Ocular Disease In Children Research Articles

Prevalence and Pattern of Ocular Diseases Among Children Aged 7-14 Years Visiting a Tertiary Care Teaching Hospital in Central India.

Ocular morbidity in children hinders their overall development.The prevalence and pattern vary amongst countries as well as within a country. Many ocular diseases if diagnosed and treated on time can prevent ocular morbidity in children to a large extent. The aim of this study is to determine the prevalence and pattern of ocular diseases in children (7-14 years) presenting tothe All India Institute of Medical Sciences, Bhopal, a tertiary care teaching hospital in central India. This is a single-center, hospital-based cross-sectional study conducted from June 2018 to August 2019.A total of 1276 children between 7and 14 years of age were included. A thorough ocular examination was done and a diagnosis was noted. Statistical analysis was performed using Microsoft Excel, Version 2013 (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, Version 23 (IBM Corp., Armonk, NY).A p-value of <0.05 was considered significant. Results: Out of 1276 children, 505 (39.6%) were of 7-10 years while 771 (60.4%) were of 11-14 years. There were 563 females (44.1%) and 713 males (55.9%). The most common ocular morbidity was a refractive error, (653; 51.1%), it was significantly higher in the age group 11 to 14 years than in children of 7 to 10 years of age (p<0.03). The second most prevalent ocular morbidity was infection/inflammation of the adnexa (18.8%) of which males were affected more than females (p<0.0005). The other morbidities were squint and neuro-ophthalmological-related diseases (8.3%), followed by trauma (3%), congenital diseases (2.6%), amblyopia (2.4%), degenerative diseases (0.7%), neoplastic (< 0.01%), and miscellaneous disorders (1.6%). The majority of ocular disorders are preventable and treatable. The most common ocular morbidity in our study is refractive error. We recommend school-based screening programs for timely detection and correction of refractive error and to prevent amblyopia.

Choroidal neovascularization in children: Etiology, diagnosis, and clinical manifestations

Few studies have analyzed choroidal neovascularization (CNV) in children because of the low incidence of this complication in pediatric ophthalmology. However, given the significant effect on visual acuity and diagnostic difficulties in children, the study of this complication is relevant.&#x0D; AIM: This study aimed to analyze the etiological structure and clinical features of CNV in children.&#x0D; MATERIAL AND METHODS: From 2014 to 2022, 61 eyes of 54 children (26 girls and 28 boys) had CNV. The patients underwent standard ophthalmologic examination and optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular zone and optic disc using the RS-3000 Advance 2 Tomograph (Nidek, Japan).&#x0D; RESULTS: At the time of CNV diagnosis, the children were 5–17 years old, with a mean of 11±3 years. In 30 children (55.6%), CNV was caused by inflammatory lesions of the retina and choroid. Of these cases, 11 occurred during remission, whereas 21 occurred alongside pathologies of the retina, choroid, and optic nerve of noninflammatory genesis (8 of which were associated with Best’s disease). In three children, CNV was considered idiopathic. The development time of postinflammatory CNV ranged from 1 month to 12 years, with an average of 7.3±5 months from disease onset. Type 2 CNV was found in most cases (48 eyes, 78.7%).&#x0D; CONCLUSION: CNV is a rare complication of various ocular diseases in children. In our cohort, it was most frequently observed in children with inflammatory lesions of the retina and choroid, even during remission. Patients at risk of CNV must be actively monitored because it occurs in various forms.

Prevalence and Characteristics of Cytomegalovirus Ocular Disease in Children: A Multi-Center Study.

