Eye Deviation Research Articles

Evaluation of e-NIHSS scale combined with HINTS for posterior circulation ischemic stroke with vestibular symptoms

Objective:To explore the predictive value of HINTS bedside examination and e-NIHSS scale for posterior circulation ischemia with vestibular symptoms. Methods:136 cases in total patients with acute vestibular syndrome（AVS） hospitalized in our hospital from April 2021 to April 2023 were selected as the study subjects, According to the classification of AVS etiology, patients with central AVS, namely posterior circulation ischemia（PCI）, were divided into case group（68 cases） and peripheral AVS patients were control group（68 cases）, Collect data and perform head impulse test-nystagmus-test of skew deviation test beside the bed, two doctors evaluated the NIHSS and e-NIHSS scales for PCI patients with vestibular symptoms respecb tively, and recorded the results after they were consistent, and improved the head MRI examination. Results:The positive rate of head pulse test in PCI patients with vestibular symptoms was 3 cases（4.41%）, and 60 cases（88.24%） with peripheral symptoms; The positive rate of nystagmus test in PCI group was 64 cases（94.12%） and peripheral 21 cases（30.88%）; The positive rate of eye deviation test in PCI group was 55 cases（80.88%） and peripheral 8 cases（11.76%）. Comparing the data with the consistency of the final diagnosis, the sensitivity was 97.0%, the specificity was 95.7%, and the accuracy was 0.963. It passed the Kappa consistency test Kappa=0.926（P<0.01）. The patients in PCI group were scored, in which the NIHSS score of brainstem group was 1.51±0.59, and the e-NIHSS score was 4.05±1.71（P<0.05）; The NIHSS score of cerebellar group was 1.42±0.62, and the e-NIHSS score was 3.86±1.59（P<0.05）; NIHSS score of thalamus group was 1.31±0.73, e-NIHSS score was 3.56±1.27 （P<0.05）; NIHSS score of non-focus group was 1.11±0.43, e-NIHSS score was 3.06±1.20 （P<0.01）. The difference between e-NIHSS score and NIHSS score in each group was statistically significant. Conclusion:HINTS examination is highly consistent with the final diagnosis of the gold standard. The e-NIHSS scoring scale has a higher detection rate than the NIHSS scoring scale for patients with posterior circulation ischemia mainly characterize〓by vestibular symptoms.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes with coexisting nemaline myopathy: a case report

BackgroundMitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes and nemaline myopathy are two rare genetic conditions. We report the first case reported in world literature with coexistence of both these rare disorders.Case presentationA 11-year-old previously healthy Sri Lankan male child, product of a nonconsanguineous marriage with normal development presented with acute onset short lasting recurring episodes of right-sided eye deviation with impaired consciousness. In between episodes he regained consciousness. Family history revealed a similar presentation in the mother at 36 years of age. Examination was significant for short stature and proximal upper and lower limb weakness. His plasma and cerebrospinal fluid lactate were elevated. Magnetic resonance imaging brain had evidence of an acute infarction in the right occipital territory. Sanger sequencing for common mitochondrial variants of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes confirmed this diagnosis. Whole exome sequencing revealed pathogenic compound heterozygous variants in NEB gene implicating in coexisting nemaline myopathy. Acute presentation was managed with supportive care, antiepileptics, and mitochondrial supplementation. Currently he is stable on daily supplementation of arginine and limb-strengthening physiotherapy. He is being monitored closely clinically and with serum lactate level.ConclusionGenetic diseases are rare. Coexistence of two genetic conditions is even rarer. Genetic confirmation of diagnosis is imperative for prediction of complications, accurate management, and genetic counseling.

