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PubMedDate not supplied

[Indications of exploration and repair of the orbital floor in fractures of the maxillozygomatic complex].

UNLABELLED: Patients with orbital fractures may develop late complications like enophthalmos, orbital dystopia or diplopia, as a result of untreated orbital floor lesions, with herniation of orbital fat. Clinical and radiological findings are not enough for diagnostic and indication of orbital floor repair. PURPOSE: To evaluate the indication of repair of the orbital floor, during the surgical treatment of maxillozygomatic or zygomatic-maxillary compound fractures, by means of systemic exploration and to compare clinical with surgical findings. METHODS: 112 patients with unilateral zygomatic-maxillary compound fracture were submitted to exploration of the orbital floor, during the surgical treatment of the fracture. Open reduction and rigid internal fixation was performed with steel wire or miniplates. An autogenous conchal cartilage graft was used to repair the floor lesion, when there was bone loss of the inferior orbital wall and periorbita discontinuity, with fat herniation. RESULTS: The repair of the orbital floor was indicated in 46.4% of the patients. Early diplopia (before surgery) was observed in 26.6% and enophthalmos in 3.30% of the cases. Among patients with early diplopia, 60% needed repair, while 36.6% of the patients without early diplopia received cartilage graft. No important complications was observed. CONCLUSION: Orbital floor exploration is a complementary maneuver for the treatment of zygomatic-maxillary compound fractures that permits the precise diagnostic of the lesion and the correct indication of repair.

Adult↗
PubMed1994

Graves ophthalmopathy. Results of transantral orbital decompression performed primarily for cosmetic indications.

PURPOSE: Transantral orbital decompression is effective treatment for excessive proptosis and optic neuropathy due to Graves ophthalmopathy. In these sight-threatening circumstances, patients willingly accept the side effects of orbital decompression. When transantral orbital decompression is performed for cosmetic indications, patients' acceptance of side effects may be different. This study reports detailed results of transantral decompression for 34 patients in whom the indications were primarily cosmetic. METHODS: The medical records of 34 patients with Graves ophthalmopathy who had transantral orbital decompression primarily for cosmetic indications were reviewed. Preoperative and postoperative physical features of the eyes were compared. Long-term assessment was formulated from follow-up examination and a follow-up questionnaire. RESULTS: The most notable improvement was in the reduction of proptosis (mean decrease, 5.2 mm). The frequency of asymmetry of proptosis, however, did not improve. Asymmetry was more than 1 mm in 44% of patients preoperatively and in 54% postoperatively. Although the palpebral fissure was decreased by an average of 2.7 mm, upper lid retraction became worse in 12 (43%) of 28 eyes. Of 15 patients who had no diplopia preoperatively, continuous diplopia developed postoperatively in 73%. The patients underwent a total of 37 eye muscle operations and 31 eyelid operations after decompression. Of 29 patients who responded to a long-term follow-up questionnaire, 69% were satisfied with the appearance of the eyes and 31% found it acceptable. No patient was dissatisfied. Symptomatic diplopia was present in 6.9% of patients at the time of the follow-up questionnaire. CONCLUSION: Transantral orbital decompression performed for cosmetic indications in Graves ophthalmopathy may need to be followed by eye muscle and lid operations. These procedures result in a high degree of patient satisfaction. However, a small percentage of patients experience persistent diplopia, despite multiple eye muscle procedures.

Adolescent↗
PubMed1986

Ocular motility disturbances following cosmetic blepharoplasty.

Five patients developed diplopia following cosmetic blepharoplasty. While temporary diplopia and visual disturbances are known to occur following this type of surgery, the persistence of diplopia with demonstrable muscle imbalance is not common. We encountered ocular motility complications involving the inferior or oblique muscle, inferior rectus muscle, and superior oblique tendon.

Diplopia↗
PubMed1992

Unexpected cyclotropia simulating disruption of fusion.

Fifteen patients with diplopia associated with prior scleral buckling, prior penetrating keratoplasty, severe corneal scarring, monocular aphakia, long-standing strabismus, or prior vertical offsets of the horizontal recti were thought to have disruption of fusion because diplopia could not be eliminated with prisms. They were each found to have a substantial symptomatic cyclotropia unassociated with an obvious dysfunction of an oblique muscle. In 13 patients, diplopia resolved after the cyclotropia was corrected surgically.

Aphakia↗
PubMed1975

[Signs, therapy and follow-up of cases with pure blow-out fractures of the orbit (author's transl)].

