Evolution of optic nerve and retina alterations in a child with indirect traumatic neuropathy as assessed by optical coherence tomography

Herein, we describe the case of a 4-year-old child with indirect traumatic optic neuropathy and serial changes of the optic nerve head and retinal nerve fiber layer (RNFL) documented using optical coherence tomography (OCT). Visual acuity improved despite progressive RNFL thinning and optic disc pallor. We concluded that OCT may be useful for monitoring axonal loss but may not predict the final visual outcome.Univ Miami, Miller Sch Med, Bascom Palmer Eye Inst, Dept Ophthalmol, 900 NW 17th St, Miami, FL 33136 USAUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, BrazilWeb of Scienc

The quest for effective pain control during suture adjustment after strabismus surgery: a study evaluating supplementation of 2% lidocaine with 0.4% ropivacaine

PURPOSE: To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures. METHODS: Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points. RESULTS: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7). CONCLUSION: We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery

Don't Miss This! Red Flags in the Pediatric Eye Exam: Blurred Disc Margins

Evaluating a patient with blurred optic disc margins, particularly a child, and establishing a diagnosis can be a demanding task. We aim to review the differential diagnosis of blurred disc margins, identify the clinical characteristics of a swollen optic disc, discuss imaging modalities used in the evaluation of the optic nerve head as tools for formulating a diagnosis, and identify red flags that may indicate a serious disorder

Clinical Importance of the Inferolateral Trunk

The inferolateral trunk (ILT), which most often arises from the intracavernous internal carotid artery (ICA), can supply cranial nerves III, IV, V, and VI. It is recognized that the ILT anastomoses with branches of the internal maxillary artery, providing a conduit for emboli arising from the external carotid artery (ECA)

11.9 - Paralytic Strabismus

Paralytic strabismus results from damage to one or more of the motor nerves to the extraocular muscles, which include the third, fourth, and sixth cranial nerves. This type of strabismus requires accurate diagnosis because it may be associated with neurological disease and may necessitate further investigation. Treatment of paralytic strabismus is challenging because ocular rotations are limited, causing the misalignment to vary in different directions of gaze. The goals of treatment are to attain good ocular alignment in the primary position and downgaze, improve the incomitance, expand the field of single binocular vision, and improve compensatory head postures. This chapter discusses the manifestations, epidemiology, pathogenesis, and treatment of paralytic strabismus

Efficacy and Complications of Radiotherapy of Anterior Visual Pathway Tumors

A progressive disturbance in visual acuity or visual field, along with an unexplained optic nerve atrophy, suggests the possibility of a tumor. Tumors that frequently affect the anterior visual pathway include primary optic nerve sheath meningiomas, intracranial meningiomas, optic gliomas, pituitary tumors, and craniopharyngiomas. The location of these tumors sometimes prohibits a complete surgical excision that might jeopardize the visual system. Radiation therapy, however, can be beneficial in these cases. This article reviews the indications for radiotherapy of tumors that involve the anterior visual pathway, along with the possible complications. Cases that present the effect of radiation therapy and radiation damage are presented