Transient eye closure and ocular preference in patients with intermittent exotropia

PurposeTo assess the relationship of sensory and motor ocular dominance to transient eye closure (TEC) under bright light conditions in patients with intermittent exotropia. MethodsForty patients (age range, 7-40 years) with intermittent exotropia were included in this prospective study. Motor and sensory ocular dominance were evaluated using the hole-in-the-card and Worth 4-Dot tests. Presence of any outward eye deviation or TEC was assessed and recorded in all participants under bright light conditions. Based on the fusion control grade of exodeviation, patients were assigned to good, fair, and poor control groups, and the results were compared. ResultsA total of 23 patients (58%) showed TEC under bright light: 18 (45%) in the good control group, 14 (35%) in the fair control group, and 8 (20%) in the poor control group. Eighteen patients (56%) with good and fair control showed TEC in the dominant eye. Five (63%) with poor control closed their nondominant eyes, and in all of them, outward eye deviation was observed before TEC. The angle of deviation at far and near and the degree of near stereopsis were not related to presence of TEC (P = 0.70, P = 0.06, and P = 0.34, resp.). ConclusionsIn patients with intermittent exotropia who exhibit TEC under bright light, those with good control tend to close the dominant eye, whereas in the majority of patients with poor control, spontaneous deviation occurs and is then followed by TEC of the nondominant eye.

Plant Fungus Gloeotinia SP: A Rare Finding in a Case of Mesial Temporal Sclerosis with Medical Refractory Epilepsy

We report a case of a 38-year-old gentleman who diagnosed since the age of 11 with medical refractory epilepsy. Semiology began with symptoms of automatism followed by deviation of eyes and unpurposeful movement of left hand.

Does the Visual Field Improve After Initiation of Intraocular Pressure Lowering in the United Kingdom Glaucoma Treatment Study?

PurposeEvidence to support the hypothesis that visual field (VF) status can improve after initiation of intraocular pressure (IOP) reducing treatment is controversial. We take advantage of participant eligibility data from the United Kingdom Glaucoma Treatment Study (UKGTS) to test this hypothesis in newly diagnosed glaucomatous patients randomised to IOP lowering therapy or placebo. DesignMulticentre, randomised, triple-masked, placebo-controlled trial. ParticipantsNewly diagnosed open-angle glaucoma patients in the UKGTS with eligibility and baseline data (n = 202 and n = 205 participants from the treatment and placebo groups, respectively). MethodsUKGTS eligibility data, including two reliable VFs (Humphrey 24-2 SITA Standard) and IOP measurements were compared to UKGTS trial baseline data acquired after allocation to treatment (topical prostaglandin analog) or placebo eye drops. Mean change in VF mean deviation (MD) and proportion of eyes that improved MD by more than different thresholds were compared across this interval in the treatment and placebo groups. Secondary analyses included stratifying the groups by level of IOP, level of VF loss and age along with pointwise analyses including change in subsets of VF locations. Main outcome measureMean change in VF MD. ResultsMean (standard deviation [SD]) time between eligibility/baseline visits and reduction in IOP was 12 (3) weeks and 4.8 (4.2) and 1.0 (3.6) mmHg for the treated and placebo eyes, respectively. Mean (SD) change in MD was almost the same for the treated (-0.03 (1.45) dB) and placebo groups (+0.08 (1.72) dB) (P=0.47). Proportion of participants with an MD improvement of 1 dB or more were similar for both groups (P=0.25). No association was found between MD improvement and magnitude of IOP lowering. Stratifying data by IOP, level of VF loss and age did not reveal any differences between the treated and placebo groups and neither did any of the pointwise VF analyses. ConclusionInitial short-term VF changes in the treatment and placebo arms of UKGTS were the same. In these newly diagnosed patients (non-advanced glaucoma) we found no evidence to support the hypothesis that VF status improves after initial lowering of IOP by medical therapy.

