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An unusual-appearing tumor of the conjunctiva presented in a healthy 11-year-old boy. It was cystic, orange in color, and well encapsulated. After 3 weeks of no response to topical cortisone drops, an excisional biopsy was performed. The histopathology showed the lesion to be a benign lymphoid hyperplasia. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):e15–e16.]

The Solar Observatory was used to observe the photosphere of the sun. The main focus to observer the photosphere are the sunspots and prominences that develop on the surface. These phenomenon can lead to Coronal Mass Ejections (CME’s). After taking pictures and analyzing them, there was only one day that had any activity on the photosphere. It was concluded that the sun is at it’s solar minima. This means that there is little to zero activity on the suns photosphere. With this, and more data over an extended period of time, it is possible to calculate a solar cycle.

Purpose To compare operating room and hospital discharge times between adult strabismus surgeries using intravenous propofol sedation with local anesthesia versus those using general anesthesia. Methods Thirty adult patients underwent uncomplicated strabismus procedures performed by one surgeon using propofol sedation and local subtenon's anesthesia. These were retrospectively matched with adult patients undergoing similar procedures by another surgeon using general inhalational anesthesia. Only one muscle had undergone previous surgery, and no adjustable sutures were used. Times from incision closure to leaving the operating room (Out OR time), and to hospital discharge (DC time) are compared. Results Propofol/local Out OR times ranged 2 to 8 minutes (mean, 4.8). General anesthesia Out OR times ranged from 3 to 28 minutes (mean, 8.8) (means differ at P P P P Conclusions Many adult strabismus surgeries may be performed more efficiently with intravenous propofol sedation and local subtenon's anesthesia than with general anesthesia. Times from the end of surgery to leaving both the OR and the hospital are decreased compared with those of general anesthesia. Extreme delays are rare with propofol/local, but they occurred with general anesthesia.

Purpose To eliminate an abnormal face turn in unilateral Duane’s syndrome, type I, the medial rectus muscle of the Duane’s eye is commonly recessed. Additional recession of the normal contralateral medial rectus muscle has been advocated in selected cases, although little has been published regarding this technique. We present poor results in a small consecutive series. Methods Four consecutive cases of unilateral Duane’s syndrome, type I, with small-angle primary position esotropia are retrospectively reviewed with attention to postoperative face turn. In all cases, the medial rectus muscle of the “normal” eye was recessed as was the medial rectus muscle of the Duane’s eye. Results Two subjects showed little to no improvement in face turn; one subject developed an increased turn; and the last subject developed a consecutive exotropia. Conclusions In small-angle Duane’s syndrome, type I, recession of the normal medial rectus may decrease the positive effects of recessing the Duane’s medial rectus muscle with respect to face turn as well as increase the risk of consecutive exotropia. An alternate theory of normal-eye Duane’s surgery is proposed.

Purpose To observe facial asymmetry in patients with ocular torticollis to better understand its cause. Design Observational case series. Participants Forty-four consecutive patients with ocular torticollis in one author's (MFG) private practice were examined for facial asymmetry from January 1998 to August 1998. Some of these, as well as selective others before January 1998 were photographed for a total of 53 photos. Methods One author (MFG) examined the frontal, maxillary, and mandibular facial areas of 44 consecutive torticollis patients for appearance of unilateral compression or reduced mass. The laterality of such findings was compared with the side of the head turn or tilt. Photographs of 53 selected ocular torticollis patients were inspected and the direction of nasal tip and columella deviation compared with the direction of head tilt or turn. Main outcome measures Subjective clinical determination of appearance of unilateral facial compression or reduced facial mass. Subjective photographic determination of nasal tip and columella deviation. Results Forty-three patients with 10 types of ocular torticollis examined were included. Forty-one of 43 showed compression or reduced mass on the same side as the head turn or tilt, including 3 with adult-onset strabismus. Eight nonsuperior oblique palsy patients had nasal deviation to the same side as the torticollis. Six of the eight had head tilts. Seventeen nonsuperior oblique palsy patients had nasal tip deviation to the opposite side of the torticollis. All were pure head turns. Eight superior oblique palsy patients had nasal tip deviation to the same side as the torticollis; nine had deviation opposite. Conclusions Patients with multiple types of ocular torticollis, including face turns, show similar appearance of facial compression on the side of the torticollis, suggesting that the tilt or turn itself may cause the asymmetry. This includes face turn strabismus, in which facial asymmetry has not previously been described. Head tilts are frequently associated with nasal tip deviation to the side of the torticollis, head turns with deviation opposite. We refer to such asymmetric facial changes associated with ocular torticollis as "ocular plagiocephaly."

