Evaluation of a tool to teach medical students direct ophthalmoscopy.

INTRODUCTION: With declining exposure to the ophthalmologic examination in medical school, medical students and their instructors need a simple, effective method for teaching direct ophthalmoscopy. OBJECTIVE: Evaluation of canisters as direct ophthalmoscopy teaching aids for medical students. METHODS: Two ounce plastic canisters were designed to simulate an eye with 35 mm fundus photographs placed at the base and an 8mm hole drilled in the center of the cap to simulate a dilated pupil. These tools were used as an optional supplement to the instruction of ophthalmoscopy. Participants included 102 second-year medical students from the Medical College of Wisconsin and 11 residents and instructors from The Eye Institute in Milwaukee, Wis. RESULTS: Effectiveness and ease of use of the canisters were assessed by analyzing questionnaires completed by the medical students and instructors. According to 76% of students and 93% of instructors, the canisters "supplemented their learning/teaching." Most students (90%) and instructors (88%) found them "easy to use." CONCLUSION: This device is a simple and effective tool for teaching direct ophthalmoscopy to medical students.

Retinal hemorrhages in children following fatal motor vehicle crashes: a case series.

OBJECTIVE: To demonstrate the severity of ocular findings in young children who died of injuries due to motor vehicle crashes. METHODS: Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case. RESULTS: Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages. CONCLUSION: The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.

Brachymesomelic dysplasia with Peters anomaly of the eye results from disruptions of the X chromosome near the SHOX and SOX3 genes.

We report on a mother and son affected with an unusual skeletal dysplasia and anterior segment eye abnormalities. Their skeletal phenotype overlaps with the SHOX-related skeletal dysplasias and is intermediate between Leri-Weill dyschondrosteosis (LWD) and Langer Mesomelic dysplasia (LMD). The mother has bilateral Peters anomaly of the eye and was reported as having a new syndrome; the son had severe bilateral sclerocornea. Chromosome analysis showed that the mother has a pericentric inversion of the X chromosome [46,X,inv(X)(p22.3q27)] and the son, a resultant recombinant X chromosome [46,Y,rec(X)dup(Xq)inv(X)(p22.3q27)]. The observed skeletal and ophthalmologic abnormalities in both patients were similar in severity. The additional features of developmental delay, growth retardation, agenesis of the corpus callosum, cryptorchidism and hypoplastic scrotum in the son are consistent with Xq28 duplication. Analysis of the son's recombinant X chromosome showed that the Xp22.33 breakpoint lies 30-68 kb 5' of the SHOX gene. This finding suggests that the skeletal dysplasia in both mother and son is allelic with LWD and LMD and results from a novel misexpression of SHOX. Analysis of the Xq27.1 breakpoint localized it to a 90 kb interval 3' of the SOX3 gene, supporting a novel role of SOX3 misexpression in the development of Peters anomaly of the eye.

Outcome of surgery for esotropia in children with down syndrome.

BACKGROUND AND PURPOSE: The outcome of surgery for esotropia in children with Down syndrome has not received significant attention. PATIENTS AND METHODS: We reviewed motor outcomes of esotropia surgery in all patients with Down syndrome in our practice from 1991-2001. RESULTS: Twenty-one patients had surgery for esotropia. The mean age at surgery was 55 months. The mean preoperative esotropia was 36(Δ). Three patients required a second surgery: two for residual esotropia and one for consecutive exotropia. A second operation was recommended for two additional patients: one with residual esotropia and one with consecutive exotropia. The mean length of follow-up was 39 months. At the last follow-up examination, fourteen patients had a deviation of 0-10(Δ) (thirteen esotropic and one exotropic). Five patients had a final deviation of 11-20(Δ) (four esotropic and one exotropic). One patient had a residual esotropia of 21-30(Δ) and one had greater than 30(Δ) of residual esotropia. CONCLUSION: The motor outcomes for esotropia surgery in children with Down syndrome were not as good as those in children with acquired esotropia but were comparable to those in children with infantile esotropia. More children had residual esotropia than consecutive exotropia, which may reflect a tendency toward conservative amounts of surgery or an underlying esotropic tendency in Down syndrome. Parents of children with Down syndrome may be counseled to expect good outcomes in the surgical management of esotropia.

Successful treatment of orthodontic-associated traumatic endophthalmitis.

PURPOSE: To report successful management of orthodontic-associated traumatic endophthalmitis. DESIGN: Interventional case report. METHODS: A 17-year-old boy developed endophthalmitis after a penetrating corneal injury produced during removal of an orthodontic wire. Treatment included pars plana vitrectomy (PPV) with broad-spectrum intravitreal and systemic antibiotics. RESULTS: Clinical endophthalmitis resolved after PPV with injection of intravitreal vancomycin (1 mg) and ceftazidime (2.25 mg), along with oral ciprofloxacin (750 mg twice daily). Microbiologic cultures of intraocular samples produced Staphylococcus epidermidis, Streptococcus viridans, and Lactobacillus species. Visual acuity improved to 20/20. CONCLUSIONS: Orthodontic-associated endophthalmitis can involve multiple organisms. It can be successfully treated with current treatment modalities, including PPV, intravitreal antibiotics, and systemic antibiotics.

Improving patient satisfaction in pediatric ophthalmology.

While there have been few studies of patient satisfaction in pediatric ophthalmology, the general medical and pediatric literature report findings that can be helpful. Interpersonal sensitivity is the most important factor for patient satisfaction. Two patients, the child and the parent, must be considered and treated. A more satisfied child, who despite the drops, enjoyed the office visit because she received direct communication and was praised and rewarded, leads to a more satisfied parent. Parents also need to be encouraged and reassured in their challenging parenting role. Satisfaction does not guarantee compliance with treatment recommendations, but helps considerably.