Clinical manifestations and outcomes associated with a high 2HELPS2B score in patients with acute impaired consciousness

PurposeThe 2HELPS2B score is an invaluable tool for assessing seizure risk in critically ill patients with unconsciousness. However, this can be challenging for non-epileptologists to use owing to its reliance on electroencephalogram (EEG) analysis. Thus, identifying clinical manifestations associated with high 2HELPS2B scores is crucial. MethodsWe examined patients who underwent EEG for acute impaired consciousness in the emergency department between 2020 and 2022. We evaluated the clinical manifestations immediately prior to the EEG tests and identified those associated with a 2HELPS2B score ≥ 2. Additionally, we investigated clinical outcomes in accordance with these manifestations and the 2HELPS2B score. ResultsA total of 78 patients were included in this study. While the median 2HELPS2B score was 1 (range: 0–6), 13 patients (16.6%) showed electrographic/electroclinical seizures or status epilepticus and 16 patients (20.5%) showed ictal-interictal continuum in their EEGs. Abnormal muscle tonus (p = 0.034) and eye deviation (p = 0.021) were Significantly associated with a 2HELPS2B score ≥ 2. The presence of these manifestations (p < 0.001) and a 2HELPS2B score ≥ 2 (p < 0.001) were both significantly associated with a favorable response to anti-seizure medication. Conversely, patients with a 2HELPS2B score ≥ 2 who exhibited these clinical manifestations were more likely to be non-dischargeable (p = 0.053), have prolonged intensive care unit stays (p = 0.002), or require extended ventilator use (p = 0.082). ConclusionAbnormal muscle tonus and eye deviation were significant manifestations compatible with a 2HELPS2B score ≥ 2 and may indicate an increased risk of seizures or the severity of the epileptic condition.

P-026 Retrospective descriptive analysis of 1300 ICSI-AOA cycles: evaluating clinical outcomes and child health in the context of artificial oocyte activation (AOA)

Abstract Study question How does the outcomes of ICSI-AOA and child health differ from those reported in the literature? Summary answer ICSI-AOA clinical outcomes, including fertilization, embryo quality, pregnancy, live birth rates, and anomaly rates in children, align with those reported for ICSI alone. What is known already The use of AOA to artificially induce calcium rises by employing calcium ionophores has been shown as an effective approach in overcoming fertilization failure following ICSI, especially in couples facing severe male factor infertility. However, a significant gap exists in reporting live birth outcomes. On the other hand, uncertainties surrounding the health implications for children born through this method necessitate further investigation due to the limited sample sizes in previous reports. This descriptive analysis fills that gap by assessing 1300 cases, providing crucial insights into the clinical outcomes and health status of babies resulting from ICSI-AOA treatment. Study design, size, duration This retrospective study analyzes 1300 cases of ICSI-AOA between 2018 and 2020. Clinical outcomes in this study includes: fertilization, embryo quality, pregnancy, and live birth rates. Questionaries regarding the children health were included from birth to two years. Participants/materials, setting, methods The study included 1300 cases that referred to Isfahan Fertility and Infertility Center (Isfahan, Iran) and underwent ICSI-AOA due to: 1) cases with testicular biopsy (N = 458), 2) cases with 99-100% sperm head abnormal morphology and/or 3) previous low fertilization or total fertilization failure after ICSI (N = 842). In all cases, to induce AOA, oocytes were subjected to a 10-minute exposure of 10 micromolar ionomycin following ICSI. Main results and the role of chance From 1300 couples, 11,756 mature, 2,012 immatures, 193 degenerate, and 76 uninjectable oocytes were obtained. Fertilization were 59.69%, and 52.18% for mature and immature oocytes, resulting in cleavage rates of 96.93% and 93.80%, respectively. On day 3, 25.14% grade A, 31.49% grade B, and 43.36% grade C were observed. In 321 couples, 571 fresh embryos were transferred on day 3, resulting in clinical pregnancy and live birth rates of 20.82%, and 19.55%, respectively. For 32 couples with 44 fresh ET on day 5, rates were 9.38%, and 9.38% respectively. Out of 3270 vitrified embryos on day 3, 1743 were thawed (337 couples) and 1147 were transferred in 643 ET cycles. Clinical pregnancy and live birth rates were 21.61%, and 20.37%, respectively. 1527 embryos remain frozen. Out of 2,974 day 5-embryos, 2,571 did not reach blastocyst, leaving 403 vitrified embryos in 699 cases. Among them, 197 embryos remain frozen (80 cases) while 206 were transferred, with clinical pregnancy and live birth rates of 22.11%, and 21.80%, respectively. Cancellation rate, encompassing failed fertilization, cancellations on multiple days, and after freeze-thawing, was 20.16%. Among 266 live births, seven children showed anomalies, including achondroplasia, combined immunodeficiency, left eye deviation, intrauterine growth restriction, hydrocephaly, epilepsy, and umbilical hernia. Limitations, reasons for caution The main limitations of this study were the lack of comprehensive information on previous cycles, the absence of an ICSI control group, and the limited long-term follow-up on the physical and mental health of children born through the ICSI-AOA method beyond age two. Wider implications of the findings ICSI-AOA yields helpful clinical outcomes in high fertilization, pregnancy, and live birth rates in infertile couples, especially those with severe male factor infertility similar to ICSI in literature. Furthermore, presently, there seem to be no real concerns about health of babies born through this method, aligning with ICSI studies. Trial registration number IR.ACECR.ROYAN.REC.1401.038

