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Temporal bone fractures are often associated with damage to middle or inner ear structures, facial nerve, and cerebrospinal fluid (CSF) leak, and rarely with abducens nerve palsy. Isolated abducens nerve palsy is not known to occur following temporal bone fracture and is most commonly associated with concurrent facial nerve injury. We report a case of an 11-year-old girl who presented with isolated right abducens nerve palsy following head trauma. The child had incurred injury following a fall from a bicycle. The presence of postauricular ecchymosis was suggestive of possible temporal bone fracture. High-resolution computed tomography scan revealed undisplaced fracture of the right temporal bone at the petrous apex. Identification of temporal bone fracture prompted toward complete neurological and otological evaluation to detect life-threatening complications like CSF otorrhea. The child was managed conservatively with occlusion therapy to alleviate diplopia and showed complete resolution of the nerve palsy after 4 months. Isolated abducens nerve palsy following the temporal bone fracture is a rare finding. Additional clinical findings like postauricular ecchymosis should be looked for, and appropriate otological evaluation sought in such cases. [ABSTRACT FROM AUTHOR]

Aberrant regeneration of the third nerve following its palsy is commonly seen after trauma and compressive lesions. This phenomenon is thought to result due to misdirection of the regenerating axons. Surgical management is a great challenge in the third nerve palsy owing to multiple muscle involvement and is often accompanied by ptosis and poor Bell's phenomenon. We present a case of a 27-year-old male who developed isolated complete third nerve palsy of the left eye following head trauma. Features of aberrant regeneration were seen after 6 months, namely, inverse Duane's sign and Pseudo-Von Graefe's sign. He underwent recess-resect procedure in the unaffected eye with adjustable suture technique which not only corrected the deviation but also the ptosis by utilizing the oculomotor synkinesis. Thus, contralateral eye surgery combined with adjustable suture technique resulted in an accurate alignment of the eye and obviated the need for ptosis correction. [ABSTRACT FROM AUTHOR]

Introduction: Trauma to extraocular muscle without globe perforation is rare. This case report describes the clinical features and principles of repair of the simultaneous injury to two extraocular muscles sustained from a goat’s horn. Methods: Case records of the 36-year-old man who suffered trauma to his left eye were reviewed. Results: Examination revealed diplopia, hypotropia of the left eye, and a lacerated superior conjunctiva through which a muscle tendon prolapsed. Magnetic resonance imaging (MRI) of the orbit indicated discontinuity and fuzziness of the left superior rectus muscle (SR). Surgical exploration showed that the prolapsed tendon belonged to the superior oblique muscle (SO). Avulsion of SR was also noted 14 mm from its insertion. The proximal end of SR was anastomosed with the distal segment. The proximal end of the SO could not be traced. Postoperatively, the elevation improved marginally and there was a small hypotropia. His diplopia was managed with prisms. Discussion:The goat’s horn acted like a hook and avulsed two contiguous muscles from orbit in a posterior to anterior direction. The hypertropia due to SO avulsion was compensated partly by the hypotropia due to the concurrent damage to the SR. Immediate surgical intervention resulted in a good alignment. [ABSTRACT FROM AUTHOR]

One-and-a-half syndrome (OAHS) is characterized by ipsilateral conjugate horizontal gaze palsy and internuclear ophthalmoplegia. We report a case of a 24-year-old gentleman who presented with a complaint of binocular diplopia, with limitation of extraocular movements. There was gaze-evoked nystagmus on attempted abduction in the right eye and down-beating nystagmus on downgaze. MRI brain showed well-defined homogeneously enhancing mass lesion in the fourth ventricle, which was surgically managed, and histopathology showed choroid plexus papilloma. This is a rare case report of Choroidal plexus papilloma causing OAHS. [ABSTRACT FROM AUTHOR]

A correction to the article "The newly sighted fail to match seen with felt" that was published in the April 10, 2011 issue is presented.

