Ocular Syndromes and Systemic Diseases


Miller Syndrome (Postaxial Acrofacial Dysostosis; Genee-Wiedemann Syndrome) 816



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Miller Syndrome (Postaxial Acrofacial Dysostosis; Genee-Wiedemann Syndrome) 816

General: Cause unknown; sporadic and familial cases known as Genee-Wiedemann Syndrome.

Ocular: Ectropion.

Clinical: Malar hypoplasia; cleft palate and lip; postaxial limb deficiency; cup-shaped ears.

Chrzanowska KH, et al. Phenotype variability in the Miller acrofacial dysostosis syndrome: report of two further patients. Clin Genet 1989; 35:157-160.

Genee E. Une forme extensive de dysostose mandibulo-faciale. J Genet Hum 1969; 17:45-52.

Miller M, Fineman R, Smith DW. Postaxial acrofacial dysostosis syndrome. J Pediatr 1979; 95:970-975.

Wiedemann HR. Missbildungs-Retardierungs-Syndrom mit Fehlen des 5 Strahls an Haenden and Fuessen, Gaumenspalte, dysplastischen Ohren und Augenlidem und radioulnarer Synostose. Klin Paediatr 1973; 185: 181-186.

Miller Syndrome (Wilms Aniridia Syndrome; WAGR Syndrome; Wilms Tumor-Aniridia-
Genitourinary Abnormalities-Mental Retardation Syndrome) 817


General: Etiology unknown; manifests an association of aniridia, which is inherited as a dominant autosomal trait, and Wilms tumor; this is one of the best studied continuous gene syndromes as defined by Schmickel.

Ocular: Glaucoma; bilateral aniridia (aniridia often not complete, with remnants of iris root present as rudimentary forms); cataract.

Clinical: Wilms tumor; mental retardation with microcephaly; genital malformations with cryptorchidism and hypospadias; hemihypertrophy; kidney anomalies (horseshoe kidney).

Fraumeni JF, Glass AG. Wilms' tumor and congenital aniridia. JAMA 1968; 206:825.

Mackintosh TF, et al. Aniridia and Wilms' tumor (nephroblastoma). Br J Ophthalmol 1968; 52:846.

McKusick VA. Mendelian Inheritance in Man; A Catalog of Human Genes and Genetic Disorders, 12th ed. Baltimore: The Johns Hopkins University Press, 1998.



Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute for Genetic Medicine, Johns Hopkins University and National Center for Biotechnology Information, National Library of Medicine, February 12, 2007. World Wide Web URL: http://www.ncbi.nlm.nih.gov/omim/.

Miller RW, et al. Association of Wilms' tumor with aniridia, hemihypertrophy and other congenital malformations. N Engl J Med 1964; 270:922.

Schmickel RD. Chromosomal deletions and enzyme deficiencies. J Pediatr 1986; 108:244-246.

Mirror Image Syndrome (Autoscopic Syndrome; Lukianowicz Phenomenon) 818

General: Patient's delusion that he or she is seeing a double of himself or herself; seen in patients with schizophrenia, epilepsy, migraine, and even depression; the "double" usually appears suddenly and is of white or gray hue (see Capgras Syndrome, of which this syndrome is a variant).

Ocular: Hallucination in the form of seeing a double of self.

Clinical: Migraine; schizophrenia; epilepsy; depression.

Lipton CW. Hallucinations of physical duality in migraine. J Nerv Ment Dis 1953; 117:345.

Lukianowicz N. Autoscopic phenomena. Arch Neurol Psychiatr 1958; 80:199.

Magalini SI, Scrascia E. Dictionary of Medical Syndromes, 2nd ed Philadelphia: JB Lippincott, 1981.



Misdirected Third Nerve Syndrome 819

General: May occur with a variety of inflammatory infections and parainfections, vascular lesions, tumors, and degenerative and demyelinating diseases that may involve the nerve anywhere; may occur as primary aberrant regeneration without prior history of acute oculomotor nerve palsy.

Ocular: Bizarre eyelid movements that may accompany various eye movements; lid may rise as the medial rectus, the inferior rectus, or the superior rectus muscle contracts; iridoplegia; ptosis.

Clinical: None.

Beard C. Misdirected third nerve syndrome. In: Mosby CV, ed. Ptosis, 3rd ed. St. Louis: CV Mosby, 1981:115.

