In two infants hospitalized at the ages of three and one-half months and 11 months because of epileptic seizures, the diagnosis of tuberous sclerosis was reached upon the basis of retinal astrocytomas found in the fundus examination. It is recommended that indirect ophthalmoscopy be performed in all infants and young children referred with signs possibly related to this disease.
Fine cotton thread is used instead of the filter paper of the Schirmer test. One end stained with fluorescein is inserted into the lateral upper conjunctival sac for 5-30 seconds. The length of the soaked portion is measured in millimeters and the two eyes are compared with each other. One test consists of several consecutive measurements. This new method has many advantages over the conventional Schirmer test: (1) It takes less time (5-30 seconds, compared to Schirmer's method which takes five minutes); (2) It is less injurious to the eye than the stiff and rather large absorbing paper; (3) A diagnosis of lacrimal deficiency must be based on several consecutive measurements and the comparison between two eyes in each measurement (the lacrimation normally is very irregular in the same person). It is difficult to measure consecutively with filter paper; (4) The fine thread itself acts as a potent mechanical trigeminal stimulator and as absorbing agent; (5) The thread maintains a stable position in the eye, while the filter paper which hangs on the lower lid sometimes shifts out of place; (6) The fluorescein dye disappearance and dilution tests can be performed simultaneously; (7) This method can be applied to children.
The case presented emphasizes that Toxocara Canis can involve the anterior segment of the eye as an isolated disease process. Most cases of ocular Toxocara Canis are not associated with the other features of the visceral larva migrans syndrome but certainly represents a spectrum of the same parasitic disease. At present, an eosinophil count and isohemagglutinin titers against A and B blood groups appear the easiest hematologic studies to perform and are fairly reliable indicators of active Toxocara infestation. The VLM syndrome is usually a benign, self-limited disease but occasionally severe ocular, pulmonary or CNS involvement may result. The diagnosis should be considered in any child with a unilateral ocular inflammatory disease, especially if there is a history of geophagia or exposure to dogs. Treatment must take into account the severity of the disease, the organ involved, and the tendency to produce an inflammatory process upon the death of the organism. Elimination of the disease requires surveillance of dogs, especially puppies, and avoidance of geophagia.
Two cases of unilateral uveitis which appeared in association with chickenpox are presented. In one of them internal ophthalmoplegia was seen. Possible pathogenic mechanisms are discussed. The unusual cycloplegia which was present in one case can be caused by viral lesion to the ciliary nerves.
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