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Compressive optic neuropathy (CON) in Graves' disease caused by hypertrophy of levator and superior rectus muscles: A case report.

Medicine (Baltimore) 2021 Apr;100(14):e25062

Department of Ophthalmology, Osaka Medical College, Osaka, Japan.

Rationale: Enlargemento of the medial rectus is the most predominant factor of compressive optic neuropathy (CON) in Graves' disease. This case report indicates that CON could develop only from the hypertrophic superior levator and superior rectus (SL/SR) muscle in a patient with poorly controlled Graves' disease, and described the possible risk of FT3-thyrotoxicosis with a prominent goiter to develop the current rare case with a review of the literature.

Patient Concerns: A 66-year-old woman undergoing endocrine management of hyperthyroidism with prominent goiter visited the Department of Ophthalmology due to right-eye upper-eyelid retraction. Read More

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Ocular and adnexal anomalies in craniofacial microsomia: Type and prevalence in a multicentre cohort study.

Int J Oral Maxillofac Surg 2021 Mar 19. Epub 2021 Mar 19.

The Dutch Craniofacial Centre, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Centre, Sophia's Children's Hospital Rotterdam, Rotterdam, The Netherlands.

The aim of this multicentre retrospective cohort study was to describe and categorize the types of ocular and adnexal anomalies seen in patients with craniofacial microsomia (CFM) and to determine their prevalence. In addition, the relationship between the OMENS-Plus and Pruzansky-Kaban classification for each patient and the presence of ocular anomalies was investigated. A total of 881 patients with CFM from four different craniofacial centres were included. Read More

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Early Experience With the Clinical Use of Teprotumumab in a Heterogenous Thyroid Eye Disease Population.

Ophthalmic Plast Reconstr Surg 2021 Mar 8. Epub 2021 Mar 8.

Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, U.S.A.

Purpose: To describe the clinical course in a heterogeneous series of subjects with thyroid eye disease (TED) treated with teprotumumab.

Methods: Cross-sectional cohort study including patients with clinical diagnosis of TED who was treated with teprotumumab. The entire cohort was analyzed together and subsequently in clinical subgroups based on stage and grade of disease. Read More

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Oculomotor nerve palsy in an asymptomatic child with COVID-19.

J AAPOS 2021 Mar 6. Epub 2021 Mar 6.

Department of Ophthalmology, Altino Ventura Foundation, Recife, Pernambuco, Brazil; Department of Research, Altino Ventura Foundation, Recife, PE, Brazil; Department of Ophthalmology, HOPE Eye Hospital, Recife, Pernambuco, Brazil. Electronic address:

We report the case of a 2-year-old girl with acute-onset divergent strabismus and ptosis in the right eye. She had an exotropia of 45 for near, eyelid ptosis affecting the visual axis, adduction, limitations of up- and downgaze, and a discrete mydriasis in the right eye. Neurological conditions were ruled out. Read More

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Quality of life and functional vision across pediatric eye conditions assessed using the PedEyeQ.

J AAPOS 2021 Feb 16. Epub 2021 Feb 16.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology and Vision Science, University of Arizona-Tucson. Electronic address:

Purpose: To evaluate eye-related quality of life (ER-QOL) and functional vision across a wide range of pediatric eye conditions, using the Pediatric Eye Questionnaires (PedEyeQ).

Methods: A total of 1,037 children with an eye condition and 254 visually normal controls, across 0-4, 5-11, and 12-17 years age groups, completed the following questionnaires: Child PedEyeQ (Functional Vision, Bothered by Eyes/Vision, Social, Frustration/Worry domains), Proxy PedEyeQ (same domains plus Eye Care), and Parent PedEyeQ (Impact on Parent and Family, Worry about Child's Eye Condition, Worry about Child's Self-perception and Interactions, and Worry about Functional Vision domains). The primary eye condition was classified as amblyopia (n = 171), cataract (n = 99), cerebral visual impairment (CVI; n = 50), cornea (n = 20), eyelid (n = 35), glaucoma (n = 24), nystagmus (n = 57), orbital (n = 19), pupil/iris (n = 7), refractive error (n = 119), retina (n = 82), strabismus (n = 332), and uveitis (n = 22). Read More

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February 2021

Amblyopia and Refractive Status in Congenital Ptosis: The Effect and Timing of Surgical Correction.

Ann Plast Surg 2021 Feb 1. Epub 2021 Feb 1.

From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, the People's Republic of China.

Purpose: The aim of this study was to explore the effect of congenital ptosis on the visual function of patients and observe the improvement in visual function after the correction of ptosis at different surgical times.