PurposeThe objective of this study was to identify the prevalence of CMV ocular disease in children and to identify associated risk factors for ocular involvement.DesignRetrospective multicenter, cross-sectional study.MethodsSetting: Hospitalized patients screened for CMV viremia by PCR between 2005 and 2018 at four pediatric referral centers. Participants: Seven-hundred and ninety-three children showed CMV viremia (>135 copies/mL by polymerase chain reaction; PCR). Main Outcomes and Measures: (1) Occurrence of ophthalmologic examination. (2) Presence of CMV ocular disease, defined as retinitis, vasculitis, hemorrhage, optic nerve atrophy, or anterior uveitis in the setting of CMV viremia without other identifiable causes.ResultsA total of 296/793 (37%) underwent ophthalmologic examination following CMV viremia. A total of23/296 patients (8%) had ocular symptoms prompting evaluation while the rest had eye exams for baseline screening unrelated to CMV viremia. Of these, 13 cases (4% of those with an eye exam) with ocular disease were identified (three congenital CMV, five severe combined immunodeficiency disorder (SCID) status post-stem cell transplantation, three hematologic malignancy status post-stem cell transplantation for two of them, one Evans syndrome status post-stem cell transplantation, and one medulloblastoma status post-bone marrow transplantation). No patients with solid organ transplantation developed CMV ocular disease in our cohort.ConclusionCMV ocular disease was a rare occurrence in this cohort without an identifiable pattern across sub-groups. Excluding the three congenital CMV cases, nine out of ten patients with CMV ocular disease were status post-stem cell transplantation. We provide integrated screening guidelines based on the best available evidence for this rare condition.

A study on the prevalence of ocular disorders among school going children in the age group of 5 to 12 years

The aim of this study is to assess the prevalence of various ocular disorders among school going children in the age group of 5 to12 years. : Vision screening is crucial for early detection of ocular disorders among young children thereby preventing the risk of uncorrectable dimunition of vision. Hence, our programme is planned as early detection of the causative factors in the childhood period and most effectively treat as early as possible.The purpose of the screening programme is to identify various ocular diseases in children like refractive errors, amblyopia, defective color vision, lid and adnexal disorders, vitamin A deficiency, allergic conjuctivitis, glaucoma, cataract and squint. Identification of such problems and its correction in early stage is crucial for their normal growth. A school based prospective cross sectional study design was adopted to examine children aged 5–12 years in randomly selected schools of Kollam district from January 2020 to March 2020. In this cross-sectional study, two Optometrist and two Ophthalmologist and other supportive staffs screened 3100 school children aged 5 to 12 years for vision and external eye examination. An Optometrist did the visual acuity testing and refraction. Detailed ophthalmic examination was done by an Ophthalmologist. The pattern of visual acuity, colour vision and ocular disorders were studied. Children needing further assessment were referred to the hospital and analysis of the data and data entry done using Microsoft office excel 2016 with Statistical software: R software (EZR 1.32).: A total number of 3100 students from 11 different schools were examined, 1570 of whom were males, and 1530 were females. The commonest eye disorder was refractive error 16.6% (514) in which most common was myopic astigmatism 78.2% (402) of which 322 were against the rule and 80 were with the rule astigmatism, followed by simple myopia 15.2%(78) simple hypermetropia 4.7%(25) and hypermetropic astigmatism 1.7%(9). Of these spectacles usage was found to be present only in 81.3% (418) students, rest 18.7%(96) were not aware of the refractive error. Next common eye disorder was allergic conjunctivitis 1.6%(49).Squint was present in 1.4%(42) children. Corneal opacity was present in 0.26%(8), defective color vision was there in 0.2%(6); lids and adnexal disorders 0.13%(4) and cataract 0.03%(1). There were no students with congenital anomalies, congenital glaucoma or Vitamin A deficiency. Uncorrected refractive error is the most common visual impairment found in school going children. There is a need to set up a regular school vision-screening programme to detect ocular disorders in order to prevent the burden on society on long term. Since most of this morbidity is either preventable or completely treatable, school screening is an effective method to reduce this burden.