30 patients with blow-out fractures were referred to our clinic because of serious "eye troubles", most frequently diplopia and haematoma of the eye lids (Table 1). The signs of the characteristic oculomotor imbalance are described. In 10 out of 29 patients motility was normalised spontaneously within 2 weeks. 19 patients underwent surgery because one of the following criteria was fulfilled: 1. Diplopia and positive traction-test not resolving within 10 days. 2. Large hermiation into the antrum. We believe, that posttraumatic diplopia is not only a result of the incarceration, but also of a direct laesion of muscles and connective tissue. Surgery was done by orbital approach. After reposition of antral prolaps and the bony fragment we used Lyodura or, when nessessary, silicon implants. In all patients treated in this way ocular motility was improved, but normalisation was achieved only in 8 cases (Fig. 8).

Diplopia↗
PubMed2000

[Graves ophthalmopathy and ocular myasthenia].

BACKGROUND: An 18-year-old woman presented with thyrotoxic symptoms - right sided lid retraction and exophthalmus. She complained of diplopia on lateral gaze. Laboratory investigations confirmed Grave's disease with hyperthyroidism and TSH receptor antibodies. PATIENTS AND METHODS: Her clinical symptoms improved after thyrostatic and steroid therapy. However, diplopia recurred 2 weeks after withdrawal of steroid therapy and a ptosis of the left lid appeared for the first time. RESULTS: A positive Tensilon test and electromyographic findings confirmed the diagnosis of myasthenia gravis with a predominantly ocular manifestation. Diplopia and ptosis improved with oral pyridostigmine. CONCLUSIONS: The coexistence of myasthenia gravis should be taken into consideration in the management of patients with Graves' ophthalmopathy.

Adolescent↗
PubMed1997

Ocular palsies in the absence of other neurological or ocular symptoms: analysis of 105 cases.

We studied prospectively 105 unselected patients complaining of ptosis and/or diplopia due to extrinsic ophthalmic muscle palsies without other neurological signs. All patients underwent the same diagnostic protocol. The presenting symptoms were: ptosis, 35 patients (33%); diplopia, 27 patients (26%); ptosis and diplopia, 43 patients (41%). The oculomotor nerve was most frequently involved, followed by the abducens nerve. The final diagnoses were: ocular myasthenia, intracranial and/or orbital pathology, thyroid ophthalmopathy, diabetic ophthalmoplegia, mitochondrial myopathy, oculopharyngeal muscular dystrophy. In 26 patients (25%) the cause remained undetermined. Our study confirms the difficulty of establishing an aetiological diagnosis in patients with isolated ocular palsies.

Abducens Nerve↗
PubMed2004

Orbital metastases in breast cancer: report of two cases and review of the literature.

PURPOSE: Intraorbital metastases of solid tumors are a rarely diagnosed clinical condition, even though pathological reports suggest an incidence of up to 30% in cancer patients. We report two cases of intraorbital, extraocular metastases in breast cancer. The first patient was a 45-year-old man who presented with diplopia, upward divergence of the left bulb, and local pain. METHODS: In the standard cerebral magnetic resonance imaging (MRI) no cerebral or ocular tumor was detectable. A subsequent T1-weighted, contrast-enhanced orbital MRI with fat suppression revealed an infrabulbar mass of 18 x 13 mm in size. The second patient, a 59-year-old woman, complained of slight diplopia when looking to the left. Cerebral MRI with fat suppression showed a retrobulbar mass with 17x13 mm. In both patients metastatic breast cancer was known for several years, and both had been in a stable disease situation. Both patients were treated with stereotactic radiation, applying a cumulative dose of 35 and 45 Gy, respectively, which resulted in marked improvement of local symptoms. Most eye metastases of breast cancer are located in the choroidea, while an extrabulbar localization within the orbit is rare, with only 3-10% of all ocular metastases. Autopsy reports reveal that an estimated 10-30% of breast cancer patients develop this form of metastasis. This is in strong contrast to rare clinical case reports, suggesting frequently absent to mild clinical signs and difficult diagnosis. CONCLUSION: If breast cancer patients complain of ophthalmological symptoms such as local pain, impaired vision, or diplopia, it is important to consider ocular or orbital metastatic disease.

Breast Neoplasms↗
PubMed2006

Restrictive horizontal strabismus following blepharoplasty.

PURPOSE: To report a case of horizontal diplopia after a four-lid blepharoplasty. DESIGN: Observational and interventional case report. METHODS: Analysis of the history and management of a 64-year-old man who underwent a four-lid blepharoplasty, after which he developed horizontal diplopia. RESULTS: The patient was found to have a restrictive esotropia. He underwent a recession of the left medial rectus on an adjustable suture, with recurrence of the same pattern of diplopia one month after surgery. CONCLUSIONS: The involvement of the extraocular muscles as a complication of blepharoplasty is uncommon, but when it is present, it may be very difficult to treat.