Methods: We performed a retrospective study of 265 patients (346 eyes) with congenital ptosis at the same hospital. Each patient underwent an ophthalmic examination, including optometry and measurement of the affected palpebral fissure height and upper eyelid margin reflex distance. Read More

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February 2021

Quality of life of patients with thyroid eye disease: 3-year follow-up in a multidisciplinary clinic in Israel.

Graefes Arch Clin Exp Ophthalmol 2021 Feb 2. Epub 2021 Feb 2.

Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel.

Background: Changes in the quality of life (QOL) of patients with thyroid eye disease (TED) were examined during a 3-year follow-up in a multidisciplinary eye clinic, and factors that may improve QOL were identified.

Methods: A retrospective review of medical records of all patients who attended the TED clinic at Sheba Medical Center, Israel, from May 2016 to May 2019 was performed. The retrieved data included demographics, comprehensive ophthalmic examination findings, clinical activity scores (CAS), laboratory test results, and QOL assessments by the Graves' Orbitopathy QOL (GO-QOL) questionnaire. Read More

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February 2021

Lying down looking down test: Evaluating patient suitability for small incision cataract surgery using assisted topical anesthesia.

Indian J Ophthalmol 2021 Feb;69(2):268-273

Department of Preventive and Social Medicine, DVVPF, Ahmednagar, Maharashtra, India.

Purpose: The objective of this study was to evaluate an OPD-based Lying down looking down (LDLD) test for the assessment of patient suitability for assisted topical anesthesia (ATA) during manual small incision cataract surgery (MSICS), and to compare it with assisted local anesthesia (ALA).

Methods: The LDLD test was carried out during preoperative assessment of 250 consecutive patients. A standard LED torch was shined in patient's eye after pupil dilation, with the patient in lying down position, while simultaneously elevating the upper eyelid digitally. Read More

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February 2021

Bilateral congenital hypertropic strabismus fixus: A case report.

Eur J Ophthalmol 2021 Jan 7:1120672120986367. Epub 2021 Jan 7.

Department of Strabismus and Oculoplasty, Tianjin Aier Eye Hospital, Tianjin, China.

Purpose: To report an unusual and rare case of both eyes fixed in an extreme superomedial position.

Case Report: A case of 48-year-old woman presented with both eyes fixed in an extreme superomedial position; the microcorneas were covered almost completely by the upper eyelids even when she opened her eyes. A forced duction test was performed to confirm there were severe restrictions in all directions. Read More

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January 2021

Single-stage Orbital Decompression, Strabismus and Eyelid Surgery in Moderate to Severe Thyroid Associated Orbitopathy.

Orbit 2021 Jan 3:1-9. Epub 2021 Jan 3.

ENT Department, Villa Tiberia Hospital - GVM Care & Research , Rome, Italy.

: To evaluate the outcome of orbital decompression, strabismus and/or eyelid surgery in patients with moderate to severe thyroid-associated orbitopathy, when combined approach is preferred. : Retrospective, comparative, non-randomized review of 45 patients operated on from 2015 to 2018. Simultaneous decompression, eyelid and/or strabismus surgery was performed in 34 eyes of 20 subjects (group 1). Read More

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January 2021

Quantitative Assessment of Orbital Decompression Surgery Using Photogrammetric Stereoimaging.

Ophthalmic Plast Reconstr Surg 2020 Nov 4. Epub 2020 Nov 4.

*Adnexal Service, Moorfields Eye Hospital †NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London, United Kingdom.

Purpose: To evaluate periorbital volume changes, using quantitative photogrammetric stereoimaging, after bony orbital decompression for thyroid eye disease (TED) and compare this to changes in Hertel exophthalmometry. Tissue volumes of the upper and lower eyelids were also assessed independently.

Design: Prospective, nonrandomized, nonconsecutive series of patients. Read More

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November 2020

Anaesthesia for ophthalmic procedures in patients with thyroid eye disease.

Anaesth Intensive Care 2020 Nov 16;48(6):430-438. Epub 2020 Nov 16.

Department of Ophthalmology, Royal Prince Alfred Hospital, Camperdown, Australia.

Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial disfigurement, functional disability and, in severe cases, blindness. Overall, approximately 20% of affected patients need some form of surgical intervention requiring anaesthesia. Read More

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November 2020

Strabismus in chronic progressive external ophthalmoplegia.

Acta Ophthalmol 2021 Mar 15;99(2):e274-e280. Epub 2020 Nov 15.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: To elucidate the patterns of strabismus and ophthalmoplegia associated with chronic progressive external ophthalmoplegia (CPEO) confirmed by mitochondrial DNA (mtDNA) deletions in Asians.

Methods: A total of 10 patients confirmed to have mtDNA deletion associated with CPEO were included. Long-range PCR encompassing the entire mtDNA was carried out. Read More

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A Case of Giant Proliferative Periocular Pyogenic Granuloma.