A Survey of Pediatric Eye Diseases in a Tertiary Hospital in Osogbo, South-west Nigeria

Background: Identifying common eye diseases in childhood is a Step towards the prevention of visual impairment and preservation of vision in children who still have many productive years ahead. Aim: The aim is to determine the spectrum of eye disorders in children attending a tertiary health institution to plan preventive and curative strategies . Methodology: This was a 4-year retrospective study of children 0–16 years who presented to a tertiary institution. Through retrieval and study of case notes, information on age, sex, duration before the presentation, month of presentation, and diagnosis were obtained and analyzed using descriptive statistics. Results: Of 1120 case notes, studied, (53.8%) were male and (46.2%) female in a ratio of 1.6:1. The mean age was 8.54 years ± 5.03 and the modal age group was 11–16 years ± 0.85. About 51% (51.2%) had normal vision while (13.4%) were blind. The commonest eye disorders were conjunctivitis 488 (43.3%), refractive errors 292 (26.1%), and cornea-related problems 94 (8.4%). The less frequent disorders found were trauma 65 (5.8%), cataract 63 (5.6%), glaucoma 14 (4.3%), uveitis 7 (0.6%), and strabismus/others 67 (6.0%). Cataract 36/150 (24.0%) and refractive error 107/198 (54.0%) were the most common causes of blindness and visual impairment. Most children presented after 2–3 weeks of the onset of symptoms. Refractive error was more prevalent in females 176/518 (34.0%), while trauma was more prevalent in males 42/602 (7.0%). Conclusion: The common causes of ocular diseases in children in this study are avoidable. There should be an unrelenting effort toward the prevention of visual impairment or amblyopia by the provision of adequate treatment through subsidized eye care services. A follow-up study to ascertain the causes of delay in presentation would be helpful.

Longitudinal Analysis of Ocular Disease in Children with Mucopolysaccharidosis I after Hematopoietic Cell Transplantation.

Corneal clouding, causing visual impairment, is seen in nearly all patients with mucopolysaccharidosis type 1 (MPS-1). Hematopoietic cell transplantation (HCT) is able to stabilize disease in many organs. Residual disease in several tissues is being increasingly recognized, however. Data on the effect of HCT on ocular disease in patients with MPS-1 are contradictory. With this study, we aim to clarify the long-term effects of HCT on ocular disease in these patients. Best corrected visual acuity (BCVA), refraction, intraocular pressure (IOP), and slit-lamp biomicroscopic and fundoscopic examinations, including corneal clouding, were collected prospectively from 24 patients with MPS-1 who underwent HCT successfully between 2003 and 2018 (92% with >95% chimerism and normal enzyme activity after HCT). The course of corneal clouding and BCVA after HCT were analyzed using a linear mixed model. Other parameters studied were clinical phenotype, age at time of transplantation, and hematologic enzyme activity after transplantation. Outcomes of additional ophthalmologic tests were described. In addition, IDUA and α-galactosidase A (AGAL) enzyme activity and glycosaminoglycan (GAG) concentration in tear fluid were determined. Corneal clouding stabilized in the first years after HCT but increased rapidly beyond 3 years (P < .0001). BCVA and IOP also worsened over time (P=.01 and P < .0001, respectively). IDUA activity in tear fluid remained very low (P < .0001). After initial stabilization in the cornea, ongoing ocular disease and low IDUA activity in tear fluid is seen in patients with MPS-1 despite treatment with HCT, unveiling a weak spot of current standard therapy. New therapies that overcome these shortcomings are needed to improve the late outcomes of patients.

Study on ocular diseases in school children in west Hyderabad

Introduction: A study on ocular diseases in children is important because early detection and treatment will reduce the burden of blindness in the society as children in the school-going age group (5-16 years) represent 25% of the population in developing countries. Most of the eye diseases start from childhood. If they are not detected early they can hamper children’s activities in school and may also cause severe ocular disability in their future. Objectives: Our school eye survey will help in early detection and treatment of ocular morbidities in rural schools of Film nagar, Hyderabad. Materials and Methods: In this study 1218 school children aged between 5 to 16 years were screened for ocular morbidities and specific treatment was given to the children with ocular diseases. SPSS software was used for statistical analysis. Results: The total prevalence of ocular morbidity was 32.5%.Refractive errors accounted for 11.0% of the cases followed by Blepharitis accounting for 10.1% of cases. The other ocular morbidities were Allergic conjunctivitis 7.6%, Amblyopia 1%, Duane's Retraction syndrome 0.3%, Meibomian gland dysfunction 0.5%, Congenital cataract 0.3%, Exotropia 0.5%, intrastromal corneal foreign body 0.2%, Bitot's spots (Vitamin A deficiency) 0.2% Corneal opacity 0.5%, Double elevator palsy 0.2%, Axenfield rieger's syndrome 0.2%, Chalazion 0.2%. Conclusion: Refractive errors was the most common ocular morbidity followed by Blepharitis. Periodic school eye health programs and ocular hygiene play an important role in reducing the ocular morbidities. Keywords: Ocular morbidity, School children, Refractive errors, School eye camps, Ocular hygiene.

