Biomedical subjects
Publications and source records attributed to Z F Pollard.
Eleven cases of inferior oblique palsy are presented. The benign nature of this entity is stressed. The etiologies of this group were congenital, trauma, and presumed vascular. No cases of CNS tumor, infection, or myasthenia gravis were seen. All of these patients have been followed for at least six months, and some for four years, without any other major illness presenting other than the inferior oblique palsy.
Twenty-one patients with bilateral superior oblique palsy were studied in order to classify them into five major categories. By classifying the presentations, an orderly approach to the diagnosis as well as the treatment of bilateral superior oblique palsy is made.
A study of 15 patients with secondary angle-closure glaucoma associated with advanced cicatricial retrolental fibroplasia is presented. Eight patients developed glaucoma acutely, while 7 showed a chronic course. In four patients the fellow eye became involved acutely within 1 month of the first eye. Seven others were also bilateral, but on a chronic basis. Twelve of the 15 presented after age 2. All were treated with lensectomy which cured the glaucoma. All have extremely poor vision in the range of light perception to hand motion, but have retained their eyes on a pain-free basis.
Posterior lenticonus usually occurs sporadically and only in one eye. However, in three families bilateral posterior lenticonus occurred in more than one member. When the defect appears bilaterally, genetic counseling should be considered to educate the family about the possibility that future offspring might have this disorder.
The involved pupil in the syndrome of aberrant regeneration of the oculomotor nerve usually remains larger than the uninvolved side, or approaches equality in size. A 4-year-old child was seen with congenital aberrant regeneration of the right third nerve. The right pupil was consistently smaller than the left, but particularly so in dim illumination. The question can be raised as to whether relative pupillary miosis more commonly follows third nerve misdirection in children than adults.
Ten cases of asymmetry in retrolental fibroplasia vary from patients with unilateral to those with bilateral involvement. In the bilateral cases, one eye was always more severely affected. This article encourages the treatment of amblyopia when present in patients with retinopathy of prematurity.
Ocular abnormalities similar to those usually found in patients with vitiligo occurred in nine patients with alopecia areata and one patient with poliosis. Exophthalmos, iris color change, discrete depigmentation, and, frequently, associated pigment hyperplasia of the choroid and retinal epithelium were found in the ten patients. Four patients had had a bilateral iris color change from dark brown to blue-green. Hypogonadism, thyroid disease, and poliosis may frequently be associated with pigmentary disturbances of the eye, as well as hair loss. Testicular dysfunction with oligospermatism to aspermatism, hypoandrogyny, hyperretractable testes, and epididymal cyst is reported. Two patients had unilateral and one patient had bilateral testicular atrophy.
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It has been shown that the diagnosis of ocular Toxocara canis is highly accurate when the typical clinical findings are associated with a positive ELISA titer in the serum of 1:8 or greater. The inflammatory reaction in this disorder can be devastating and not infrequently leads to a tractional detachment of the posterior pole or a rhegmatogenous detachment and/or a progressive cyclitic membrane leading to phthisis bulbi. We have recently performed vitreoretinal surgery on 17 patients with complications secondary to ocular T canis. Fifteen patients had stability or improvement in visual acuity, and one patient had a decrease in visual acuity. There were no surgical complications present. The clinical features, operative techniques used, and postoperative course are summarized, and the indications for the used of various surgical procedures are presented.
Five patients had cicatricial retrolental fibroplasia with a complication of secondary angle-closure glaucoma. In all the patients, the glaucoma occurred after age 2 years. All were treated with a pars plana lensectomy and anterior vitrectomy, which alleviated the glaucoma. They all achieved normal intraocular pressure and a pain-free eye. However, visual acuity was poor, in the range of light perception to hand motions. All patients have been followed up for one year and in only one patient has the fellow eye developed secondary angle-closure glaucoma.
A case of superior oblique paresis is presented which appeared to be due to cautherization of the superior oblique tendon. The torsional diplopia and head tilt were corrected with recession of the contralateral inferior rectus muscle.
Twenty-four patients with serologically confirmed toxocaral ocular larva migrans (OLM) and 24 age- and sex-matched controls were the subjects of an epidemiologic study. Information on the exposure to dogs and other factors possibly associated with transmission of toxocariasis was obtained by contacting the parents of the subjects. The odds of having had a dog present in the household within the year previous to onset of illness were 3 to 1 for cases vs controls. An association of pups (< 3 months) in the households of OLM patients within one year of onset was statistically significant (P < .05). Twenty-three of 24 OLM patients had had dogs in their homes some time before their illness, and the twenty-fourth patient had a history of geophagia, a behavioral pattern previously identified as a risk factor for toxocariasis. Exposure to cats and other animals in or outside the home did not differ for patients and controls. Infected dogs, especially pups, in the patients' homes were the most probably sources of infection for this group of OLM patients.
To my knowledge this study of two families with ocular Toxocara is the first in the literature to report involvement of more than one sibling. All four children had far-advanced disease with irreversible loss of macular vision in the affected eye. The clinical findings were confirmed by the ELISA test. With laboratory confirmation of the clinical findings, I expect to find not only more patients in the population at large with ocular Toxocara, but also expect to find numerous siblings in a particular family to be involved as well. Therefore, when ocular Toxocara is found in a child, every sibling in the family should be examined. Just as the young child with amblyopia does not complain of decreased vision, even so the young child with ocular Toxocara often will not complain of any visual problems.
The enzyme-linked immunosorbed assay test was positive in 37 of 41 patients (90%) suspected of having clinical Toxocara infections. The antigen used in this test is prepared from the Toxocara egg and is felt to be extremely specific in making the diagnosis. The prevalence of Toxocara infection is much greater than previously believed. It is hoped that this test will help the surgeon fell more secure in not enucleating eyes containing masses suggestive of Toxocara infection.
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Three cases of congenital euryblepharon are presented. In these cases, horizontal width of the eyelid margin is abnormally increased in comparison to the globe and orbit. The 3 cases were all different. One case had involvement of all 4 lids. Another had unilateral involvement of upper and lower eyelids. A third case had bilateral lower lid involvement associated with other anomalies. The additional anomalies which have not been previously reported include a double row of meibomian gland orifices and an extreme lateral displacement of the lower canaliculus and punctum. All cases had varying degrees of vertical shortage of skin in the involved lids leading to lagophthalmos with a mild to moderate exposure keratitis. A review of previously reported cases of euryblepharon is made. The types of surgical procedures used to correct the deformities are discussed.
Nineteen patients with A pattern exotropia and 1 with A esotropia, all of whom had marked overacting superior oblique muscles bilaterally, were evaluated surgically. Nine with A exotropia and 20 prism diopters or less in the primary position were treated only with bilateral superior oblique tenectomy. Very little correction occurred in the primary position while an average correction of 35 prism diopters occurred in downgaze. Eleven patients with at least 25 prism diopters of deviation in the primary position were treated with bilateral superior oblique tenectomy in addition to horizontal rectus muscle surgery at the same sitting. A routine amount of horizontal surgery was performed with good results without regard for any effect which superior oblique tenectomy might cause in the primary position. This is a safe method for planning surgery in A patterns as abduction by the superior oblique muscles occurs mainly in downgaze.
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