Comparison of balloon dacryocystoplasty to probing as the primary treatment of congenital nasolacrimal duct obstruction.

PURPOSE: In children older than 18 months, primary probing procedures for congenital nasolacrimal duct obstruction (CNLDO) are thought to have lower rates of success. This study compares the results of primary probing to balloon dacryocystoplasty (DCP) in children stratified by age category. METHODS: In a retrospective chart review, 29 eyes with CNLDO that underwent balloon DCP in children older than 18 months were identified and age-matched to 29 eyes that underwent probing. The eyes were divided into 3 age categories: category 1 (18-24 months), category 2 (24-36 months), and category 3 (>36 months). RESULTS: Of the 29 eyes treated with balloon DCP (mean age, 37.1 months), 26 were successfully treated. Twenty-five of the 29 matched probed eyes (mean age, 31.1 months) were successfully treated, resulting in an overall success rate of 90% for balloon DCP and 86% for primary probing. Within each age category, the success rate varied but did not show an advantage to balloon DCP. The presence of crusting and expressible discharge from the puncta during preoperative evaluation predicted a successful probing (OR, 16; 95% CI, 1.3-192). CONCLUSION: Overall, balloon DCP did not appear to present an advantage as compared with primary probing as the initial treatment in these children. Primary probing has an impressive overall success rate that did not diminish in the children older than 36 months.

How does vision affect learning? Part II.

1. Dyslexia is a language-based learning disability in which phontiec analysis is genetically deficient. 2. Nonverbal learning differences are frequently overlooked in evaluating learning disabled children. 3. Children often have more than one category of learning difference, all of which must be diagnosed correctly to be effectively remediated.

Migraine in a pediatric ophthalmology practice.

PURPOSE: A prospective study of children between the ages of 2 and 15 years was conducted to investigate the prevalence and characteristics of migraine in children seeking ophthalmic care. METHODS: A questionnaire, based on established criteria for the diagnosis of migraine, was administered to 1479 consecutive children presenting to a single pediatric ophthalmologist (H.P.K.). Over 25% of all respondents reported headaches that met the criteria for migraine. In general, these individuals were older than non-migraine sufferers (mean age of 8.3 years vs. 6.6 years). There were no significant sex differences. RESULTS: Headache was the chief complaint for 8.9% of all patients seeking ophthalmic care in this study population. Eighty percent of this subpopulation described headaches that met the diagnostic criteria for migraine. This study found childhood migraine symptoms to be present in a significant proportion of the patient population of a pediatric ophthalmologist. CONCLUSION: Ophthalmologists must be aware of the high prevalence of migraine in children seeking ophthalmic care with a chief complaint of headache. Such knowledge will aid the ophthalmologist in the timely diagnosis, treatment, and appropriate referral of patients with symptoms of migraine.

Sub-Tenon's infusion of local anesthetic for strabismus surgery.

We used a blunt irrigating cannula to infuse tetracaine 0.5% solution into the posterior sub-Tenon's space in 26 consecutive patients undergoing strabismus surgery under local anesthesia. All patients were sedated with combinations of fentanyl citrate and either propofol or midazolam. The results suggest that this technique is a safe and effective method of performing strabismus surgery under local anesthesia.

Signs distinguishing spasmus nutans (with and without central nervous system lesions) from infantile nystagmus.

Clinical findings as well as eye and head movement recordings were analyzed from 23 patients with spasmus nutans without central nervous system (CNS) changes, 10 patients with spasmus nutans-like disease (head nodding, intermittent nystagmus associated with intracranial anomalies or visual pathway disorders), and 25 patients with infantile nystagmus. Ten diagnostic signs were established to differentiate between the patient groups. Although they were helpful in separating patients with infantile nystagmus from those with spasmus nutans, no difference was found between the patients with spasmus nutans with and without CNS lesions. This study indicates that eye and head movement recordings do not allow differentiation between benign spasmus nutans and spasmus nutans-like disease. The differentiation must be made on the basis of neuroimaging.

Cutis marmorata telangiectatica congenita associated with bilateral congenital retinal detachment.

Cutis marmorata telangiectatica congenita is a rare congenital vascular disorder of the skin, characterized by persistent telangiectasia of the cutaneous blood vessels often associated with cutaneous ulcers. The only previously recognized ophthalmic association with this condition has been rare instances of unilateral congenital open angle glaucoma. The authors report their observations in a child in whom this cutaneous disorder was associated with congenital bilateral total retinal detachments and secondary neovascular glaucoma. The retinal detachments produced bilateral leukocoria simulating retinoblastoma. The cutaneous disorder and the ocular findings were confirmed histopathologically.

Unusual glioma of the optic nerve.

A 3 1/2-year-old white girl presented with unilateral proptosis and an orbital tumor that was diagnosed histopathologically as an unusual form of glioma of the optic nerve. The optic foramen was not enlarged but the ultrasonogram indicated a definite retrobulbar mass.