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Recurrent, unilateral, isolated, idiopathic lateral rectus muscle palsy is an uncommon but well-recognized disorder in children that has not been recognized as well in other age groups. We studied five cases of this uncommon entity that we encountered in adults and adolescents. Ages at onset ranged from 15 to 72 years and there were three to eight episodes per patient. Most of the patients shared the following features with the previously reported pediatric cases: ipsilateral recurrence, lack of pain, spontaneous recovery within six months, and no clear cause. Unlike the children, females or left-eye involvement was not preponderant in adults.

• We report a case of Horner's syndrome due to ipsilateral posterior hypothalamic infarction, occurring in the absence of other signs of hypothalamic dysfunction. Associated symptoms of contralateral faciobrachial weakness and dysarthria correlated with the extension of the infarct into the posterior limb of the internal capsule seen by magnetic resonance imaging. The likely vascular anatomy of this lesion is discussed.

Fibrous dysplasia is a rare disorder of bone that may be associated with acute loss of vision. Surgical intervention is generally advocated and sometimes restores vision in these patients. We report a case of a patient with unilateral optic neuropathy from fibrous dysplasia who suffered two acute episodes of visual impairment. The first episode of vision loss was reversed by surgery and the second by corticosteroid treatment. A trial of corticosteroid therapy may be beneficial in cases of acute vision loss due to fibrous dysplasia.

• Fifteen patients spontaneously developed paralysis of one superior oblique muscle, which remained unexplained after an initial evaluation. Follow-up evaluation showed that all of the patients' conditions were improved. Twelve of the patients had enjoyed spontaneous, functional recoveries within four months. Three had residual diplopia that was relieved by prisms. No patient subsequently developed evidence of any local or systemic disease that could explain the ophthalmoplegia. One patient suffered a recurrence 3½ years after his first episode that lasted three months and spontaneously cleared.

OBJECTIVE: To determine whether characteristics of optic nerve swelling assist in distinguishing between optic neuritis and anterior ischemic optic neuropathy. METHOD: Optic nerve stereophotograph review by masked observers. RESULTS: Altitudinal swelling, pallor, arterial attenuation, and hemorrhage are found more commonly in anterior ischemic optic neuropathy than in optic neuritis. CONCLUSION: Optic disc appearance does help to distinguish anterior ischemic optic neuropathy from optic neuritis, although there are overlapping features.

• Questionnaires were completed by 1083 nonesotropic control subjects and 170 patients with nonparalytic esotropia to determine handedness. The subjects, who had been drawn from patients attending ophthalmic clinics and private practices, were classified as righthanded, left-handed, or ambidextrous based on their answers to five questions about hand preference. Analysis of the results indicated that the handedness of patients with esotropia differed significantly from that of nonesotropic controls. The difference resulted primarily from an excess of non-right-handers among those with esotropia. Non-right-handedness is probably a marker of anomalous cerebral dominance and the disproportion of left-handed and ambidextrous subjects with esotropia may indicate that some persons with esotropia have anomalous brain architecture. In such cases, the structural anomalies might be the cause of the strabismus.

• Intrapapillary refractile bodies were observed in seven of 13 patients with chronic optic disc edema secondary to optic nerve sheath meningioma. The observation of refractile bodies preceded or coincided with decline in vision and disappeared as optic atrophy supervened. Intrapapillary refractile bodies appear to be a nonspecific sign of chronic optic disc edema.

Carotid artery dissection frequently causes transient ipsilateral visual impairment. We present 2 cases of permanent ocular vaso-occlusion sequelae consequent to dissection of the ipsilateral internal carotid, definite in one and probable in the other. In both, the ocular strokes led to the recognition of the underlying carotid vasculopathy.

• We examined 14 patients with acute, unilateral optic nerve injury after blunt head trauma. In each patient the optic canal was decompressed through an ipsilateral external ethmoidectomy. The patients also received treatment with dexamethasone during the perioperative period. There was no morbidity or mortality. Eleven of the 14 patients improved, including 3 of the 5 who could not perceive light preoperatively. Transethmoid-sphenoid optic canal decompression is a safe and effective treatment for indirect optic nerve trauma.

• We evaluated the condition of a patient with chronic papilledema due to pseudotumor cerebri in whom a permanent, monocular, inferior, altitudinal, visual field defect suddenly developed. Clinical and fluorescein angiographic findings indicated that the loss of visual field was due to ischemic optic neuropathy. Ischemic optic neuropathy might occur in papilledema if the tissue pressure in the optic disc becomes sufficiently elevated to occlude the pressure-sensitive prelaminar arterioles.

