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Alice Shen, Karen Revere, Yinxi Yu, Gui-Shuang Ying, William Katowitz, Gil Binenbaum; Prevalence of Incidental Ophthalmic Findings in Children Presenting to Oculoplastic Surgeons. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6236.
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Early diagnosis of amblyogenic factors is important to promote healthy visual development. Children presenting with oculoplastics problems offer an opportunity to identify amblyogenic factors that may otherwise go undetected. We sought to determine the prevalence and characteristics of incidental pathologic ophthalmic findings in children who present with an orbital or oculoplastics issue.
Retrospective cross-sectional study of children under age 8 years evaluated at the oculoplastics clinics of Children’s Hospital of Philadelphia in a 4-year period. All had a complete exam by a pediatric oculoplastic specialist. A subgroup was also examined by a pediatric or pediatric neuro-ophthalmologist. The primary outcome was the presence of one or more ophthalmologic findings in any of three categories: significant refractive error, eye movement abnormality, and intraocular abnormality. Eyelid and ocular surface (conjunctival/corneal) findings were excluded as outcomes, as they were considered part of and not incidental to the oculoplastics exam.
3,787 children under age 8 years were studied. Presenting complaints included tearing(33%), eyelid abnormality(28%), ptosis(26%), hemangioma(7%), trauma(7%), orbital lesion(7%), an/microphthalmia (3%), and other(13%). Overall, 737 children (19.5%) had an incidental potentially visually significant ocular finding. These included high refractive error (10.2%), astigmatism being most prevalent (8.8%); strabismus (8.9%); motility abnormality (5.7%); nystagmus (2.3%); anterior intraocular abnormality (iris, lens) 2.7%; posterior segment (retinal or optic nerve) abnormality (3.9%). 1,055(28%) children also had a pediatric/neuro-ophthalmologist exam, of whom 28.4% had an abnormality based upon oculoplastics exam, and 36.5% had an abnormality based upon non-oculoplastics exam.
One fifth of children in the amblyopic age range presenting with oculoplastics-related issues had additional potentially visually significant ophthalmic abnormalities. Our findings highlight the importance of a complete ophthalmological examination, including funduscopic examination and cycloplegic refraction, in young children presenting with oculoplastics issues. If necessary, referral to a pediatric ophthalmologist can be considered to complete a full examination.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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