Harley RD, ed. Pediatric Ophthalmology, 4th ed. Philadelphia: WB Saunders, 1998.

Lepore FE, Glaser JS. Misdirection revisited: a critical appraisal of acquired oculomotor nerve synkinesis. Arch Ophthalmol 1980; 98:2206-2209.

Miller NR, ed. Walsh and Hoyt’s Clinical Neuro-Ophthalmology, vol. III. 4th ed. Baltimore: Williams & Wilkins, 1988.

Roy FH. Ocular Differential Diagnosis, 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Schatz NJ, et al. Primary aberrant oculomotor regeneration: a Sign of intracavernous meningioma. Arch Neurol 1977; 34:29-32.

ML I (Mucolipidosis I; Lipomucopolysaccharidosis; Dysmorphic Sialidosis; Spranger Syndrome) 820

General: Rare storage disease; autosomal recessive; increased sialic acid and deficiency of the enzyme alpha-N-acetylneuraminidase in cultured mucolipidosis I fibroblasts.

Ocular: Variable corneal clouding; macular cherry-red spot; optic atrophy; lens opacity; pupillary reflexes anomaly; grayish area around cherry-red spot.

Clinical: Moderate progressive mental retardation; skeletal changes of dysostosis multiplex; peripheral neuropathy; myoclonic jerks; tremor; cerebellar signs; gait abnormalities.

Carta F, et al. Mucolipidosis 1: ocular signs in three sisters. Metab Ophthalmol 1985; 8:21-27.

Duane TD. Clinical Ophthalmology. Philadelphia: JB Lippincott, 1987.

Shinkai H, et al. Connective tissue naevus with pseudo-Hurler polydystrophy. Br J Dermatol 1994; 130:528-533.



ML II (I-Cell Disease; Mucolipidosis II) 821

General: Autosomal recessive mucolipidosis is a Hurler-like disorder with some radiologic features, striking fibroblast inclusions, and no excess mucopolysacchariduria; abnormal N-acetylglucosamine phosphotransferase.

Ocular: Minimal corneal clouding; glaucoma; megalocornea.

Clinical: Congenital dislocation of the hips; thoracic deformities; hernia; hyperplastic gums; retarded psychomotor development and restricted joint mobility; dysmorphic facies; skeletal deformities; organomegaly; short stature; mental retardation.

Ben-Yoseph, et al. Mucolipidoses II and III variants with normal N-acetylglucosamine I-phosphotransferase activity toward alpha-methylmannoside are due to nonallelic mutations. Am J Hum Genet 1992; 50:137-144.

Borit A, et al. Ocular involvement in I-cell disease (mucolipidosis II). Light and electron microscopic findings. Graefes Arch Klin Exp Ophthalmol 1976; 198:25-32.

Collins JF. Handbook of Clinical Ophthalmology. New York: Masson, 1982.

Duane TD. Clinical Ophthalmology. Philadelphia: JB Lippincott, 1987.

Libert J, et al. Ocular findings in I-cell disease (mucolipidosis type II). Am J Ophthalmol 1977; 83:617-628.



ML III (Pseudo-Hurler Polydystrophy; Mucolipidosis III) 822

General: Autosomal recessive disorder, almost indistinguishable biochemically from mucolipidosis II; decreased levels of N-acetylglucosamine phosphotransferase.

Ocular: Increased corneal thickness; wrinkled maculopathy; granular pigmentary changes of fundus; papilledema; hyperopic astigmatism; corneal opacities; retinal vascular tortuosity; visual field defects.

Clinical: Joint stiffness; coarse facial feature; short stature; aortic valve disease; arm and hand deformities; self-mutilation of the distal phalanges; carpal tunnel syndrome.

Collins JF. Handbook of Clinical Ophthalmology. New York: Masson, 1982.

Duane TD. Clinical Ophthalmology. Philadelphia: JB Lippincott, 1987.

Traboulsi EI, Maumenee IH. Ophthalmologic findings in mucolipidosis III (pseudo-Hurler polydystrophy). Am J Ophthalmol 1986; 102:592-597.

Zammarchi E, et al. Self-mutilation in a patient with mucolipidosis III. Pediatr Neurol 1994; 11:68-70.

