Refractive error changes in children with intermittent exotropia under overminus lens therapy / Alterações nos vícios refracionais em crianças com exotropia intermitente submetidas ao tratamento por meio da hipercorreção com lentes negativas

PURPOSE: Intermittent exotropia may be decreased by stimulation of accommodative convergence. Once excessive accommodation has been related to myopia, our objective was to evaluate refractive errors changes in children under overcorrecting minus lens therapy. METHODS: A retrospective chart review of 21 children with intermittent exotropia was performed. All patients were treated with occlusion, and a 13-patient subset of them received overminus lens therapy (group A). Eight children received spectacles as necessary (group B). Initial age, age interval, initial spherical equivalent (SE), and magnitude of overcorrection were considered as co-variables of the mean variation in refractive error (SE of each eye) between groups, through a multivariate analysis. RESULTS: Overcorrection used in group A ranged from 0.5 D to 3.5 D (2.46 ± 0.87 D). Although initial SE of each eye was significant different between group A and B (OD - p=0.02; OS - p=0.01), initial age (p=0.69), age interval (p=0.90), and mean variation in refractive errors (p=0.36) did not differ between groups. Multivariate analysis with linear regression showed no significantly difference regarding all co-variables enrolled. CONCLUSIONS: Treatment of intermittent exotropia with overcorrecting minus lens did not induce refractive errors changes, even considering age, treatment period, initial spherical equivalent and overcorrection magnitude used.

OBJETIVO: A exotropia intermitente pode ser diminuída pela estimulação da convergência acomodativa. Uma vez que uma acomodação excessiva tem sido relacionada à miopização, o objetivo deste trabalho foi o de avaliar alterações nos vícios de refração de crianças submetidas à hipercorreção com lentes negativas. MÉTODOS: Foi realizada revisão dos prontuários de 21 crianças com exotropia intermitente. Todos os pacientes foram tratados com oclusão, sendo que 13 deles foram submetidos à hipercorreção com lentes negativas (grupo A). As 8 crianças restantes receberam prescrições ópticas conforme necessário pelas suas ametropias (grupo B). A idade inicial, tempo de tratamento, equivalente esférico (EE) inicial e magnitude da hipercorreção foram considerados como covariáveis na análise das diferenças das médias de erro refrativo (EE de cada olho) entre os grupos, pela análise multivariada. RESULTADOS: A hipercorreção utilizada no grupo A variou entre 0,5 D e 3,5 D (2,46 ± 0,87 D). Embora o EE inicial de cada olho ter sido significativamente diferente entre os grupo A e B (olho direito - p=0,02; olho esquerdo - p=0,01), a idade inicial (p=0,69), o tempo de tratamento (p=0,90) e a variação média nos erros refrativos (p=0,36) não diferiram entre os grupos. A análise multivariada com regressão linear não mostrou diferença significativa, considerando as covariáveis em questão. CONCLUSÕES: O tratamento de crianças com exotropia intermitente por meio de hipercorreção óptica com lentes negativas não induziu alterações nos vícios de refração, mesmo considerando fatores como idade inicial, o tempo de tratamento, equivalente esférico inicial e a magnitude da hipercorreção utilizada.

Refractive error changes in children with intermittent exotropia under overminus lens therapy.

PURPOSE: Intermittent exotropia may be decreased by stimulation of accommodative convergence. Once excessive accommodation has been related to myopia, our objective was to evaluate refractive errors changes in children under overcorrecting minus lens therapy. METHODS: A retrospective chart review of 21 children with intermittent exotropia was performed. All patients were treated with occlusion, and a 13-patient subset of them received overminus lens therapy (group A). Eight children received spectacles as necessary (group B). Initial age, age interval, initial spherical equivalent (SE), and magnitude of overcorrection were considered as co-variables of the mean variation in refractive error (SE of each eye) between groups, through a multivariate analysis. RESULTS: Overcorrection used in group A ranged from 0.5 D to 3.5 D (2.46 +/- 0.87 D). Although initial SE of each eye was significant different between group A and B (OD - p=0.02; OS - p=0.01), initial age (p=0.69), age interval (p=0.90), and mean variation in refractive errors (p=0.36) did not differ between groups. Multivariate analysis with linear regression showed no significantly difference regarding all co-variables enrolled. CONCLUSIONS: Treatment of intermittent exotropia with overcorrecting minus lens did not induce refractive errors changes, even considering age, treatment period, initial spherical equivalent and overcorrection magnitude used.

Orbital abscess secondary to acute dacryocystitis: case report.

Acute dacryocystitis usually induces preseptal infection. In rare instances the infection that is confined to the lacrimal sac can extend to the orbital contents resulting in orbital cellulitis. We present a case of intraconal abscess secondary to acute dacryocystitis and review the literature of orbital cellulitis resulting from acute lacrimal sac infection.

Orbital abscess secondary to acute dacryocystitis: case report / Abscesso orbitário secundário à dacriocistite aguda: relato de caso

Acute dacryocystitis usually induces preseptal infection. In rare instances the infection that is confined to the lacrimal sac can extend to the orbital contents resulting in orbital cellulitis. We present a case of intraconal abscess secondary to acute dacryocystitis and review the literature of orbital cellulitis resulting from acute lacrimal sac infection.

A dacriocistite aguda comumente evolui para infecção pré-septal. Raramente a infecção localizada no saco lacrimal pode estender-se ao conteúdo orbitário resultando em celulite orbitária. Apresentamos um caso de abscesso orbitário intraconal secundário à dacriocistite aguda e uma revisão de literatura de celulite orbitária causada por infecção aguda do saco lacrimal.