Spasm of the near reflex has been characterized as the variable appearance of pseudomyopia, convergent strabismus and miosis. These characteristics may appear together or separately. In addition, abnormalities of accommodation may appear not only as pseudomyopia, but may also be manifest in cases with significant hypermetropia in which the patient is unable to relax accommodation even when plus lenses are used. The intent of this review is to identify the various clinical presentations of anomalies of the entire near reflex as well as the component parts. The relationship to functional and organic disorders are discussed as well as the related neuroanatomy. We suggest that one may more readily understand the clinical manifestations as a spectrum of anomalies of the near reflex rather than a multitude of disconnected entities.

Accommodation, Ocular↗

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Current indications and techniques in evaluating inflammatory disease and neoplasia of the sinonasal cavities.

Imaging strategies of the sinonasal cavities have undergone extensive revision over the last 5-year period. The traditional imaging examination of the paranasal sinuses, plain film radiography, does reasonably well in diagnosing maxillary, frontal, and sphenoid sinusitis. However, it less reliable in depicting abnormalities in the ethmoid sinuses, the most common area first affected with inflammatory disease. Compared with sinus computed tomography (CT), plain films prove to be less specific and sensitive in depicting the extent of sinus abnormalities. One series plainly concluded that sinus radiographs were not reliable enough to be an integral part of the clinical decision process. The use of plain radiographs of the sinuses has clearly been reduced by medical cost-containment concerns, replacement by superior techniques, and by clear weaknesses of the modality. Although it is inexpensive and easily accessible, the low sensitivities and inaccuracies of plain film radiography have resulted in the current use of CT and high-field-strength (1.5 Tesla) magnetic resonance imaging (MRI). By using this cross-sectional imaging, we now visualize directly the pathologic conditions within the sinuses, as well as the normal anatomy. We discuss current use of diagnostic imaging in the evaluation of patients with nasosinusoidal complaints (most commonly resulting from acute and chronic inflammatory disease), with complications of sinonasal inflammatory disease, and with suspected/documented neoplasia. In addition to developing an imaging algorithm to provide the information affecting clinical decision making, we detail the specific imaging techniques necessary accurately to obtain that information. We also review the specific concerns about imaging patients in the intensive care unit and touch on several emerging imaging techniques. The imaging workup in pediatric patients and patients with congenital anomalies is beyond the scope of this review.

Algorithms↗

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CT-guided percutaneous drainage of syringomyelia.

PURPOSE: Our purpose is to describe CT-guided percutaneous drainage of syringomyelia as a possible contribution in patient management. METHOD: CT-guided percutaneous drainage was performed on three patients with symptomatic syringomyelia. We determined the success of percutaneous decompression by subsequent CT and MRI. The effect of syringomyelia decompression in relation to the patient's symptoms was determined. This information was then used to help guide clinical management. RESULTS: In Case 1, percutaneous drainage of a large syrinx in a C5 quadriplegic patient with increasing lower extremity spasticity demonstrated significant decompression by imaging but did not result in clinical improvement. A surgical procedure to decompress the syrinx was not performed on the basis of this information. In Case 2, percutaneous drainage of a large syrinx in a quadriplegic patient with increasing upper extremity numbness and weakness demonstrated significant decompression by imaging and resulted in sustained clinical improvement, temporarily obviating the need for surgery. In Case 3, percutaneous drainage of the rostral aspect of a septated syrinx cavity in a patient with a Chiari I malformation and a syringoperitoneal shunt in place resulted in decompression by imaging but failed to relieve the patient's newly developed symptoms. An additional shunt was therefore not placed. In no case did the patient experience periprocedural complications or worsening of symptoms. CONCLUSION: CT-guided percutaneous drainage of syringomyelia is a safe and successful technique. It can be used diagnostically to identify patients that may or may not benefit from surgical syrinx decompression and in some cases may provide a temporary therapeutic alternative to surgery.

Adolescent↗

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Modification of temporal approach to superior oblique tenotomy.

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Humans↗

PubMedDate not supplied

Treatment of chronic sixth nerve palsy.

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Abducens Nerve↗

PubMedDate not supplied

Lincoln's vertical strabismus.

BACKGROUND: The vertical strabismus manifested by Abraham Lincoln has been noted. This article reviews the historical findings and provides a specific diagnosis. MATERIALS: Previous reports of symptoms and history relating to Lincoln's left hypertropia were reviewed. A series of photographs were reviewed. Lincoln's own description of his symptoms is provided. RESULTS: Previous history indicates an intermittent left hypertropia. A family history of vertical strabismus was noted with regard to Mr Lincoln's cousin. There also is a history of trauma to the left frontal area and life-mask evidence of fracture over the left eye. The findings include a history of head tilt and diplopia, presumably most readily in downgaze. CONCLUSION: Given the history and findings, the diagnosis of left superior oblique paresis of either congenital or traumatic origin seems appropriate.

Famous Persons↗

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Treating amblyopia.

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Adolescent↗

PubMedDate not supplied

Bilateral Duane's syndrome.

Two cases with bilateral Duane's Syndrome are presented. Both showed immediate large angle exotropia following bilateral medial rectus recession for esotropia. In both cases, the forced duction test was then found to be positive in adduction and negative after disinsertion of the lateral rectus. It is suggested that both the medial rectus muscles and lateral rectus muscles are tight in bilateral Duane's Syndrome and that seemingly simultaneous recession of the medial and lateral rectus muscles would be indicated.

Adolescent↗

PubMedDate not supplied

Abnormal eye movements in rubella syndrome.

A patient with a characteristic picture of rubella eye disease is presented. Its interest lies in the associated finding of asymmetric nystagmus and ocular flutter. The presence of flutter would indicate cerebellar or cerebellar pathway disease, a previously unassociated finding.

Cataract↗