Olfactory Neuroblastoma with Intracranial Extension

Background: Olfactory Neuroblastoma (ONB), so called esthesioneuroblastoma, is a rare malignant tumor of the sinonasal tract. ONB represents 6.3% of all sinonasal tract malignancies, with a prevalence of 0.4 cases per million population. These tumors are slow-growing and there may be intracranial extension of the tumor. Nasal obstruction, anosmia, recurrent epistaxis and pain are typical early manifestations. Imaging studies are essential in determining tumor extension and surgical planning of ONB. Endonasal biopsy is required to confirm the diagnosis of ONB. The case provides a basis for discussion of ONB and highlights the possibility of extension of this tumor. Case: A 45-year-old male presented with a generalized clonic seizure, conjugate eye deviation, and pre-seizure headache. Post-seizure, the patient was unconscious and incontinent, later appearing conscious but confused. The patient had a history of seizures at home and in the ER, along with occasional headaches over the past year. The patient described nasal congestion, decreased smell, and recurrent nosebleeds, having undergone ethmoidectomy in 2020 for papilloma. Discussion: The patient experienced symptoms of seizures, headache, and nasal disturbances. Olfactory neuroblastoma (ONB) tumor was detected after comprehensive examination. Treatment involves multimodal therapy, including surgery, chemotherapy, and radiotherapy, with prognosis depending on tumor stage and grade. Conclusion: Early diagnosis of ONB is necessary to prevent further tumor progression. Intracranial extension of the ONB should be carefully investigated. Imaging as well as histopathological and immunohistochemical examinations are very helpful in identifying the location, metastasis and degree of malignancy of the tumor.

The effects of refractive status on the outcomes of strabismus surgery in patients with esotropia

BackgroundThe success of the strabismus surgery can hinge on several factors. One of these factors is refractive condition like hyperopia or myopia. Our study seeks to evaluate the surgical outcomes in patients with esotropia and myopia.MethodsThis case-control study encompassed all surgical cases of esotropia at Torfe and Negah Hospital between 2016 and 2021, which satisfied our specified inclusion criteria. The initial variables from electronic medical records were collected, including demographic, clinical, and surgery-related factors. At the final follow-up appointment, the level of eye deviation, both at distance and near, was recorded. We considered the operation a “success” for patients with a post-surgery distance eye deviation of 10(Pd) or less. Patients with greater deviation were classified as surgery failure. Statistical analyses were executed using SPSS software (version 16.0), and a P-value less than 0.05 was considered significant.ResultsOf the 194 patients evaluated, 112 were incorporated into the study. Surgical failure was observed in 14.29% of myopic patients, 29.79% of hyperopic patients, and 31.82% of emmetropic patients. The myopia group displayed a 0.19 odd ratio for surgical failure compared to the combined hyperopia and emmetropia groups, not statistically significant (OR: 0.19, CI 95%: 0.03–1.02). Additionally, patients diagnosed with Lateral Rectus Under-action were found to be 6.85 times more likely to experience surgery failure(OR: 6.85, CI 95%: 1.52–30.94). An elevated risk of surgical failure was also identified in patients who underwent Inferior Oblique Weakening procedure, indicated by a 3.77-fold increase in the odds ratio for failure(OR: 3.77, CI 95%: 1.08–13.17).ConclusionIn our study, despite numerical disparities, there was no statistical difference among the success rates of all esotropia patients with different refractive errors. The patients with LRUA or IOOA showed lower success rates. Myopic patients had higher post-op overcorrection with lower reoperation rates compared to hyperopic or emmetropic patients.