Longitudinal Analysis of the Effect of Hematopoietic Cell Transplantation on Ocular Disease in Children with Mucopolysaccharidosis I Shows Ongoing Disease Progression

Aim Corneal clouding is seen in nearly all patients with Mucopolysaccharidosis-1 (MPS-1) causing visual impairment. Hematopoietic cell transplantation (HCT) is able to stabilize disease in many organs including the brain. However, residual disease in peripheral tissues is often described. Therefore, the aim of this study was to determine the long-term effect of HCT on ocular disease in MPS-1 patients. Methods Corneal clouding (grade 0-4) and visual acuity (Decimal scale) were prospectively collected from all consecutive MPS-1 patients treated with HCT between 2003 and 2018 at the UMC Utrecht. The primary outcomes of interest, the effect of time on corneal clouding and visual acuity, were analyzed using a linear mixed model. The correlation between corneal clouding and visual acuity was analyzed with Pearson's rho. Other parameters studied were clinical phenotype, age at time of transplantation and hematological enzyme level after transplantation. Other outcomes of interest analyzed included intra-ocular pressure, refraction, and macula and lens abnormalities. Results 24 successfully engrafted MPS-1 patients were included (92% with >95% chimerism and normal enzyme levels after HCT). Corneal clouding stabilized during the first years after HCT, but increased rapidly beyond three years (figure 1). Other predictors for increased corneal clouding were age at time of transplantation (0.74, 95%CI 0.34:1.15; p=0.0026) and clinical phenotype (−1.02, 95%CI −0.18:−1.86; p=0.0335). Visual acuity also worsened significantly over time (−0.03, 95%CI −0.06:−0.007; p=0.01). Corneal clouding was strongly negatively correlated with visual acuity (ρ −0.60, p = 7.12e−11). Conclusion After initial stabilization, ongoing ocular disease is seen in MPS-1 patients despite successful HCT. This hallmarks the shortcomings of current standard therapies. New therapies that overcome the weak spots of these therapies are necessary to improve the late outcomes of these patients.

CtGEM typing: Discrimination of Chlamydia trachomatis ocular and urogenital strains and major evolutionary lineages by high resolution melting analysis of two amplified DNA fragments.

Chlamydia trachomatis infects the urogenital tract (UGT) and eyes. Anatomical tropism is correlated with variation in the major outer membrane protein encoded by ompA. Strains possessing the ocular ompA variants A, B, Ba and C are typically found within the phylogenetically coherent “classical ocular lineage”. However, variants B, Ba and C have also been found within three distinct strains in Australia, all associated with ocular disease in children and outside the classical ocular lineage. CtGEM genotyping is a method for detecting and discriminating ocular strains and also the major phylogenetic lineages. The rationale was facilitation of surveillance to inform responses to C. trachomatis detection in UGT specimens from young children. CtGEM typing is based on high resolution melting analysis (HRMA) of two PCR amplified fragments with high combinatorial resolving power, as defined by computerised comparison of 65 whole genomes. One fragment is from the hypothetical gene defined by Jali-1891 in the C. trachomatis B_Jali20 genome, while the other is from ompA. Twenty combinatorial CtGEM types have been shown to exist, and these encompass unique genotypes for all known ocular strains, and also delineate the TI and T2 major phylogenetic lineages, identify LGV strains and provide additional resolution beyond this. CtGEM typing and Sanger sequencing were compared with 42 C. trachomatis positive clinical specimens, and there were no disjunctions. CtGEM typing is a highly efficient method designed and tested using large scale comparative genomics. It divides C. trachomatis into clinically and biologically meaningful groups, and may have broad application in surveillance.

