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Purpose: To study the OCT (optical coherence tomography) features of cases of unexplained macular edema, which were not combined with fluorescein leakage on angiography., Patients and Method: We report a retrospective series of three patients who presented with visual acuity impairment due to unilateral macular thickening visible on OCT examination. All eyes studied underwent OCT and angiography and electrophysiological examinations. None of the patients had a medical record and none of the eyes studied was highly myopic., Results: OCT profiles shared characteristics of myopic foveoschisis or X-linked retinoschisis. No fluorescein leakage was detected on angiography. The electrooculogram was impaired in one eye while other electrophysiological investigations were normal in all eyes., Discussion: Most frequently, macular edemas are associated with a fluorescein leakage on angiography. Macular edemas without angiographic leakage may correspond to unilateral idiopathic retinoschisis or macular edemas, with an atypical mechanism of intraretinal fluid accumulation.

Background: Uveitis is a major cause of visual impairment throughout the world. Analysis of cytokine profiles in aqueous humor specimens may provide insight into the physiopathological processes that underly retinal damage in this context., Methods: Using a multiplex assay, we determined the concentrations of 17 cytokines and chemokines in aqueous humor specimens obtained from patients with ocular toxoplasmosis or viral uveitis and compared these concentrations with those in specimens obtained from patients with noninfectious intermediate uveitis or cataract., Results: Five mediators (interleukin [IL]-8, monocyte chemoattractant protein-1, tumor necrosis factor-alpha, IL-4, and IL-10) were detected in >50% of patients in all groups. In contrast, IL-5 and IL-12 were specific for ocular toxoplasmosis, and granulocyte monocyte colony-stimulating factor and IL-1 were specific for viral uveitis; these mediators could present specific markers for diagnostic purposes. Interferon-gamma, IL-6, and macrophage inflammatory protein-1beta were common markers of ocular toxoplasmosis and viral uveitis. IL-17 was a common marker of ocular toxoplasmosis and intermediate uveitis., Conclusions: We found specific cytokine profiles for each type of uveitis, with large interindividual variations and no etiological or clinical correlations. Ocular cytokine mapping contributes to a better understanding of the physiopathology of specific forms of uveitis and provides guidance for new targeted treatment.

Lyme borreliosis is the most common human tick-borne disease in the Northern Hemisphere. The prevalence of Lyme borreliosis is estimated to be 20-100 cases per 100,000 persons in the United States and 100-155 cases per 100,000 persons in Europe [ 1 , 2 ]. It is caused by the spirochete Borrelia burgdorferi sensu lato [ 2 , 3 ]. The course of clinical manifestations is thought to occur in 3 stages: early, disseminated, and chronic [ 2 , 4 ]. Lyme borreliosis can cause a variety of ocular manifestations, and the frequency of these manifestations among cases of Lyme disease involving systemic manifestations is approximately 1% [ 5 ].

Purpose: To report the association between Weber-Christian disease and an intraocular inflammation., Methods: Case report., Results: We report the case of a 62-year-old woman who presented with a granulomatous panuveitis and focal chorioretinitis accompanied by systemic signs of Weber-Christian disease, which is an idiopathic relapsing nodular panniculitis, confirmed by a biopsy showing a lobular panniculitis in a nodule of the arm. The evolution was favorable under long-term oral prednisolone administration., Conclusion: Ocular involvement is a rare feature of Weber-Christian Disease. Neverthless, fat tissue examination should be considered in presence of an ocular inflammation of unknown origin and a skin biopsy can be helpful in this context.

Purpose: We report a patient with chronic Sweet syndrome (SS) treated by anti-Tumor Necrosis Factor (TNF) therapy, who presented with a severe bilateral chemosis., Methods: Case report., Results: Conjunctival biopsy revealed an ocular localization of SS., Conclusions: SS is a rare disorder that usually affects middle-age women. It is characterized by an acute febrile neutrophilic dermatosis. To our knowledge, this is the first documented case of an ocular localization in SS and the first report of a severe bilateral chemosis as ocular manifestation.