Visual and Ocular Characteristics of Anisometropic Children.

To compare the demographic and ocular characteristics of patients with low and high levels of anisometropia compared with non-anisometropic individuals. This cross-sectional study was conducted on 1803 individuals (age range, 1 to 30 years) examined at strabismus clinics between January 2019 and December 2020. Of these, 203 subjects had anisometropia (11.2%); 66 cases were excluded due to the history of prior ocular surgery except from strabismus surgery. Finally, data from 137 subjects were analyzed. Spherical or cylindrical differences of 1.50 or 3.00D between the two eyes were defined as low or high anisometropia, respectively, and isometropic subjects (n = 1600) served as controls. No significant difference was observed between cases and controls regarding age (10.25 8.41 vs. 9.2 1.7 years; P = 0.133) and sex (P = 0.051). History of ocular surgery was present in 33% of anisometropic patients versus 0.8 % of isometropic cases. The rate of amblyopia was 83% and 2.3% in anisometropic and non-anisometropic groups, respectively. Best corrected visual acuity (BCVA) was comparable in amblyopic eyes in both study groups, while BCVA of non-amblyopic eyes of non-anisometropic subjects was better (non-anisometropic: 0.01 0.01 vs. anisometropic: 0.06 0.17 LogMAR; P = 0.001). Eye deviation was significantly more prevalent among anisometropic patients (36.5% vs. 3.25%, P 0.001) and exotropia was the common type of deviation. Anisohyperopia and anisomyopia were the most common refractive errors under low and high anisometropia categories, respectively. Simultaneous manifestation of amblyopia and strabismus were observed in 30.6% of anisometropic cases, while only 0.7% of subjects with isometropia had a similar status (P 0.001). High rates of amblyopia and strabismus in anisometropic subjects, especially with higher degrees of anomaly, indicate the necessity of early visual acuity and refractive error screening to improve detection and enhance the outcomes of treatment.

ETMR-21. PRIMARY DIFFUSE LEPTOMENINGEAL MELANOMATOSIS (PDLM) ASSOCIATED WITH INTRACRANIAL BLEEDING AND RAPID PROGRESSION IN A CHILD

Abstract BACKGROUND PDLM is a rare and aggressive disease with limited cases reported worldwide and few cases in the pediatric population. Herein we report on clinical, histologic, and molecular/genetic findings of a young child with PDLM and rapid clinical progression. CASE STUDY A 12-year-old right-handed male presented with two months of intermittent fevers, progressive frontal headaches, lethargy, vomiting, and weight loss, and one month of focal seizures with altered awareness, speech arrest, eye deviation, and tonic posturing. Examination revealed bilateral papilledema and signs of increased intracranial pressure. A brain CT demonstrated increased density of the anterosuperior right frontal lobe and punctate focus of increased density along the left frontal lobe suggestive of hemorrhage. MRI revealed diffuse leptomeningeal thickening and enhancement throughout the brain and spinal cord. At biopsy, the frontal lesion was noted to be grossly abnormal and discolored, and on pathology demonstrated a melanocytic neoplasm infiltrating the subarachnoid space and extending into Virchow-Robin spaces. Tumor cells stained strongly for HMB45, vimentin, Melan-A, and PRAME and were BRAFV600E negative. RNA sequencing was negative for structural variants, Whole exome sequencing revealed a Tier I missense variant in NRAS (c.181C&amp;gt;A) among other copy number variations and loss of heterozygosity. Comprehensive ophthalmologic and dermatologic examinations as well as whole body PET/CT did not reveal any other sites of disease. He was due to commence immunotherapy with combination PD-1/CTLA-4 inhibitors but developed status epilepticus and raised intracranial pressure, warranting ventriculoperitoneal shunt insertion. Three days later, he had further deterioration with altered level of consciousness, hypertension, eye deviation, and vomiting. CT brain revealed large bifrontal hematomas with mass effect and care was redirected to palliation. CONCLUSION PDLM can be challenging to diagnose with a rapidly progressive course. Advanced molecular diagnostics may provide new targets for precision therapy, though overall outcomes remain dismal.