ML IV (Mucolipidosis IV; Berman Syndrome) 823

General: Storage disease in which corneal clouding is an early sign with no evidence of systemic involvement until age 1 year; autosomal recessive; cases seen in Ashkenazi Jews; abnormal neuraminidase.

Ocular: Corneal clouding; corneal opacities; epithelial edema; retinal atrophy; pale optic nerve; diffuse corneal clouding present at birth or in early infancy.

Clinical: Progressive psychomotor retardation; skeletal dysplasia; facial anomalies.

Collins JF. Handbook of Clinical Ophthalmology. New York: Masson, 1982.

Duane TD. Clinical Ophthalmology. Philadelphia: JB Lippincott, 1987.

Folkerth RD, et al. Mucolipidosis IV. Morphology and histochemistry of an autopsy case. J Neuropathol Exp Neurol 1995; 54:154-164.

Merin S, et al. Mucolipidosis IV. Ocular, systemic, and ultrastructural findings. Invest Ophthalmol 1975; 14:437-448.

MMMM Syndrome (Neuhauser Syndrome; Megalocornea, Macrocephaly, Mental and Motor
Retardation) 824


General: Rare

Ocular: Megalcornea

Clinical: Mental retardation; hearing loss; sensorineural complications; hypoplasia; corpus callosum; macrocephaly

Tominaga N, Kamimura N, Matsumoto T, et al. A case of megalocornea mental retardation syndrome complicated with bilateral sensorineural hearing loss. Pediat Int 1999; 41:392-394.

Tonaki H: Megalcornea-mental retardation syndrome. Turk J Pediatr. 2002; 44: 274-277

Möbius I Syndrome (Hemicrania, Hemiplegic; Hemiplegic-Ophthalmoplegic Migraine; Hemiplegic
Familial Migraine) 825


General: Etiology unknown; indirect indications of unilateral cerebral edema due to vasomotor phenomena; occurs in young adults; recovery usually follows after a few days; no clear etiology has been determined, including a vascular theory of embryopathogene-sis, a chromosome translocation, and exposure to teratogens.

Ocular: Extraocular palsy; permanent damage of oculomotor nerve III.

Clinical: Hemicrania; hemiparesis; aneurysm of internal carotid; neoplasia; headache.

D'Cruz OF, et al. Mobius syndrome: evidence for a vascular etiology. J Child Neurol 1993; 8:260-265.

Donahue SP, et al. Broad-spectrum Mobius syndrome associated with a I; II chromosome translocation. Ophthalmic Paediatr Genet 1993; 14:17-21.

Kankirawatana P, et al. Mobius syndrome in infant exposed to cocaine in utero. Pediatr Neurol 1993; 9:71-72.

Lipson T, et al. The Mobius syndrome: etiology, incidence of mental retardation and genetics [Letter]. J Med Genet 1990; 27:533-535.

Magalini SI, Scrascia E. Dictionary of Medical Syndromes, 2nd ed. Philadelphia: JB Lippincott, 1981.

McKusick VA. Mendelian Inheritance in Man; A Catalog of Human Genes and Genetic Disorders, 12th ed. Baltimore: The Johns Hopkins University Press, 1998.

Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute for Genetic Medicine, Johns Hopkins University and National Center for Biotechnology Information, National Library of Medicine, February 12, 2007. World Wide Web URL: http://www.ncbi.nlm.nih.gov/omim/.

Mobius PJ. Ueber Periodishe Wiederkehrende Oculomotoriuslachennung. Klin Wochenschr 1884; 21:604-608.



Möbius II Syndrome (Congenital Facial Diplegia; Congenital Paralysis of the Sixth and Seventh Nerves; Congenital Oculofacial Paralysis; Von Graefes Syndrome) 826

General: Congenital; possibly failure of development of facial nerve cells or primary defect of muscles deriving from first two brachial arches or both; recovery in a few weeks or nonprogressive permanent paralysis of face; asymmetrical; if incomplete, usually spares lower face and platysma.

Ocular: Proptosis; ptosis; weakness of abductor muscles; normal convergence; limitation to internal rotation in lateral movements; esotropia.

Clinical: Facial diplegia; deafness; loss of vestibular responses; webbed fingers or toes; clubfoot.

