title: Ophthalmic Features of Outpatient Children Diagnosed with Intracranial Space-Occupying Lesions by Ophthalmologists.
abstract: BACKGROUND
  Brain tumors in children often involve the visual system, but most retrospective series are by neurologists or oncologists. In this study we highlight the ophthalmic findings of outpatient children with visual complaints and/or strabismus who, based on ophthalmic examination, were suspected to and confirmed to harbor intracranial space-occupying lesions by magnetic resonance imaging (MRI).
  
  
  METHODS
  Retrospective case series of children (less than 18 years) who for visual complaints and/or strabismus underwent cranial MRI at a referral eye hospital (2005-2012), which revealed intracranial space-occupying lesions. Exclusion criteria were known preexisting orbital or ocular trauma, ocular tumor, or neurological disease.
  
  
  RESULTS
  For 26 patients (3 months-17 years; mean 7 years; median 9 years; and 14 boys), the most common clinical presentation was decreased vision with disc pallor (10) or swelling (three). Other presentations were strabismus with disc pallor or swelling (four; two of which were left sixth nerve palsies), acquired esotropia with diplopia (three; one bilateral and two left sixth nerve palsies), acquired exotropia (four; two of which were bilateral third nerve palsies, one of which was left partial third nerve palsy, and one of which was associated with headache), nystagmus (one), and disc swelling with headache (one). Most lesions were in the sellar/suprasellar space (10), posterior fossa (six), or optic nerve/chasm (four).
  
  
  CONCLUSIONS
  The majority of outpatient children diagnosed by ophthalmologists with intracranial space-occupying lesions presented with disc swelling or pallor in the context of decreased vision or strabismus. Two strabismus profiles that did not include disc swelling or pallor were acquired sixth nerve palsy and acquired exotropia (with ptosis (third nerve palsy), nystagmus, or headache).
authors.affiliation: Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Umm Al Hamam Al Gharbi, Riyadh, Saudi Arabia.
authors.forename: Nayef
authors.initials: N
authors.lastname: Alswaina
authors.affiliation: Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Umm Al Hamam Al Gharbi, Riyadh, Saudi Arabia.
authors.forename: Sahar M
authors.initials: SM
authors.lastname: Elkhamary
authors.affiliation: Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Umm Al Hamam Al Gharbi, Riyadh, Saudi Arabia.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Shammari
authors.affiliation: Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Umm Al Hamam Al Gharbi, Riyadh, Saudi Arabia.
authors.forename: Arif O
authors.initials: AO
authors.lastname: Khan
mesh_terms: D020434:Abducens Nerve Diseases / Q000175:diagnosis*; D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D004172:Diplopia / Q000175:diagnosis*; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis*; D009885:Ophthalmology; D010045:Outpatients; D010211:Papilledema / Q000175:diagnosis*; D012189:Retrospective Studies; D013285:Strabismus / Q000175:diagnosis*; D014786:Vision Disorders / Q000175:diagnosis*
keywords: Brain Tumor; Optic Nerve; Pediatric; Strabismus