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BACKGROUND: An abnormal head posture (AHP) is an important clinical sign; it may be due to non-ocular or ocular causes. The literature on the subject is disperse, however. OBJECTIVE: To present a comprehensive discussion on the subject. CLINICAL CONDITIONS: AHP due to an ocular cause can be observed in conditions both not related or related to the extraocular motility. In the latter group, comitant deviations, incomitant deviations, supranuclear palsies, A and V pattern, nystagmus, and central nervous system disorders are included. Facial asymmetry can be a feature of a long-standing congenital or acquired AHP.

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BACKGROUND: Double elevator palsy (DEP) is a not uncommon congenital or acquired clinical entity. Although a full tendon transposition of the horizontal rectus muscles is the widely accepted treatment, the number of reports in the literature is not great, and the techniques used are varied. This study reports on patients with congenital or early onset "acquired" DEP submitted only to a transposition of the horizontal rectus muscles according to Knapp, to add our experience to the literature. SUBJECTS AND METHODS: Ten consecutive patients without complicating factors had the horizontal rectus muscles transposed to the angle of the insertion of the superior rectus. Patient ages ranged from 10 months to 7 years 4 months. The vertical deviation in primary position ranged for distance from 14 PD to 50 PD (mean 30.6 PD) and at near from 12 PD to 50 PD (mean 27.4 PD). Five patients had only a vertical deviation, and five also a horizontal deviation. The first postsurgical evaluation was done between 7 and 39 days (mean 14.3) and the last between one and 196 months (mean 102.1). The fusional status was assessed using the Worth Four-Dot Test and Major Amblyoscope. RESULTS: Postoperatively, 3/10 patients had no vertical deviation for distance. Two were undercorrected (by 1 PD, 8 PD); and five were overcorrected (3 PD, 4 PD, 10 PD and two by 25 PD). The mean correction for distance was 36. 4 PD. Three of the ten patients had no vertical deviation at near; two were undercorrected (by 1 PD, 8 PD); and five overcorrected (two by 4 PD, one each by 6 PD, 7 PD, and 9 PD). The mean correction at near was 29.5 PD. Long term followup changes: The correction for distance between the first and last postsurgical evaluation increased (the preop' deviation decreased) in 8/10 patients (range 3 PD to 45 PD, mean 18.6 PD). At near, 9/10 patients had an increase in the correction of the vertical deviation over this period (range 4 PD to 24 PD, mean 13.8 PD). CONCLUSION: This transposition procedure can reduce or eliminate the vertical deviation both for distance and at near, and has an increased effect over time.

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Histological and morphometric evaluation of ocular inflammation is difficult, particularly when there is extensive ocular involvement with abscess formation and necrosis. A quantitative imaging procedure applicable to humans would be important clinically. To establish such a procedure, turpentine-induced ocular inflammation was obtained by subconjunctival injection in the right eye of 55 rabbits. The left eye was used as control and injected with a volume of saline equal to the volume of turpentine in the right eye. Volumes of turpentine or saline were 0.02, 0.04, 0.06, 0.2 and 0.6 ml, and the rabbits were divided into groups 1-5, according to these volumes. Imaging was performed 48 h after turpentine injection and 6 h after intravenous injection of 10 mCi of technetium-99m glucoheptonate (99mTc-GH). An inflammatory reaction index (IRI), defined as the ratio of counts of the right eye divided by counts of the left eye, was used. IRIs were proportional to the degree of inflammation and allowed the distinction of 3 subgroups: one represented by group 4, one by group 5 and one by groups 1, 2 and 3. This method of quantification of ocular inflammatory processes using 99mTc-GH is original, rapid, non-invasive, reproducible and safe, although unable to differentiate inflammatory processes caused by doses of turpentine which are very small and close to each other. It is conceivable that its application to humans will bring new insight into the ocular inflammatory process and response to therapy.

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The physiopathological features concerning the affected and the fellow eye were considered. As far as the diagnosis is concerned, the test of Bicas, examination of binocular rotations and of versions, and the Maddox double rod test are discussed; the features of a bilateral palsy were stressed. For surgical treatment, the various weakening procedures of the inferior oblique are evaluated. The author's technique for resection of the superior oblique is described.