Abbott RL, et al. Saccadic velocity studies in Mobius syndrome. Ann Ophthalmol 1978; 10:619-623.

Fenichel GM. Congenital facial asymmetry (aplasia of facial muscles). In: Fenichel GM, ed. Clinical pediatric neurology, 2nd ed. Philadelphia: WB Saunders, 1993:341-342.

Kawai M, et al. The syndrome of Mobius sequence, peripheral neuropathy, and hypogonadotropic hypogonadism. Am J Med Genet 1990; 37:578-582.

Menkes JH, Kenneth T. Mobius syndrome. In: Menkes JH, ed. Textbook of child neurology, 5th ed. Baltimore: Williams & Wilkins. 1995:309-310.

Merz M, Mojtowicz S. The Mobius syndrome. Am J Ophthalmol 1967; 63:837.

Mobius PJ. Uber Angeborene Doppelseitige Abducens-Facialislahmung. Munch Med Wochenschr 1888; 35:91.

Pucket CL, Beg SA. Facial reanimation in Mobius syndrome. South Med J 1978; 71:1498-1501.



Mohr-Claussen Syndrome (Oral-Facial-Digital Syndrome Type II; OFD Syndrome; Orofaciodigital Syndrome II) 827

General: Rare; autosomal recessive; certain features similar to Papillon-Leage-Psaume, Carpenter, Laurence-Moon-Bardet-Biedl, and Ellis-Van Creveld syndromes (see Papillon-Leage-Psaume Syndrome; Laurence-Moon-Bardet-Biedl Syndrome; Ellis-Van Creveld Syndrome).

Ocular: Epicanthus; bridged chorioretinal colobomata.

Clinical: Clefts and fibroma of tongue; polydactylia; broad nasal bridge; narrow-arched palate; short humerus, femur, and tibia; irregular teeth; hypotonia; mental retardation; deafness; thin and fair hair; cerebellar atrophy.

Anneren G, et al. Abnormalities of the cerebellum in oro-facio-digital syndrome II (Mohr syndrome). Clin Genet 1990; 38:69-73.

Claussen O. Et Arvelig Syndrome Omfattende Tungemisdannelse og Polydaktyli. Nord Med 1946; 30: 1147.

Geeraets WJ. Ocular Syndromes. 3rd ed. Philadelphia: Lea & Febiger, 1976.



Moller-Barlow Disease 828

General: Vitamin C deficiency in children.

Ocular: Hemorrhages around and, in rare cases, in eyes; yellow-brown discoloration from hemosiderin may remain for some time after resolution of a subconjunctival hemorrhage; hemorrhage in eyelids, conjunctiva, anterior chamber, and retina; proptosis in infantile scurvy.

Clinical: Tenderness of the lower extremities; ecchymoses.

Gabay C, et al. A case of scurvy presenting with cutaneous and articular signs. Clin Rheumatol 1993; 12:278-280.

Goskowicza M, Eichenfield LF. Cutaneous findings of nutritional deficiencies. Curr Opin Pediatr 1993; 5:441-445.

Pau H. Differential diagnosis of eye diseases. New York: Thieme, 1987.



Molluscum Contagiosum 829

General: Etiologic agent of this disease is a poxvirus that can cause proliferative skin lesions anywhere on the body; commonly found in patients who are immunosuppressed.

Ocular: Lesions of lid, lid margin, conjunctiva, and cornea; conjunctivitis; keratitis; corneal ulcer.

Clinical: Well-defined, pearly appearing papules with umbilicated centers of varying size (3 to 10 mm); eczematization of the surrounding skin.

Collins JF. Handbook of Clinical Ophthalmology. New York: Masson, 1982.

Fraunfelder FT, Roy FH. Current Ocular Therapy, 5th ed. Philadelphia: WB Saunders, 2000.

Harley RD, ed. Pediatric Ophthalmology, 4th ed. Philadelphia: WB Saunders, 1998.

Hindaal CH, Van Bijsterveld OP. Molluscum contagiosum of the palpebral conjunctiva. Ophthalmologica 1979; 178: 137-141.

Kohn SR. Molluscum contagiosum in patients with acquired immunodeficiency syndrome. Arch Ophthalmol 1987; 105:458.



Monbrun-Benisty Syndrome (Ocular Stump Causalgia) 830

General: Sympathetic irritation of resected sympathetic fiber to the eye; occurs after trauma of eye.

