[When should an orthoptic evaluation be prescribed in the management of orbital floor fracture? A prospective study of 47 fractures]. / Quand demander un examen orthoptique dans la prise en charge des fractures du plancher de l'orbite ?

INTRODUCTION: We evaluated the indication of orthoptic evaluation for the management of orbital floor fractures in a prospective series. MATERIAL AND METHOD: Forty-seven patients presenting with an orbital floor fracture were included in our prospective study. Consultations in orthoptics and maxillo-facial surgery were regularly carried out. Diplopia and motility were systematically assessed as well as a coordimetric examination according to Hess-Lees's technique. RESULTS: Nineteen percent of coordimetric motility disorders were observed among asymptomatic patients, after trauma. No diplopia or clinical motility disorder were observed 1 and 2 months after trauma, and coordimetric examinations came back to normal 2 and 3 months after trauma respectively for non-operated (26) and operated (21) patients. CONCLUSIONS: An orthoptic evaluation is necessary for the management of orbital floor fractures to diagnose the type of diplopia, motility disorders, and to indicate a coordimetric examination if diplopia is present. We suggest this orthoptic evaluation for patients presenting with diplopia between 5 and 10 days following trauma, 1 month after trauma for non-surgical treatment and 2 months after trauma for surgical treatment.

[Keratoconus: what happens with older patients?]. / Kératocône: que deviennent les patients âgés?

INTRODUCTION: Keratoconus is a degenerative corneal disease that is most often seen in young patients. The object of the present study was to analyze the demography of keratoconus patients. PATIENTS AND METHODS: We conducted a prospective study at Bordeaux University Hospital from January 2001 to September 2001. The study included all the consecutive patients with a diagnosis of keratoconus, detected previously or during the current examination. Inclusion criteria included evidence of unilateral or bilateral abnormal corneal steepening with videotopography. RESULTS: We included 121 patients. The results showed a mean age of 33.4 years in males and 37.1 years in females. The number of patients older than 50 was low: 3 out of 83 (3.6%) males and 6 out of 38 (15.7%) females. CONCLUSION: Two hypotheses on the low number of older patients can be suggested. 1) Keratoconus, which is a collagen disorder of the corneal stroma, may be associated with other undetected systemic diseases, which could induce premature death. Different studies have suggested a relationship between keratoconus and mitral valve prolapse. In this case, we can propose preventive treatment. 2) These patients, who have been informed of the nature and the therapeutical modalities of their disease, no longer consult at the hospital, but are followed by their local ophthalmologists.

[Cyclic strabismus. Presentation of two new cases and critical review of the literature]. / Le strabisme cyclique. Présentation de deux nouveaux cas et revue critique de la littérature.

Description of cyclic strabismus has been restricted for a long time to circadian esotropia. In this mysterious phenomenon, the eyes are crossed every other day with no binocular vision, but remain perfectly normal during the straight days. The usual characteristics are those of a non-accommodative and non-paretic strabismus, with onset in early childhood. There is no response to conservative treatment, and the cycles become irregular with time until the deviation becomes constant, with an excellent functional result after surgery in every case. Recently, other papers comprising data irrelevant to the classic picture suggest that cyclic strabismus includes, in fact, several different entities. The only common point is the existence of ocular motility disorders that recur more or less regularly, and whose pathologic substrate is primarily heterogeneous, whether it is thought as a mere hypothesis or a likely mechanism. Two new cases of circadian esotropia are presented together with a review of the literature relating to the criteria of the syndrome.