Most studies show a trend toward a beneficial or at least neutral effect of associating corticosteroids and antibiotics. However, caution must be taken, with various factors considered: the type, virulence, and size of the inoculum, and the treatment chosen. Early intravitreal administration of 400 microg of dexamethasone seems to be beneficial in treating postoperative Staphylococcus epidermidis-related endophthalmitis. However, a large-scale prospective, randomized, controlled study is mandatory to gain evidence supporting steroid therapy in postoperative endophthalmitis.

We report the case of a 3-year-old boy who developed persistent unilateral mydriasis after the injection of botulinum toxin in both medial rectus muscles. The mydriasis was still present at the last documented visit 9 months after the procedure.

Keratomycosis is a rare sight-threatening infection of the cornea. Predisposing factors in its pathogenesis are corneal trauma, mostly of plant origin, contact lenses, and overuse of topical corticosteroids. We report a case of a 44-year-old woman, with no ophthalmologic history, who developed severe keratitis 7 days after beginning topical therapy with a corticosteroid and antibiotic. Microbiological analysis revealed Fusarium oxysporum keratitis. Despite aggressive antifungal therapy with Voriconazole and Amphotericin B, she required a penetrating keratoplasty for impending corneal perforation. A second keratoplasty was performed because of corneal-transplant rejection after 6 months. There was no recurrence of Fusarium infection.

Purpose: To analyze clinical and paraclinical characteristics of recurrent isolated optic neuropathy., Patients: and method: In three university hospitals (Montpellier, Nimes, and Strasbourg), between October 2005 and September 2006, the charts of patients with corticosensitive recurrent isolated optic neuropathy and normal cerebral magnetic resonance imaging included prospectively were reviewed. The following parameters were analyzed: date of the first relapse, age at onset, duration at the time of inclusion, recurrence after steroid withdrawal, unilateral or bilateral involvement, number of relapses, visual acuity, retinal nerve fiber layer thickness, diagnostic workup, and long-term treatment with immunosuppressive or immunomodulatory drugs., Results: During the predefined period, 13 patients (11 women, 2 men; age, 17-54 years at onset) matched the inclusion criteria. Between two and six relapses of optic neuropathy were observed. The median duration was 4 years. In untreated patients (n=7), a significant (Spearman p=0.0156) inverse correlation was observed between visual acuity and duration of the disease; this correlation was not found in the group of patients (n=6) with long-term treatment (Spearman p=0.1032)., Conclusion: The progressive loss of vision over time in this retrospective study of recurrent isolated optic neuropathy could be related to axonal loss. A prospective cohort study is necessary to confirm this hypothesis and to evaluate the benefit of long-term treatment on this progression.

Red eye in children is a common consultation purpose. Mostly benign, this sign may also cause visual impairment. We differentiate three kinds of red eye: localised, diffused and perikeratic injection. The last one must be recognized because of its association with severe ocular diseases. Diagnosis must be sure and treatment has to be efficient to not pertubate childrens visual development. Unfortunately, physical examination on children is not always easy. Consultation with an ophthalmologist is justified if a doubt remains, in case of chronic pathology or resistance to first intention treatment.

Development of vision mainly takes place during the first year of life. Visual function isn't restricted to the measurement of visual acuity, but includes functions of environment exploration, relative appreciation of objects, control of body position and movements organization. Visual function comprises sensorial, oculomotor and cognitive elements. Each alteration in visual experience exposes to amblyopia inside the period of sensitivity of visual function.

Introduction: Diplopia is a well-known complication of scleral buckling for retinal detachment. It is generally caused by ocular motility disturbances., Subjects and Methods: We conducted a retrospective study on patients operated on for retinal detachment between 1998 and 2006 at Strasbourg University Hospital (France) who secondarily complained of diplopia. Patient history, scleral buckling type, and early and late postoperative complications were described., Results: Among 821 patients who underwent scleral buckling, 12 developed diplopia lasting more than 3 months. Six of the scleral buckling operations were vertical, three horizontal, and three oblique. Examination of the 12 patients showed seven cases of hypertropia, two cases of hypertropia associated with esotropia, one case of hypertropia with exotropia, and two cases of exotropia. The scleral buckle was removed in first intention in all 12 patients; binocular single vision was restored in six cases. Secondarily, prism correction restored binocular vision in three additional patients. Strabismus surgery was necessary for the remaining three patients., Discussion: Diplopia following retinal detachment usually responds to simple measures. In our study, the removal of the buckle restored binocular vision in the majority of cases, a prism correction was useful for the remaining patients. Strabismus surgery was often very efficient., Conclusion: Diplopia complicating scleral buckling generally responds to simple treatments that can eliminate a handicapping functional deficit.

