Eye oscilations with neurological implications in pediatric age
D Celdrán-Vivancos1, S Noval-Martín2, M González-Manrique3
1Servicio de Oftalmología, Hospital Universitario de La Princesa, Madrid, Spain.
Insights
Infantile ocular oscillations, often benign, can signal serious neurological conditions in 33% of cases. Early neuro-ophthalmological evaluation and imaging are crucial for accurate diagnosis and management of these complex eye movements.
Area of Science:
- Neuroscience
- Ophthalmology
- Pediatrics
Background:
- Congenital eye oscillations, including nystagmic and non-nystagmic types, are observed from birth.
- Most cases present as infantile nystagmus within the first six months, encompassing idiopathic, sensory, and latent motor forms.
- Approximately 33% of ocular oscillations are linked to underlying neurological diseases or syndromes, necessitating prompt identification due to potential visual and vital complications.
Purpose of the Study:
- To systematically review literature on supranuclear gaze control mechanisms and ocular oscillations with neurological implications in children.
- To assess existing clinical-anatomical associations for these conditions.
- To propose a protocol for complementary diagnostic studies in pediatric cases of ocular oscillations.
Main Methods:
- Systematic literature review focusing on supranuclear gaze control and pediatric ocular oscillations.
- Analysis of existing clinical-anatomical associations.
- Development of a proposed protocol for diagnostic investigations.
Main Results:
- Certain anatomical pathways in supranuclear gaze control remain incompletely understood.
- Specific anatomical explanations for the pathogenesis of most ocular oscillations (except seesaw and upbeat nystagmus) were not identified.
- The importance of comprehensive neuro-ophthalmological examinations and additional testing for children with neurologically indicative ocular oscillations is evident.
Conclusions:
- Supranuclear gaze control involves a complex neurological network requiring further research.
- Enhanced understanding of this network may elucidate the specific presentations of ocular oscillations.
- Neuroimaging is frequently indicated, with other tests selected based on individual clinical presentation.
Introduction:
Eye oscillations, both nystagmic and non-nystagic, can occur from birth. Most correspond to infantile nystagmus that dubates in the first six months of life, which include idiopathic, sensory, latent, or overt latent motor nystagmus. Those associated with neurological diseases or syndromes correspond to approximately 33%, their identification and correct evaluation being important given the potential visual and vital complications.
Material And Methods:
We made a systematic review of the literature on supranuclear gaze control mechanisms and the main ocular oscillations with possible neurological implications, both in childhood. With this, we intend to assess if there are already established clinical-anatomical associations, and to propose a protocol on the complementary studies to be carried out in these cases.
Results:
There are still anatomical pathways involved in supranuclear gaze control that are not fully clarified and understood. Besides, except in the case of nystagmus in seesaw and upbeat, we did not find anatomical explanations for their pathogenesis. The need for complete neuro-ophthalmological physical examinations and the request for additional tests in children who present ocular oscillations with neurological characteristics are clear.
Conclusions:
Supranuclear gaze control follows a complex neurological network that still needs to be studied better. With a better dissection of the same we could try to understand why the ocular oscillations that we studied have these specific forms of presentation. As for the complementary requests, the request for neuroimaging tests is practically constant, making the others according to the specific case before which we find ourselves.
