasolacromal duct obstructions seem to be more likely to have amblyopia risk factors and therefore should have a full comprehensive pediatric ophthalmological examination, including cycloplegic refraction.

patients risk factors duct amblyopia nasolacrimal pediatric obstruction children strabismus amblyogenic known examination review refraction congenital likely significant ophthalmology present

Purpose: To evaluate the psychometric properties of the original Parent and new Child Amblyopia Treatment Index (ATI), questionnaires that assess the burden of amblyopia treatment in children and families, and to compare scores between children treated with atropine or patching.Methods: Parent ATI and Child ATI were administered to 233 children 7 to

parent treatment child children amblyopia burden family psychometric compare between index treate methods property questionnaires evaluating scores assess atropine evaluate

Purpose: To define the ocular parameters associated with anisometropic ambylopia in children with severe hyperopia, myopia, or astigmatism in 1 eye.Methods: Anisometropic and fellow eyes of 13 children, ages 7-8, with anisometropia >3.0 D and amblyopia without strabismus or other visually significant ocular pathology were studied. Axial length, corneal curvature, anterior chamber depth, and corneal diameter measurements of amblyopic and fellow eyes were obtained using the IOL Master (Carl Zeiss Meditec, Dublin, CA).Results: Comparing amblyopic eyes with unaffected fellow eyes as reference, patients with anisohyperopia had shorter axial lengths by an average of 1.49 mm (p = 0.001), and patients with anisomyopia had longer axial lengths by an average of 2.26 mm. Corneal astigmatism was the source of amblyogenic refractive error in 1 child.Conclusions: In children with anisometropic amblyopia, interocular differences in spherical refractive error was attributed to axial length with no differences in corneal curvature, whereas the anisoastigmatism observed in 1 case was attributed to asymmetric corneal curvature.

corneal axial curvature anisometropic children eyes length fellow amblyopia refractive lengths astigmatism differences attribut patients error amblyopic average ocular severe

Purpose: To evaluate the results of 2 methods of vertical rectus muscle transposition surgery for sixth (abducens) nerve palsy.Methods: Retrospective, comparative case series. Historically at our institution, transposed vertical rectus muscles were adjusted toward or attached at the adjacent corners of the lateral rectus muscle (?conventional transposition?) before the development of a technique in which adjustable sutures are passed beneath the lateral rectus muscle to attach at its opposite corners (?crossed-adjustable transposition?). Comparative outcomes with these 2 techniques were analyzed in a consecutive series of sixth nerve palsy patients.Results: The change from preoperative to postoperative deviation at distance was 39.3? ± 22.7? in 23 conventional transposition cases and 48.5? ± 27.8? in 19 crossed-adjustable transposition cases, which demonstrated no statistically significant difference (p = 0.24, t-test). Simultaneous medial rectus weakening was needed less in the crossed-adjustable transposition group (37%) than in the conventional transposition group (83%), and this difference was statistically significant. (p = 0.004, Fisher exact test).Conclusions: Adjustable vertical rectus muscle transposition surgery for the management of chronic sixth nerve palsy, enhanced by passing the adjustable sutures beneath the lateral rectus muscle, requires simultaneous medial rectus muscle weakening less than half as often for satisfactory results.

transposition rectus adjustable muscle palsy lateral conventional sixth cross vertical surgery nerve cases significant sery simultaneous enhanc comparative attach statistically

Introduction: The authors of previous studies suggest that the oxygenation status of premature infants contributes to the development of retinopathy of prematurity (ROP). In this study we compared the incidence and severity of ROP before and after institution of a new neonatal intensive care unit oxygen protocol.Methods: A retrospective chart review was performed of all eligible inborn patients screened for ROP during the 2 years immediately before (Group1) to and the 2 years after (Group 2) the initiation of a new oxygen protocol. In the new protocol, target oxygen saturation was adjusted from 90%-99% to 85%-93%. Treatment criteria adhered to Early Treatment for Retinopathy of Prematurity guidelines for the study's duration.Results: There were 387 infants in Group 1 and 386 infants in Group 2 (descriptive statistics adjusted for correlation due to multiple births). Mean birth weights (BWs) and gestational ages were 1,194 g and 29.2 weeks (ranges, 525-2,085 g; 23 2/7-39 6/7 weeks) for Group 1 and 1,139 g and 28.9 weeks (ranges, 520-2,500 g; 22 6/7-35 3/7 weeks) for Group 2 (p = 0.02/0.10). ROP developed in 32.7% of infants in Group 1 and 27.8% in Group 2 (p = 0.17). The incidence of ROP requiring treatment was 19.9% in Group 1 and 20.5% in Group 2 (p = 0.91). Subanalysis of infants with BW ?1,000g (Group, 1 n = 119; Group 2, n = 141) revealed ROP incidence of 75.1% versus 57.1%, respectively (p < 0.01); treatable disease occurred in 37.5% and 21.9% of affected infants (p = 0.19).Conclusions: Lowering target oxygen saturation for inborn premature infants was associated with decreased incidence of ROP only in infants with BW ?1,000 g. Severity of disease, including need for treatment, was similar in both groups.

