Uniplanar nystagmus associated with perceptual and cognitive visual dysfunction due to presumed focal ischemic occipital cortical atrophy: a missed diagnosis and new observation

Uniplanar nystagmus has been described in relation to pathology of the brain stem, retina, optic nerve, sensory visual deprivation, periventricular leucomalacia, and drug toxicity. This paper describes a case of uniplanar nystagmus associated with features of higher visual dysfunction and a presumed focal insult to the occipital lobes following an episode of neonatal apnea

Need for diurnal variation of intraocular pressure testing in eyes with pseudoexfoliation

INTRODUCTION: Glaucoma is the second leading causes of blindness globally today.[1] In India it is the third most common cause of blindness. It is estimated that glaucoma affects 12 million in India and is responsible for 12.8% of the blindness in the country. Glaucoma affects people of all ages producing serious health and economic consequences. In nearly all cases blindness from glaucoma is preventable if the disease is detected early and proper treatment is implemented. AIM: 1. To record the diurnal variation in intraocular pressure in eyes with pseudoexfoliation syndrome. 2. To record the disc findings and visual fields in eyes with pseudoexfoliation syndrome. 3. To determine the usefulness of diurnal measurement of intraocular pressure compared to initial intraocular pressure in diagnosing pseudoexfoliation glaucoma. 4. To document the outcome of cataract surgery in patients with pseudoexfoliation in terms of intraocular pressure, disc appearance, visual improvement and field testing. 5. To use the above data to determine, if possible, the effect of cataract surgery on intraocular pressure in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. MATERIALS AND METHODS This study was conducted in the Department of Ophthalmology, Christian Medical College from March 2005 to June 2006. TYPE OF STUDY: Prospective cohort study INCLUSION CRITERIA: All patients found to have pseudoexfoliation in one or both eyes on presentation, with or without evidence of glaucoma. EXCLUSION CRITERIA: Patients were excluded from the study if any one or more of the following was present: 1. Any patient who had previously undergone any intraocular surgery in the eye with pseudoexfoliation. 2. Any patients on anti-glaucoma medications or on topical or systemic steroids. 3. Any patient with a history of ocular trauma or a documented history of uveitis. 4. Any other ocular pathology apart from age-related cataract that could contribute to development of a secondary glaucoma, eg corneal scars suggestive of suppurative keratitis. CONCLUSIONS: 1. Recording diurnal variation of intraocular pressure in eyes with pseudoexfoliation does not provide any additional benefit compared to the initial presenting IOP. 2. Initial intraocular pressure recording is sufficient to diagnose glaucoma in eyes with pseudoexfoliation. Disc changes may provide an additional indication of advanced glaucoma. 3. Visual field recordings in patients with pseudoexfoliation presenting to an ophthalmology OPD were found to be unreliable due to the profound drop in visual acuity caused by cataract. 4. Cataract surgery was not shown to have any effect on intraocular pressure in eyes with pseudoexfoliation

Asymptomatic Intracorneal Graphite Deposits following Graphite Pencil Injury

Reports of graphite pencil lead injuries to the eye are rare. Although graphite is considered to remain inert in the eye, it has been known to cause severe inflammation and damage to ocular structures. We report a case of a 12-year-old girl with intracorneal graphite foreign bodies following a graphite pencil injury

Setting up of a cerebral visual impairment clinic for children: Challenges and future developments

Aim: The aim of this study is to describe the setting up of a cerebral visual impairment (CVI) clinic in a tertiary care hospital in South India and to describe the spectrum of cases seen. Materials and Methods: The CVI clinic, set up in February 2011, receives interdisciplinary input from a core team involving a pediatrician, neurologist, psychiatrist, occupational therapist, pediatric ophthalmologist, and an optometrist. All children, <18 years of age, with cerebral palsy (CP), learning disability, autism, neurodegenerative diseases, and brain trauma are referred to the clinic for functional vision assessment and opinion for further management. Results: One thousand four hundred and seventy-eight patients were seen in the CVI clinic from February 2011 to September 2015. Eighty-five percent of the patients were from different parts of India. In the clinic, 61% had CP, 28% had seizure disorders, autism was seen in 9.5%, and learning disability, neurodegenerative conditions, and brain injury together constituted 1.5%. Most of the children (45%) had moderate CP. Forty percent of CVI was due to birth asphyxia, but about 20% did not have any known cause for CVI. Seventy percent of patients, who came back for follow-up, were carrying out the habilitation strategies suggested. Conclusions: Average attendance of over 300 new patients a year suggests a definite need for CVI clinics in the country. These children need specialized care to handle their complex needs. Although difficult to coordinate, an interdisciplinary team including the support groups and voluntary organizations is needed to facilitate the successful implementation of such specialized service