Introduction: Hepatitis C is a viral infection that can lead to hepatocellular carcinoma. According to current recommendations, the treatment is based on the association of pegylated interferon and ribavirin. Strict treatment criteria are available and apply for the 8,000 patients diagnosed every year in France. Ophthalmological side effects are numerous, unpredictable, and sometimes severe., Case Report: We report the case of a patient treated with an association of interferon and ribavirin for hepatitis C, who presented two periods of decreased visual acuity 4 years apart. Interferon-related toxic retinopathy was suggested for the first event, while optical neuropathy was diagnosed for the second., Conclusion: Ocular complications of hepatitis C treatment with interferon and ribavirin are frequent but often benign. Our recommendations are periodic ophthalmological examinations, including visual acuity and fundus examination, before starting the treatment, at 3 months, and if necessary at 9 months.

Purpose: To evaluate the different therapeutic solutions for the management of periorbital hemangioma of infancy and childhood., Material: and methods: A retrospective study conducted between 2000 and 2006, including nine children (five girls and four boys), aged from 1 month to 9 years old. All children underwent a complete clinical evaluation, orbital ultrasonography, computerized tomography, and magnetic resonance imaging scans. The different histopathological forms and the different management options were analyzed: surgical excision, intralesional steroid injection, and oral steroids., Results: Surgery was performed in three cases and the results are discussed. Intralesional corticosteroid injections are effective and lead to complete reduction of tumoral volume and to the disappearance of the initial symptoms. With oral steroids, regression of the tumor was noted, followed by regrowth of the hemangioma at reduction or termination of therapy; complementary therapy such as surgery or intratumoral corticoid injection was often needed., Conclusion: It therefore seems necessary to establish therapeutic processes adapted to the age of the child, the tumoral histology, the location of the tumor, as well as the clinical and functional impact, in order to offer the patient the best chances of healing, taking into account that surgery and intralesional corticotherapy remain the methods of choice in the treatment of periorbital hemangioma in infancy and childhood.

Mitochondrial disorders can be linked to mutations in both mitochondrial and nuclear deoxyribonucleic acid, corresponding to various clinical phenotypes. Mutations in nuclear genes, including NDUFV1, have been associated with severe encephalomyopathies in infants, but genotype-phenotype correlations have remained elusive. This report details the complete clinical, biochemical, and molecular data of a 7-year-old male who presented at the age of 7 months with progressive ophthalmoplegia and later developed cerebellar ataxia, spasticity, and dystonia. Complex I deficiency was demonstrated in muscle, and two pathogenic missense mutations were present in the NDUFV1 gene. Ketogenic diet has seemingly improved the oculomotor palsy but has been unable to correct other neurologic symptoms. Considering other cases from the literature, this report broadens our understanding of genotype-phenotype correlations for NDUFV1 mutations and illustrates a potential and partial efficacy of ketogenic diet in complex I deficient patients.

Rationale: Oculomotor balance and contrast sensitivity are known to be impaired after an intake of a single dose of lorazepam. To the best of our knowledge, these effects have not been explored in long-term users of lorazepam, despite the potential importance of such deficits in everyday life., Objective: We tested the ophthalmological effects and contrast sensitivity for static stimuli in long-term lorazepam users., Materials and Methods: There were 15 lorazepam users and 15 sex-, age- and education level-matched control subjects tested, using a simple blind procedure., Results: The ophthalmological effects were scarce, with a discrete exophoria. Visual acuity was preserved. Contrast sensitivity, however, was more markedly impaired, consistent with the effects of an acute dose of lorazepam. The effects were not correlated with anxiety or sedation., Conclusions: The results are discussed in terms of their possible impact on everyday life. As visual acuity does not allow the detection of the impairments that are observed in the present study, it is suggested that a more systematic exploration of contrast sensitivity be carried out in long-term users of benzodiazepines.