Blepharoplasty↗
PubMed2004

Evaluation of ocular changes secondary to blowout fractures.

There has been extensive debate over the standard of care of orbital fractures. Entrapment, diplopia, and hypoglobus, with or without enophthalmos, are the most common clinical indications for surgical intervention. Evaluation of these injuries is often limited in the early postinjury period because of edema. In assessing the severity of the injury, the clinician often uses parameters such as changes in visual acuity, patient-reported diplopia, gross changes in globe position, and an evaluation of the extraocular muscles. Many of these parameters are only grossly assessed and therefore are not specifically documented and tracked. The decision to proceed with surgical intervention may be based only on these gross clinical findings. The purpose of this article is to present a reliable and repeatable method for evaluating the degree of diplopia and the globe position of the orbital trauma patient by describing the use of the double Maddox rod test (Wilson Ophthalmic, Mustang, OK) and Hertel exophthalmometer (Wilson Ophthalmic). These methods can provide sequential documentation of the progression of the injury and help better define the need for surgical intervention and to follow the postoperative course.

Diagnostic Techniques, Ophthalmological↗
PubMed2005

Endoscopic endonasal reduction of blowout fractures of the orbital floor.

OBJECTIVES: The aim of this study was to document the usefulness of the endoscopic endonasal approach as a surgical treatment of isolated blowout fractures of the orbital floor. STUDY DESIGN: Retrospective study. SETTING: Between 1997 and 2003, using only an endonasal endoscopic surgical approach, we operated on 62 patients complaining of diplopia due to isolated blowout fractures of the orbital floor. In order to perform the endonasal reduction surgery, supplemental septoplasty and/or submucous conchotomy were done. Immediately following the reduction and the fixation, eye traction tests were performed to confirm the ocular motility improvement. Tampon gauzes or balloon catheters were used for the temporal fixation to support the orbital floor. RESULTS: Postoperatively, diplopia completely disappeared in 55 of the 62 patients (88.7%) that were followed over 6 months. CONCLUSION: The high success rate with regard to diplopia indicates that the endoscopic endonasal approach may be an alternative to extranasal methods. EBM RATING: B-3.

Adolescent↗
PubMed2002

Lymphomatous meningitis of the Burkitt type presenting with multiple cranial neuropathies.

PURPOSE: To describe diplopia as the initial manifestation of the Burkitt lymphoma. DESIGN: Observational case report. METHODS: Retrospective chart review. RESULTS: A 53-year-old human immunodeficiency virus (HIV)-positive man presented with a severe headache associated with binocular diplopia. Flow cytometric analysis of the cerebrospinal fluid demonstrated a monoclonal B-lymphoid cell population consistent with the Burkitt lymphoma. CONCLUSION: Ophthalmologists should be aware that diplopia may be the presenting manifestation of Burkitt lymphoma in an immunocompromised patient.

Burkitt Lymphoma↗
PubMed1995

Unsatisfactory treatment of acquired nystagmus with retrobulbar injection of botulinum toxin.

PURPOSE: We quantified the effects of botulinum toxin injected into the retrobulbar space of patients with acquired nystagmus with prominent vertical or torsional components. METHODS: We measured binocular eye rotations in three planes before and after injection of botulinum toxin (10, 12.5, or 25 units) into the retrobulbar space of one eye of each of three patients, ages 28 to 37 years, with acquired pendular nystagmus. RESULTS: Retrobulbar injection of botulinum toxin abolished or reduced all components of the nystagmus in the treated eye in all three patients for about two to three months. The patient who received 25 units developed complete external ophthalmoplegia and blepharoptosis. The other two patients retained some voluntary movements but developed diplopia. In one patient, visual acuity improved from Jaeger 5 to Jaeger 1. In a second patient, filamentary keratitis developed, and visual acuity declined from Jaeger 2 to Jaeger 7; keratitis was a recurrent problem one year after the botulinum toxin injection. In the third patient with predominantly torsional nystagmus, visual acuity was unchanged at Jaeger 2. No patient was pleased with the results, because of blepharoptosis, diplopia, or discomfort (from keratitis), and none elected to repeat the procedure. CONCLUSIONS: The side effects of botulinum toxin administered by retrobulbar injection limit its therapeutic value in the treatment of acquired nystagmus. Even smaller doses that do not abolish nystagmus may produce troublesome diplopia.

Adult↗
PubMed1998

Visual function after foveal translocation with scleral shortening in patients with myopic neovascular maculopathy.

