Periocular capillary hemangioma: a review for pediatricians and family physicians.

The pediatrician or family physician is usually the first person to examine an infant with a periocular capillary hemangioma. The physician should know that, in addition to being cosmetically disfiguring, capillary hemangiomas have the potential to cause serious ocular complications such as amblyopia, strabismus, proptosis, and optic atrophy. Prompt evaluation and management of periocular hemangiomas are essential in order to prevent permanent visual loss. Corticosteroids have been the mainstay in the treatment of patients with large periocular hemangiomas, but other therapeutic modalities such as radiation, interferon, and surgical excision also have been effective in selected patients. This review provides pediatricians and family physicians with information on the natural history, complications, and current management of periocular hemangiomas in infants.

Sensitivity to vasovagal maneuvers in normal children and adults.

In 15 male and 15 female healthy subjects who were 10 to 48 years of age, we studied alterations in heart rate and finger blood flow in response to the cold pressor test and four strong vasovagal maneuvers: diving response (apneic facial exposure to an ice water bag), Valsalva maneuver (forced expiration against a column of mercury to 40 to 50 mm Hg), unilateral carotid sinus massage, and oculocardiac reflex (inflation of a Honan balloon against one eye). Peripheral vasoconstriction as a consequence of the diving response paralleled the vasoconstriction from the cold pressor test, but it preceded the bradycardia that resulted from the diving response maneuver. In contrast, the rate of finger blood flow was high during the bradycardia that followed stage 4 of the Valsalva maneuver. Changes in heart rate correlated with age for the diving response, the Valsalva maneuver, and the oculocardiac reflex. Changes in heart rate and finger blood flow were not dependent on sex. The change in heart rate noted with the diving response was significantly correlated with that noted with the Valsalva maneuver and the oculocardiac reflex. Changes in finger blood flow did not correlate with changes in heart rate for any maneuver. This study provides a response profile of relative sensitivities to strong vasovagal maneuvers in normal children and adults.

Visual function and academic performance.

Evaluation of 1,910 first-, second-, and third-grade students indicated that visual function and academic performance as measured by reading were not positively related. Visual function tests included visual acuity, muscle balance, preferred eye and hand, color vision, refraction, sensory and motor function, and a writing and drawing task. Academic tests included the Metropolitan Readiness Test, the Cognitive Abilities Test, the Iowa Test of Basic Skills, and the teacher's assessment of reading level. A simple test which can be completed during the office visit and interpreted by the ophthalmologist in the office included drawing, copying, and writing. A segment of this test, the "draw a bicycle test," can be used by an ophthalmologist to demonstrate the difference between vision and performance when examining a child up to third-grade level who is referred because of school failure.

Photographic and clinical techniques for outcome assessment in sixth nerve palsy.

PURPOSE: There are few data on the reproducibility of clinical assessment of ductions and alignment. We evaluated photographic methods that may be used for masked outcome determination in a clinical trial and compared them with clinical measures. DESIGN: Interexaminer reliability study. PARTICIPANTS: Twenty-three patients with unilateral sixth nerve palsy and three control participants were clinically evaluated by two masked examiners. MAIN OUTCOME MEASURES: Abduction deficit was graded as 0 to -5. Simultaneous prism and cover tests (SPCT) and alternate cover tests (ACT) were performed at distance and near fixation. Photographs were taken of abduction and distance alignment by each examiner. The photographs were evaluated by a third masked reader, who assigned abduction grade, measured absolute abduction (mm) and relative abduction (%), and calculated alignment in prism diopters (pd). Agreement was evaluated by calculating intraclass correlation coefficients (r(i)), weighted kappa statistics (kappa), and Spearman rank correlation coefficients (r(S)). RESULTS: There was excellent agreement between the two clinicians in clinical abduction deficit (kappa = 0.86) SPCT and ACT at distance and near (r(i) 0.94-0.96), between the clinical grade and masked photographic grade (kappa = 0.83), and between the two sets of photographs for absolute abduction and relative abduction (r(i) = 0.98 and 0.97). Both photographic measures of abduction correlated well with the clinical grade (r(S) = -0.96 for each). Measurements of alignment from photographs correlated with clinical SPCT measurement (r(i) = 0.88), but had a lower level of absolute agreement (38% within 5 pd) than between two independent SPCT measurements (96% within 5 pd). CONCLUSIONS: The excellent interexaminer agreement of our new photographic abduction assessment and of masked clinical measures suggest that these methods would be useful in clinical trials. In contrast, our simple method of photographic assessment of alignment lacks excellent agreement with the clinical assessment. These data are important in planning clinical trials in strabismus.

Pilomatrixoma of the eyelids and eyebrows in children and adolescents.

PURPOSE: To review the clinical features of pilomatrixomas of the eyelids and eyebrows in children and adolescents. METHODS: The authors reviewed the medical records of 95 patients, all of whom were 20 years old or younger and had the histopathologic diagnosis of pilomatrixoma made from 1976 through 1995. Special attention was given to that subgroup of patients with tumors involving the eyelids and eyebrows. Data analyzed included age at diagnosis, patient sex, location and size of tumor, preoperative diagnosis, and clinical description of tumor. RESULTS: Eleven (12%) of 95 patients had lesions involving the eyelid or eyebrow. Six of those patients (55%) were female. Eight patients (73%) were 10 years old or younger, and three were 11 to 20 years old. The tumor occurred on the upper lid or in the brow in eight patients, the lower eyelid in two patients, and the medial canthus in one patient. Tumor diameter was 1 cm or less in all 11 patients. Pilomatrixoma was included in the preoperative differential diagnosis in only four of the 11 patients. The most common misdiagnoses were epidermoid and dermoid cyst. Three patients had pink or blue discoloration of the overlying skin, two had visible yellow-white patches in the tumor, and two had dilated vessels on the tumor surface. CONCLUSIONS: Pilomatrixoma is an uncommon tumor that can occur on the eyelids and in the brow region of children and adolescents. It is commonly misdiagnosed preoperatively as an epidermoid or dermoid cyst. Distinctive clinical features, however, suggest the correct diagnosis.