Cariprazine-Induced Extrapyramidal Symptoms and a Rare Downward Eye Deviation in Oculogyric Crisis: A Case Series

Cariprazine is one of the newer generation antipsychotics with dopamine receptor partial agonist activity which has been approved for management of schizophrenia and bipolar affective disorder. It is known to have lesser propensity to cause extrapyramidal adverse effects due to D2 and D3 partial agonism. We intend to disseminate our newly acquired experience regarding tolerability and the adverse effect profile of cariprazine. In this case series, we describe three cases with different symptom profiles who had experienced significant adverse drug reaction with cariprazine. We also describe a unique presentation of oculogyric crisis in the form of downward fixation of eyes as well the use of amantadine as an alternative option for the management of extrapyramidal adverse effects.

Mối liên quan giữa lâm sàng và hình ảnh học của nhồi máu não tái phát do tổn thương động mạch não giữa

Objectives: Evaluate the relationship between clinical and imaging of recurrent cerebral infarction dued to MCA damaged. Subjects and method: A cross-sectional, descriptive study of 77 patients with recurrent cerebral infarction dued to damaged middle cerebral artery treated at the Neurological Center, Bach Mai Hospital from July 2021 to August 2022. Results: Motor paralysis of the hemibody on the opposite side of the injury, paralysis of the central VII nerve on the opposite side of the injury and decreased sensation of the hemibody on the opposite side of the injury are symptoms seen at a high rate, accounting for 100% respectively; 90.9% and 77.9%. The proportion of patients with consciousness disorders from the beginning accounted for 49.4% of patients, 2 patients were in a deep coma when hospitalized (accounting for 2.6%). Language disorders including Broca’s language disorder, Wernicke’s language disorder and mixed language disorder accounted for 20/77 patients (26.0%). Horizontal eye and head deviation, circular muscle disorders, loss of attention on one side of the body, and hemianopia account for 32.5% respectively; 26.0%; 22.1%; 26.0%. 7.8% of patients had mental disorders and 14.3% of patients had seizures when hospitalized; The symptoms of headache, nausea, and vomiting accounted for 45.5% and 31.2%, respectively. Patients with symptoms clustered into Gerstman syndrome and Anton - Babinski syndrome account for a low rate: 9.1% and 11.7%. The most damaged arterial branch is the M1 branch with 31 patients, accounting for 40.2%; Oblique branches of the middle cerebral artery or putamen-striatum branches account for 32.5%. Only 4 patients had damage to branches M3 - M4 (accounting for 5.2%). The number of patients with damage to the M1 branch who had consciousness disorders accounted for the highest rate of 33.8%, with no patients with damage to the deep branch having consciousness disorders. Symptoms at hospital admission: consciousness disorders, speech disorders, turning eyes and head to the damaged hemisphere have a statistically significant relationship with the location of the damaged middle cerebral artery branch (p &lt; 0.05)Conclusion: Recurrent cerebral infarction due to damage to the middle cerebral artery has diverse clinical symptoms, depending on the damaged middle cerebral artery branch.