PURPOSE: To document the visual outcome after successful foveal translocation with intentional retinal detachment and scleral shortening for the treatment of myopic neovascular maculopathy. METHODS: Two severely myopic patients with subfoveal neovascular membranes underwent surgical translocation of the fovea to an area of healthy retinal pigment epithelium by means of scleral shortening and intentional retinal detachment. In the postoperative period, monocular and binocular visual function were studied. RESULTS: In one patient, best-corrected visual acuity improved from 20/150 to 20/20 postoperatively. In the second patient, acuity initially improved from 20/70 to 20/30. In both patients, the fixation point shifted from the site of the neovascular membrane. Oblique astigmatism developed and was managed with hard contact lenses. Diplopia and subjective torsion occurred transiently. Micropsia occurred in one patient. Peripheral fusion assessed by Worth four-dot testing after resolution of diplopia disclosed suppression in the nondominant eye in both cases. CONCLUSIONS: Foveal translocation with intentional retinal detachment and scleral shortening was useful in improving visual acuity in two patients with myopic neovascular maculopathy. Diplopia and aniseikonia occurred but resolved over time as suppression developed. This technique is promising for patients with myopic neovascular maculopathy.

Adult↗
PubMedDate not supplied

Surgical outcome of blowout fracture: early repair without implants and the usefulness of balloon treatment.

PURPOSE: To determine the surgical intervention time, which is most likely to achieve a high success rate for blowout fracture repair without implants and the usefulness of treatment with an intramaxillary sinus balloon. METHODS: Two hundred patients with isolated fractures of the orbit were evaluated by the Hess screen test, the Hertel exophthalmometer, and coronal computed tomography of the orbit. Operative criteria included diplopia within 30 degrees and enophthalmos >3 mm. An inferior lid incision approach was used to expose the orbital floor for realignment of bone fragments. Eighty of the patients received a gingival incision, followed by an osteotomy to create a 10-mm opening into the maxillary sinus for placement of a silicon-Teflon-silicon balloon. RESULTS: The highest success rate, with diplopia completely improved in 66% of the patients, was observed when surgery was performed within 3 days after the injury. This success rate declined as surgical intervention was delayed. In 197 cases, enophthalmos was improved to <2 mm postoperatively for patients who had surgery within 14 days. The balloon treatment was well tolerated and caused no complications. CONCLUSIONS: Surgery within 3 days is recommended in cases with diplopia and enophthalmos. An intramaxillary sinus balloon treatment was useful for the cases with large orbital floor fracture that could cause latent enophthalmos.

Adolescent↗
PubMed2000

Vergence disorders in patients with spinocerebellar ataxia 3/Machado-Joseph disease: a synoptophore study.

Diplopia, a common symptom in spinocerebellar ataxia 3/Machado-Joseph disease (SCA3/MJD) cases, is not always due to asymmetric ophthalmoplegia. We found a Japanese SCA3/MJD family, in which three patients clearly had an impairment of divergence eye movement. We thus quantitatively examined the vergence ranges in eight Japanese SCA3/MJD cases using the synoptophore test. An impairment of the vergence eye movements was found in all patients, and the vergence impairment pattern, but not the ophthalmoplegia pattern, was found to be compatible with the diplopia pattern. The diplopia in SCA3/MJD cases is, therefore, attributed, at least in part, to the impairment of the vergence eye movements.

Abducens Nerve↗
PubMedDate not supplied

Compensation procedures for the anisometropic presbyope.

When changing to bifocal lenses from distance anisometropic lenses, presbyopic patients may experience diplopia when attempting to do close work. Prescription failure can be dramatically reduced by utilizing the procedures outlined in this article. Why would a patient experience diplopia when attempting to read with bifocals? The diplopia may simply be a result of the optical difference in power between the two lenses. Anisometropia creates a disparity in the size of the retinal image as well as a prismatic imbalance when looking away from the optical center. A practical approach to coping with these problems is recommended.

Accommodation, Ocular↗
PubMed1979

Acquired central disruption of fusional amplitude.

Acquired central disruption of fusional amplitude is characterized by a complete loss of fusional amplitude, the patient maintaining fusion for only a moment under test conditions before breaking to constant diplopia. Under normal viewing conditions, the patient has constant diplopia with both eyes open. Patients who have bilateral superior oblique palsy may mimic this loss of fusion and constant diplopia, but they are distinguished by fusing readily on the troposcope, which compensates for the excyclotorsion, in contrast to prisms, which do not remove the double vision. Case reports document an association with convergence palsy, an infranuclear unilateral superior oblique palsy, and a nonparetic acquired strabismus in visual adults. Head trauma is the usual cause.

Adult↗