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The setting-sun eye phenomenon in infancy
Insights
The setting-sun sign in infants can occur in healthy babies, but may signal increased intracranial pressure in specific age groups and under certain conditions. Early recognition is limited, requiring careful observation of associated symptoms.
Area of Science:
- Pediatrics
- Neurology
- Ophthalmology
Background:
- The setting-sun eye phenomenon, characterized by downward gaze and eyelid retraction, is observed in infants.
- Its association with neurological conditions, particularly increased intracranial pressure, warrants investigation.
Purpose of the Study:
- To evaluate the occurrence and significance of the setting-sun sign in infants during their first year of life.
- To determine the diagnostic value of the setting-sun sign for detecting increased intracranial pressure.
Main Methods:
- A longitudinal study observed 19 infants exhibiting the setting-sun phenomenon.
- Infants were monitored for signs of illness, and the elicitation of the setting-sun sign through positional changes and light stimuli was assessed.
Main Results:
- Nine infants remained healthy, while eight developed increased intracranial pressure requiring surgery.
- Two infants had transient increased intracranial pressure that resolved spontaneously.
- The phenomenon's elicitation varied with infant age and stimulus type.
Conclusions:
- The setting-sun sign can be present in healthy infants, limiting its standalone diagnostic value for increased intracranial pressure.
- Specific elicitation methods and age ranges may suggest increased intracranial pressure when combined with other neurological signs.
Abstract:
In a longitudinal study, 19 infants who displayed the setting-sun eye phenomenon were observed during the first year of life. Nine of the infants showed no signs of illness, eight had an evident increase in intracranial pressure requiring surgical relief, and two had transient signs of increased intracranial pressure which resolved spontaneously. The setting-sun phenomenon could be elicited both by alteration of the infant's position and by removal of light, and it also occurred spontaneously. The effectiveness of the eliciting mechanism depended on the age of the infant. The component parts of the phenomenon consist of downward rotation of the eyeballs and retraction of the upper eyelids, sometimes accompanied by raising of the brow. The phenomenon can be observed in healthy infants, and its value in early recongnition of increased intracranial pressure is limited. The response might indicate increased intracranial pressure if it can be elicited by alteration of position in infants older than four weeks of age or if there is a marked response to removal of light in infants younger than eight weeks or older than 20 weeks of age, especially if the response is combined with constant or intermittent strabismus or undulating eye-movements.