Fixed scleral-suture strabismus surgery generally produces a postoperative undercorrection drift, especially following recession surgery, exotropia or overcorrection at the first postoperative week.
Objective: To identify the cause of excessive blinking in apparently healthy children, and to evaluate its association with visual activities including visual display terminal use.
Material and Methods: The present study was a descriptive cross-sectional case-control study included 200 children aged 6 to 14 years with chief complaints of excessive blinking (study group) and routine eye check-up visits (control group). All participants underwent a complete eye examination including blink rate and tear break-up time measurement. Parents were asked to answer questionnaires regarding tic disorder and duration of visual activities.
Results: One hundred children in the study group (mean age 7.9±2.0 years) and 100 children in the control group (mean age 9.5±2.3 years) were enrolled. Participants in the study group were predominantly male (77% versus 44%) and had a higher blink rate (30 versus 9 blinks/minute) compared to the control group. In the study group, there was a significantly higher percentage of participants diagnosed with dry eyes (73% versus 6%, p<0.001), allergic conjunctivitis (41% versus 0%, p<0.001) and tic disorder (19% versus 9%, p 0.042) than in the control group. One third of the participants in the study group had mixed diagnoses of dry eyes and allergic conjunctivitis. There was no significant difference in the duration of visual activities including visual display terminal use between groups.
Conclusion: Excessive blinking occurred more commonly in boys. The most common associated disorders with excessive blinking in children were dry eyes, followed by allergic conjunctivitis and tic disorder. There was no association between excessive blinking in children and duration of visual display terminal use.
Keywords: Blinking; Excessive blinking; Dry eyes; Visual display terminal
Three or 4 horizontal muscles surgery in large-angle exotropia can achieve successful motor outcomes and improve stereopsis. Surgeons should aim for initial overcorrection in order to maximize long-term success.
PurposeTo evaluate the success rate and long-term motor and sensory outcomes of the full tendon vertical rectus transposition (VRT) with Foster suture for unilateral complete sixth cranial nerve palsy.Patients and methodsWe reviewed the medical records of patients with unilateral acquired sixth cranial nerve palsy who underwent unilateral full tendon VRT with Foster suture between 2005 and 2016 and had a follow-up of ≥2 years. Data on pre- and postoperative diplopia, face turn, ocular deviation, and limitation of abduction were collected. A successful outcome was defined as a horizontal deviation ≤10 prism diopter (PD) of ortho in a primary position at distance and absence of diplopia.ResultsA total of 20 patients were included in this study. Median (IQR) preoperative deviation was esotropia 65 (40–130) PD, which improved to 10 (−4 to 45) PD postoperatively. Median (IQR) improvement of esotropia was 54 (30–76) PD (P<0.001). Median (IQR) preoperative limitation of abduction was −15° (−22.5° to 10°; negative value means before reaching midline), which improved to 15° (7.5°–45°) pass midline postoperatively. Median (IQR) improvement of abduction deficit was 26° (15°–35°) (P<0.001). Successful surgical outcomes were obtained in eleven patients (55%). All patients in the non-successful group (n=9, 45%) had residual esotropia. Two of them underwent additional bilateral medial rectus recession. No postoperative vertical deviation or torsional diplopia was observed.ConclusionIn our series, the full tendon VRT with Foster suture in unilateral complete sixth cranial nerve palsy resulted in significant improvement of the ocular alignment and range of abduction over the 2-year follow-up period.
PurposeWe aimed to 1) determine the time of maximum cycloplegia after instillation of cyclopentolate 1% in children with brown irises, 2) evaluate the correlation between the pupillary reaction and time of maximum cycloplegia, and 3) identify any side effects of the medication.Patients and methodsThis was a prospective analytical study involving children aged 5 to 14 years who were attending refraction clinic. Cyclopentolate 1% was instilled three times at 10-minute intervals. The spherical equivalent, pupillary reaction, and pupillary diameter were recorded before the first drop and nine times after the last drop at 10-minute intervals. Side effects were assessed. Time of maximum cycloplegia was determined from the time point at which the 95% confidence interval of the differences between the mean spherical equivalent at each point and its final value at 110 minutes was reached and remained within the equivalence limit (±0.25 D).ResultsSixty children were enrolled in this study. Their mean age was 9.8 years (range: 5–4 years). Time of maximum cycloplegia was reached at 30 minutes after the first instillation of cyclopentolate. A poor correlation was observed between the pupillary reaction and the time of maximum cycloplegia (r=−0.07). The mean pupillary diameter at 30 minutes was 3.7±1.3 mm, and further dilation occurred thereafter. No side effects were observed.ConclusionIn most children, maximum cycloplegia was reached 30 minutes after the first instillation of cyclopentolate. The absence of a pupillary reaction should not be used as an indicator of maximum cycloplegia.
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