group infants oxygen weeks protocol retinopathy incidence treatment study saturation before target prematurity years ranges adjust initiation severity oxygenation eligible

Purpose: To evaluate the efficacy of achieving a 360° ab externo trabeculectomy using an illuminated ophthalmic microcatheter for the treatment of primary congenital glaucoma.Methods: This retrospective, consecutive case series included 16 eyes of 10 patients ?3 years of age at the time of surgery and diagnosed with primary congenital glaucoma. All patients underwent a trabeculectomy via microcatheter with the intent of catheterizing the full circumference of Schlemm?s canal and rupturing the entire canal in a single procedure. The main outcome measure was the success rate of achieving a complete 360° as compared to a partial trabeculectomy. Secondary outcome measures included intraocular pressure (IOP), glaucoma medication usage, and adverse events. Clinical examination data are reported up to 12 months postoperatively.Results: Of 16 eyes included, 12 (75%) achieved a complete 360° trabeculectomy using the microcatheter; 4 of 16 eyes (25%) achieved a partial trabeculectomy. For all treated eyes the postoperative reduction in IOP from baseline was statistically significant at the 1-, 3-, and 6-month follow-up visits (p < 0.001). At 6 months, IOP was significantly lower in the complete as compared to the partial trabeculectomy cohort (p = 0.03).Conclusions: A complete or partial trabeculectomy was safely completed in eyes with primary congenital glaucoma using a microcatheter with an illuminated, atraumatic tip.

trabeculectomy microcatheter eyes glaucoma includ congenital achieving partial complete outcome patients primary illuminate case canal retrospective achiev significant reduction postoperatively

Objective: To report the prevalence, clinical findings, and outcomes in children diagnosed with congenital dacryocystocele in a well-defined population during a 20-year period.Methods: The medical records of all Olmsted County, Minnesota, patients diagnosed with congenital dacryocystocele from January 1, 1988, through December 31, 2007, were retrospectively reviewed.Results: A total of 9 children were diagnosed with dacryocystocele during the 20-year period, yielding a birth prevalence of 1 in 3,884 live births. The median age at diagnosis was 12 days (range, birth to 40 days); 7 (78%) were female. Eight patients (89%) had unilateral disease. Clinical findings included a cystic mass in all 9, dacryocystitis in 3 (33%), intranasal cysts in 3 (33%), and 1 (11%) each with facial cellulitis and dacryocystocele-induced astigmatism. Conservative treatment resolved the obstruction in 3 (33%), whereas the remaining 6 (67%) each underwent one surgery. Complete resolution was observed in all 9 patients.Conclusions: Congenital dacryocystocele is an uncommon unilateral condition of predominantly neonatal females. Clinical findings support a relatively high incidence of complications such as dacryocystitis and intranasal cysts as well as a less common finding of astigmatism that resolved without evidence of amblyopia. One-third of the cases were successfully managed with conservative treatment alone; most patients required surgical intervention.

dacryocystocele congenital clinical patients findings diagnos prevalence treatment astigmatism birth during intranasal children year cysts days conservative dacryocystitis unilateral resolv

Purpose: To compare the success rate of monocanalicular versus bicanalicular silicone intubation of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO).Methods: In a prospective randomized clinical trial, 70 eyes of 57 children with CNLDO underwent either monocanalicular silicone intubation (MCI) (n = 35 eyes) or bicanalicular silicone intubation (BCI) (n = 35 eyes). All procedures were performed by 1 oculoplastic surgeon. Tube removal was planned for 3 months postoperatively. The results were assessed using a Munk score. Treatment success was defined as Munk score 0-1 at 3 months after tube removal.Results: The surgical outcome was assessed in 29 eyes with MCI and 27 eyes with BCI. The mean age of treatment was 34.9 ± 12.7 months for MCI and 38.7 ± 18.6 months for BCI. Treatment success was achieved in 25 of 29 eyes (86.2%; 95% CI, 79%-96%) in the MCI group compared with 24 of 27 eyes (89%; 95% CI, 84%-94%) in the BCI group (RR = 0.96; 95% CI, 0.79-1.18). There were no corneal or canalicular complications in either group.Conclusions: MCI and BCI were successful in a similar percentage of children with CNLDO. The mainadvantage of the former technique was easy tube removal without sedation in the office.

eyes months intubation silicone duct bicanalicular monocanalicular tube cnldo treatment removal nasolacrimal group success score either versus congenital assess munk

Summary: Thyroid eye disease affects the eyelids, orbital compartment, and extraocular muscles, resulting in a highly variable degree of chemosis and enlargement of the preorbital fat pads, eyelid retraction, proptosis, restrictive strabismus, torticollis, and, rarely, compressive or congestive optic neuropathy. Although most patients with thyroid eye disease are best treated conservatively, those more severely affected may benefit from orbital decompression, strabismus surgery, or eyelid retraction repair after stabilization has occurred. Botulinum A toxin, high-dose intravenous corticosteroids, and radiation treatment are therapeutic options in select cases. Compressive or congestive optic neuropathy and severe corneal exposure warrant consideration of surgical intervention on an urgent basis without waiting for stabilization. Epidemiology and risks and benefits of high-dose steroids and radiation therapy are reviewed along with recommendations to improve conservative as well as surgical management of this disease. Strategies to manage strabismus and optimize outcomes are provided.

disease strabismus thyroid orbital congestive surgical stabilization dose neuropathy optic radiation compressive retraction eyelid improve high recommendations outcomessummary provid conservatively

Unilateral, peripapillary, retinal nerve fiber myelination involving the macula, with optic disk hypoplasia, myopia, and amblyopia, is rare. We performed spectral domain optical coherence tomographic findings in 2 patients with this condition. Both patients had normal foveal morphology, reduced retinal thickness in the same distribution as the myelination, and optic nerve hypoplasia.

retinal nerve coherence hypoplasia peripapillary tomographic patients myelination optic involving optical spectral domain myelinate amblyopia foveal thickness characteristics reduc findings

Bilateral lesions of the lateral geniculate bodies are rare and produce unusual field defects that can be predicted on the basis of their vascular anatomy. We report a rare case of bilateral sectoranopic visual field defects caused by bilateral infarction of the lateral geniculate nucleus in a 14-year-old boy with inflammatory bowel disease and recurrent pancreatitis.

bilateral geniculate rare infarction inflammatory defects field bowel year caus body lateral basis disease vascular unusual nucleus pancreatitis report lesions

Choroidal osteoma is a rare, yellowish-white lesion of the choroid that predominantly affects young women in the second decade of life. Subretinal neovascularization or collection of subretinal fluid may occur in 50 % or more patients in the long run. A 15-year-old girl presented to our practice with bilateral choroidal osteoma associated with advanced bilateral optic atrophy. The underlying cause for optic atrophy is unclear; possible explanations include mechanical pressure effect and ischemic damage.

bilateral optic osteoma subretinal atrophy choroidal second associate practice occur explanations lesion fluid underlying present collection yellowish possible advanc mechanical

In infants with intracranial hemorrhage, the most common cause of intraocular hemorrhages is abusive head trauma. Terson syndrome is rare in infants, and the retinal findings, although not well reported in the literature, are generally limited to the posterior pole. We report a case of a 7-month-old boy who developed ipsilateral, extensive preretinal and intraretinal hemorrhage after subarachnoid hemorrhage from a ruptured intracranial aneurysm.

hemorrhage ipsilateral intracranial infants report syndrome terson month develop retinopathy hemorrhages common abusive retinal ruptur rare generally preretinal posterior pole

Toxic anterior segment syndrome is an acute, sterile, anterior segment inflammation that occurs after any anterior segment surgery. The condition is an increasingly recognized complication of adult cataract surgery. Here we report the clinical findings of a case of toxic anterior segment syndrome in a child after uneventful congenital cataract surgery.

anterior segment syndrome surgery cataract toxic adult child uneventful clinical recognize complication report condition case occurs surgerytoxic inflammation acute pediatric

Accommodation is considered to be a symmetrical response and to be driven by the least ametropic and nonamblyopic eye in anisometropia. We report the case of a 4-year-old child with anisometropic amblyopia who accommodates asymmetrically, reliably demonstrating normal accommodation in the nonamblyopic eye and antiaccommodation of the amblyopic eye to near targets. The abnormal accommodation of the amblyopic eye remained largely unchanged during 7 subsequent testing sessions undertaken over the course of therapy. We suggest that a congenital dysinnervation syndrome may result in relaxation of accommodation in relation to near cues and might be a hitherto unconsidered additional etiological factor in anisometropic amblyopia.