Ondine's Curse or congenital central hypoventilation syndrome (CCHS) is a neurocristopathy (failure of migration or differentiation of neural crest-derived precursor cells) and is characterized by hypoventilation or apnea, which is most pronounced during sleep, with no other abnormalities of the neuro-respiratory system. Because of respiratory distress soon after birth, patients must be intubated and ventilated for a long time. This disorder may be associated with other symptoms of neurocristopathy (Hirschsprung disease, neuroblastoma, neuroganglioma) and other abnormalities of the autonomic nervous system (vasomotor dysfunctions or ophthalmic abnormalities: abnormal pupils, insufficient convergence, strabismus, or ptosis). We report the original case of a CCHS patient who presented with alternative ptosis of both the right and left eyes and esotropia. The ocular findings should lead to earlier diagnosis and speedier adequate treatment.

Introduction: Combined hamartoma of the retina and retinal pigment epithelium is a rare condition, characterized by a proliferation of the retinal pigmentary epithelium and retinal gliosis leading to a disorganization of the retina and papilla. This study aimed to demonstrate the advantages of early diagnosis and regular monitoring., Observations: We report a series of four children followed between 2001 and 2004 with combined hamartoma of the retina and retinal pigment epithelium, with age of diagnosis ranging from 3 months to 8 years. The main reason for consultation was reduction of vision. The clinical examination objectified the existence of a slightly grayish peripapillary formation with tortuous retinal vessels. This condition was confirmed by angiography with fluorescein in three cases and by optical coherence tomography (OCT) in one case. Progression showed the persistence of low vision in all four cases and the appearance of a neovascular membrane in one case., Discussion: Combined hamartoma of the retina and retinal pigment epithelium is probably a congenital tumor whose pathogenesis has not yet been elucidated. The diagnosis is clinical and the patient can be thoroughly examined by retinal angiography and optical coherence tomography (OCT). In this disorder, it is important to eliminate retinoblastoma and malignant melanoma of the choroid, showing the advantage of radiological exploration. Progression is stationary; nevertheless a reduction in visual acuity can be related to an epiretinal membrane or a neovascular membrane., Conclusion: Knowledge of the clinical aspect is essential to differentiate this condition from the malignant retinal processes. This tumor can progress in spite of its benign character. Regular follow-up is essential and can improve the visual prognosis.

Purpose: To evaluate the results of cataract extraction without primary intraocular lens (IOL) implantation in children., Setting: Ophthalmology Unit, University Hospital, Strasbourg, France., Methods: This retrospective study comprised 157 congenital cataract cases (55 bilateral and 47 unilateral) treated between 1985 and 2001. Evaluated were the functional results (visual acuity, binocular vision) and factors influencing the prognosis (age at surgery, stage of cataract development, associated pathology, postoperative complications). In all patients, cataract extraction was via the pars plana and anterior vitrectomy was performed, leaving a peripheral capsular collarette in place. Postoperatively, all the patients were fitted with glasses or contact lenses, after which they had secondary implantation of an IOL in the ciliary sulcus., Results: The functional results were similar to those in the literature for eyes with or without an IOL. Nevertheless, the literature reports a 25% risk for reoperation in the first 2 years after implantation and secondary vitrectomy for reopacification of the visual axis in 20% of bilateral cases and 38% of unilateral cases., Conclusions: Our functional results indicate that in cases of bilateral congenital cataracts, initial rehabilitation with aphakic correction and secondary IOL implantation leads to a predictable postoperative refraction and fewer complications. Visual rehabilitation in unilateral aphakia was more difficult because of poor compliance with contact lenses, generally leading to a preference for early IOL implantation.