Objective: To describe a case of surgically induced scleral necrosis in Treacher Collins syndrome after strabismus surgery.Methods: A 19-year-old girl underwent bilateral squint surgery. Two weeks postoperatively, she presented with subconjunctival abscess in the left eye. The surrounding conjunctiva was markedly inflamed with raised edges. Surgical debridement, microbiological evaluation and medical management were started immediately. Screening for autoimmune and vasculitic conditions did not provide any positive results.Results: On subsequent follow-up, conjunctival retraction and an area of scleral necrosis with thinning was noted. Significant healing with antibiotics and steroids was noted within one week. The integrity of the globe was well maintained and no further procedure for tectonic support was performed.Conclusion: Surgically induced scleral necrosis can be immune-mediated or following surgical site infection. Pre-existing scleral thinning due to neuroectodermal apoptosis in Treacher Collins syndrome remains a possible explanation for the accelerated necrotising scleritis in our case.

Purpose: To study the clinical profile of patients with microspherophakia and the factors associated with poor vision following lensectomy surgery., Methods: A multicenter, retrospective, cross-sectional analysis was conducted from January 2010 to June 2022 on patients diagnosed with microspherophakia., Results: A total of 102 eyes from 51 patients were enrolled, of whom 24 (47.1%) were male and 27 (52.9%) were female. All patients presented with bilateral involvement. The most common presenting complaint was defective vision, affecting 98 (96.1%) eyes. Patients exhibited varying degrees of lenticular myopia, with a mean refractive error of -13.54 ± 11.92 D. Glaucoma was present in 36 (35.3%) eyes at presentation. Subluxation of the crystalline lens was observed in 50 (49.1%) eyes, dislocation of the lens into the anterior chamber in 24 (23.5%) eyes, and dislocation into the vitreous cavity in 4 (3.9%) eyes. Limbal or pars plana lensectomy was performed in 54 (52.9%) eyes. The mean corrected visual acuity improved from 1.05 ± 0.82 logMAR units to 0.82 ± 0.79 logMAR units after lensectomy (P = 0.029). Poor postoperative visual acuity (less than 20/200) was associated with poor preoperative visual acuity (P = 0.005), presence of glaucoma at the first visit (P = 0.013), and intraocular pressure >30 mmHg (P < 0.001)., Conclusion: Microspherophakia is associated with high lenticular myopia, subluxation, and dislocation of the crystalline lens. Significant improvement in postoperative vision was observed after lensectomy. Factors associated with poor postoperative vision included poor preoperative corrected vision, presence of glaucoma, and high intraocular pressure., (Copyright © 2024 Indian Journal of Ophthalmology.)

Aim: To study the factors affecting residual exotropia (>10 PD) at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus (LR) recession or unilateral recess resect procedure]., Methods: A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia (>10 PD) and successful outcome (within 10 PD of orthotropia) at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount (mm) of muscle surgery done., Results: One hundred and fifty-seven patients with mean age of 14y (range 3-53y) were included. Twenty-seven patients (17.2%) had residual exotropia at 4-6wk postoperative follow up. Age at surgery ( P =0.009) and preoperative deviation for distance ( P ≤0.001) and near ( P =0.001) were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done (recess-resect or bilateral LR recession). The effect/dose ratio was more in deviations >40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group (1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery)., Conclusion: Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.

Dissociated vertical deviation (DVD) is an enigmatic strabismus entity for which various theories of causation have been proposed. Commonly seen in association with infantile esotropia, it responds unpredictably to surgical intervention hence fuelling theories for a supranuclear center defect albeit at the midbrain level. Cases of DVD associated with A- pattern eso or exotropia and superior oblique overaction have been reported, although rarely. We report a case of bilateral congenital ptosis associated with this complex. Not reported earlier, we hope this case may help in better understanding of the obscure etiology of this symptom complex.

Optic pathway glioma associated with neurofibromatosis 1 has a classically indolent course. However, involvement of the optic radiations is relatively rare and is associated with a more aggressive course. A three-year-old girl presented with strabismus and loss of vision in the left eye with relative afferent pupillary defect and optic disc pallor. She had multiple cafiota au lait spots. Visually evoked potential was suggestive of an optic nerve conduction defect and magnetic resonance imaging of the brain was suggestive of an optic pathway glioma involving the optic nerves, the optic chiasma and the optic tracts. The optic radiations and the dendate nuclei had hamartomas. Optic nerve biopsy confirmed pilocytic astrocytoma. Radical radiotherapy under general anesthesia was subsequently given. This case report aims to highlight the involvement of the optic radiations and the unusually aggressive clinical course in this case.