Congenital oculomotor nerve palsy, cerebellar hypoplasia, and facial capillary hemangioma

We saw two infants with the unusual combination of oculomotor nerve palsy, facial capillary hemangioma, cerebellar hypoplasia, and apparent gaze palsy. Systematic imaging of children with congenital oculomotor nerve palsy may lead to the recognition of more associated neurologic abnormalities that are not clinically apparent, as was the case in our patients.

Spontaneous regression of optic glioma in a patient with neurofibromatosis

We describe a young girl with neurofibromatosis and enlargement of the optic chiasm and intracranial left optic nerve. Serial MRIs over 32 months demonstrated spontaneous, marked reduction in the size of these lesions. Spontaneous regression must be considered in evaluating therapies for optic glioma.

Congenital dacryocele. A collaborative review

Fifty-four cases of congenital dacryocele from several medical centers were reviewed retrospectively. There was strong female preponderance (73%) and unilateral involvement (88%). Lacrimal sac contents could be expressed by local massage through the puncta in 21% of cases. Probing and irrigation were done under general (27.8%) or local (55.6%) anesthesia, while in other cases (16.7%), the cyst resolved before intervention. Recurrence of the dacryocele occurred in 10 patients (22%) after probing. Nasal cysts were visualized in six cases. Marsupialization of nasal cysts was necessary in four cases. In one center, after conservative therapy, 80% of cysts resolved spontaneously and 20% developed dacryocystitis. Surgical intervention is indicated in cases of dacryocystitis, cellulitis, breathing difficulty from large nasal cysts, recurrent dacryocele, and lack of its resolution after a short trial of digital massage.

Congenital vertical ocular motor apraxia

The case of a 4 1/2-year-old boy with congenital vertical ocular motor apraxia who was otherwise developmentally and neurologically normal is reported. The presence of perinatal hypoxia in this patient may have been etiologic. While the presence of a supranuclear vertical ocular motor abnormality usually suggests a serious, acquired neurologic or systemic disease it may rarely occur as an isolated congenital finding, as demonstrated in this case.

Achromatopsia. Clinical diagnosis and treatment

Six cases of classic achromatopsia are presented. The methods of practical clinical diagnosis are discussed, including paradoxical pupillary constriction in darkness, the easily performed Sloan achromatopsia test, and electrophysiologic studies which are useful in young children. The visual and cosmetic benefits of heavily tinted contact lenses in such patients are stressed.

Evaluation of clinical stereoacuity tests

Sixty children ages two to seven were separated into two age-matched groups of thirty each, one consisting of a group of normal children, and the other a strabismic-anisometropic group. All subjects were examined with four currently available stereoacuity tests, the RDE, Randot, Titmus, and the TNO. Significant differences in performance were found between the two groups. Across all tests there was a 10 to 17% over-referral rate and a 33-37% under-referral rate. Untestability in the normal group ranged from 3.3-6.7% across tests, while in the patient group it ranged from 3.3-20.0%. The under-referral rate is unacceptable and casts doubt on the value of our present stereoacuity tests in screening for subtle defects in binocular function in the young child.

Vertical offsets of the horizontal recti

The results of an analysis of the surgery performed to correct both horizontal and vertical strabismus in patients without fusion potential is presented. Recession and resection of the horizontal recti combined with vertical offsets was the procedure employed. These results indicate that both esotropia and exotropia along with a coexisting hypertropia can be made cosmetically acceptable by this procedure.