Purpose: Several ocular defects have been identified as a consequence of the PAX6 gene mutations. With regard to the implication of this gene in unusual phenotypes, we report a family presenting with congenital nystagmus, foveal hypoplasia, and iris hypoplasia or atypical coloboma., Design: Observational case report., Methods: The entire transcribed region of the PAX6 gene was submitted to mutation search at the DNA and mRNA levels in five affected members of a French family in test with 82 normal subjects., Results: A novel heterozygous PAX6 gene splice mutation (IVS4 + 5G>C) was identified. The mutation is located in IVS4 within the consensus donor splice site. A mutant mRNA lacking exon 4 as the sole defect was evidenced. The resultant protein was predicted to contain a cryptic ATG initiation codon in exon 3 and a slightly altered paired-domain in an open reading frame extended by 13 amino acids., Conclusions: The association of anterior segment anomalies and foveal hypoplasia with one of the slightest alterations of the PAX6 protein described to date confirms the association of variant phenotypes with hypomorphic alleles. Mutation screening of the PAX6 gene could be useful in elucidating the origin of complex ocular malformations.

The authors report their experience in preschool vision screening in the east of France, involving the Mother and Child Welfare Service and the School Health Service, under the administration of the National Ministry of Education. The review underlines the importance of early diagnosis of visual disorders in children before they reach three years of age. They recommend screening of every child at least once before the age of four years.

Deoxyribonucleic acid (DNA) repair is a fundamental process designed to keep the integrity of genomic DNA that is continuously challenged by intrinsic or environmental induced alterations. Numerous genes involved in DNA repair have been cloned and are involved in different DNA repair pathways: base excision repair, nucleotide excision repair, mismatch repair, DNA recombination. Inherited conditions due to mutations in DNA repair genes include mainly: xeroderma pigmentosum, Cockayne syndrome, Trichothiodystrophy, Bloom syndrome, Rothmund-Thomson syndrome, and Werner syndrome. Minor to major ocular manifestations occur in these syndromes. For example, eyelid skin cancers in xeroderma pigmentosum and retinal dystrophy in Cockayne syndrome are major features of these syndromes. This review focuses on the DNA repair pathways, the general and ocular features of the related syndromes, the laboratory tests useful for diagnosis, and the general processes implied with DNA repair (ultraviolet sensitivity, carcinogenesis, apoptosis, oxydative stress, and premature aging).

Purpose: To improve existing MRI (magnetic resonance imaging) methods of assessing ocular motility in horizontal gaze by using a multistatic fast imaging T2W MRI sequence, preventing patient head movement and convergence of the eyes during the study for diagnosis and management of complex paralytic strabismus., Methods: A turbo-RARE image of the orbits was acquired in a set plane each time the patient fixed on a virtual image of 1 of 15 LEDs (light emitting diodes). The head was positioned and immobilized with a security cushion at an 8 degrees tilt of the 25-cm quadrature head coil. After completion of the study (5 mn), the MRI images were transferred to a work station and then onto a magnetic video tape to be replayed in cine mode on a PC using standard software. The qualitative analysis was completed by the study of quantitative parameters: visual axis, minor axis of the lens, the lines and angles of the horizontal rectus muscles with the optic nerve and the visual axis. We used digital image analysis to measure the cross-sectional areas of these muscles and also to determine muscle volume. Twenty normal volunteers and 3 cases of oculomotor palsies were studied., Results: The experimental setup allowed us to obtain images which:1), Conclusion: This method will provide useful functional quantitative information in the evaluation of ocular motility disorders. The procedure is readily clinically applicable.

