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Acute Pupillary Disorders in Children: A 10-Year Retrospective Study of 101 Patients
Giacomo Garone1,2, Marco Roversi3, Mara Pisani4
1Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Acute-onset pupillary motility disorders (APMD) in children can indicate urgent conditions, especially when bilateral or with extra-ocular symptoms. Isolated cases warrant observation and exclusion of toxic exposure.
Area of Science:
- Pediatric Emergency Medicine
- Ophthalmology
- Neurology
Background:
- Acute-onset pupillary motility disorders (APMD) in children are not well-studied.
- Distinguishing benign from urgent conditions (UCs) in the Emergency Department (ED) is critical.
- This study aims to characterize pediatric APMD and identify risk factors for UCs.
Purpose of the Study:
- To describe clinical characteristics of pediatric APMD.
- To identify associations between APMD presentation and the risk of urgent conditions.
- To inform diagnostic and management strategies in the ED.
Main Methods:
- Retrospective pediatric study of APMD cases over 10 years.
- Analysis of clinical features in the overall sample and subgroups based on condition urgency.
- Logistic regression to identify predictors of urgent conditions.
Main Results:
- 101 pediatric patients analyzed; 59.4% had isolated APMD.
- Extra-ocular involvement included altered consciousness, headache, and vomiting.
- Urgent conditions were more frequent in older children with bilateral APMD and/or other manifestations.
- Toxic agent exposure reported in 48.5% of cases.
Conclusions:
- Bilateral APMD and associated symptoms increase the likelihood of urgent conditions.
- Unilateral or isolated APMD may be managed with ophthalmological examination, toxicology exclusion, and observation.
- Early identification of risk factors is crucial for timely intervention.
Background:
To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs.
Methods:
We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition.
Results:
We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations.
Conclusions:
Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended.
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