Orbit 2020 Nov 12:1-2. Epub 2020 Nov 12.

Department of Plastic Surgery, Queen Elizabeth Hospital , Birmingham, UK.

Pyogenic granuloma (PG) is a common vascular anomaly affecting the skin with occasional involvement of mucosa. Ophthalmic surgeons typically encounter these lesions as solitary, bright red, rapidly growing papules following surgery or trauma to the conjunctiva, e.g. Read More

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November 2020

Management of Patients With Graves Orbitopathy Using Endonasal Endoscopic Techniques.

J Craniofac Surg 2020 Nov 9. Epub 2020 Nov 9.

Department of Otolaryngology/Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

Objective: The aim of the authors' study is to show their surgical results in orbital decompression using different endonasal endoscopic techniques. These approaches are according to the degree of proptosis and the presence or not of sight threatening.

Methods: The authors performed 31 orbital decompressions on 20 Graves orbitopathy patients. Read More

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November 2020

Open-care telemedicine in ophthalmology during the COVID-19 pandemic: a pilot study.

Arch Soc Esp Oftalmol 2020 Dec 13;95(12):586-590. Epub 2020 Oct 13.

Departamento de Oftalmología, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.

Background: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. Read More

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December 2020

Gender differences in clinical presentation and prognosis of thyroid eye disease.

Eur J Ophthalmol 2020 Nov 6:1120672120964112. Epub 2020 Nov 6.

Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.

Objective: To examine the clinical differences in manifestation, treatment, and prognosis of thyroid-eye-disease (TED) between men and women.

Methods: This is a longitudinal cohort study. Men and women, who diagnosed with TED and treated at a multidisciplinary TED clinic, were compared regarding differences in demographics, eye examination, disease activity, and quality of life evaluation. Read More

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November 2020

Ocular Emergencies in Children: Demographics, Origin, Symptoms, and Most Frequent Diagnoses.

J Ophthalmol 2020 1;2020:6820454. Epub 2020 Oct 1.

Department of Ophthalmology, Ramón y Cajal University Hospital, Irycis, Rementería Clinic, Madrid, Spain.

Purpose: To describe the epidemiology of ocular emergencies in children in a hospital-based emergency room (ER).

Methods: The medical reports of all children, 14 years of age and younger, who attended La Paz University Hospital (Madrid, Spain) ER from September 2015 to August 2016 were prospectively collected. Demographic data, origin, symptom for consultation, diagnostic tests, final diagnosis, and final referral of patients were recorded. Read More

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October 2020

Medical and Surgical Treatment of Thyroid Eye Disease.

Intern Med J 2020 Sep 25. Epub 2020 Sep 25.

Department of Endocrinology & Diabetes, The Alfred, and Department of Medicine, Monash University Alfred Health, Melbourne, Australia, 3004.

Thyroid eye disease (TED) is an autoimmune inflammatory disease strongly associated with thyroid disease, principally Graves' disease. It can range from mild disease requiring observation or symptomatic treatments only, through to sight-threatening disease requiring major drug therapy and orbital surgery. Severity is graded by the NOSPECS system and activity by the Clinical Activity Score (CAS) to assist in treatment selection. Read More

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September 2020

CHARGE syndrome without colobomas: Ophthalmic findings.

Am J Med Genet C Semin Med Genet 2020 09 10;184(3):611-617. Epub 2020 Sep 10.

Cincinnati Children's Hospital, Abrahamson Pediatric Eye Institute, Cincinnati, Ohio, USA.

To report ophthalmic findings of patients without colobomas, and with a clinical and molecular diagnosis of CHARGE Syndrome. Retrospective study of ophthalmic findings in 67 CHARGE patients-clinically confirmed diagnosis with positive CHD7 mutation-seen in the Ophthalmology department of Cincinnati Children's Hospital Medical Center between January 1, 2008 through September 25, 2018. Criteria for inclusion in this study was absence of any form of a coloboma in either eye. Read More

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September 2020

Ocular Myasthenia Gravis with Severe Blepharitis and Ocular Surface Disease: A Case Report.

Case Rep Ophthalmol 2020 May-Aug;11(2):322-329. Epub 2020 Jul 13.

Department of Ophthalmology, Assuta-Samson Medical Center, Ashdod, Israel.

Ocular myasthenia gravis (OMG) is an autoimmune disease of the neuromuscular junction and commonly associated with other immune diseases. We describe a 16-year-old female who presented to our clinic with 1-month complaints of diplopia and strabismus, visual acuity deterioration, and ocular irritation. Her examination showed crossed diplopia and alternating exotropia of 25 prism diopters, severe blepharitis, conjunctival hyperemia, corneal pannus, epithelial irregularities, and subepithelial opacities. Read More

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Ophthalmological features and treatments in five cases of Waardenburg syndrome.