Introduction: The number of staff subjected to significant amounts of on-screen work with visual complaints is currently increasing., Objective: This epidemiological study aimed to observe the influence of changes in working conditions and an ophthalmological treatment on vision and eye complaints due to on-screen work., Materials and Methods: This comparative study included a transversal initial study on the visual symptoms and function as well as a longitudinal follow-up of the efficacy of the recommendations given by the company medical officer. The studied subjects were be exposed to screen irradiation for at least 4 hours a day during the study. The control group was selected according to the age, sex, and education level of the investigated group., Results: We examined 814 subjects under investigation and 325 control subjects. The subjective signs of visual fatigue with on-screen work (burning or stinging eyes, diplopia or blurred vision after work, tearing, globe heaviness and fatigue, and headaches, the latter particularly in female subjects) were significantly more frequent in the exposed group than in the control group. A statistically significant correlation was found with the following factors: poor working conditions, frequent keyboard data entry, far vision optic correction, far vision significantly more often corrected to less than 10/10 at least in one eye, and, finally, near vision exophoria more than 7 diopters. We re-examined 465 exposed and 139 control subjects 1 and 2 years after consultation with the company medical officer. Following the recommendations proved to be effective in 50.5% of the employees. Improving vision by changing the optical correction showed the strongest statistical relation with the decrease in visual fatigue complaints. Organizational and material improvements also led to positive effects on functional discomfort., Discussion: The far vision of those exposed to screen irradiation was significantly worse than in those who were not exposed. The people from the exposed group had vision correction significantly more often. The probable relation between progressive myopia and on-screen work is not excluded, but further investigation is needed. The proposed measures were effective for preventing visual fatigue. However, 49.5% of the study group had persistent visual symptoms, probably because of not following the recommendations, not having an ergonomic correction, or because modifications of blinking, tear film, and the ocular surface were ot taken into account., Conclusion: The coordination between the occupational medicine and ophthalmology departments during this study has significantly reduced visual fatigue. Nevertheless, there is still a considerable number of people from the exposed group with persistent symptoms.

Background: Chronic Progressive External Ophthalmoplegia (CPEO) encompasses different conditions having in common a slowly progressive external and general ophthalmoplegia. The discovery of CPEO is suggestive of mitochondrial cytopathy, but this is not necessarily so., Case Report: We report here a case, presenting at age 9 months, characterized by bilateral blepharoptosis and partial third nerve oculomotor deficiency, with no nystagmus. Mitochondrial cytopathy was suspected on cranial MRI and confirmed by muscle biopsy. Enzyme studies revealed a defect on the complex I respiratory chain. This case is unique in that the symptoms completely resolved under a Ketogen diet.

Background: Previous studies have shown an effect of the tranquilizer lorazepam on visual perception. We explored the effects of the drug on binocular vision, visual acuity and accommodation., Subjects and Methods: Twenty-four paid healthy volunteers (13 women, 11 men) were recruited from the University of Strasbourg (mean age: 23.6 years, mean weight: 66.8 Kg). They were randomly assigned to one of two parallel groups of 12 subjects each (a placebo group and a lorazepam 0.038 mg/kg group). Visual acuity was measured for each eye separately (Snellen chart and Parinaud scale). Binocular vision was studied using the cover tests, measurement of the fusional amplitudes (with Berens prisms), and the Duane Scale Test (near point rule) measuring convergence and/or accommodation in centimeters or diopters as a function of age., Results: Regarding vision, there was no lorazepam effect, at either 33 cm or 5 m. An esophoria was observed after the intake of lorazepam (0Delta before intake and 2.8Delta after intake, p=0.001). Both fusional convergence and fusional divergence amplitudes decreased by lorazepam, (p=0.008, and p=0.002). Lorazepam also impaired the near point of convergence but did not affect accommodation., Conclusion: A single dose of lorazepam induces an esophoric oculomotor imbalance and impaired fusional convergence and divergence amplitudes without impairing visual acuity or accommodation.

Purpose: To improve existing MRI (Magnetic Resonance Imaging) methods of assessing ocular motility in horizontal gaze by using a multi-static fast imaging T2W MRI sequence, preventing patient head motion and convergence of the eyes during the study for the diagnosis and management of complex paralytic strabismus., Subjects and Methods: A turbo-RARE image of the orbits was acquired in a set plane each time the patient fixed on a virtual image of one of 15 LEDs (Light Emitting Diodes). Positioning and securing the head was by a security cushion with an 8 degree tilt of the 25 cm quadrature head coil. After completion of the study (5 minutes) the MRI images were transferred to a work station and on to a magnetic-video tape to be replayed in cine mode on a PC using standard software. The qualitative analysis was completed by the study of quantitative parameters: visual axis, minor axis of the lens, the lines and angles of the horizontal rectus muscles with the optic nerve and the visual axis. We used digital image analysis to measure the cross-sectional areas of these muscles and also to determine muscle volumes. Twenty normal volunteers and 3 cases of oculomotor palsies were so studied., Results: The experimental setup allowed us to obtain: 1) rapid (14 s) and high resolution images (256 x 196 x 3 mm); 2) which were free artifacts; 3) with no detectable eye convergence; 4) in which the lateral and medial rectus muscles and anatomical details of the orbit were clearly depicted; 5) from which additional functional information was obtained from the cine loop analysis; 6) wherein the visual axes did not converge during horizontal versions; 7) which permitted horizontal rectus muscle angles to be followed during contraction and relaxation; and 8) allowed the cross-sectional area of the four rectus muscles to be compared during contraction and relaxation (difference of 0.2 cm2)., Conclusions: This method will provide useful functional quantitative information in the evaluation of ocular motility disorders. The procedure is readily clinically applicable

