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Persefoni Kourti, Athanasios Michos, Efthymia Tsina; Acute strabismus and diplopia in a large series of pediatric patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2417. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical spectrum of diplopia or strabismus in children presented at the emergencies of a pediatric tertiary hospital.
Data of children presented at the emergencies of the ophthalmological department of “Aghia Sophia” Children's Hospital for diplopia or acute strabismus from January 2015 to November 2016 were reviewed. All cases had undergone complete ophthalmological workup, neurological clinical examination, imaging of the brain and orbits, and lumbar puncture when indicated.
A total of forty children, nineteen males and twenty-one females, aged from 5 months to 12 years (mean age 5.7 years) were assessed. Twenty-four children complained for acute strabismus and sixteen for diplopia. Symptoms were first noticed a few hours to nine months before presentation at the emergencies.Clinical examination revealed esotropia (n=12), exotropia (n=4), pseudostrabismus (n=1), cranial nerve palsy (n=4, three with VI nerve palsy and one with III nerve palsy), proptosis (n=1), amblyopia (n=2) and high refractive errors (n=3).Fundus examination showed bilateral optic nerve edema in three children, suspected retinoblastoma of the posterior pole in two children and diffuse retinal hemorrhages in one child. Further workup revealed primary intracranial hypertension in two patients with optic nerve edema and T-cell acute lymphoblastic leukemia in the case with retinal hemorrhages.Imaging findings were abnormal in five children. Magnetic Resonance Imaging was consistent with rhabdomyosarcoma of the orbit in one case, astrocytoma of the pons, thalamus and hippocampus in one case, cavernous sinus thrombosis in one case, and retinoblastoma in two patients.
Of forty children presented at the emergencies complaining for diplopia or strabismus, only twenty-two (55%) had positive clinical findings of either ocular, neurological or oncological origin. Nevertheless, since our study revealed a substantial number of life-threatening underlying pathologies, special caution with extensive workup is warranted when evaluating those cases. To our knowledge, this is the largest series of pediatric patients presented for acute strabismus or diplopia reported so far.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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