Summary for the Clinician
■Twenty-five percent of patients with unilateral microphthalmos and 50% of patients with unilateral anophthalmos had anomalies in the fellow eye, chiefly in the form of coloboma, dermoid, sclerocornea, and glaucoma.
7.3 Results |
111 |
Summary for the Clinician
■Nineteen percent of the children were found to have pathological findings on MRI. Most frequently encountered and in clinical terms, the most serious were developmental anomalies of the corpus callosum; these were about four times more common in bilateral than in unilateral anophthalmos (21.4% vs 4.5%) but were not observed at all in microphthalmos.
7.3.8Neuroradiological Findings (Brain MRI)
Table 7.1. History taking and previous findings in patients treated
|
Unilateral |
Bilateral |
||
|
(n = 54) |
(n = 21) |
||
Normal for age |
44 |
|
14 |
|
Pathological |
5 |
|
6 |
|
(Fig. 7.4) |
Anophthalmos |
■ |
One agenesis |
|
|
■ |
One almost |
|
of corpus |
|
|
total hypoplasia |
|
callosum |
|
|
of the corpus |
■ |
One agenesis |
|
|
callosum, |
|
of corpus |
|
|
extreme |
|
callosum, |
|
|
enlargement of |
|
moderate |
|
|
the lateral |
|
ventricular |
|
|
ventricles |
|
enlargement |
|
■ |
One hypoplasia |
■ |
One agenesis |
|
|
of the corpus |
|
of corpus |
|
|
callosum |
|
callosum, |
|
■ |
One suprasellar |
|
small sella/ |
|
|
hamartoma |
|
pituitary |
|
Microphthalmos |
■ |
One minimally |
|
|
■ |
One minimally |
|
enlarged CSF |
|
|
enlarged CSF |
|
spaces |
|
|
spaces |
■ |
One small |
|
■ |
One general |
|
subarachnoid |
|
|
reduction in |
|
cyst |
|
|
cerebral |
Microphthalmos |
|
|
|
volume |
■ |
One |
|
|
|
|
myelinization |
|
|
|
|
disorder |
Findings still |
2 |
|
0 |
|
awaited |
|
|
|
|
Findings not |
3 (all |
1 (anophthalmos) |
||
available |
|
anophthalmos) |
|
|
(abroad) |
|
|
|
|
CSF cerebrospinal fluid
7.3.9Nasolacrimal System Findings
Patients who had undergone extensive previous surgical procedures involving the nasolacrimal system—or with a history of manipulation performed elsewhere—were excluded from this assessment because otherwise it would not have been possible to differentiate between primary and secondary nasolacrimal system pathology (Table 7.1).
Evaluable findings obtained during probing and irrigation of the nasolacrimal system were available for 61 of the 75 children (30 of 38 with unilateral anophthalmos, 18 of 20 with bilateral anophthalmos, and 13 of 17 with microphthalmos) (Fig. 7.5). Consequently, 80 a total of 96 affected orbits (83.3%) were considered here.
Inpatientswithunilateralanophthalmos/microphthalmos the contralateral healthy side was normally developed and freely irrigable, except for two cases with classic congenital stenosis of the lacrimal fold.
Normal anatomy and irrigation outcome were noted in barely one quarter of cases with anophthalmos. Well over half of the patients showed an association with stenosis of both canaliculi, which could be probed for a distance of between 1 and 8 mm (mean 4 ± 1.9 mm). Eight children showed typical stenosis at the level of the valve of Hasner. Stenoses of one canaliculus (5%) and of the common canaliculus (6%) were comparatively rare. Other pathologies, such as aplasia of the lacrimal puncta or fistulas, were not observed.
Summary for the Clinician
■Nasolacrimal duct pathology was present in about 75% of the children in the study sample. This primarily took the form of canalicular stenosis. Typical congenital stenosis of the lacrimal fold was not encountered more frequently than normal.