Ocular Manifestations In Children Research Articles

Ocular Manifestations in Children with Juvenile-Onset Systemic Lupus Erythematosus

ABSTRACTPurpose: To study the ocular manifestations of juvenile systemic lupus erythematosus (JSLE), including the ocular side-effects of the systemic medications used. Methods: A descriptive cross-sectional study on 40 children diagnosed with JSLE was conducted. Ophthalmological and laboratory investigations as well as a calculation of the Systemic Lupus Disease Activity Index 2000 (SLEDAI-2K) were performed. Results: Forty consecutive children, 32 females and 8 males, with JSLE were examined. Their mean age was 13±2.8 years and the mean SLEDAI-2K was 4.3±3.1. An abnormal Schirmer test was found in 16 patients (40%), retinal vascular changes were found in seven patients (17.5%), and one patient (2.5%) had faint posterior subcapsular cataract. Conclusion: Serious sight-threatening complications were not detected in our study; dry eye was the most common ocular finding, and the detected retinopathy was related to systemic hypertension and could not be correlated to either disease activity or duration.

Study of the different ocular manifestations in children with juvenile idiopathic arthritis

Purpose The aim of this study was to describe the features of uveitis in children with juvenile idiopathic arthritis (JIA). Patients and methods The present study was an observational study of 132 eyes of 75 children with JIA and uveitis, who were examined with a slit-lamp biomicroscope and a noncontact fundus lens. The features of uveitis are described. Results Among the 75 patients with JIA-associated uveitis, 132 eyes were affected by uveitis. At least one ocular complication was present in 64% of patients and in 67% of eyes affected with uveitis at presentation. In the 132 affected eyes, band keratopathy was the most frequent complication observed (32%), followed by posterior synechiae (28%), cataract (22%), and ocular hypertension (15%). Conclusion In summary, poor vision and ocular complications still occur commonly among children with JIA-related uveitis, particularly if there is a long delay in referral to a tertiary-care center.

Ophthalmologic Findings in Children with Leukemia: A Single-Center Study.

Objectives:Ophthalmologic disease in patients with acute leukemia occurs due to primary leukemic infiltration (involvement), or secondary to the disease and its treatment. In recent years the life expectancy of acute leukemia patients has increased with the advent of modern therapies. The present study aimed to determine the incidence of ocular manifestations in children with acute leukemia.Materials and Methods:The study included 120 patients diagnosed with acute leukemia at Başkent University Hospital, Pediatric Hematology Department between 1995 and 2010. All the patients were examined by an ophthalmologist via direct and indirect ophthalmoscopy.Results:Among the patients, 83 (69.2%) were diagnosed with acute lymphoblastic leukemia, 35 (29.1%) with acute myeloblastic leukemia, and 2 (1.7%) with mixed-lineage leukemia. In all, 58 ophthalmic manifestations were noted in 41 patients (34.2%). In our patients, 12 ophthalmologic involvements were present at admission and 46 ocular findings occurred during follow-up. The incidence of these manifestations increased with age.Conclusion:Ophthalmologic manifestations were not correlated with gender, hematological parameters at disease onset, type of leukemia, or the frequency of relapse and survival. To more clearly determine the effect of ophthalmologic manifestations on the prognosis of leukemia, larger scale and multi-center studies are needed.

Clinical guidelines for diagnosing and managing ocular manifestations in children with mucopolysaccharidosis

The mucopolysaccharidoses (MPS) are a group of rare lysosomal storage disorders characterized by the accumulation of glycosaminoglycans in several tissues and organs. This accumulation results in an array of clinical manifestations and premature death in severe cases. Ocular problems are very common in children with MPS and may involve the cornea, sclera, trabecular meshwork, retina, optic nerve and also the posterior visual pathways. The aims of this study are to give an overview of ocular problems in MPS and to provide clinical guidelines for paediatric ophthalmologists for early diagnosis and management of ocular manifestations in children with MPS. Diagnostic problems may arise in children with severe corneal clouding, hampering visualization of the fundus. Intraocular pressures may be falsely high, even leading to suspicion and unnecessary pressure-lowering treatment. Simple interventions such as the use of prescription glasses or photochromatic glasses can considerably improve quality of life in children with MPS.

Ocular manifestations in children and adolescents with thyrotoxicosis.

Thyrotoxicosis is a rare disorder in childhood and adolescence. The frequency ranges from 0.1 in 100000 in young children to 3.0 in 100000 in adolescents and the most frequent cause is Graves' disease. Few children and adolescents suffer from thyrotoxicosis during the course of autoimmune thyroiditis and non-autoimmune hyperthyroidism due to constitutively active mutations of the TSH-receptor have been reported in single patients with neonatal hyperthyroidism and rare familial cases. From a survey of the literature it is apparent that infiltrative ophthalmopathy is very rare in children and adolescents. Milder ocular manifestations as retraction of the upper eyelid, upper lid lag and "staring eyes" are reported in varying frequencies ranging from 25 to 60% of all patients. In our own series of 43 children and adolescents (34 females, 9 males) with thyrotoxicosis only 16 (37%) had clear ocular manifestations of upper lid retraction, lid lag and slight protrusio bulbi. However, only three of of them had soft tissue involvement and significant exophtalmus. In none of the patient corneal or optic nerve involvement or paralysis of the extraorbital muscles was observed. Newborns with congenital hyperthyroidism due to maternal Graves' disease seem to present significant transitory ocular manifestations more frequently, but again no infiltrative ophtalmopathy requiring specific therapy is present. Recently at least four different newborns with congenital thyrotoxicosis due to gain-of-function mutations of the TSH-receptor have been reported, who also had significant ocular manifestations. The presence of staring eyes, slight proptosis and lid retraction in these newborns without any autoimmune or inflammatory process supports the hypothesis that these ocular manifestations are caused by the increased thyroid hormone actions. The involvement of the eyes is usually transitory in newborns as well as in children and adolescents and the symptoms usually disappear when euthyroidism is restored. The administration of steroids therefore is restricted to the rare severe cases with eye muscle or soft tissue involvement. There are no reports on surgical decompression or orbital irradiation therapy of ophtalmopathy in children and adolescents, which again indicates that ocular involvement in thyrotoxicosis in children and adolescents is less frequent and much less severe than in adults.

Ocular manifestations in children with HIV infection in Dar es Salaam, Tanzania.

A study of ocular lesions among 62 HIV seropositive and 47 HIV seronegative children admitted to the paediatric ward of Muhimbili Medical Centre was conducted. The prevalence of ocular manifestations was 38 per cent among the HIV seropositive children and 25 per cent among HIV seronegative children. While conjunctival lesions were common in both groups, fundus and corneal lesions were more common in HIV seropositive children. The common lesions were macular oedema, haemorrhages and sheathing of retinal vessels. In addition, HIV seropositive children had a 10 per cent prevalence of abnormal visual acuity compared with HIV seronegative children who had a 6 per cent prevalence. This study showed that ocular manifestations of HIV is high in African children and can be confounded by nutritional status. The commonest non-ocular manifestation was pulmonary tuberculosis and malnutrition. Children with HIV infection should have an ocular examination.

Ocular manifestations in children and adolescents with Lyme arthritis

BACKGROUNDLyme arthritis is the most frequent late manifestation of Lyme borreliosis and has been associated with ocular inflammation.METHODSA group of 153 children and adolescents with arthritis, 84 of whom had...