Objective: To analyse cases of Horner's syndrome (HS) and its opposite, Pourfour du Petit's syndrome (PPS), occurring in anaesthesia and intensive therapy with consideration of the data of current literature., Data Sources: For this paper we have reviewed the French, English and German literature published in anaesthesia and intensive care journals using Medline search and the current textbooks., Study Selection: All observational studies on these syndromes, whether clinical cases or letters to the editor, form the basis for this article., Data Extraction: The articles were analysed mainly with regard to diagnosis, therapy and prognosis of syndromes due to iatrogenic causes., Data Synthesis: HS is caused by a paralysis of the ipsilateral sympathetic cervical chain and includes a ptosis of the upper eyelid, a slight elevation of the lower lid, a sinking of the eyeball, a constriction of the pupil, a narowing of the palpebral fissure, a nasal stuffiness associated with anhidrosis, and flushing of the affected side of the face. Regional anaesthesia (intra-oral anaesthesia, brachial plexus block, epidural anaesthesia whether by thoracic, lumbar or caudal approach, as well as interpleural analgesia) is the main anaesthetic cause for HS. HS due to the effect of a local anaesthetic is transient, it can precede a high spinal block and a cardiovascular collapse. HS from puncture of the internal jugular vein is most often permanent. When transient, HS regresses within 3 months after puncture. Other causes of HS include intraoperative posture, pleural drain, neck surgery, neck trauma. A mydriatic collyrium, such as phenylephrine, resolves ptosis for less than 1 hour and results in blurred vision from pupillary dilation. Major ptosis requires surgery. PPS is the reciprocal HS and is caused by a stimulation of the ipsilateral sympathetic cervical chain. PPS can precede HS. It carries a risk for conjunctivitis, keratitis and epiphora in case of major exophthalmia. PPS is often reported as an unilateral mydriasis. PPS has the same causes as HS. Myotic collyriums are relatively inefficient. Major lid retraction requires a tarsorraphy, pomades and nocturnal lid occlusion. A part of HS and most PPS occurring in anaesthesia and intensive care remain unrecognized or are recognized with delay, especially if they remain minor and transient or when they occur in unconscious patients, in horizontal posture.

Panton-Valentine leucocidin arises from the combination of one S component (LukS-PV) with one F component (LukF-PV), whereas gamma-haemolysin comprises two S components (HlgA and HlgC) with one F component HlgB. The intravitreal injection of rabbit eye with the six combinations (S + F) of channel-forming leucotoxins produced by Staphylococcus aureus ATCC 49775 induced acute inflammatory reactions depending on time and doses of toxins. These reactions involved posterior chamber as well as anterior chamber and conjunctiva, eyelids and annexes. Histological examination confirmed the involvement of eye tissues and the disruption of the retinal barrier. The lesions began only 4 h after injections and persisted for at least 5 days. Clinical and biological effects of each leucotoxin were modulated by the speed of onset and intensity of inflammation and necrosis, leading to a functional classification according to the severity of the lesions (HlgA + LukF-PV > HlgA + HlgB > or = LukS-PV + HlgB > or = LukS-PV + LukF-PV > HlgC + HlgB > or = HlgC + LukF-PV). Moreover, N-acetyl beta-D glucosaminidase assays on crude extracts of vitreous revealed granules and granule secretions from polymorphonuclear cells with levels according the above classification. These results show that channel-forming leucotoxins have a very significant inflammatory activity. As most S. aureus strains produce two or even six leucotoxins depending on the production of Panton-Valentine leucocidin, these compounds could be considered to be virulence factors.

