Original articleEvidence for Visual Compromise in Preverbal Children with Orbital Vascular Birthmarks
Section snippets
Methods
Four consecutive infants with unilateral periocular vascular lesions that intermittently obstructed vision in the affected eye, and no clinical evidence of amblyopia, were evaluated. Children ranged in age from 7 to 19 months (Figure 1). All underwent a complete eye examination, which showed normal findings except for the vascular marks. No child had anisometropia greater than 0.50 diopter (D) in the greatest meridian as measured by cyclopleged exam. None had strabismus, and no child showed a
Results
Figure 3 shows vector-averaged response amplitudes as a function of stimulus visibility. VEP vernier amplitudes were diminished across most of the sweep range in the affected eyes, with the effect being most pronounced at the most visible end of the sweep. Vernier acuity thresholds were also higher (worse) in the affected eyes: 2 affected eyes had measurable thresholds that were a factor of 3 to 4 times worse than in the fellow eye. The other 2 affected eyes had immeasurable thresholds while
Discussion
When children look in the direction of an adnexal mass, the affected eye may be covered, resulting in intermittent occlusion of vision in the affected eye. Any resultant visual deprivation in this clinical situation is transient (occurs for a few seconds) but is repeatedly present throughout the day. In this study, 4 such children showed vernier acuity deficits consistent with amblyopia. In 3 children, the mass was on the upper eyelid, and in 1 child, the lower lid. None had any clinical signs
Dr William Good is a Senior Scientist at the Smith-Kettlewell Research Eye Institute, San Francisco, California. His specialty certifications are American Boards of Psychiatry & Neurology (1983) and Ophthalmology (1990). He graduated from Princeton University in 1973 and received his MD from University of Cincinnati College of Medicine in 1977. Dr Good did his residency in ophthalmology and fellowship in Pediatric Ophthalmology at the University of California, San Francisco and with Arthur
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Cited by (3)
Hemangiomas and the eye
2015, Clinics in DermatologyCitation Excerpt :A sign of threatened occlusion was defined by one group as “upper or lower eyelid ptosis within 1 or 2 mm of the pupillary border”50 and signifies a patient who should be very closely followed with a low threshold for starting treatment (Figure 9). Additionally, even though a pupil may be unobstructed, if an upper or lower lid encroaches on binocular vision in certain gaze directions (eg, up or down gaze), it may lead to intermittent occlusion and amblyopia.52 Complete visual occlusion is a vision–threatening emergency, and these patients always deserve prompt and aggressive treatment.11
Detection of amblyopia using sweep VEP vernier and grating acuity
2018, Investigative Ophthalmology and Visual ScienceHaemangiomas are common benign tumors of the child
2016, Ceska a Slovenska Oftalmologie
Dr William Good is a Senior Scientist at the Smith-Kettlewell Research Eye Institute, San Francisco, California. His specialty certifications are American Boards of Psychiatry & Neurology (1983) and Ophthalmology (1990). He graduated from Princeton University in 1973 and received his MD from University of Cincinnati College of Medicine in 1977. Dr Good did his residency in ophthalmology and fellowship in Pediatric Ophthalmology at the University of California, San Francisco and with Arthur Jampolsky, MD.