Identification of a novel GJA3 mutation in a large Chinese family with congenital cataract using targeted exome sequencing.

Autosomal dominant congenital cataract (ADCC) is a clinically and genetically heterogeneous ocular disease in children that results in serious visual impairments or even blindness. Targeted exome sequencing (TES) is an efficient method used for genetic diagnoses of inherited diseases. In the present study, we used a custom-made TES panel to identify the genetic defect of a four-generation Chinese family with bilateral pulverulent nuclear cataracts. A novel heterozygous missense mutation c.443C>T (p. T148I) in GJA3 was identified. The results of the bioinformatic analysis showed that the mutation was deleterious to the structure and hemichannel function of Cx46 encoded by GJA3. Plasmids expressing wild-type and mutant human Cx46 were constructed and ectopically expressed in human lens epithelial cells (HLECs) or human embryonic kidney (HEK-293) cells. Fluorescent images indicated aggregated signals of mutant protein in the cytoplasm, and a higher protein level was also detected in T148I stable cell lines. In summary, we identified a novel mutation in GJA3 for ADCC, which provided molecular insights into the pathogenic mechanism of ADCC.

A REVIEW ON COMPREHENSIVE EYE EXAMINATION IN PEDIATRIC PHYSICAL THERAPY

Background: Even early in Eye disease, children have reduced economy of activity of daily living. Early eye examination, diagnosis and management will reduce the consequences of other system originated by eye problems. The current literature is aimed to provide and explore the knowledge of Pediatric Physical Therapist about pediatric eye examination. This will help in early detection of any eye disorder and in good prognosis of visual health, physical growth, social and mental health as well.Methods: The data and contents of current literature have been explored from different webpages, books and by personnel experience in pediatric physical therapy and optometry.Results: In the beginning disclosure and immediate treatment of ocular diseases in children is necessary to prevent lifelong visual deterioration. Checkup of the eyes should be carrying out early in the neonates period and at all well-child visits. Neonates should be checked for ocular structural abnormalities, such as cataract, corneal opacity, and ptosis, which are known to cause in visual problems. Every child who are bring into being have an ocular anomaly or who fail vision examination should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients.Conclusions: Children account for a large and growing percentage of the population of the India. Studies have demonstrated that the prevalence of eye and vision disorders is substantial in this group. Researches also reveal that early detection and intervention are particularly important in children because of the very quick development of the visual system in early childhood and its sensitivity to interference. When disorders such as amblyopia and squint are undetected, the long-term consequences can be serious in terms of quality of life, comfort, appearance, and career opportunities.

Prevalence and clinical characteristics of ocular disease in children with HIV/AIDS

Describe the prevalence and clinical characteristics of ocular disease in children with HIV/ AIDS.

Ocular disease in the cobalamin C defect: a review of the literature and a suggested framework for clinical surveillance.

The association between combined methylmalonic acidemia and homocystinuria of cblC type (cobalamin C defect, cblC) and ocular disease is now well recognized, and is a significant component of morbidity and disability associated with the condition. In this review, through collation of historically reported cases of early- and late-onset cblC and previously unreported cases, we have attempted to characterize the epidemiology, clinical features, and pathomechanisms of individual ocular features of cblC. These data suggest that maculopathy and nystagmus with abnormal vision are extremely common and affect the majority of children with early-onset cblC, usually before school age; strabismus and optic atrophy are also seen at relatively high frequency. The timing of progression of macular disease may coincide with a critical period of postnatal foveal development. Maculopathy and retinal disease may be subclinical and show only partial correlation with the extent of visual deficits, and visual deterioration may be relentlessly progressive in spite of aggressive treatment of biochemical abnormalities. In later-onset forms of the disease, visual loss and ocular complications appear to be infrequent. Finally, we discuss investigational strategies in diagnosing and characterizing eye disease in individuals with cblC, explore possible therapeutic avenues that may attenuate progression and severity of eye disease, and propose a clinical surveillance guideline for monitoring progression of ocular disease in children and adults with cblC.

