[Atypical tonic pupil as a complication of chickenpox infection]

A case of internal ophthalmoplegia associated with varicella zoster

The authors report a case of internal ophthalmoplegia in a 5-year-old boy presenting after primary varicella infection. This is an uncommon and mostly irreversible ocular manifestation after chickenpox. The internal ophthalmoplegia showed a potential mild improvement with oral acyclovir. Consideration should be given to starting treatment on presentation in such cases.

[Unilateral isolated partial third nerve palsy and sphenoiditis in a child: A case report]

We report a case of unilateral mydriasis associated with sphenoid sinusitis and mucocele in a child. An 11-year-old girl with a history of unilateral mydriasis was referred for ophthalmologic examination. She complained of a mild headache over the past four days. The right pupil was dilated and nonreactive to light. The left pupil was normal and reactive. There was no ptosis or other focal neurological deficit. She was orthotropic. Visual acuity in both eyes, ocular motility and fundi were normal. Magnetic resonance imaging (MRI) showed a sphenoid sinus mucocele with sphenoiditis. The diagnosis was partial third nerve palsy without ophthalmoplegia. Treatment with antibiotics was initiated and led to complete resolution of the mydriasis. Sphenoid sinus mucoceles are relatively rare. Failure to diagnose and treat can lead to serious neurologic sequellae such as third nerve palsy, compressive optic neuropathy, cavernous sinus thrombosis, meningitis or brain abscess. Head imaging by reconstructed CT and MRI can lead to the diagnosis of mucocele. Isolated unilateral mydriasis as a sign of third nerve palsy may be caused by a slowly enlarging lesion. In a child with isolated unilateral mydriasis, head MRI should be performed to rule out a compressive lesion of the oculomotor nerve.

Isolated unilateral mydriasis with delayed oculomotor nerve palsy secondary to intracranial arachnoid cyst

A 16-month-old boy presented with isolated unilateral mydriasis. Fourteen months after initial presentation, he developed an acute oculomotor nerve palsy. His initial computed tomography scan, with contrast, was normal. Subsequent magnetic resonance imaging revealed an enlarging arachnoid cyst at the exit of the oculomotor nerve from the midbrain. Isolated unilateral mydriasis may be caused by a slowly enlarging lesion, which is easily missed on neuroimaging.

Delayed internal ophthalmoplegia and amblyopia following chickenpox

INTRODUCTION

Chickenpox can be responsible for various ophthalmologic complications [4].

DISCUSSION

An internal ophthalmoplegia could be observed in this context and is responsible for a fixed pupil [2]. This complication is extremely rare and seems to occur mainly in young children during the two weeks following cutaneous eruption. We report an atypical observation of internal ophthalmoplegia due to chickenpox that occurs with a particularly prolonged interval.

CONCLUSION

We would like to emphasize the consequences of the paralysis of accommodation associated with this tonic pupil on visual acuity.

Reversible posterior leukoencephalopathy and Adie's pupil after measles vaccination

Reversible posterior leukoencephalopathy syndrome is an increasingly recognized disorder with typical radiologic findings of bilateral gray- and white-matter abnormalities in the posterior regions of the cerebral hemispheres. The majority of patients with reversible posterior leukoencephalopathy syndrome are adults, and it is rare in children. Previously reported associations of reversible posterior leukoencephalopathy syndrome include hypertension, vasculitis, nephrotic syndrome, severe hypercalcemia, hemolytic uremic syndrome, eclampsia, renal failure, and use of immunosuppressive drugs. Adie's pupil is described as the presence of a large unilateral or bilateral tonic pupil related to virus infections or trauma. In this article, we describe a case of reversible posterior leukoencephalopathy and Adie's pupil association that occurred after measles vaccination. To our knowledge, this association has not been reported.

Klassifikation biomedizinischer Forschungsberichte als Grundlage evidenzbasierter Medizin in der Augenheilkunde

BACKGROUND

Evidence-based medicine requires careful appraisal of published data derived from experimental and clinical studies. Based on classification of biomedical research reports, evidence levels can be determined and recommendations for therapeutic decisions can be made.

METHODS

A classification system for clinical studies was developed. It was evaluated in classifying the reports published in Der Ophthalmologe during 2003-2004 (study design: descriptive cross-sectional study, case series).

RESULTS

In the 2-year interval, 70 longitudinal and 95 cross-sectional studies were published. The vast majority of the longitudinal studies were interventional cohort studies. Not considering case reports, 73% of the original articles were longitudinal prospective studies, 1% were retrospective (case-control) studies, and 26% were cross-sectional studies.

CONCLUSIONS

The study design of all published articles could be classified using the classification system. This classification system proves to be applicable in the context of clinical studies in ophthalmology and may be helpful in the process of critical appraisal of the literature and synthesis of clinical evidence and an evidence-based recommendation.

Kranielle Bildgebung und Serologie bei Pupillotonie nicht hilfreich

BACKGROUND

Tonic pupil (TP) is a common disorder of parasympathetic innervation. In contrast to textbook recommendations, cranial imaging is still being performed in most of the patients with TP. The intention of the present study is to show that cranial imaging is of no benefit.

PATIENTS AND METHODS

The medical records of 33 patients with TP were analyzed retrospectively. All patients had undergone a complete ophthalmological, orthoptic, and neurological investigation. Cranial imaging was performed by computed tomography or magnetic resonance imaging. Serology tests were carried out in some of the patients.

RESULTS

Diagnostic imaging provided no additional data revealing the underlying cause of TP.

CONCLUSIONS

Cranial imaging in isolated tonic pupil is not helpful. Because of therapeutic implications, diagnostic evaluation can be recommended only in patients older than 50 years to exclude giant cell arteritis and syphilis.