Exp Ther Med 2020 Oct 23;20(4):3072-3077. Epub 2020 Jul 23.

Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China.

The present study aimed to investigate the ocular characteristics and treatment of Waardenburg syndrome (WS). A total of five patients with Waardenburg syndrome from our hospital, aged between 1 and 8 years, were included in the present study. The clinical data of these patients were analyzed, and the ocular manifestations and treatments were described. Read More

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October 2020

Prospective Correlation of Risk of Obstructive Sleep Apnea With Severe Clinical Features of Thyroid Eye Disease.

Ophthalmic Plast Reconstr Surg 2020 Aug 24. Epub 2020 Aug 24.

Columbia University Edward S. Harkness Eye Institute.

Purpose: To evaluate the association between risk of obstructive sleep apnea (OSA) and severity of thyroid eye disease (TED) using a validated OSA screening tool.

Methods: A prospective, observational cohort study was performed. New adult TED patients were offered OSA screening with the Snoring Tired Observed Pressure (STOP)-Bang survey during their initial evaluation. Read More

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Complex strabismus: a case report of hypoplasia of the third cranial nerve with an unusual clinical presentation.

Arq Bras Oftalmol 2020 Sep-Oct;83(5):424-426

Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço da Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Congenital cranial dysinnervation disorders are a group of complex strabismus syndromes that present as congenital and non-progressive ophthalmoplegia. The genetic defects are associated with aberrant axonal targeting onto the motoneurons, development of motoneurons, and axonal targeting onto the extraocular muscles. We describe here the surgical management of a 16-year-old boy who presented with complex strabismus secondary to hypoplasia of the third cranial nerve and aberrant innervation of the upper ipsilateral eyelid. Read More

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January 2021

Peribulbar injection of glucocorticoids for thyroid-associated ophthalmopathy and factors affecting therapeutic effectiveness: A retrospective cohort study of 386 cases.

Exp Ther Med 2020 Sep 17;20(3):2031-2038. Epub 2020 Jun 17.

Department of Ophthalmology, Ophthalmic Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.

Thyroid-associated ophthalmopathy (TAO) is common in Graves' disease. However, to date, no standard treatment has been established for TAO. The present study aimed to assess peribulbar injection of corticosteroids for TAO treatment as well as factors affecting therapeutic effectiveness. Read More

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September 2020

Visual preservation in congenital orbital fibrosis.

Can J Ophthalmol 2021 Feb 7;56(1):37-42. Epub 2020 Aug 7.

Cullen Eye Institute, Baylor College of Medicine, Houston, Tex.; Cincinnati Children's Hospital Medical Center, Cincinnati, OH.. Electronic address:

Objective: Congenital orbital fibrosis (COF) is a nonprogressive, unilateral, congenital process in which variable fibrosis is demonstrated in the orbit, resulting in restrictive strabismus, upper eyelid malposition, and axial displacement of the globe. We present 4 new pediatric cases of COF and discuss factors that impact visual development. We also describe a patient with local compressive optic neuropathy/edema who underwent optic nerve sheath fenestration (ONSF) for visual preservation. Read More

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February 2021

Unilateral medial rectus muscle recession combined lateral rectus muscle marginal myotomy for the treatment of Duane's retraction syndrome: A promising surgical procedure.

J Res Med Sci 2020 22;25:54. Epub 2020 May 22.

Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Duane's retraction syndrome is a congenital eye movement anomaly with narrowing of the palpebral fissure and globe retraction on attempted adduction. There are several surgical approaches to treat the narrowing of the palpebral fissure. The purpose of the present study was to evaluate the efficacy of unilateral medial rectus recession (MRR) muscle combined lateral rectus (LR) muscle marginal myotomy (MM) with unilateral MRR alone in the management of narrowing of the palpebral fissure of patients with Type 1 Duane's retraction syndrome (DRS). Read More

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Retrobulbar and Tongue Base Pyogranulomatous Myositis Resulting in Strabismus in a Dog: Case Report.

Front Vet Sci 2020 26;7:360. Epub 2020 Jun 26.

Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, TN, United States.

A seven-year-old female spayed Australian Shepherd was presented for a 3-day history of left eye ventromedial strabismus, episcleral injection, protrusion of the third eyelid, miosis, and enophthalmia. Magnetic Resonance Imaging (MRI) identified lesions in the left medial pterygoid muscle and left tongue base. Cytology and histopathology revealed pyogranulomatous inflammation with rod-shaped bacteria and pyogranulomatous myositis, respectively. Read More

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Response to comments on: A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects.

Indian J Ophthalmol 2020 07;68(7):1504-1505

Professor, Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India.

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