Ocular: Severe refractory pain of orbital cavity.

Clinical: Pain of face and the corresponding hemicranium; congestion and hyperhidrosis of region involved.

Barre JA, Klein M. Un Cas de Syndrome de Monbrun-Benisty (Causalgie du Moignon Oculaire) Gueri par Gasserectomie. Revotoneuro-Ophthalmol 1934; 11:755-758.

Magalini SI, Scrascia E. Dictionary of Medical Syndromes, 2nd ed. Philadelphia: JB Lippincott, 1981.

Monofixation Syndrome (Blind Spot Syndrome; Primary Monofixation) 831

General: No hereditary factor; uncommon.

Ocular: Deviation of eight prism diopters or less by simultaneous prism and cover test; central scotoma; stereopsis; good fusional vergences found in patients with congenital esotropia; unilateral syphilitic optic perineuritis (rare); congenital esotropia (inherited in a multifactorial fashion).

Clinical: Syphilis (rare).

Bolet RV. Development of mono fixation syndrome in congenital esotropia. J Pediatr Ophthalmol Strabismus 1981; 18:49-51.

Fletcher WA, et al. Acute Idiopathic blind spot enlargement. Arch Ophthalmol 1988; 106:44-49.

Hahn E, et al. Factors associated with binocular single vision in microtropia/monofixation syndrome. Can J Ophthalmol 1991; 26:12-17.

McBurney J, Rosenberg M. Unilateral syphilitic optic perineuritis presenting as the big blind spot syndrome. J Clin Neuro-Ophthalmol 1987; 7:167.

Morris RJ, et al. Fusion after surgical alignment of long-standing strabismus in adults. Ophthalmology 1993; 100: 135-138.

Parks MM. The monofixation syndrome. Trans Am Ophthalmol Soc 1969; 67:809-855.

Scott MJ, et al. Prevalence of primary mono fixation syndrome in parents of children with congenital esotropia. J Pediatr Ophthalmol Strabismus 1994; 31:298-301.



Moraxella Lacunata 832

General: Gram-negative rod; causes chronic angular blepharoconjunctivitis; without treatment, may persist for months or years; normally found in flora of respiratory tract; seen more frequently in alcoholics and those with poor sanitary habits; Moraxella organisms produce proteases, although those are not related directly to their pathogenetic mechanism.

Ocular: Catarrhal angular conjunctivitis; corneal ulcer; hypopyon, chronic blepharitis; eczema; lateral canthal skin erythema; iridocyclitis.

Clinical: Alcoholism; impaired nutrition; dermatitis.

Baum J, et al. A survey of Moraxella corneal ulcers in a derelict population. Am J Ophthalmol 1980; 90:476-480.

Burd EM. Bacterial keratitis and conjunctivitis. In: Smolin G, Thoft RA, eds. The Cornea. Boston: Little, Brown and Company, 1994:20-21.

Fraunfelder FT, Roy FH. Current Ocular Therapy, 5th ed. Philadelphia: WB Saunders, 2000.

van Bijsterveld OP. The incidence of Moraxella on mucous membranes and the skin. Am J Ophthalmol 1972; 74: 72-76.

Morgagni Syndrome (Hyperostosis Frontalis Interna Syndrome; Intracranial Exostosis; Metabolic Craniopathy) 833

General: Dominant inheritance; onset around age 45 years; occurs almost exclusively in females. Cataract; optic nerve injury within the optic canal by bony protrusions, with resulting blindness.

Clinical: Hyperostosis frontalis interna; obesity (mainly trunk and proximal portions of limbs); hirsutism; menstrual disorders; hypertension; arteriosclerosis; headache; hypertrichosis; no case of male-to-male transmission is known; hyperprolactinemia.

Falconer MA, Pierard BE. Failing vision caused by a bony spike compressing the optic nerve within the optic canal. Report of two cases associated with Morgagni's syndrome benefited by operation. Br J Ophthalmol 1950; 34:265.

Geeraets WJ. Ocular Syndromes, 3rd ed. Philadelphia: Lea & Febiger, 1976.

McKusick VA. Mendelian Inheritance in Man; A Catalog of Human Genes and Genetic Disorders, 12th ed. Baltimore: The Johns Hopkins University Press, 1998.



