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This course covers information on diagnosis and management of ophthalmic problems encountered in everyday practice in Core Ophthalmic Knowledge for Pediatric Ophthalmology/Strabismus. Core ophthalmic knowledge is defined as necessary clinical knowledge expected of all ophthalmologists regardless of practice emphasis area.

Weekly case challenge

Investigators evaluated whether structural grading of foveal hypoplasia could help in the diagnosis and prognosis of children with infantile nystagmus.

Lid nystagmus is an unusual rhythmic upward jerking of the upper eyelids that occurs in isolation or relation with the eye movements, secondary to compressive lesion. It is considered a sign of intrinsic midbrain disease. However, this present case developed nystagmus in the setting of III nerve aberrant regeneration. A 31-year-old woman with a III nerve palsy due to grade IV of glioblastoma in the temporal lobe, left cavernous sinus, underwent surgery, followed by radiotherapy and chemotherapy. The patient developed signs of III nerve aberrant regeneration. After three years, left palpebral nystagmus was evident in rest and in all eye positions except when attempt to look up. The cerebral magnetic resonance showed tumor increase. Lid synkinesis etiopathogenesis is unknown. Most hypothesis suggest abnormal disruption of the pretectal inhibitory influence on the levator motoneurons. In this case, probably the tumor growing caused more abnormal regeneration movements in the III nerve branches.

Three-wall orbital decompression is performed for severe cases of proptosis in thyroid eye disease. The limited visualization and soft-tissue expansion often make identification of the bony landmarks difficult for a novice surgeon. This video demonstrates the basic steps of three-wall orbital decompression on a human skull, intermixed with computed tomography animations and surgical steps to maximize understanding. Surgical steps such as periosteal incisions, standard neurovascular encounters and tips for safe bony decompression are depicted. This aids in better understanding of this otherwise difficult-to-visualize surgery.

Nystagmus is clinically described based on amplitude, frequency, and direction of oscillations. It can be broadly classified as physiologic or pathologic. Except for physiologic nystagmus, all forms should be considered a symptom of a condition rather than a diagnosis in itself.

This lecture from Pediatric Ophthalmology 2017 discusses a case of 60-year-old man found to have a giant orbital mass as an incidental finding during workup for peripheral neuropathy–type complaints.

Dr. Richard Hertle addresses surgical treatment of nystagmus. The presentation includes general surgical objectives, indications, techniques, expected outcomes, and common complications.

Ataxia, developmental delay, and optic-nerve dysfunction are warning signs that further neurological investigation is needed.