No abstract

Inadvertent globe perforation during posterior sub-tenon (PST) injection is rare, and the use of ultrasound biomicroscopy (UBM) in the diagnosis of occult globe perforation is not reported yet in the literature. We hereby intend to discuss the case of a 42-year-old male who presented with left eye loss of vision following PST triamcinolone acetate (TA) injection. On examination, right eye vision was 20/20 and it was 20/120 for the left eye. Fundus examination of the left eye showed a whitish fluffy mass like preretinal lesion over the macula with vitreous haze. The patient was thoroughly investigated for intermediate and posterior uveitis. However, all reports turned out to be within the normal limits. The 360° UBM scan of the left eye showed well-defined hypoechoic scleral tract suggestive of globe perforation at 2 o’clock position. The, whitish preretinal mass in the left eye was suspected to be intravitreal TA deposit following an inadvertent globe perforation during the posterior sub-tenon TA injection. UBM can be considered important diagnostic aid in ruling out possibility of occult globe perforation in certain circumstances.

Purpose: The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy. Methods: This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management. Results: A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third ( n = 35, 38.88%) followed by sixth ( n = 23, 25.55%) and fourth nerve ( n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital ( n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve ( n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy ( n = 27, 77.14%). The radio-imaging yield was maximum ( n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery. Conclusion: The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy.