Nelson_Pediatric Ophthalomology, 3e

MICROPHTHALMIA 15

● Eyelid findings ■ Narrow palpebral fissures

correct refractive error to aid in visual devel opment and achieve visual potential. ● Treatment of amblyopia: patching of the healthy eye to stimulate as much potential vision as possible ● Protection of the healthy eye in children with unilateral involvement ● Visual aids and other visual resources for children with reduced vision ● Orbital conformers: placed over the mi crophthalmic eye to stimulate growth of the bony orbit. These can be painted or with the pupil left clear for vision. ● Ocular prosthesis: can be fitted over the globe to improve appearance, if needed ● Microphthalmia with cyst is often treated after age 5 to allow time for the cyst to expand within the orbit. When the orbit reaches ~90% of adult volume, surgical excision can be performed. Prognosis ● For severe microphthalmia, the prognosis is the same as for anophthalmia. ● For simple microphthalmia, the visual prog nosis depends on the severity of the condi tion and the associated ocular abnormalities.

■ Foreshortening of the eyelids ■ Shrunken conjunctival fornices ■ Levator function is decreased or absent with poor eyelid folds. ■ Contracture of the orbicularis oculi muscle Differential Diagnosis ● Microcornea with a normal-sized globe ● High hyperopia Diagnostic Evaluation ● Anomalous eyelid and orbital features ● Clinical examination looking for evidence of a cornea or globe ■ Palpation of the orbit to estimate globe size ■ Measurement of corneal diameter (nor mal range, 9.0-10.5 mm in neonates) ● B-scan ultrasonography to evaluate the in ternal structures of the globe ( Fig. 2-6B ) ● CT scan or MRI of the brain and orbits to evaluate the size of the globe and its inter nal structures, the presence of optic nerve and extraocular muscles, and brain anatomy ( Fig. 2-6A,C ) Treatment ● For severe microphthalmia, the treatment is the same as for anophthalmia. ● For simple or complex microphthalmos with a functional eye, there may be a need to

REFERENCES

McLean CJ, Ragge NK, Jones RB, Collin JR. The management of orbital cysts associated with congenital microphthalmos and anophthalmos. Br J Ophthalmol . 2003;87(7):860-863. Verma AS, Fitzpatrick DR. Anophthalmia and mi crophthalmia. Orphanet J Rare Dis . 2007;2:47.

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