Congenital Cataracts With Thin Lenses (Leptophakia) in Children: Morphology and Surgical Outcomes

To determine the morphology and postoperative outcomes of pediatric cataracts with thin (leptophakic) lenses. Retrospective comparative clinical cohort study. We identified the records of pediatric patients who had undergone cataract surgery between 2018 and 2023 and lens thickness less than 2 standard deviations of age-stratified normal eyes in the general population. Matching controls were identified based on sex, age at surgery, and intraocular lens implant status. Data abstracted include axial length, anterior chamber depth, lens thickness, visual acuity, intraocular pressure, and surgical details. A total of 13 eyes from 7 patients were identified to be leptophakic, 8 of which had matching controls. Compared with the control eyes, leptophakic eyes had thinner lenses (2.74 ± 0.39 mm vs 4.82 ± 1.01 mm, P < .01) with comparable anterior chamber depth (3.28 ± 0.76 mm vs 2.98 ± 1.28 mm, P = .13) and axial lengths (19.17 ± 2.61 mm vs 20.76 ± 1.76 mm, P = .20). Following cataract surgery, visual acuity improved for both the leptophakic and control cohorts within 2.5 months postoperatively (-0.68 ± 0.37 logMAR vs -0.06 ± 0.42 logMAR, P = .03) and at 1-2 years postoperatively (-1.58 ± 1.03 logMAR vs -0.60 ± 0.49 logMAR, P = .22) without any glaucoma-related adverse events. Of note, 5 of 13 leptophakic eyes (38%) were found to have posterior capsular ruptures intraoperatively. Leptophakic eyes demonstrated similar intraoperative and short-term postoperative outcomes when compared to control eyes, although vigilance for posterior capsular defects and ruptures may be necessary.

Idiopathic Intracranial Hypertension With Unusual Presentation in an Adolescent Girl: A Case Report

Background: Idiopathic intracranial hypertension (IIH) or pseudotumor cerebri is a rare disorder. Regarding the latest diagnostic criteria for this disorder, we present a rare case of IIH. Case presentation: The case was an 11-year-old girl referred to our center with generalized body pain and mild left-eye deviation with no other visual symptoms. She had a severe generalized pain especially in her back and prevertebral area. In the neurological examination, there was a mild left sixth nerve palsy and bilateral papilledema. We treated the patient with acetazolamide and to lumbar puncture, which reduced intracranial pressure. The generalized body pain was reduced gradually in ten days, eye deviation in three weeks, and papilledema in two months after treatment. Conclusion: Based on the serious complications of IIH, a thorough assessment of suspicious cases, including ophthalmoscopic examinations, is mandatory. Furthermore, clinicians should consider even rare and unknown specific symptoms in these patients.

Conjunctival Epithelial inclusion Cyst after Strabismus Surgery: A Case Report

Abstract We present a case of a 26-year-old man with outward deviation of left eye since birth, diagnosed with exotropia underwent squint correction surgery, and later developed a conjunctival cyst. The histopathological findings from the biopsy indicated an epithelial inclusion cyst with retention.

Multifaceted Interactions of Stereoacuity, Inter-Ocular Suppression, and Fixation Eye Movement Abnormalities in Amblyopia and Strabismus.

Amblyopic and strabismus subjects experience inter-ocular suppression, impaired stereoacuity, and increased fixation instability. The purpose of the study was to investigate factors affecting suppression and stereoacuity and examine their relationship to fixation eye movement (FEM) abnormalities. We recruited 14 controls and 46 amblyopic subjects (anisometropic = 18, strabismic = 14, and mixed = 14) and 11 subjects with strabismus without amblyopia. We utilized the dichoptic motion coherence test to quantify suppression, and stereoacuity was assessed using the Titmus Fly test. We recorded FEMs using high-resolution video-oculography and classified subjects that did not have nystagmus (n = 27) versus those with nystagmus (n = 32; fusion maldevelopment nystagmus [FMN], n = 10) and nystagmus that did not meet the criteria of FMN (n = 20). We also recorded FEMs under dichoptic viewing (DcV) at varied fellow eye (FE) contrasts and computed the amplitude and velocity of the fast and slow FEMs and vergence instability. Inter-ocular suppression and stereoacuity deficits were closely correlated with an amblyopic eye (AE), visual acuity, and strabismus angle. Subjects with nystagmus displayed more pronounced stereoacuity deficits than those without nystagmus. Strabismic subjects with and without amblyopia, who demonstrated a fixation switch at 100% FE contrast, had lower inter-ocular suppression than subjects lacking a fixation switch under DcV. Amplitude of fast FEMs and velocity of slow FEMs, and vergence instability were increased as the FE contrast was lowered in both amblyopic and strabismic subjects. The current study highlights the intricate relationships between AE visual acuity, eye deviation, and FEM abnormalities on suppression and stereoacuity deficits and underscores the need to evaluate FEM abnormalities while assessing dichoptic treatment outcomes.

