A reexamination of end-point and rebound nystagmus in normals.

In order to detail the characteristics of end-point (EPN) and rebound nystagmus (RN), two series of experiments were performed with infrared oculography for measurement of horizontal eye movements. Experiment 1 consisted of EPN recordings during sustained lateral gaze (40° and 50°) in 20 normal subjects. Experiment 2 consisted of recordings of RN in 5 normal subjects. Nine of 20 subjects demonstrated a jerk EPN. EPN almost always appeared immediately and was sustained for 15-25 sec. In Experiment 2, RN occurred in 5 of the 5 subjects who demonstrated EPN. The mean amplitude of RN was always less than that of EPN, and decayed over a 5-10-sec time period. The experiment demonstrated that RN can be evoked in normals even when a fixation target, in a fully lit room, is present

Enlargement of the bony orbit by orbital recurrence of choroidal melanoma 21 years after enucleation

A case is presented of a 58-year-old retarded male with a 6 cm, painless, hard, pigmented tumor filling the left orbit completely, after enucleation 21 years previously for retinal detachment, glaucoma and no light perception. CT scan and MRI revealed, besides the tumor, an outspoken enlargement of the bony orbit with thinning of the orbital walls. A biopsy showed a spindle B cell melanoma. In one of the paraffin histology sections of the globe enucleated 21 years previously a very small spindle B cell melanoma under the detached retina was present, with tumor cells in several vortex veins. The tumor was debulked centrally and it was exenterated and the eyelid skin was closed over the empty orbit. The patient is well 15 months after surgery. This case re-emphasizes that a choroidal melanoma can recur locally decennia after enucleation, that the histology of the tumor may change concomitantly and that a slowly growing orbital tumor can enlarge the bony orbit without perforating the periborbit or eroding the bone

Kearns-Sayre's syndrome developing in a boy who survived Pearson's syndrome caused by mitochondrial DNA deletion

Documenta Ophthalmologica 1992, Volume 82, Issue 1-2, pp 73-79 Kearns-Sayre's syndrome developing in a boy who survived Pearson's syndrome caused by mitochondrial DNA deletion Dr H. J. Simonsz, K. Bärlocher, A. Rötig … show all 3 hide » Download PDF (2,322 KB) Abstract A 7-year-old boy presented with bilateral ptosis and atypical retinitis pigmentosa. Before age two, he had had an Fe-refractory anemia, with neutropenia and thrombopenia. Just prior to the ophthalmic examination, the patient developed lactate acidosis, muscular hypotonia, ataxia and increased protein in the spinal fluid. Pancytopenia, pancreas dysfunction and growth retardation are the main features of Pearson's syndrome, most children not surviving beyond age three. The cause of Pearson's syndrome in our patient turned out to be a 5 kb deletion in the mitchondrial DNA. Similar deletions have been described in the Kearns-Sayre syndrome. It seems that children who survive the initial phase of Pearson's syndrome, may develop Kearns-Sayre syndrome

Differences in quality-of-life dimensions of Adult Strabismus Quality of Life and Amblyopia & Strabismus Questionnaires

