Clinical Study of Concomitant Strabismus.

Background and Objectives: Strabismus is a condition in which there is misalignment of visual axes of two eyes. Concomitant strabismus is a condition in which the angle of deviation is constant in all the directions of gaze. Concomitant strabismus is further classified as convergent, divergent, hyperdeviation and hypodeviation. Major presenting complaints include cosmetic blemish, diminution of vision, asthenopic symptoms like headache, eye strain and diplopia. This study was conceptualized to study the clinical and ophthalmological profile of patients with concomitant strabismus, in order to generate evidence to manage this condition more effectively. Material and Methods : This cross-sectional, observational study was conducted over a period of two years in 120 patients with concomitant strabismus. Ocular history and visual acuity were recorded. Cover, cover-uncover, alternate cover test, Hirschberg test, Krimsky test and examination by synaptophore were done. Refraction and fundus examination was also done. Result: Majority of the patients were under 5 years of age (46.6%) with male to female ratio of 2:3. Convergent squint was more common (71.6%) with majority of patients having moderate degree of deviation (58.8%). Hypermteropia was more commonly associated with squint (65%) more so with convergent squint. Eccentric fixation was present in only 10% of the cases. Conclusion: Convergent concomitant squint is more common type with majority of patients having moderate degree of deviation. Hypermetropia is more commonly associated with concomitant squint. Appropriate refraction and timely intervention can help in preventing amblyopia in young children

Patient with COVID – 19 infection presenting with acute 6th cranial nerve palsy: A case report

We present a case of a 55 year old lady, hypertensive and diabetic who was infected with COVID-19 presenting with acute 6th cranial nerve palsy. The patient was diagnosed with COVID-19 on Sept 01 2020. Seven days later she developed double vision and headache. At that point on complete neurological examination including examination of cranial nerves she was found to have 6th cranial nerve (Abducens) palsy with convergent squint. As the patients cranial nerves were all intact initially it is suspected that her 6th nerve palsy was related to the viral illness. She was assessed by ophthalmologist and neurologist. She underwent MRI scan of the brain to look for other causes of 6th nerve palsy and it was unremarkable. After almost one week of continued inpatient management her diplopia improved but she still complained of intermittent diplopia with convergent squint. Bangladesh Crit Care J September 2020; 8(2): 129-130

Cornelia De Lange Syndrome in Iraq

Background: Cornelia de Lange syndrome is a rare syndrome of highly variable phenotype making a spectrum ranging from classic syndrome with many cardinal features to mild condition few cardinal features. Typically patients with classic syndrome had growth and mental retardation and distinctive facial dysmorphism including thick (bushy) and / or long eyebrows commonly with synophrys, short nose with depressed or concave nasal bridge and/or upturned nasal tip , long or smooth or indistinct philtrum, thin upper lip vermilion and/or downturned corners of mouth, and low set ears. The diagnosis of the syndrome is clinical. Ocular abnormalities that can be associated with Cornelia de Lang syndrome squint, nystagmus, refractive errors, and ptosis. Materials and methods: The occurrence of Cornelia de Lange syndrome has not been reported or well-documented. The first four Iraqi patients (Three boys and one girl) with Cornelia de Lange syndrome are described. The relevant literatures were reviewed with aim of determining the early documentation of the syndrome in the medical literatures. Results: All the patients were sporadic cases and had growth retardation, severe mental retardation with significant developmental delay, thick eye brows with some degree of synophrys, short nose with depressed or concave nasal bridge, and low set ears. All the patients had normal karyotype. One male patient had all of the classical features including long smooth and indistinct philtrum, thin upper lip vermilion, and downturned corners of mouth. The second male patient had a concave nasal bridge that becomes more obvious during crying, nystagmus and bilateral convergent squint. The third boy had milder dysmorphic features. The fourth patient was a girl who was the second of a twin. She had severe growth retardation and was hypotonic with poor head control. She also had bilateral convergent squint, refractive error, and reduction in visual acuity. Conclusion: The first four Iraqi patients with Cornelia de Lang syndrome are reported.

Surgical outcome of strabismus

Introduction: Strabismus is encountered daily by paediatric ophthalmologists and orthoptists in their practice.Strabismus and amblyopia affect 5% of the population. The aim of the study was to determine the surgicaloutcome of strabismus.Methods: It was a prospective study conducted at Nepal Eye Hospital from 2010 to 2011 with the samplesize of 40. Patients undergoing strabismus surgery either for esotropia or exotropia were included in the study.Detailed preoperative and postoperative orthoptic evaluation of all the patients was done apart from the anteriorand posterior segment examination and the surgical outcome was assessed.Results: Forty patients of which 52.5% males and 47.5% females with mean age of 21.025 years underwentstrabismus surgery. Manifest divergent squint was present in 61%, manifest convergent squint in 38% andintermittent squint in 5% of patients. 87.5% underwent 2 muscle surgery, 10% underwent 3 muscle surgeryand 2.5% underwent single muscle surgery. Postoperative deviation for near was 0 ???? in 10%, 2-8 ???? in 37.5%and 10-15???? in 27.5%. Similarly, postoperative deviation for distance was 0???? in 22%, 2-8???? in 27% and 10-15????in 22%. Binocular single vision was present in 50% patients preoperatively and 53% patients postoperatively.Conclusion: Though cosmesis has been improved in most of the patients after strabismus surgery, binocularsingle vision and stereopsis improved in very minimal percentage of patients as the surgery was done after theage of visual maturation in most of the cases. This accentuates the need for strabismus surgery within the yearsof cortical plasticitydoi: http://dx.doi.org/10.3126/mjsbh.v12i2.12921

Convergent Squint- a Symptom Of Thrombosis

Anticoagulative treatment of children has always presented problems due to a lack of generally approved clinical standards. We present the case of a 5 -year-old boy with bilateral convergent strabismus. It was preceded by otitis, which was treated with antibiotics for a few days before admission to hospital. In the last two days before admission his condition worsened, he complained of a headache and started vomiting. In neurological examination on the second day of his stay, the boy presented with decreased spontaneous activity and hypersomnia. This muscle tone, reflexes were decreased and he had, poor motor coordination. There were no abnormal reflexes and cerebellar testing showed no aberrations. There was 1 cm nuchal rigidity. Examination of cranial nerves showed sixth nerve palsy on both sides. Ophtalmological examination revealed bilateral papilledema. Neuroimaging showed thrombosis of the transverse and sigmoid sinus. A lumbar puncture was not performed because anticoagulative treatment, had been started. The final diagnosis was: bilateral sixth nerve palsy due to sinovenosous thrombosis as a complication of otitis in a patient with a genetic disorder The patient received anticoagulative, antiinflammatory, antibiotic and anti - edemal treatment. He responded to therapy, showing clinical improvement followed by normalisation in neuroimaging. On examination after 1.5 months his general condition was good. Motor coordination was poor and muscle tone was lowered as before. His comprehension was good. Speech was limited to the first syllables of words, as before. He had convergent strabismus in his left eye, without sixth nerve palsy symptoms. Movements of the right eye were normal. In thrombophilic investigation the presence of factor V Leiden mutation was found. The boy is now in outpatient care. He is undergoing vision therapy and speech therapy. Convergent squint can be a symptom of thrombosis in children. Neuroimaging is essential in diagnosis. Disclosures: No relevant conflicts of interest to declare.