Design, Methodology and Baseline Data of a School-based Cohort Study in Central China: The Anyang Childhood Eye Study

Purpose: To report the design, methods and baseline data of the Anyang Childhood Eye Study (ACES), aiming to determine the prevalence, incidence and risk factors of myopia and other ocular diseases in children in central China.Methods: The ACES was a school-based cohort study conducted in Anyang city. Students have been examined and will be followed-up annually for 3–5 years. Ocular examinations included visual acuity, identification of amblyopia and strabismus, ocular biometry, optical coherence tomography, retinal photography, cycloplegic autorefraction, accommodative response, peripheral refraction, visual perception and so on. A questionnaire survey was performed to collect risk factors for myopia including near work, outdoor activity, parental myopia, birth history, habits of wearing spectacles and reading, living habits, food habits and so on.Results: Of 3112 grade 1 and 2363 grade 7 students eligible for the ACES, 2893 (93.0%) and 2267 (95.9%) participated in the study, with a mean age of 7.1 years (range 5.7–9.3 years) and 12.7 years (range 10.0–15.9 years), and proportions of male to be 57.8% and 50.0%, respectively. The prevalence rates of myopia, high myopia, emmetropia and hyperopia were 3.9%, 0.1%, 72.9% and 23.3% in grade 1, and 67.3%, 2.7%, 31.4% and 1.2% in grade 7, respectively. Similar data were found in the children confined in 6-year-old and 12-year-old ages.Conclusions: The ACES is the first large-scale cohort study in China with baseline response rates over 90%. Continuous documentation of changes and risk factors of refractive errors in these cohorts would provide new insights into myopia control in school-aged children.

Occurrence and pattern of ocular disease in children with cholestatic disorders

To describe visual function and ocular manifestations in patients with onset of cholestasis during the neonatal period. Patients with neonatal cholestasis, either transitory or chronic, who came for assessment to our tertiary referral centre were included in a cross-sectional study and underwent ophthalmological examinations including fundus photography. A total of 57 patients (24 girls and 33 boys), aged 0.4-18.0 years, were included. Of these, 28 patients had biliary atresia, 11 had Alagille's syndrome, five had progressive familiar intrahepatic cholestasis and nine had different disorders such as pituitary insufficiency, alpha-1-antitrypsin deficiency, mitochondriopathy, congenital infections or cholestasis caused by unknown reasons. Visual dysfunction and/or one or several ocular manifestations occurred in 39 out of 57 patients. Major ocular malformations occurred in five patients. Out of three patients with biliary atresia, one patient had severe visual impairment caused by microphthalmia and chorioretinal coloboma, one patient with Cat Eye syndrome had bilateral uveochorioretinal coloboma and one patient had Rieger's anomaly. Two patients, both with pituitary deficiency and transient cholestasis, had severe unilateral visual impairment caused by optic nerve hypoplasia. The majority (68%) of the patients with cholestasis had ocular manifestations. Although the severity of ocular complications varied with diagnosis, and was most apparent among patients with biliary atresia or pituitary deficiency, no conclusion can be drawn regarding the connections between these conditions from the present study. Nevertheless, ocular assessment is important for diagnostic purposes and for early intervention in patients with cholestasis.

Ocular disease in children with vertically acquired human immunodeficiency virus infection

Background: Clinical reports suggest that ocular disease in infants and children vertically infected with human immunodeficiency virus (HIV) is different from that in adults. Pediatric patients with acquired immunodeficiency syndrome (AIDS) and HIV infection are being treated more aggressively and are living longer, but current literature on the incidence of AIDS-related ocular disease in vertically acquired HIV infection is limited. Methods: Thirty-three children with culture-positive, vertically acquired HIV infections were prospectively followed with ophthalmic examinations between September 1991 and August 1996 at the University of Massachusetts. Patients were categorized as having symptomatic or asymptomatic HIV disease according to the U.S. Centers for Disease Control and Prevention guidelines. Absolute CD4 counts and other measures of immune function were obtained. Results: The average length of follow-up was 30 months, and the average number of ophthalmic examinations per patient was 4.8. Ten patients developed ophthalmic findings. Nine of 18 (50%) patients with symptomatic AIDS disease developed ophthalmic findings. One of 15 asymptomatic HIV-infected patients developed ocular findings. Two patients with absolute CD4 counts less than 10 developed cytomegalovirus retinitis. Conclusions: These results suggest that AIDS-related ophthalmic disease is less common in vertically infected children than in adult AIDS patients. It also supports intensified clinical surveillance for cytomegalovirus retinitis in children with end-stage disease and very low CD4 counts.