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Subperiosteal abscess may accompany orbital cellulitis secondary to sinusitis. Common surgical principles include incision and drainage of all abscesses. Previous evidence suggests that some orbital abscesses may be treatable with intravenous antibiotics, especially in young children. Children's hospital records were reviewed to determine which abscesses may be treated medically.Records of patients admitted for orbital cellulitis from 1993 to 1996 were reviewed. Patients with subperiosteal abscess on CT scan were included. Clinical outcomes for initial surgical versus medical management of medial abscesses were compared. Differences in age, hospital stay, and intracranial involvement were analyzed for medial versus nonmedial abscesses.All patients had abscesses adjacent to infected sinuses. Eighteen young children had medial abscesses. Twelve of 13 were cured by initial medical treatment; 4 of 5 underwent successful initial drainage. Outcomes were not statistically different (P.490). Seven children with nonmedial abscesses were older (P.001) and had more complicated courses than those with medial abscess. Three of 6 children with superior orbital abscess also had intracranial abscess. Intracranial complication was more likely with superior versus medial orbital abscess (P.01).Medial subperiosteal orbital abscesses secondary to sinusitis in children 6 years of age and younger are highly amenable to treatment with intravenous antibiotics. Older children and children with nonmedial abscesses may have more complicated infections. Children with superior orbital abscesses are at higher risk for intracranial abscess.

In this retrospective cephalometric study of mandibular rotational change, we studied 60 cases. All patients were treated with full fixed appliances and exhibited an opening rotation of at least 1.5 degrees during treatment, as measured on the basis of the angle of the Y-axis to the sella-nasion line (SN). Our objective was to determine whether this opening rotation was sustained during retention. Paired t tests were used to test the hypothesis that the treatment change or opening rotation was stable and that these patients did not return to their original mandible-to-cranium relationship in the posttreatment period. Stepwise regression analysis was used to determine which (if any) changes in the independent variables during treatment could predict the subsequent behavior of the angle of the mandibular plane to the SN and the angle of the Y-axis to the SN during retention. During treatment, the mean increase in the angle of the Y-axis to the SN was 2.43 degrees. After an average posttreatment period of 54 months, this angle was reduced on average by only 0.73 degrees. Stepwise linear-regression analysis indicated that none of the treatment changes seen in the independent variables strongly predicted the ensuing closing rotation seen during retention. The correlation coefficient between the Y-axis angle and the mandibular-plane angle during treatment was 0.67. Mandibular opening rotations as a consequence of orthodontic treatment do not invariably return to the pretreatment value, and their negative effects--although sometimes small--cannot be discounted. Because the preponderant evidence of a closing rotation occurs in the terminal pubertal growth stages, the net effect may be even more significant.

OBJECTIVE: Acute rectus muscle palsy caused by orbital myositis is often confused with infectious orbital cellulitis. The purpose of this article is to clarify the former condition by explaining how it is manifested and treated. METHODS: The seven children less than age 11 years in this study were examined after having an acute onset of ocular pain. Physical examination indicated a loss of motility in the field of action of the involved extraocular rectus muscle. Computed tomographic examination confirmed the existence of orbital myositis. Treatment consisted of intravenous or oral administration of corticosteroids. RESULTS: In all the initial evaluations, computed tomography showed the isolated rectus muscle to be enlarged. In four of the patients in whom the lateral rectus was involved, esotropia was present in the primary position. In the fifth patient with lateral rectus involvement, esotropia was seen only in the field of gaze of the involved lateral rectus muscle. The patient with medial rectus involvement had exotropia, and the patient with superior rectus involvement had hypotropia on the involved side. Each had injection and chemosis of the conjunctiva and Tenon fascia only in the quadrant overlying the involved rectus muscle. CONCLUSIONS: Children with orbital myositis can have an acute rectus muscle palsy. The inflammation and strabismus are exquisitely sensitive to systemic corticosteroid therapy, which produces a rapid resolution of symptoms. If the steroid therapy is discontinued abruptly, the myositis can recur. (J PEDIATR 1996;128:230-3)

During growth the muscles of mastication alter their lines of action. Research on long bones indicates that the apparent migration of muscle attachments is due to the movement of the periosteum relative to the underlying bone. To assess whether the pig masseter muscle follows the periosteum during growth, implants of titanium granules in a gelatin matrix were placed simultaneously in various parts of the masseter muscle and its periosteal and bony attachments. Growth movements of these tissues were followed radiographically for 2 months. Granule position was verified histologically. Periosteal movement was the dominant growth process at the insertion of the masseter. All implants migrated caudally relative to the mandible. However, a strong position effect was seen dorsoventrally: implants placed high in the ascending ramus migrated dorsally as well as caudally; low implants migrated only caudally. This differential migration, ascribed to the influence of the condyle, accounts for the increasing horizontal orientation of dorsal fibers. A similar differential was seen along the rostrocaudal axis of the ramus. In contrast to the insertion, the origin of the masseter from the zygomatic arch shows no periosteal movement. Rather, the entire bone-muscle complex becomes displaced by sutural growth, leading to increasing vertical orientation of the masseter. Thus two different aspects of skull growth are responsible for the change in muscle anatomy. © 1993 Wiley-Liss, Inc.

