Disorders of Ocular Motility in Childhood

Ocular motility disturbances In childhood encompass a somewhat broader range of diagnostic posslblities than similar disturbances seen In adults. Prenatal and perinatal injury, genetic contributions, and Inborn metabolic errors may all warran consideration. For example, neonatal ophthalmoplegia may certainly follow a hypoxlcflschemlc Insult or Injury In the perinatal period. However, Identical clinical findings may be seen as the result of a genetic defect In congenhal fiber type disproportion myopathy; In prenatal embryonic developmental defects, I.e. the Mobius syndrome; the result of an inborn error of amino acid metabolism (Maple Sugar Urine Disease), or be the result of deposition of bilirubin in the kernicterus encephalopathy Some ocular motilltyd lsturbances seem age dependent. Spasmus nutans, for example, appears sometlm afterthe first three months of life and tends to be a self-limited condition. Opsoclonus associated w~h a neuroblastoma also appears in the latter part of infancy. Later In the first d ade, ocular tics appear, at about the same age the Gilles-de-laTourette syndrome develops. It is generally towards the end of the first decade or beyond that voluntary nystagmus Is first seen.