Ocular manifestations of immunological and rheumatological inflammatory disorders.

Our understanding of ocular manifestations in immunological and rheumatological inflammatory disorders has continued to expand over the past year. A report on the characteristics of ocular disease in children with Behçet's disease is presented. Two reports of Vogt-Koyanagi-Harada syndrome in 4-year-old children are discussed, and the uncommon complication of macular edema in this syndrome is highlighted. An article reporting the presence of Epstein-Barr virus DNA in the vitreous of a patient with Vogt-Koyanagi-Harada syndrome is reviewed. Radiologic imaging patterns of orbital disease in Wegener's granulomatosis are presented. Unusual manifestations of sarcoidosis, systemic lupus erythematosus, and Wegener's granulomatosis are also reported.

Ocular manifestations of immunological and rheumatological inflammatory disorders.

Further exploration of ocular manifestations in systemic immunologic and inflammatory disease continues to yield new information regarding the genetic associations, diagnosis, and treatment of these disorders. The use of color Doppler ultrasound to diagnose giant cell arteritis is reported to be of diagnostic promise. The prognosis of scleritis associated with systemic immunologic and inflammatory disease is recently highlighted in two articles. The treatment of scleritis and uveitis associated with inflammatory bowel disease is reviewed. Two reports of Vogt-Koyanagi-Harada syndrome in monozygotic twins provide further understanding of the genetic factors involved in this disease. Unusual presentations of sarcoidosis and Wegener's granulomatosis are also reported.

Vernal Keratoconjunctivitis (VKC)

Vernal keratoconjunctivitis (VKC) is an allergic ocular disease in children and young adults. It is linked to atopy but it is characterized by typical inflammatory changes of ocular tissues. The conjunctiva often shows hyperplasia, with infiltration of lymphocytes and eosinophils; also mast cells, confined to the substantia propria in normal subjects, invade the epithelium in VKC. Both mucosal (MC(T)) and connective tissue (MC(TC)) types of mast cell can be found in the conjunctival tissues of VKC patients, whereas MC(TC) predominate in the normal eye. Much of the damage caused to the surface of the eye in VKC appears to be due to cytotoxic factors released from the invading eosinophils. Ongoing studies of cell/mediator interactions involved in the inflammatory process are contributing to the understanding of VKC and other allergic eye diseases also providing the rationale for effective treatment which may be found by blocking the immunological inflammatory network at specific points. Therapeutic studies with nedocromil sodium have shown encouraging results. For example, a six-week placebo comparison in Italy found nedocromil sodium eye drops to be efficacious in reducing hyperaemia, eye itching and inflammatory cells present in tears. Similarly, a four-week trial in Egypt showed this drug superior to sodium cromoglycate using the same q.i.d. regimen.

The Eye in Childhood

For the relatively new subspecialty of pediatric ophthalmology fathered by Frank Costenbader, MD, a spate of new books is appearing on this subject. The ramifications are naturally large, including diseases found most commonly but not exclusively in children, and accordingly this textbook is written by 29 authors. It sets out the practical experience of the staff of the Hospital for Sick Children in Toronto, rather than a historical review of scientific studies and controlled surveys. In fact, the easily readable text does not document the source of much information but only includes a selected bibliography at the end of each chapter. The general tone of the book is set by the dedication: "This book is dedicated to all the children." Most chapters begin with an elementary description of embryology, anatomy, and physiology that would be of value to a pediatrician. The book omits few, if any, ocular diseases in children,