Purpose To present patients who had the onset of strabismus or the recurrence of strabismus after converting to a monovision system of seeing. Design Retrospective interventional case series. Methods Clinical records of 12 patients from the private practice of the corresponding author of this paper (Z.F.P.) were reviewed. Patients obtaining monovision via contact lenses, LASIK, and cataract surgery with posterior chamber intraocular lenses were studied if their monovision produced a new strabismus or was related to the recurrence of a previous strabismus. Results All patients were first treated by converting the monofixing near eye to distance vision and then using reading glasses for near work. Of the 12 patients, 7 regained their fusion by doing away with monovision and 5 required surgery to reestablish motor or sensory control. All of the surgery patients obtained an excellent alignment but 1 did not regain sensory fusion. Conclusion Monovision is successful for the far majority of patients who try it. However, in patients with a previous history of strabismus or those with significant phorias, caution should be used in recommending monovision, and if monovision is elected, keeping the anisometropia to small levels such as 1.25 to 1.50 diopters (D) might lessen the chance of producing strabismus post monovision. The majority of our patients developed strabismus after 2 years of monovision, telling us that while a trial of monovision with a contact lens prior to surgery may suggest that the patient could tolerate monovision, it is not a guarantee.

The records of 48 patients with persistent hyperplastic primary vitreous (PHPV) were reviewed. Approximately 17% had vision of 20/100 or better after surgery, contact lens fitting, and amblyopia therapy. Only eyes with a purely anterior presentation had successful visual outcomes. Lensectomy alone prevented glaucoma, but a membranectomy as well was required to ensure a successful visual result. Eyes with a posterior PHPV had poor visual results because of posterior pole abnormalities. I recommend that an attempt be made to visually salvage eyes with an anterior presentation. Eyes with a posterior or a combination anterior-posterior PHPV can be successfully treated for glaucoma, but the visual results will be poor.

The movement of the entire tongue and intermolar eminence during mastication is described in the domestic rabbit (Oryctolagus cuniculus). Tongue movement and jaw position were analyzed videofluorographically from separate lateral and dorso-ventral views in six rabbits. Metallic markers were inserted into the tongue so that its movement was visible on the fluorographic image. Frame-by-frame analysis of the videofluorographic tape recordings demonstrates that tongue movement in all animals was identical in direction during each part of the chewing cycle. In the lateral view the forepart of the tongue moves down and forward during the opening stroke, whereas the intermolar eminence moves up and forward to appose the palate. During the closing stroke, as the tip of the tongue moves up and back, the intermolar eminence lowers from the palate and retracts. During the power stroke the forepart of the tongue is at its most elevated and retruded position, while the intermolar eminence is its lowest and most retruded. The dorso-ventral view showed that lateral movement of the tongue and mandible are highly synchronous. The intermolar eminence decreases in width during the power stroke, possibly twisting to place or keep food on the teeth. An anterior to posterior undulating movement of the entire tongue occurs throughout the chewing cycle. As the intermolar eminence elevates to appose the palate during the opening stroke, it may replace the bolus on the teeth on the chewing side. The intermolar eminence also appears to be twisting during the closing and power strokes to place or maintain food on the teeth.

Five children lost their ability for motor fusion after traumatic injury to either the eye or head. All patients had the onset of accommodative esotropia within two months of the traumatic episode. The ocular alignment of each child was controlled by the use of spectacles that corrected the accommodative requirements. These patients are unique because they did not show any evidence of accommodative esotropia before their injuries. One child developed accommodative esotropia with a high ratio of accommodative convergence to accommodation. The use of bifocal spectacles controlled the deviation for this child.

The absence of extraocular muscles, particularly the superior rectus1, 2 or superior oblique3, 4 has been recognized to cause strabismus among patients with craniosynostosis. Absence of multiple muscles is less common. In case 1 we note a patient with Pfieffer's syndrome and absent left superior rectus and inferior oblique, with the presence of only a vestigial left superior oblique and an underdeveloped and misinserted left inferior rectus. In case 2 we describe a patient with Apert's syndrome with bilateral absence of the superior rectus and superior oblique muscles. Unsuspected superior rectus absence led to a bilateral elevation deficit after inferior oblique weakening. Also, during the course of treatment, all 3 remaining recti muscles in 1 eye were disinserted. To our knowledge, this is the first report of absent extraocular muscles in Pfieffer's syndrome. Some evidence suggests that collateral anterior segment blood flow exists in cases of absent recti muscles. Further study is needed to determine whether all remaining muscles could be used for strabismus repair. Last, when patients with craniosynostosis require strabismus surgery, we feel that a limited exploration of all extraocular muscles should be carried out.

Three patients with chin-up head postures caused by a nystagmus null point in downgaze were treated using bilateral superior oblique tendon expanders and inferior rectus muscle recessions. Preoperative chin-up head postures measured from 25 to 45 degrees. Postoperatively, 2 patients had complete resolution of their abnormal vertical head postures, and the third showed improvement.