[Lacrimal pathology in the infant and the child]. / Pathologie lacrymale du nourrisson et de l'enfant.

Tearing and lacrimal pathologies are very frequent motives of consultation. The pediatrician must know the congenital dacryocele, and nasolacrimal duct obstruction by the Hasner valve imperforation, which represents the main reason of tearing of the infant. Nasolacrimal duct obstruction is treated by probing by the ophthalmologist from the third month and by probing with silicone intubation in case of failure, or in the children of more than one year old.

[Management of five pediatric cases of orbital floor fractures]. / Prise en charge de cinq cas de fracture du plancher orbitaire chez l'enfant.

OBJECTIVE: To assess the management of orbital floor fractures and their aftereffects in children. PATIENTS AND METHODS: We retrospectively studied five children with isolated orbital floor fractures who were operated (with a perioperative steroid and antibiotic treatment) between 1998 and 2007 in our pediatric hospital. At the first visit, they all had a complete clinical examination, a Hess-Lancaster test, and a computed tomography (CT) scan. At the last visit, they all had a clinical examination and four children underwent a Hess-Lancaster test. RESULTS: After a median follow-up of 26 months (range, 4-100 months), no child had diplopia, all Hess-Lancaster tests were normal, and two children suffered from infraorbital hypoesthesia. CONCLUSION: Surgical repair associated with steroids and antibiotics in orbital floor fracture with our surgical indications has led to good functional results with minimal complications.

[Anhidrotic ectodermal dysplasia: "congenital ameibomia"]. / Dysplasie ectodermique anhidrotique: "l'ameibomie congénitale".

Anhidrotic ectodermal dysplasia is a congenital, generally X-linked dermatosis that associates facial dysmorphy, short stature, and severe blepharitis. The anomalies of the skin are epidermic abnormalities; reduction of the glands of the derm, particularly the sweat glands, explaining the hypohidrosis; onychodysplasia; trichodysplasia; and abnormal dentition. The ophthalmologic manifestations are palpebral anomalies with a reduction in or an absence of Meibomian glands, dysfunction of the Moll and Zeis glands, leading to chronic squamous blepharitis and lacrimal punctal atresia. These anomalies result in severe attacks of the ocular surface, developing during the second decade, which are often invalidating and require a rigorous follow-up to avoid corneal complications.

[Painful ophthalmoplegia in children: Tolosa-Hunt syndrome or ophthalmoplegic migraine?]. / Les ophtalmoplégies douloureuses de l'enfant: place du syndrome de Tolosa-Hunt et de la migraine ophtalmoplégique.

In children with painful ophthalmoplegia, the diagnosis of Tolosa-Hunt syndrome or of ophthalmoplegic migraine should only be considered when tumoral, infectious, inflammatory or vascular causes have been excluded by appropriate investigations. Both entities are classified as "neuralgia" by the International Headache Society, and seem to share a similar pathogenic mechanism. Both diseases have many clinical similarities with slight differences concerning pain characteristics or ocular associated symptoms. High resolution CT scan or contrast enhanced MRI can be necessary to exclude other causes of painful ophthalmoplegia. They can sometimes objectify an inflammatory process of the cavernous sinus in Tolosa-Hunt syndrome or a reversible enhancement and thickening of the cisternal segment of the oculomotor nerve during an ophthalmoplegic migraine. Pain and ophthalmoplegia quickly resolve with corticosteroids. Such treatment may decrease the risk of recurrence. It is important to follow-up these patients for a 2 years period and to repeat the etiologic assessment. We report here 2 cases of children with painful ophtalmoplegia.

[Multiple embolizations of the branches of the ophthalmic artery: an unknown serious complication of facial surgeries]. / Embolisations multiples des branches de l'artère ophtalmique: complication grave et encore méconnue des chirurgies faciales.

We present a patient with ocular ischemia following autologous refined fat injection (lipostructure) into the glabellar area to treat wrinkles. We think this visual loss is directly a consequence of the surgery, by retrograde arteriolar microembolus into the ophthalmic artery via peripheral anastomoses with the arteries of the face. These complications are on the rise because of the esthetic facial injections of viscous materials. We explain the pathophysiology and present a review of the litterature.

[Nodular melanoma on primary acquired conjunctival melanosis]. / Mélanome nodulaire sur mélanose acquise primitive de la conjonctive.

A 74-year-old woman consulted for bloody tears. The etiology was a large conjunctival nodular melanoma hidden in the left superior fornix that had developed quietly on an unknown primary acquired melanosis. In this report the clinical and histological features as well as the treatment are presented. A decisional tree summarizes the treatment for conjunctival melanosis.

Basal cell carcinomas of the eyelids.

Basal cell carcinomas (BCC) are the more frequent malignant tumors seen in France as in other western countries. They represent 20% of eyelid tumors and 90% of eyelid malignancies. Due to their local growth, problems may arise when treating BCC, and curative exeresis must be the preferred choice each time it is possible. BCC of the eyelids have a high risk of recurrence. Recurrences are more aggressive, infiltrative and destructive and have a considerably poorer rate of cure than primary tumors. Eyelid reconstructions can entail use of complex methods which should only be carried out by a trained ophthalmologist who is also able to treat any associated age-related ocular pathologies. BCC is the most common cause leading to eyelid reconstructive surgery; a surgery which has a triple objective: tumor removal, functionality and an esthetic outcome.

Association of peripheral multifocal choroiditis with sarcoidosis: a study of thirty-seven patients.

OBJECTIVE: To assess the clinical spectrum of peripheral multifocal choroiditis (PMC) and its association with sarcoidosis. METHODS: Thirty-seven patients examined between November 1997 and November 2001 who met all diagnostic criteria for PMC were included in this retrospective study. Patients were assessed for the following signs of sarcoidosis: typical changes on chest radiography or computed tomography; predominantly CD4 lymphocytosis in bronchoalveolar lavage fluid; elevated serum angiotensin-converting enzyme levels; elevated gallium uptake; and noncaseating granuloma on biopsy. RESULTS: Most of the patients were female (30 of 37; 81%) and white (30 of 37; 81%). Mean +/- SD age at onset was 57.5 +/- 18.7 years. Seven (19%) of the 37 patients had biopsy-proven sarcoidosis and 18 patients (49%) with presumed sarcoidosis met at least 2 of the above-mentioned criteria for sarcoidosis but had normal biopsy results. Twelve patients (32%) had an indeterminate diagnosis. Patients with presumed sarcoidosis did not differ from those with proven sarcoidosis as regards the above-mentioned criteria, except for noncaseating granuloma, implying that more than two-thirds of patients (predominantly whites) had underlying sarcoidosis. Most patients with positive gallium scintigraphy had increased mediastinal uptake, as described in sarcoidosis. Patients with underlying sarcoidosis had more severe visual impairment due to cystoid macular edema (CME). Weekly methotrexate (0.3 mg/kg) seemed to control CME. CONCLUSION: White patients with PMC should be considered to have sarcoidosis. The identification of sarcoidosis in patients with severe ocular disease can help with therapeutic choices.

[Optic nerve ischemia as a complication of dental extraction: a case report]. / Ischémie du nerf optique compliquant une extraction dentaire.

We report the clinical observation of a 16-year-old male, with no particular medical or ocular history, who presented with loss of vision in the right eye on the first post-operative day after uncomplicated extraction of the four third molar roots under general anesthesia. Loss of vision, due to optic disc ischemia, persisted after 2 months. The clinical and pathogenic features of this rare optic nerve ischemia complication are discussed.