As our ptosis project progresses, we continue to receive recognition from the medical community; we will be presenting our ptosis results at the National Meeting of the American Association for Pediatric Ophthalmology and Strabismus this April in Seattle, Washington.
The American Academy of Ophthalmology sponsored a Pediatric Symposium in Chicago in November 2005 in which Dr. Marc Greenberg gave a speech concerning "Expanded Use of Superior Oblique Expanders."
Using the superior oblique muscle silicone expander on overacting superior oblique muscles has produced results in which the patients do not complain of torsional problems in over 250 cases. Only one patient had a mild paresis of a superior oblique and only one had a mild residual overaction of the superior oblique muscles. These results have been truly wonderful for our patients.
Below, we highlight a small sample of the challenging and diffcult cases treated at the James H. Hall Eye Center in the past year. The first is truly our most exciting case of the year and has been a life saving adventure.
A 12-year old male presented with the right eye turned outward called exotropia and both upper eyelids drooping, which is called bilateral ptosis. This young male had been twice to the emergency room and had been examined by 2 pediatricians and one pediatric neurologist. No diagnosis had been made after a normal CT scan and a normal MRI of the brain. The patient was referred to Dr. Pollard who examined the patient and diagnosed Myasthenia Gravis and found high serum titers of antibodies to acetylcholine receptor sites. The patient was admitted to the hospital as he was having trouble with slurred speech and swallowing. Consultation with the neurology service at Scottish Rite Hospital confirmed our diagnosis and he was treated in the Intensive Care Unit with systemic steroids, Mestinon, a drug for Myasthenia Gravis and plasma phoresis. So far he has had complete remission of his symptoms. In Myasthenia Gravis there is not enough of the chemical acetylcholine to work at the neuro-muscular junction. Many muscles are affected with paralysis or paresis such as droopy eyelids (weakness of the muscle that opens the eyelids), weakness of the right medial rectus muscle and weakness of the muscles of speech and swallowing.
This 7-month old patient underwent tear duct probing to open up a blocked tear duct to alleviate excessive tearing. This picture was taken in the operating room at Scottish Rite Children’s Hospital.
A one-year-old patient came to the Center because her parents were concerned that one eye looked bigger than the other eye. The exam was difficult as her corneas were cloudy. We were able to determine that her eye pressure was elevated, but we could not see into the eye. We scheduled an exam under anesthesia so that we could better assess her condition. In the operating room, we were able to determine that her retina was detached. We discovered a large retinoblastoma tumor using ultrasound. The eye was subsequently removed, which in this child’s case was a lifesaving procedure.
Our training fellow examined a 10-year old boy who complained of blurred vision. This child with limited financial resources needed financial assistance for transportation to the Fulton County Clinic as well as for medical care. A dilated exam of his retina revealed severe retinal hemorrhages with an initial diagnosis of Coat’s disease, an exudative retinopathy occurring in young males. In consultation with Dr. Zane Pollard, the Pediatric Director, a blood pressure reading was taken. The blood pressure reading of 240/160 indicated severe hypertension caused by renal artery stenosis. The patient was immediately admitted to the ICU at Scottish Rite Hospital. If left undetected and untreated, this condition could result in a stroke and could be life threatening.
This is a 4-month-old female with both eyes turning outward which is very unusual as usually one eye is fixating and one eye is turned out. This young baby has bilateral exotropia due to an unusual type of strabismus, which we call Duane’s Type II. 
At surgery the lateral rectus in each eye was extremely tight and neither eye could be rotated past the midline toward the nose until each lateral rectus was recessed. The post-operative appear-ance of this girl at 6 months of age shows straight eyes.
A 12-year-old male with keratoconus, a disease in which the cornea protrudes like a cone, was treated at the Center. His vision had decreased to 20/200 in each eye because of irregular astigmatism. However, with the use of specialty fitted contact lenses, his vision improved to 20/25.
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