Online Mendelian Inheritance in Man, OMIM. McKusick-Nathans Institute for Genetic Medicine, Johns Hopkins University and National Center for Biotechnology Information, National Library of Medicine, February 12, 2007. World Wide Web URL: http://www.ncbi.nlm.nih.gov/omim/.

Morgagni GB. De Sedibus et Causis Morborum Peranatomen Indagatis Libri Quinque (2 volumes). Venetiis: Typog. Remondiniana, 1761. Alexander B, English translation, 3 volumes. London, 1769. (Selections in Med Classics 1940; 4:640).

Pawlikowsky M, et al. Hyperostosis frontalis, galactorrhea, hyperprolactinemia, and Morgani-Stewart-Morel syndrome [Letter]. Lancet 1983; 1:474.

Morning Glory Syndrome (Hereditary Central Glial Anomaly of the Optic Disk) 834

General: No hereditary factor; rare; anomaly of optic disk with deep excavation resembling the flower for which syndrome is named.

Ocular: Strabismus; abnormality of embryologic development of anterior chamber (anterior chamber cleavage syndrome); remnants of hyaloid system; chorioretinal pigment surrounding optic disk; narrow branches of retinal arteries at edge of optic disk; retinal exudates and detachment; subretinal hemorrhages and retinal neovascularization; enlarged pink optic disk, funnel shaped with a central white fluffy dot; nerve head surrounded by elevated annulus of chorioretinal pigment, unilateral.

Clinical: Midline cranial facial defects such as hypertelorism, cleft lip/palate, basal encephalocele, agenesis of corpus callosum, sphenoid encephalocele defects in the floor of the sella turcica; cranial, facial, and neurologic associations; pituitary dwarfism; association with the CHARGE syndrome.

Caprioli J, Lesser RL. Basal encephalocele and morning glory syndrome. Br J Ophthalmol 1983; 67:349.

Chang S, et al. Treatment of total retinal detachment in morning glory syndrome. Am J Ophthalmol 1984; 97: 596-600.

Eustis HS, et al. Morning glory syndrome in children. Association with endocrine and central nervous system anomalies. Arch Ophthalmol 1994; 112:204-207.

Handemann M. Erbliche, Vermutlich Angeborene Zentrale Gliose Entartung des Sehnerven mit Besonderer Beteiligung der Zentralgefasse. Klin Monatsbl Augenheilkd 1929; 83:145.

Itakura T, et al. Bilateral morning glory syndrome associated with sphenoid encephalocele. Case report. J Neurosurg 1992; 77:949-951.

Kindler P. Morning glory syndrome: unusual congenital optic disc anomaly. Am J Ophthalmol 1970; 69:376.

Morphea (Localized Scleroderma; Circumscribed Scleroderma) 835

General: Localized chronic connective tissue disease of unknown etiology; etiology remains unknown, although there is a possible association with Borrelia burgdorferi infection.

Ocular: Circumscribed plaque like lesions of the eyelid; prevalent in females; onset usually in second to fourth decades of life; onset occasionally associated with trauma, pregnancy, or menopause.

Clinical: Firm skin plaques over entire body, but most frequently on trunk, lower extremities, upper extremities, face, and genitalia; abdominal pain; migraine; generalized joint pain; renal crisis; Raynaud phenomenon; systemic sclerosis; eosinophilia; positive antinuclear factor; increased immunoglobulin (immunoglobulin G [IgG]); seizures; skin sclerosis; alterations in tryptophan metabolism.

Baba FE, et al. Morphea of the eyelids. Ophthalmology 1982; 89:1285-1288.

Ghersetich I, et al. Localized scleroderma. Clin Dermatol 1994; 12:237-242.

Maricq HR. Capillary abnormalities, Raynaud's phenomenon, and systemic sclerosis in patients with localized scleroderma. Arch Dermatol 1992; 128:630-632.

Trevisan G, et al. Borrelia burgdorferi and localized scleroderma. Clin Dermatol 1994; 12:475-479.

West RH, Barnett AJ. Ocular involvement in scleroderma. Br J Ophthalmol 1979; 63: 845-847.

Wigley FM. Clinical aspects of systemic and localized scleroderma. Curr Opin Rheumatol 1994; 6:628-636.




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