accommodation amblyopia amblyopic anisometropic nonamblyopic near relation symmetrical hitherto cues child therapy case unchang result consider least during dysinnervation ametropic

Silent sinus syndrome is an insidious maxillary sinus inflammatory disease causing a lowering, thinning, or even absorption of the orbital floor. Patients usually present with progressive enophthalmos and hypoglobus. We report a 41-year-old man with silent sinus syndrome who presented with cyclovertical diplopia masquerading as superior oblique muscle paresis in the fellow eye. Inferior oblique myectomy in the fellow eye resulted in excellent alignment.

sinus syndrome oblique fellow present superior cyclovertical causing paresis silent progressive patients eyesilent usually disease insidious inflammatory maxillary year floor

Mixed-phenotype acute leukemia is a rare condition with no previously reported intraocular involvement. We present clinical, radiologic, and cytologic findings of leukemic intraocular relapse in a 23-month-old girl, with lineage switch presenting as conjunctivitis after allogeneic bone marrow transplantation. A diagnostic approach using fine needle aspiration is described.

leukemia phenotype intraocular acute relapse bone conjunctivitis previously girl aspiration irismix allogeneic describ presenting cytologic involvement month radiologic present switch

In congenital cyanotic heart disease, oxygenated and deoxygenated blood mixes, and oxygen saturation of the arterial blood is not maintained. As a result, an ischemic environment prevails in the entire body. While various ocular findings have been described in patients with cyanotic heart disease, proliferative retinopathy has not been previously noted. We report a child with congenital cyanotic heart disease and multiple fibrovascular fronds over the fundus consistent with proliferative retinopathy.

heart cyanotic proliferative congenital retinopathy disease child blood arterial diseasein note report various oxygen mixes describ fronds entire oxygenate fundus

Intravitreal injection of bevacizumab has been shown to satisfactorily treat retinopathy of prematurity; nevertheless, the safety of antivascular endothelial growth factor therapy in children remains uncertain. We report a patient with bilateral, zone 1, stage 3 plus retinopathy of prematurity who was treated with combined laser photocoagulation and intravitreal ranibizumab injection and demonstrated full regression at 3 months after injection but then developed bilateral retinal detachments 1 month later.

injection retinopathy intravitreal prematurity retinal bilateral zone ranibizumab plus remains satisfactorily detachments safety onset factor month uncertain demonstrate patient months

Abducens nerve palsies associated with infectious diseases are infrequent. Scrub typhus is an acute, febrile, infectious illness caused by Orientia tsutsugamushi (formerly Rickettsia tsutsugamushi), an obligate-intracellular gram-negative bacterium. The organism has been reported to be capable of entering the nervous system, causing meningitis and focal neurologic abnormalities. We report a case of isolated abducens nerve palsy associated with a scrub typhus infection.

scrub nerve palsy isolate typhus tsutsugamushi abducens infectious associate report patient bacterium organism nervous typhusabducens neurologic negative acute intracellular meningitis

A 4-year-old girl was hospitalized for psychomotor delay, low vision, and horizontal nystagmus. She was found to have bilateral chorioretinal atrophic scars and 2 large occipital porencephalic cavities. High plasma ornithine levels led to the presumed diagnosis of gyrate atrophy of the choroid and retina. After 6 months of arginine-restricted diet and high-dose pyridoxine (300 mg/d), there was no change of plasma ornithine level or ocular findings. To our knowledge, this is the first report showing an association of porencephaly with gyrate atrophy of the choroid and retina.

choroid gyrate atrophy plasma ornithine retina occipital porencephaly high child delay diagnosis horizontal knowledge pyridoxine report arginine vision presum diet

Dutton GN, Bax M, eds. Visual Impairment in Children due to Damage to the Brain. Clinics in Developmental Medicine 186. London: Mac Keith Press; 2010. 224p. Hardcover. ISBN: 9781898683865.

children press visual books damage london brain clinics impairment keith isbn hardcover developmental receiveddutton medicine

The Journal regrets and apologizes for the following error: Mostafa AM, Kassem RR. A comparative study of medial rectus slanting recession versus recession with downward transposition for correction of V-pattern esotropia. J AAPOS 2010;14:127-31. The institutions at which the study was conducted were both the Ophthalmology Department at Al-Azhar University for Boys in Cairo, Egypt, and the Ophthalmology Department at Cairo University, Egypt.

study cairo department recession university egypt ophthalmology following pattern transposition azhar slanting medial mostafa apologizes error rectus comparative regrets correction