This case report presents a child with intermittent exotropia who was treated with tuina. The main clinical manifestation was right eye deviation, which was diagnosed as liver and kidney deficiency and spleen and stomach qi deficiency. The treatment principles focused on harmonizing qi and blood, dispersing wind and unblocking orifices, and tonifying the liver and kidney. Tuina was applied at the head, face, and neck regions, including "opening the heavenly gate", "pushing kan palace", "rubbing the forehead" and point stimulation of Jingming (BL1), Cuanzhu (BL2), Yuyao (EX-HN4), Sizhukong (TE23), Tongziliao (GB1), as well as massaging Taiyang (EX-HN5), Qiuhou (EX-HN7), Quanliao (SI18), Chengqi (ST1), Sibai (ST2), Muchuang (GB16), Chengguang (BL6), Yifeng (TE17), and Yiming (EX-HN14). Tuina was also applied at upper limbs, including massaging Binao (LI14), Quchi (LI11), and the lower limbs, including pressing and plucking along the liver meridian. The treatment was combined with eye exercises with a "" character pattern. The tuina was administered daily during the first week; every other day from the second to fourth weeks; every four days in the second month; and once weekly in the third month. After 3 months of treatment, the patient's eye position returned to normal. A follow-up after 3 months revealed no recurrence.
Child ; Humans ; Acupuncture Points ; Exotropia/drug therapy*

An 11-year-old female presenting diplopia only at distance was found to have comitant esotropia of 20 prism diopters (PD) at distance and normal alignment at nearer proximity. Other ocular movement, including abduction, was normal and a thorough neurologic examination was also normal. The deviation angle of esotropia was increased to 35 PD in 6 months, and a brain magnetic resonance imaging with venogram at that time demonstrated no intracranial lesion. A lumbar puncture showed increased opening pressure but the cerebrospinal fluid composition was normal. The patient was diagnosed as having idiopathic intracranial hypertension and treated with oral acetazolamide. Three months after treatment, the deviation angle decreased to 10 PD. This is a case report of divergence insufficiency in pediatric idiopathic intracranial hypertension, with an increasing deviation angle of esotropia. Although sixth cranial nerve palsy is a common neurologic manifestation in intracranial hypertension, clinicians should be aware of the possibility of divergence insufficiency. Also, ophthalmoparesis may not be apparent and typical at first presentation, as seen in this case, and therefore ophthalmologists should be aware of this fact, while conducting careful and proper evaluation, follow-up, and intervention.
Acetazolamide/administration & dosage ; Administration, Oral ; Child ; Diagnosis, Differential ; Diuretics/administration & dosage ; Esotropia/diagnosis/*etiology/physiopathology ; Exotropia/diagnosis/*etiology/physiopathology ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Pseudotumor Cerebri/*complications/diagnosis/drug therapy ; Spinal Puncture/methods ; Vision, Binocular ; Visual Acuity

PURPOSE: To report a case of primary yolk sac tumor of the orbit. METHODS: A 15-month-old girl was referred for evaluation of ptosis and strabismus in the right eye which had developed over the previous two weeks. On examination, ptosis, exotropia, proptosis, and restriction of extraocular muscle movement of the right eye were noted. A computed tomography (CT) scan of the orbit showed a 2.4 cm x 3.4 cm-sized soft tissue mass in the posterior aspect of the right orbit which enveloped the optic nerve and invaded the maxillary sinus, posterior ethmoid sinus, nasal cavity, and intracranial space. Endoscopic biopsy of the nasal cavity mass was performed. RESULTS: Histologic evaluation revealed solid proliferation of germ cells with large, clear cytoplasm and intracellular, extracellular hyaline globules. Immunohistochemical staining for alpha-fetoprotein was positive. Results of further systemic evaluation were all negative. The tumor regressed after combined chemotherapy and radiotherapy. The patient has been disease free for 2 years. CONCLUSIONS: The possibility of yolk sac tumor should be considered in the differential diagnosis in a younger patient for an orbital mass with rapidly increasing size and adjacent bony destruction. Prompt diagnosis and appropriate therapeutic approaches are essential.
alpha-Fetoproteins ; Biopsy ; Cytoplasm ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Endodermal Sinus Tumor* ; Ethmoid Sinus ; Exophthalmos ; Exotropia ; Female ; Germ Cells ; Humans ; Hyalin ; Infant ; Maxillary Sinus ; Nasal Cavity ; Optic Nerve ; Orbit* ; Radiotherapy ; Strabismus ; Yolk Sac*

PURPOSE: In order to make an accurate diagnosis, we investigated clinical manifestations and ocular findings in children with ocular myasthenia gravis that can be easily misdiagnosed. METHODS: The medical records of 7 boys and 18 girls under the age of 15 years with ocular myasthenia gravis were reviewed retrospectively. The mean follow-up period was 37 months. RESULTS: The mean age at onset was 37 months. Ptosis was found in 22 patients(88%), strabismus in 21 patients(84%) and amblyopia in 5 patients(20%). Exotropia combined with vertical heterotropia was the most frequent type of strabismus. Ocular motility abnormality was found in 17 patients(68%). The limitation of supraduction or infraduction was most frequently observed. The manifestations of strabismus and ocular motility abnormality were variable and frequently changed during follow-up period. Prednisolone was used more often than pyridostigmine as a maintenance therapy. Ptosis was more responsive to drug therapy than strabismus. CONCLUSIONS: The main ocular findings in ocular myasthenic children were ptosis and exotropia that was not commonly found in Caucasian children. Vertical heterotropia as well as ptosis were commonly accompanied with the horizontal heterotropia. The type and angle of strabismus as well as ocular motility in duction/version were variable during follow-up period
Amblyopia ; Child* ; Diagnosis ; Drug Therapy ; Exotropia ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Myasthenia Gravis* ; Prednisolone ; Pyridostigmine Bromide ; Retrospective Studies ; Strabismus