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Um caso de sindrome de Moebius associado a anomalia de Poland e laringomalacia e relatado. O paciente apresenta paralisia do sexto e setimo pares craniano em adicao a ausencia do musculo peitoral maior direito afundamento do hemitorax direito com hipoplasia da segunda, terceira e quarta costelas; a mao direita apresenta hipoplasia do primeiro, segundo e terceiro dedos e sindactilia do quarto e quinto dedos. Pe torto congenito bilateral, em equinovaro, foi observado

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Sao relatados 13 casos de diverticulos de uretra em pacientes de ambos os sexos, e idade compreendida entre 10 e 78 anos, atendidos nos Servicos de Urologia do Hospital de Clinicas e Santa Casa de Misericordia de Curitiba

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Os AA. comparam dois grupos geograficamente diferentes de pacientes com microtropia, um de Leeds (Inglaterra) e outro de Sao Paulo (Brasil) e comentam as diferencas e semelhancas encontradas

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Tear calcium contents were measured in 30 normal subjects divided into six groups of 5 individuals each, age ranging from the second to the seventh decade. No significant difference was found among the age groups. A mean of 4.40 mg of calcium/100 ml was determined for the 30 subjects with a standard deviation of 1.22 and a range 2.60-7.60 mg/100 ml. The tear calcium as percentage of the serum calcium was similar in the six groups and a mean of 45.68 was found for the 30 subjects. This figure is quite similar to that of serum ionised calcium as percentage of the total serum calcium values obtained by different authors.

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Foi extirpado o ganglio esquerdo em 11 caes.Em 6 animais foi estudada a influencia desta cirurgia sobre a pressao intra-ocular, o coeficiente de facilidade de escoamento do humor aquoso e o diametro pupilar,uma semana apos a ressecao do ganglio. Nos outros 5 animais as medidas foram realizadas apos 5 semanas da extirpacao.Observou-se que na primeira semana os tres parametros mostraram-se estatisticamente diferentes dos obtidos no olho controle, direito. Apos 5 semanas apenas o diametro pupilar mantinha-se diferente; a pressao intra-ocular e o coeficiente de facilidade de escoamento do humor aquoso nao foram estatisticamente diferente dos obtidos no olho controle, direito

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Foi relatado o caso de paciente adulto, do sexo masculino, que sofreu picada de vespa na palpebra superior esquerda. Ao quadro inflamatorio classico seguiu-se necrose que comprometeu grande parte do anexo. O paciente foi submetido a tratamento com antibioticos, por via sistemica e local, bem como com anti-inflamatorio. Houve cicatrizacao da lesao, sem comprometimento funcional

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Uma paciente de 13 meses foi atacada por um cao, sem contudo que o animal a tocasse No dia seguinte apresentou esotropia incomitante, com paresia de nervo abducente esquerdo. Investigacao oftalmologica, pediatrica, hematologica e laboratorial revelaram apenas o estrabismo. A tomografia axial computadorizada mostrou infarto do operculo a esquerda. Angiografia carotidea esquerda e vertebrobasilar foram ambas normais. As causas patogeneticas possiveis sao discutidas. A paciente foi submetida a cirurgia e os resultados apos um curto seguimento foram satisfatorios

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Em estudo retrospectivo foram levantados os casos de microtropias vistas no Servico de Motilidade Extrinseca da Clinica Oftalmologica do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo no periodo de lo de outubro de 1975 a lo de outubro de 1980, sendo analisados 135. Estudaram-se assim os casos, apos diagnostico baseado em diversos parametros, quanto a incidencia desta entidade; a presenca de componente vertical associado; as diferencas entre primarias e secundarias, microesotropias e microexotropias; a frequencia no sexo masculino e feminino; ao tratamento para ambliopia e seu resultado; a acuidade visual do olho fixador em relacao ao adelfo; a idade de apresentacao a preferencia por OD ou OE como fixador; a refracao; a percepcao macular simultanea; a fusao e sua amplitude e a estereopsia para longe. Os resultados sao discutidos assim como as diferencas entre os diversos subgrupos, baseando-se para isso nos dados obtidos

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A bilateral recession of an overacting superior oblique was performed in nine patients with "A" pattern ranging from 12 to 48 diopters, with an average of 24 prism diopters.There were six esotropic and three exotropic subjects. In all cases but one, some surgery of one or two horizontal recti was done at same time.An under correction was observed in two patients, of respectively 13 and 9 prism diopters. An overcorrection not exceeding 15 prism diopters was seen in six patients; in four it measured 3 prism diopters or less. A full correction was obtained in one case. The mean correction of "A" pattern was 25 prism diopters.Complications were not observed during the follow-up period.

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Recession of the superior oblique was performed bilaterally in 12 patients with the A phenomenon and unilaterally in four patients with vertical imbalance. The results are discussed.

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