OBJECTIVE: To describe patients with orbital apex masses involving the optic nerve who enjoyed spontaneous improvement in visual function without therapy. METHODS: A retrospective chart review of cases in an academic neuro-ophthalmology practice identified three cases of tumorous compression of the optic nerve in which there was spontaneous improvement in visual function. Each patient had undergone a full neuro-ophthalmologic evaluation, followed up with serial imaging. RESULTS: The first patient initially had a visual acuity of 2/200 and central visual field defects. Over a 4-year period, her visual acuity improved to 20/40 and her visual field expanded centrally. The second patient initially had a visual acuity of 20/40 and a cecocentral visual field defect. After a 4-year follow-up, her visual acuity had improved to 20/15 and her cecocentral defect had shrunk. The third patient had an initial visual acuity of 20/25, an afferent pupillary defect, and optic atrophy. Over a 2-year period she developed a paracentral scotoma and her visual acuity worsened to 20/30. In the next 2 years her visual acuity improved to 20/10 and her visual field normalized. CONCLUSIONS: In exceptional instances, visual dysfunction from tumorous compression of the optic nerve in the orbital apex may spontaneously improve. Clinicians who use the natural history of visual loss in differential diagnosis should be aware that spontaneous remission is compatible with the presence of tumor.

• We examined three patients with a chiasmal syndrome due to metastasis and were able to find only two additional cases in the literature. The characteristic presentation consisted of progressive impairment of vision without headache or abnormal plain skull x-ray films in patients with weight loss or diabetes insipidus. In three of the five patients, the primary malignant neoplasm was occult when symptoms and signs of chiasmal dysfunction were seen. Four patients responded well to irradiation. The chiasm may be compromised by suprasellar extension of pituitary metastasis, by infiltration from an infundibular or hypothalamic metastasis, or by hematogenous spread of tumor.

Chromosome analyses have revealed consistent abnormalities in several congenital disorders. Two of these, mongolism (21 trisomy)1 and 13-15 trisomy2 are of established ophthalmic importance. This communication reviews the opthalmic facets of a third chromosomal aberration, Turner's syndrome. TURNER'S SYNDROME Approximately one in every 5,000 phenotypic females possesses one X chromosome instead of two and a total of 45 chromosomes instead of 463 (Figure). The Barr body of somatic cells, which is dependent upon the presence of at least two X chromosomes, is absent in the cells of XO individuals. Generally, such persons present the clinical picture described by Turner in 1938.4 Ovarian dysgenesis, primary amenorrhea, undeveloped breasts, infantile genitalia, scanty pubic hair, short stature, webbed neck, shield chest, and cubitus valgus dominate the picture. Coarctation of the aorta, multiple pigmented nevi, recurrent aural infections, and congenital lymphedema occur often. Recently, diabetes and myxedema have been frequently

Band keratopathy and conjunctival calcification are recognized ocular manifestations of hypercalcemia.1-3 Their occurrence has been recorded in Boeck's sarcoid, hypervitaminosis D, hyperparathyroidism, carcinoma of the parathyroid, the milk-alkali syndrome, chronic immobilization, and renal insufficiency. The purpose of this communication is to document the association of the ocular signs of hypercalcemia with a rare, inborn-error of metabolism, hypophosphatasia. REPORT OF CASE* A 17-week-old, white male was admitted to the pediatric service of the New York Hospital on Sept 13, 1957, because of vomiting and failure to gain weight. He was the product of a normal, spontaneous delivery following an uncomplicated, full-term pregnancy. The patient weighed 9 lb 12 oz (4,423 gm) and was 22 inches long at birth. Head circumference was 15.25 inches. Development was unremarkable until the seventh week when excessive regurgitation of feedings was noted. He also appeared unusually irritable. Despite alterations in formula and the use of

• Palinopsia refers to the persistence or reappearance of an image of a recently viewed object. Typically, patients with palinopsia have other visual symptoms or signs, and the underlying cause is a structural lesion of the posterior portions of the cerebral hemispheres. However, we treated three patients who experienced palinopsia as an isolated symptom, apparently as a side effect of trazodone hydrochloride therapy for depression. The palinopsia was dose related and disappeared with reduction or cessation of therapy.

• A 27-year-old man presented with an isolated, pupil-sparing, partial third-nerve palsy. Etiologic investigations proved unrevealing. Subsequent development of an optic neuropathy prompted magnetic resonance imaging, which confirmed the clinical suspicion of multiple sclerosis. Rarely does multiple sclerosis present with oculomotor nerve involvement.

The prospective observation of persistent arterial collateral vessels between the ciliary and retinal circulations has never been documented angiographically. REPORT OF A CASE. —A 44-year-old woman presented with 6 months of decreasing vision in her right eye. Corrected visual acuities were 20/60 OD and 20/20 OS. An afferent pupil defect, dyschromatopsia, and inferotemporal field loss were present in the right eye. The right eye was 2.5 mm proptotic, with increased resistance to retropulsion. The inferior margin of the right optic disc was elevated. The macula and vessels were unremarkable. The left eye was normal.Fluorescein angiography showed a region of hyperfluorescence at the lower margin of the right disc (Fig 1, top). Computed tomographic scans demonstrated a mass that was 2 cm in diameter within the posterior right orbit, causing upward and lateral displacement of the optic nerve. There was tumor enhancement with contrast injection. The lesion was thought to