Purpose: The Adult Strabismus Quality of Life Questionnaire (AS-20) and the Amblyopia & Strabismus Questionnaire (A&SQ) both measure health-related quality of life in strabismus patients. We evaluated to what extent these instruments cover similar domains by identifying the underlying quality-of-life factors of the combined questionnaires. Methods: Participants were adults from a historic cohort with available orthoptic childhood data documenting strabismus and/or amblyopia. They had previously completed the A&SQ and were now asked to complete the AS-20. Factor analysis was performed on the correlation-matrix of the combined AS-20 and A&SQ data to identify common underlying factors. The identified factors were correlated with the clinical variables of angle of strabismus, degree of binocular vision, and visual acuity of the worse eye. Results: One hundred ten patients completed both questionnaires (mean age, 44 years; range, 38–51 years). Six factors were found that together explained 78% of the total variance. The factor structure was dominated by the first four factors. One factor contained psychosocial and social-contact items, and another factor depth-perception items from both questionnaires. A third factor contained seven items—only from the AS-20—on eye strain, stress, and difficulties with reading and with concentrating. A fourth factor contained seven items—only from the A&SQ—on fear of losing the better eye and visual disorientation, specific for amblyopia. Current visual acuity of the worse eye correlated with depth-perception items and vision-related items, whereas current binocular vision correlated with psychosocial and social-contact items, in 93 patients. Conclusions: Factor analysis suggests that the AS-20 and A&SQ measure a similar psychosocial quality-of-life domain. However, functional problems like avoidance of reading, difficulty in concentrating, eye stress, reading problems, inability to enjoy hobbies, and need for frequent breaks when reading are represented only in the AS-20. During the development of the A&SQ, asthenopia items were considered insufficiently specific for strabismus and were excluded a priori. The patients who generated the items for the AS-20 had, in majority, adulthood-onset strabismus and diplopia and were, hence, more likely to develop such complaints than our adult patients with childhood-onset strabismus and/or amblyopia

The effect of prolonged monocular occlusion on latent nystagmus in the treatment of amblyopia

We recorded eye movements in 5 patients with latent nystagmus (LN) before and after 2 days of occlusion of the better eye. The slow-phase speed of the nystagmus (SPS) was in general, before occlusion, lower when the better eye fixated but, after occlusion, lower when the worse eye fixated. However, the sum of SPS during right fixation and SPS during left fixation remained constant. Oscillopsia complaints gradually disappeared during the period of occlusion. These findings indicate that the difference between the SPS during fixation with the right eye and the SPS during fixation with the left eye in LN patients is caused by a compensatory drift that decreases LN during fixation with the better eye but increases LN during fixation with the worse eye. During occlusion, this compensatory drift changes its direction and magnitude slowly over days. Hence, occlusion of the better eye in children with amblyopia and LN should be prescribed only in days per week, not in hours per day

An orbital fistula complicating anaerobic frontal sinusitis and osteomyelitis

A patient is described with an orbital fistula complicating frontal sinusitis and osteomyelitis of the frontal bone. The fistula was excised, but a fortnight later an acute exacerbation occurred. From the discharging pus a Staphylococcus aureus was cultured and from mucosa obtained during surgery a microaerophilic Streptococcus. These findings led to the diagnosis: synergistic bacterial inflammation of the frontal sinus, with osteomyelitis and orbital cellulitis

Why did Donders, after describing pseudotorsion, deny the existence of ocular counterrolling together with Ruete, Volkmann, von Graefe and von Helmholtz, until Javal reconfirmed its existence?

After the rapid spread of strabismus surgery by total tenotomy, which had been proposed by the orthopedist Louis Stromeyer from Göttingen in 1838 and performed by the plastic surgeon Johann Friedrich Dieffenbach on October 26th and by the ophthalmologist Florent Cunier on October 29th, 1839, brilliant researchers studied the physiology of eye movements, resulting in the laws by Franciscus Cornelis Donders on pseudotorsion in tertiary positions of gaze and by Johann Benedict Listing that each eye position can be reached by rotation about an axis perpendicular to the primary and the new position of gaze. John Hunter had first described ocular counterrolling (OCR) with head tilt in 1786. The anatomist Alexander Friedrich von Hueck inferred from anatomical studies, however, that up to 28.6° OCR would be possible onhead-tilt to right or left shoulder in 1838, and estimated his own OCR seen in a mirror at approximately 25°. Donders, Christian Georg Theodor Ruete, Alfred Wilhelm Volkmann, Albrecht von Graefe and Hermann von Helmholtz subsequently denied the existence of OCR for many years and thought that only pseudotorsion existed. Louis Emile Javal had myopia and astigmatism, and he re-established the existence of OCR in 1867 when he noticed that, on head tilt to either shoulder, the axis of astigmatism of his eyes no longer coincided with the axis of astigmatism of his glasses