Don’t Miss This! Red Flags in the Pediatric Eye Examination: Ophthalmoplegia in Childhood

Research output: Contribution to journalArticle

Abstract

Paralytic strabismus in children is rare, occurring in about 0.1% of children. This rate is far less common than the 3% rate usually noted for comitant strabismus. The relative rates of ocular motor pareses were fourth nerve palsies in 36%, sixth in 33%, third in 22%, with multiple ocular motor nerve palsies in 9%. In a single population series from Minnesota, few cases were associated with neoplasm. However, institutional case series reports a high rate of neoplasm for acquired third nerve and sixth nerve palsies after excluding trauma and congenital causes. Tumor is rare in children with fourth cranial nerve palsies, usually associated with other neurologic disease. Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles. Myasthenia most often presents as ptosis with exotropia. Rarer still is involvement of the extraocular muscles in childhood thyroid disease.

Original languageEnglish (US)
Pages (from-to)93-97
Number of pages5
JournalJournal of Binocular Vision and Ocular Motility
Volume69
Issue number3
DOIs
StatePublished - Jul 3 2019

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Ophthalmoplegia
Trochlear Nerve Diseases
Strabismus
Pediatrics
Oculomotor Muscles
Abducens Nerve Diseases
Exotropia
Neoplasms
Myasthenia Gravis
Thyroid Diseases
Paresis
Nervous System Diseases
Paralysis
Wounds and Injuries
Population

Keywords

  • abducens nerve
  • myasthenia gravis
  • oculomotor nerve
  • ophthalmoplegia
  • Paralytic strabismus
  • trochlear nerve

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "Don’t Miss This! Red Flags in the Pediatric Eye Examination: Ophthalmoplegia in Childhood",
abstract = "Paralytic strabismus in children is rare, occurring in about 0.1{\%} of children. This rate is far less common than the 3{\%} rate usually noted for comitant strabismus. The relative rates of ocular motor pareses were fourth nerve palsies in 36{\%}, sixth in 33{\%}, third in 22{\%}, with multiple ocular motor nerve palsies in 9{\%}. In a single population series from Minnesota, few cases were associated with neoplasm. However, institutional case series reports a high rate of neoplasm for acquired third nerve and sixth nerve palsies after excluding trauma and congenital causes. Tumor is rare in children with fourth cranial nerve palsies, usually associated with other neurologic disease. Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles. Myasthenia most often presents as ptosis with exotropia. Rarer still is involvement of the extraocular muscles in childhood thyroid disease.",
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