Our goal was to improve existing MR methods used in the assessment of ocular motility in the horizontal gaze direction, by using high resolution 20 s images and an experimental setup that prevents physiologically induced head motion in patients and eye convergence to the fixation point, thus improving the analysis of the relationships between the eyeball and the right muscle bellies in horizontal gaze exploration. The method has potential clinical applications for the diagnosis and/or follow-up of complex strabismus.

Previous studies have shown a lorazepam effect on visual perception. We tested whether this impairment resulted from a peripheral effect induced by benzodiazepines. A first experiment showed that a single dose of lorazepam induces an oculomotor imbalance without impairing visual acuity or accommodation. In a second experiment, we tested whether the impairment induced by lorazepam on visual perception still occurred in monocular vision. Subjects matched incomplete forms controlled on the spacing and alignment of their local contour elements. A reference object was first displayed and followed by two laterally displayed objects, a target and a distractor. The distractor was the mirror-reversed version of the target. Performance was impaired in the lorazepam group when the reference was an incomplete form with a spacing of 10.8' or 22.2' of arc. These results were not correlated with sedation. They confirm that lorazepam has a central deleterious effect on visual perception. A post-hoc analysis also suggested that lorazepam-treated subjects used asymmetry in the stimuli as a compensatory strategy. This result is discussed in relation to previous hypotheses about the physiological mechanisms that determine the effects of lorazepam on visual perception.

The reliability of measurement of visual acuity by Teller's card was studied in young children under 18 months (3 to 42.5 months) to detect amblyopia. Repeated tests with Teller's cards were performed in children (two exams at least) divided into several pathologies. Visual acuity changed over time (in 2000 exams). Results were compared with those given by drawing tests (Pigassou) at two years and a half. Middle amblyopia occurred in 44%, low amblyopia in 40% and high amblyopia in 16%, as the results by Teller's cards were considered as normal. These results were found in 54% among the 2000 Teller's studied. Teller's test was thus shown to be unreliable to detect middle or low amblyopia. Objective réfraction is required.

A case of a stellate hemorrhage of the macula occurring in a young man is reported. Analysis of this rare clinical entity allowed us to link it to combined occlusion of the central retinal vein and cilioretinal artery. With regard to this case and to a review of the literature, clinical and angiofluorographic features of this syndrome are recalled. The usually good prognosis of this disease was not observed in our case. Finally, the controversial pathophysiological data are discussed.

After reviewing the various etio-pathogenic hypotheses for pterygium in which the discontinuity of the lacrymal film at the corneo-limbic junction appears to play an essential role, the authors discuss the current therapeutic choices. The value and place of lamellar keratoplasty overlapping the limbus are discussed.

A two-month-old girl presented with a unilateral benign cystic medulloepithelioma from the ciliary body associated with bilateral retinal non-attachment. The authors discuss the histopathologic findings and the pathogenesis of the congenital retinal non-attachment: are these incidental occurrences or do they arise from a common pathogenetic mechanism?

The authors report the results of a retrospective study of 76 patients enucleated for a choroidal melanoma, in whom prognostic factors of survival were studied. The presence of metastasis at the time of diagnosis, the size of the tumor and the epithelioid cellular type are the most pejorative factors (though statistically not significant). A peak mortality can be observed between the second and the fourth year after enucleation. A predominance of the liver metastases is clearly established (75% of the metastases observed in our sample). We observed a majority of small tumors (40%) of spindle cell type (50%).

The authors report 2 cases of unilateral cerebellar atrophia presenting in the neonatal period with facial peripheral palsy and iso-immune thrombocytopenia respectively. The recognition of cerebellar atrophia has been made by MRI. Unilateral cerebellar atrophia be due to ischemia. MRI seems to be a useful tool in the recognition of cerebellar malformations in the neonatal period.