Comparison of intraocular pressure measurements in healthy pediatric patients using three types of tonometers

Objectives: This study aimed to compare intraocular pressure (IOP) measurements in healthy pediatric patients using three types of tonometers. Materials and Methods: Seventy-eight eyes of 78 patients under the age of 18 who underwent a routine ophthalmologic examination were included in the study. IOP was measured using Tono-Pen (TP) tonometry, Goldmann applanation tonometry (GAT), and non-contact tonometry (NCT), consecutively. IOP was adjusted based on central corneal thickness (CCT). Patients with any ocular disorders other than a limited refractive error were excluded from the study. Results: The study consisted of 46 girls and 32 boys. The mean age was 12.6±2.7 (range: 5-17) years. The mean CCT was 559.3±35.3 µm. The mean refractive error was -0.50±1.70. The mean level of visual acuity was 0.98±0.1 (range: 0.3-1.0) using the Snellen chart. Significant differences were found between the measurement results of each of the three tonometric methods. Mean IOP was 12.1±2.2 mmHg for TP, 15.7±2.5 mmHg for GAT, and 17.1±3.1 mmHg for NCT. The correlations between measurement methods revealed that the highest correlation was between NCT and GAT (p<0.001, r=0.670). The second highest correlation was between NCT and TP (p<0.001, r=0.477). The lowest correlation was between GAT and TP (p<0.001, r=0.403). A positive correlation was found between CCT and each IOP measurement method. Conclusion: In pediatric patients, TP and NCT measurements were found to be positively correlated with GAT measurements. Because TP measurements were lower than GAT measurements and NCT measurements were higher than GAT measurements, patient follow-ups, treatment strategies, and surgery plans must be organized taking these differences into consideration

Orbital cellulitis presenting as a first sign of incomplete kawasaki disease

A 6-year-old boy was referred to our hospital with orbital cellulitis. He had a history of 7 days of fever despite antibiotherapy. At first, he only had pharyngitis and conjunctivitis, but then an orbital mass evolved which restricted the movement of his right eye and there was also periorbital inflammation resembling orbital cellulitis. Examination at presentation revealed conjunctivitis with secretion, periocular inflammation and edema, right-preauricular lymphadenopathy and restriction of upgaze in the right eye. Laboratory findings included a white blood cell count of 19,000 cells per mm3, with 81.5% neutrophils, 15.0% lymphocytes, 1.2% monocytes and 0.4% basophils. The erythrocyte sedimentation rate was 52 mm/h and the C-reactive protein level was 46.3 mg/dl. Magnetic resonance imaging confirmed orbital cellulitis and pansinusitis. Vancomycin (60 mg/kg/day) and meropenem (100 mg/kg/day) were administered, but desquamation on his fingertips and a rash appeared on the tenth day. A pediatric consultation resulted in a diagnosis of incomplete Kawasaki disease (KD). After administration of aspirin, the orbital inflammation regressed in 3 days. No coronary artery lesions were detected on the first echocardiography, but these did appear 6 weeks later. This confirmed the KD diagnosis