Comparison of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection versus topical steroids for treatment of postcataract surgery inflammation in children

BACKGROUND: The aim of this study is to compare the clinical efficacy of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection with postoperative topical steroids in controlling intraocular inflammation in uncomplicated pediatric cataract surgery. MATERIALS AND METHODS: A prospective comparative study of children (<13 years of age) undergoing cataract surgery in a tertiary care eye center in South India. Preoperative evaluation was similar in both groups. The surgical procedure was the same for both groups except at the end of surgery only Group 1 (right eye of bilateral cataracts and all unilateral cataracts) received intraoperative 0.5 ml (40 mg/ml) posterior sub-Tenon's injection of triamcinolone acetonide. Postoperatively, Group 1 was administered only topical antibiotic and Group 2 was put on topical antibiotic, mydriatic, and steroids. Intraocular inflammation and intraocular pressure (IOP) were assessed clinically on day 1, 1st week, 1st month, and 3 months, postoperatively. RESULTS: A total of 30 eyes were included in the study. Age ranged between 1 month and 132 months, with 18 eyes included in Group 1 and 12 eyes in Group 2. The mean postoperative IOP at the 3 months follow-up was not significantly different between groups (P = 0.4). The presence of intraocular lens had no role in postoperative inflammation (P = 1). Group 2 showed more anterior segment inflammation with six eyes (50%) developing posterior synechiae and distortion of the pupil 3 months postoperatively. CONCLUSION: In pediatric cataracts, a single intraoperative sub-Tenon's capsule injection of triamcinolone acetonide appears to be safe and effective in controlling postcataract surgery inflammation

Pediatric Balint’s syndrome variant: A possible diagnosis in children

Balint’s syndrome is well described in adults, but not in children. It is caused by bilateral posterior parietal lobe damage and comprises a triad of simultanagnosia (inability to simultaneously see more than a small number of items), optic ataxia (impaired visual guidance of movement of the limbs and body), and apraxia of gaze (inability to volitionally direct gaze despite the requisite motor substrate) often associated with homonymous lower visual field loss. We, here, describe five children (four males, one female; mean age 7.4 years, [range 4−11 years]; birth weight ≤ 2.5 kg; four were born ≤ 36 weeks of gestational age and one at 40 weeks) who presented to the Cerebral Visual Impairment Clinic at a tertiary care center in South India with clinical features remarkably consistent with the above description. In all children neuroimaging showed bilateral parietooccipital gliosis with regional white matter volume loss and focal callosal thinning, consistent with perinatal hypoxic ischemic encephalopathy and possible neonatal hypoglycemia

Spectrum of ocular firework injuries in children: A 5-year retrospective study during a festive season in Southern India

Purpose: Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them. Materials and Methods: A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days - the day of Diwali, 1 day before, and 1 day after Diwali - were included in this study. Results: Eighty-four children presented with firework-related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty-four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval - 2-13%). Conclusion: Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of  protective eyewear should be considered

A Validation of an Examination Protocol for Cerebral Visual Impairment Among Children in a Clinical Population in India.

INTRODUCTION: Cerebral Visual Impairment (CVI) is a leading cause of vision impairment in developed and developing countries due to and increased survival of preterm and low birth weight infants. There are few data concerning the validity of protocols available to diagnose CVI. AIM: This study aimed to document the face, content and construct validity of an assessment protocol namely, a 15-domain, Structured Clinical Question Inventory (SCQI), which is based on structured history taking and clinical examination, for the diagnosis of CVI in a clinical population of India. MATERIALS AND METHODS: This study was a retro-spective chart analysis of all children below the age of 18years, referred to the CVI clinic of a tertiary care teaching hospital in Southern India from March 2011-Feb 2012. Clinical case-notes including the SCQI findings of all children referred to the clinic were reviewed. The data were extracted after Institutional Review Board approval. STATISTICAL ANALYSIS: Pearson correlation coefficient, Cronbach's alpha and exploratory factor analysis were used to document the content and construct validity of the examination protocol. RESULTS: A total of 342 children (35.7% male, 64.3% female), with a mean age of 3.8 years (range 0-17 years, the median was 3 years) were included in the study and their data were examined. The internal consistency of the SCQI was 0.93 suggesting it as an excellent tool to characterise and profile CVI and a 2-factor model (Dorsal Stream Dysfunction and Ventral Stream Dysfunction) based on a biologically plausible model explained 63% of the variance. CONCLUSION: The results of using the SCQI affirm published data and endorse a theoretical construct similar across cultures. The potential diagnostic accuracy, reliability and utility of this measure for CVI needs to be studied further. The clinical use of a short version of the SCQI may be helpful to contribute to the identification of CVI, especially for middle and low-income countries