What's new AAPOS 2008 - The Private Eye Clinic

NEURO-OPHTHALMOLOGY
Adverse effects of apraclonidine used in the diagnosis of Horner’s syndrome in
infants.
Watts T, Satterfield D, Kim MK.
J AAPOS 2007; 11: 282-83.
The authors present an index case of a five-month-old infant girl along with four
additional cases provided through the pediatric ophthalmology listserve. Three of these
children had drowsiness and two cases required emergency admission for
unresponsiveness. One case had associated bradycardia, hypertension, and
decreased oxygen saturations. The authors recommend that apraclonidine be used
with caution or not at all in infants under six months of age. If used the patient should
be observed for a period of at least two hours after installation of the drops with
admission to the pediatric ward if lethargy, bradycardia or reduced respiratory rate
develop.
Pediatric idiopathic intracranial hypertension
Rangwala LM, Liu GT. Surv Ophthalmol 2007; 52: 597-617.
This review article summarizes currently knowledge regarding pediatric idiopathic
intracranial hypertension. The use of rigorous methodologies and standard definitions
in recent studies has demonstrated distinct demographic trends: (1) The incidence of
idiopathic intracranial hypertension seems to be increasing among adolescent children,
and among older children its clinical picture is similar to that of adult idiopathic
intracranial hypertension (female and obese). Within younger age groups there are
more boys and nonobese children who may develop idiopathic intracranial
hypertension. (2) The pathogenesis of the disease has yet to be elucidated. Idiopathic
intracranial hypertension among young children has been associated with several new
etiologies, including recombinant growth hormone and all-trans-retinoic acid. (3) More
modern neuroimaging techniques such as MRI and MRI-venograms are being used to
exclude intracranial processes. (4) Although most cases of pediatric idiopathic
intracranial hypertension improve with medical treatment, those who have had visual
progression despite medical treatment have undergone optic nerve sheath fenestration
and lumboperitoneal shunting. (5) Because idiopathic intracranial hypertension in
young children appears to be a different disorder than in adolescents and adults,
separate diagnostic criteria for younger children are warranted. The authors propose
new criteria for pediatric idiopathic intracranial hypertension in which children should
have signs or symptoms consistent with elevated intracranial pressure, be prepubertal,
have normal sensorium, can have reversible cranial nerve palsies, and have an opening
cerebrospinal fluid pressure greater than 180 mm H 2 O if less than age 8 and
papilledema is present, but greater than 250 mm H 2 0 if age 8 or above or less than 8
without papilledema.
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