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Oculomotor consequences of intraventricular hemorrhages in premature infants
Insights
Intraventricular hemorrhages in preterm infants can cause significant oculomotor deficits, including downward eye deviation and esotropia. While upgaze palsy may improve, persistent esotropia often requires surgical intervention.
Area of Science:
- Ophthalmology
- Neurology
- Neonatology
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm infants.
- Oculomotor deficits following IVH are not well-characterized in neonates.
- Similarities exist between ocular findings in infants with IVH and adults with hypertensive thalamic hemorrhages.
Purpose of the Study:
- To describe the ocular findings in preterm infants with intraventricular hemorrhages.
- To investigate the relationship between IVH and specific oculomotor abnormalities.
- To determine the prognosis of these oculomotor deficits.
Main Methods:
- Case series of 11 preterm infants with documented intraventricular hemorrhages.
- Clinical examination of ocular movements and deviations.
- Comparison of findings with adult hypertensive thalamic hemorrhage cases.
Main Results:
- All 11 infants exhibited tonic downward and esotropic eye deviations.
- No upgaze response was observed in any of the infants.
- Oculomotor deficits were attributed to direct hemorrhage effects on thalamic and mesencephalic structures.
Conclusions:
- Intraventricular hemorrhages in preterm infants lead to characteristic oculomotor deficits.
- Prognosis for upgaze palsy is generally good, with variable recovery times.
- Large-angle esotropia frequently persists and necessitates surgical correction.
Abstract:
We report the ocular findings in 11 preterm infants who sustained intraventricular hemorrhages. The defects were similar to those in adults who suffer from hypertensive thalamic hemorrhages. All 11 infants showed tonic downward and esotropic deviations of their eyes. Upgaze response could not be elicited in any of the infants. Although the role of secondary hydrocephalus cannot be discounted, we conclude that the direct effect of the hemorrhage on thalamic and mesencephalic structures is essential in the production of these oculomotor deficits. The prognosis for recovery of the upgaze palsy in these patients is good, although the time course may vary. However, the large-angle esotropia usually persists and requires surgical correction.