Biomedical subjects
Publications and source records attributed to R D Harley.
Infants with capillary hemangiomas of the eyelid are at risk for amblyopia and strabismus. Several methods of treating these tumors have been associated with complications and limitations. The use of intralesional corticosteroid injections has been demonstrated to be a simple, safe, and effective method of treating capillary hemangiomas of the eyelid.
In some patients, weakening procedures on the superior oblique muscles may cause a vertical and/or torsional deviation postoperatively. A case is presented to illustrate this point with suggestions to help identify these patients preoperatively to avoid this pitfall.
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Included in the discussion is the management of anomalies of abnormal formation of the lid folds, disorders of differentiation of the lid margins, and disorders of tissue differentiation. Also discussed are lid involvement with bacterial lesions and viral diseases.
Discussed is the treatment of a variety of conditions that affect the structures responsible for the production and drainage of tears.
An unusual age of presentation of cyclic strabismus, which became constant in a relatively short period of time without a previous history of surgery, trauma, or strabismus, is reported. The mechanism of cyclic strabismus is still unknown; however, most cases are treated successfully with strabismus surgery. Cyclic strabismus is distinct from other rhythmic diseases in that peripheral manipulation of the target organ results in resolution of the deviation.
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The results of a retrospective study of the etiologic incidence of all cases of third fourth, and sixth nerve palsies in patients at Wills Eye Hospital and St Christopher's Hospital are reported. A total of 121 patients ranging in age from birth to sixteen were studied. Thirty-two cases of third nerve palsy, eighteen cases of fourth nerve palsy, and sixty-two cases of sixth nerve palsy were identified in this series. Nine additional cases illustrated combinations of multiple nerve involvement. With few exceptions, acquired third nerve palsy in children is an ominous sign whereas the congenital form is generally indicative of developmental anomaly or birth trauma. Acquired sixth nerve palsy in a child is always a matter of concern since it may represent the first sign of a brain-stem glioma. Active force studies may be carried out periodically to assess the speed of recovery and indicate when it is time to initiate a more aggressive role in the surgical management. The surgical results in children with paralytic strabismus that have been carefully evaluated offer a favorable prognosis.
Congential fibrosis of the extraocular muscles is characterized by the replacement of normal contractile muscle tissue by fibrous tissue or fibrous bands in varying degrees. The clinical entities which result from the fibrous replacement can be classified under the following headings: general fibrosis syndrome, congenital fibrosis of the inferior rectus muscle with blepharoptosis, strabismus fixus, vertical retraction syndrome and congential unilateral fibrosis, enophthalmos and blepharoptosis. Genetic factors may or may not be apparent. One pedigree with general fibrosis syndrome was traced through five generations. Light and electron microscopy demonstrated replacement of normal muscle by collagen and dense fibrous tissue with occasional areas of degenerated skeletal muscle. The surgical mangement attempts to achieve some functional readjustment of the ocular and lid position as well as the abnormal head posture. The surgical results were considered satisfactory when compared with the original position of the eyes and the backward head tilt.
1. Blunt trauma to the orbital region may result in a blowout fracture, characteristically found in the orbital floor, which may contain herniated orbital contents including both inferior muscles of the eye. Persistent diplopia continues as a problem in a significant number of patients following the surgical management of a blowout fracture of the orbit. 2. Prompt recognition and treatment of blowout fractures exhibiting diplopia is usually successful. Inferior rectus and inferior oblique muscles incarcerated in a blowout fracture site for periods varying from two months to nine years may fail to function properly even following successful release of the entrapped muscles. There is some presumptive evidence to suggest a myogenic or neurogenic cause for such dysfunction. 3. Vertical diplopia that persists beyond three months following release of entrapped muscle tissue requires surgical correction, depending on the degree of vertical dissociation. 4. Motility surgery was required in 18 of 20 cases of persistent diplopia. Multiple muscle combinations are frequently required to achieve success. The criterion for a successful result was elimination of vertical diplopia in the primary and reading positions.
A retrospective study of dermoid cysts in children over the past 13 years at St. Christopher's Children's Hospital of Philadelphia, showed that 37% of the dermoids in the body occurred in the orbital and peri-orbital areas. An unusually high percentage of these occurred in the left eyebrow which appears to be the most frequent location for dermoid cysts in children. Dermoid cysts are a very common lesion encountered by ophthalmologists inasmuch as 3.3% of all ophthalmic surgical procedures in children were performed for dermoids. All 231 cases in this series were benign. The manner and time of presentation of these lesions are discussed as well as the treatment.
Two infants had bilateral congenital corneal clouding and abnormal acid mucopolysaccharide accumulation in a thickened Bowman's membrane. This unusual entity was not associated with acid mucopolysaccharide deposits in the skin and visceral tissues or with increased levels of acid mucopolysaccharide in the urine. The similarity and differences have been compared to the systemic mucopolysaccharidosis and macular corneal dystrophy.
A 3 1/2-year-old white girl presented with unilateral proptosis and an orbital tumor that was diagnosed histopathologically as an unusual form of glioma of the optic nerve. The optic foramen was not enlarged but the ultrasonogram indicated a definite retrobulbar mass.
Persistent diplopia continues as a problem in a significant number of patients following the surgical management of a blowout fracture of the orbital floor even when repaired within 15 days of the traumatic incident. Inferior rectus and inferior oblique muscles which have been incarcerated in a blowout fracture for longer periods have a worse prognosis for adequate functioning postoperatively. There is some presumptive evidence to suggest a myogenic or neurogenic cause for such dysfunction. Experiments with posterior fractures clearly demonstrate that the nerve entering the inferior rectus can be damaged. Vertical diplopia which persists beyond 3 months following release of entrapped muscle tissue requires surgical correction depending upon the degree of vertical dissociation. Motility surgery was required in 18 of 20 patients with persistent diplopia. Multiple muscle combinations were frequently required to achieve success. The criterion for a successful result was elimination of vertical diplopia in the primary and reading position. The elimination of persistent diplopia in association with blowout fractures of the orbit is usually possible even in late treated cases when one uses specific criteria for success. Three cases were considered cured since there was no diplopia in any direction of gaze, while 17 cases developed single binocular vision in the primary and reading positions. In these latter patients, on extreme upward or downward gaze, diplopia could still be demonstrated in all patients, especially when the individuals were specifically requested to look for diplopia.
The Roto-Extractor, designed by Nicholas Douvas, M.D., was used by the authors in 66 eyes for cataracts, secondary membranes, and persistent hyperplastic primary vitreous. The average age of the patients with congenital cataracts was 2.4 years, for traumatic cataracts 16.4 years. The pupil wal cleared well in 63 of these eyes. There was no vitreous to the wound in any of the eyes. Unplanned iridectomies and prolonged inflammation were the major complications.
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