A Rare Pediatric Encounter: Diagnosing and Managing Upward Eye Deviation Due to Maxillary Sinus Hydatid Cyst

A Rare Pediatric Encounter: Diagnosing and Managing Upward Eye Deviation Due to Maxillary Sinus Hydatid Cyst

Usefulness Assessment of Automated Strabismus Angle Measurements Using Innovative Strabiscan Device.

The variability of the obtained results of manual tests assessing the angle of strabismus depends on the experience, skills, and training of the examiner. The authors hope that this new measuring device will provide a more sensitive and repeatable method for detecting small strabismus angles compared to the gold standard-PCT. The purpose of this article is to present an innovative strabismus angle demonstration device, called Strabiscan, to provide automated measurements of eye deviation and to compare the obtained results of these measurements to the traditional manual method. For patients with manifest strabismic disease (n = 30) and a group of healthy subjects (n = 30), a detailed history was taken and routine ophthalmologic examinations were performed, including best-corrected distance visual acuity, assessment of refractive error using an autorefractometer after cycloplegia, biomicroscopic evaluation of the anterior segment of the eye and evaluation of the eye fundus by indirect ophthalmoscopy. Subsequently, each patient and healthy subject was subjected to a prismatic cover-uncover test using a manual method, after which the presence of strabismus was detected and its angle assessed using a Strabiscan demonstration device. In the control group using the Strabiscan demonstration device, small-angle latent strabismus ≤ 3DP was diagnosed in 83% of patients, while >3DP was found in 13%. In contrast, using the prismatic cover-uncover test, latent strabismus ≤ 3DP was diagnosed in only 13% of patients, and latent strabismus with an angle > 3DP was found in 13% of patients. No statistically significant differences were noted in the measurements of strabismus angles made by the different methods. The Strabiscan demonstration device allows quick and accurate assessment of the strabismus angle. Compared to the prismatic cover-uncover test, it has a higher sensitivity for detecting low-angle latent strabismus. Measurements with the Strabiscan do not require the presence of additional assistants for the test.

Outcomes of "a new modification of Jensen technique combined with medial rectus recession" in patients with complete sixth cranial nerve palsy.

To report the outcomes of "our modified Jensen technique" for treating esotropia in cases with complete sixth cranial nerve (CN VI) palsy. This study is a 30-year case series of isolated complete CN VI palsy who underwent combined medial rectus recession and our modified Jensen operation. We modified the original technique by anchoring the muscle-unifying sutures to the sclera near the equator using a non-absorbable suture. Major outcomes such as postoperative diplopia, face turn, horizontal and vertical eye deviations, and abduction limitation were assessed. Successful surgery was defined as orthotropia or esotropia equal to or less than 8 prism diopters (PD) and the absence of any vertical deviation. Fifty-three cases with a mean age of 28 years old were included in this study. The male-to-female ratio was 3 to 1. Forty-five cases (85%) presented with unilateral palsy, whereas 8 patients (15%) had bilateral palsy. Trauma was the most common etiology (85%). Diplopia or face turn, presented in 42 patients before the operation, remained in seven cases after the operation. Primary position esotropia, which was the main complaint in all patients, decreased from 49 PD to 4 PD in unilateral palsy and from 101 PD to 10 PD in bilateral palsy. The mean reduction of abduction deficit was 1.78 in unilateral and 1.75 in bilateral palsy. The success rate was 76% in unilateral and 62% in bilateral palsy. Our modified Jensen operation was effective in treating patients with complete CN VI palsy, producing no significant permanent complications.