This several month old infant has eyes looking downward and bilateral upper eyelid retraction. We call this the “setting sun sign” as the eyes appear to be “setting”. This child has nothing wrong with the eyes but this is a sign of increased pressure in the brain.
This child was diagnosed with a brain tumor which has been operated on. It was benign. Sometimes children are sent to us with a problem which appears to be in the eyes but actually turns out to be a sign of something more ominous such as a brain tumor. We do a lot of pediatric neuro-ophthalmology at the Hall Eye Center.
A mother is rewarded with a smile!
Dr. Pollard examined a 3-year-old child with extreme nearsightedness. When the child was fitted with glasses for the first time, he looked at the doctor and smiled. Then he looked at his mother and gave her a big smile. His mother cried with emotion as she realized that her child was able to see clearly for the first time.
Twins open their eyes at last!
Dr. Pollard operated on twin girls born with severe ptosis (droopy eyelids) resulting in a slit-like opening of only 1-2 mm. Their parents had never been able to see their daughters’ eyes opened normally. After surgery on both girls, their eyelids are fully open, and they no longer have to tilt back their heads in order to see.
A chemical injury is treated successfully!
A 3-year-old boy accidentally sprayed both eyes with a cleaning solution. The chemical caused severe corneal abrasions. After the doctor irrigated the child’s eyes with normal saline to neutralize the chemical, he recov-ered completely.
Exotropia and Bilateral Ptosis in Myasthenia Gravis Patient
: A 12-year old male presented with the right eye turned outward called exotropia and both upper eyelids drooping, which is called bilateral ptosis. This young male had been twice to the emergency room and had been examined by 2 pediatricians and one pediatric neurologist. No diagnosis had been made after a normal CT scan and a normal MRI of the brain. The patient was referred to Dr. Pollard who examined the patient and diagnosed Myasthenia Gravis and found high serum titers of antibodies to acetylcholine receptor sites. The patient was admitted to the hospital as he was having trouble with slurred speech and swallowing. Consultation with the neurology service at Scottish Rite Hospital confirmed our diagnosis and he was treated in the Intensive Care Unit with systemic steroids, Mestinon, a drug for Myasthenia Gravis and plasma phoresis. So far he has had complete remission of his symptoms. In Myasthenia Gravis there is not enough of the chemical acetylcholine to work at the neuro-muscular junction. Many muscles are affected with paralysis or paresis such as droopy eyelids (weakness of the muscle that opens the eyelids), weakness of the right medial rectus muscle and weakness of the muscles of speech and swallowing.
This 7-month old patient underwent tear duct probing to open up a blocked tear duct to alleviate excessive tearing. This picture was taken in the operating room at Scottish Rite Children’s Hospital.
A one-year-old patient came to the Center because her parents were concerned that one eye looked bigger than the other eye. The exam was difficult as her corneas were cloudy. We were able to determine that her eye pressure was elevated, but we could not see into the eye. We scheduled an exam under anesthesia so that we could better assess her condition. In the operating room, we were able to determine that her retina was detached. We discovered a large retinoblastoma tumor using ultrasound. The eye was subsequently removed, which in this child’s case was a lifesaving procedure.
Esotropia Crossed Eyes and Bilateral Tearing
This three year old girl was flown here to the James Hall Eye Center from Tajikistan in Central Asia. The first picture shows her with bilateral excessive tearing due to a tear duct obstruction on both sides. She also has esotropia – crossed eyes. The second photo shows her without tearing after bilateral surgery on her tear ducts. It was important to clear up her tear duct obstruction before operating on her crossed eyes as a blocked tear duct would be a source of infection which would compromise any muscle surgery. The second photo shows her after her successful eye muscle surgery for her esotropia – crossed eyes.
Duane’s Type II
This is a 4-month-old female with both eyes turning outward which is very unusual as usually one eye is fixating and one eye is turned out. This young baby has bilateral exotropia due to an unusual type of strabismus, which we call Duane’s Type II.
At surgery the lateral rectus in each eye was extremely tight and neither eye could be rotated past the midline toward the nose until each lateral rectus was recessed. The post-operative appearance of this girl at 6 months of age shows straight eyes.
Severe headaches are resolved!
A 12-year-old boy with leukemia and thrombosis of several large veins in his brain complained of recurrent headaches. Initially, a spinal tap indicated that his intracranial pressures were normal. The headaches per-sisted. On a subsequent visit, our ophthalmologist diagnosed swollen optic nerves. He was referred to a neu-rosurgeon for surgery. His headaches were alleviated.
Diagnostic expertise makes a difference!
A 4-year-old child who had a corneal transplant performed elsewhere presented with orbital cellulitis. She was unable to open her left eye, indicating a condition called endophthalmitis. After an intravitreal injection with antibiotics, her condition was resolved.
A traumatic injury is repaired!
A teenage boy presented with a ruptured globe and a traumatic cataract resulting from an eye injury caused by a stick. His ruptured globe was repaired, followed by cataract surgery with lens implant. As he healed from surgery, his visual acuity improved dramatically.
Coat’s Disease / Renal Artery Stenosis
Our training fellow examined a 10-year old boy who complained of blurred vision. This child with limited financial resources needed financial assistance for transportation to the Fulton County Clinic as well as for medical care. A dilated exam of his retina revealed severe retinal hemorrhages with an initial diagnosis of Coat’s disease, an exudative retinopathy occurring in young males. In consultation with Dr. Zane Pollard, the Pediatric Director, a blood pressure reading was taken. The blood pressure reading of 240/160 indicated severe hypertension caused by renal artery stenosis. The patient was immediately admitted to the ICU at Scottish Rite Hospital. If left undetected and untreated, this condition could result in a stroke and could be life threatening.
A 12-year-old male with Keratoconus, a disease in which the cornea protrudes like a cone, was treated at the Center. His vision had decreased to 20/200 in each eye because of irregular astigmatism. However, with the use of specialty fitted contact lenses, his vision improved to 20/25.