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PubMedDate not supplied

[Fractures of the orbital floor. Review of 346 cases].

From 1976 to 1988 346 fractures of the orbital floor were repositioned in the ENT-Department of the University of Mainz. 145 (41.9%) cases were pure orbital fractures, in 201 (58.1%) cases the fractures were extended. Assaults followed by accidents were the most frequent causes of injury. Preoperatively, diplopia and enophtalmus were among the most frequent symptoms, followed by fracture of the orbital rim, parestesias or anestesias of the infraorbital nerve and limitation of ocular motility. A support of the orbital floor was necessary in 122 (32.7%) of the cases, which was achieved by a modified vesical Foley catheter. In 194 (56.1%) patients lyofilized dura was used to cover the repositioned bone fragments. The orbital floor had to be reconstructed in 37 cases (10.7%) with autologue cartilage or bone. Supplementary wiring was necessary in 95 (27.5%) cases. In the follow up, diplopia and alterations of the infraorbital nerve were studied. 176 (50.8%) of the patients had diplopia with or without alterations of ocular motility, which was confirmed by routinely performed explorations in the Department of Ophthalmology. In 24 (6.9%) cases light alterations of ocular motility persisted six months postoperatively. 113 (32.7%) patients referred parestesias of the infraorbital region, persisting in 40 (11.6%) patients for at least six months.

Adolescent↗
PubMed1989

[A case of Burkitt's lymphoma with numb chin syndrome as the initial manifestation].

In 1963, Calverley and Mohnac reported four cases with sensory disturbance of the mental nerve region. They emphasized the symptomatological significance of that finding because of the underlying ominous diseases. The purpose of this paper is to emphasize the clinical importance of this symptom especially as the initial manifestation of the underlying malignant diseases. A 56-year-old Japanese female was seen in consultation because of complaints of the paresthesia over the distribution of the right mental nerve, diplopia and ptosis of the right side. The patient had been well until a hundred days prior to admission, when she noted numbness with pain of the right mental nerve region. This symptom was followed by ptosis of the right side and diplopia after five weeks. MRI-CT scan revealed an abnormally low intensity echo (in T1 weighted image) of the bone around sphenoid sinus and tumor of the cavernous sinus (in T2 weighted image) compressing the right internal carotid artery. The patient was transferred to this hospital 100 days after the occurrence of the initial symptom. Physical examination revealed neither superficial lymph node swelling nor buccal tumor. Abnormal findings were restricted to the cranial nerve regions such as diplopia, adduction disturbance, sluggish light reflex of the right side and hypesthesia on the right chin, lower lip and buccal mucous membrane. Other neurological findings were not significant. Laboratory findings showed elevated LDH (1,503 IU/L). Leucocyte cell count was 7,500/mm3 with almost normal composition. CSF was normal. A diagnosis of Burkitt's lymphoma stage IV was done by nasopharynx and bone marrow biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Burkitt Lymphoma↗
PubMed1987

Steroids and orbital blowout fractures--a new systematic concept in medical management and surgical decision-making.

Thirty-eight patients with computed tomography (CT)-proven orbital fractures and diplopia were studied prospectively to determine the efficacy of steroids in the medical management of orbital fractures. The protocol is based on double-blind assignments to steroid (ST) and non-steroid (NT) treatment groups. Outcome analysis was based on sorting fractures into three CT classes: I-without soft tissue prolapse (n = 15); II-with soft tissue prolapse (n = 14); and III-CT evidence of inferior rectus entrapment (n = 9). Results included resolution of diplopia without surgery in both ST and NT groups in CT classes I and II. Median time course of resolution was compressed to less than 5 days in the ST treatment group, however, versus 13 days in the nontreatment group. All fractures in class III had residual diplopia with five of nine patients having surgical results that were enhanced in the ST treatment group. In addition, enophthalmos was unmasked in the ST treatment group within 1 week of treatment versus 5 months without treatment. A protocol for medical management and surgical decision-making in blowout fracture is presented.

Double-Blind Method↗
PubMed1986

[Neurinoma of the oculomotor nerve: case report].

A case of solitary neurinoma of oculomotor nerve is reported. A 40-year-old female had a sudden headache with nausea and vomiting in January, 1978. She complained of diplopia and right ptosis two months later and visited a neurosurgical clinic, but radiological examination was told to be normal. Headache and right ptosis diminished, but diplopia continued. She was admitted to our clinic on Aug. 30, 1984, complaining of diplopia and right ptosis which were noticed only when she was tired. On admission, she had no neurological deficits except for right oculomotor nerve palsy. There was no cutaneous manifestation of von Recklinghausen's disease. Plain skull radiogram and angiogram showed normal study. CT scan showed a solitaly enhancing mass in the right prepontine region. On Sept. 22, 1984, a right frontotemporal craniotomy was performed, and the tumor was totally removed by pterional approach. The tumor was located beside the right internal carotid artery and the oculomotor nerve was incorporated in the tumor. The histological diagnosis was Antoni B type neurinoma. The clinical features of fourteen reported cases of neurinoma of the oculomotor nerve in the literature were reviewed.

Adult↗
PubMed1981

The effect of anterior orbital decompression on motility in thyroid exophthalmos.

Nineteen orbits from 13 patients with endocrine exophthalmos were effectively decompressed into the maxillary and ethmoid antra through an anterior orbitotomy. Six patients with preoperative diplopia had improved ocular ductions and return of binocular single vision in functional positions. Diplopia was not induced in five patients with normal pre-op motility. In one patient with active orbitopathy, a large postoperative esotropia was caused by worsening of medial rectus inflammation. This approach appears to lessen the incidence of postoperative diplopia and may make subsequent extraocular muscle procedures unnecessary.

Adult↗
PubMed1993

[Isolated inferior rectus muscle paresis from midbrain infarction].

A 74-year-old woman, with hypertension and dilated cardiomyopathy, presented with sudden onset of diplopia without vertigo and other neurological symptom. Examination revealed left inferior rectus muscle paresis. Other neurological findings were normal. She had no cerebellar ataxia and sensori-motor dysfunction. Magnetic resonance imaging showed increased signal intensity on T2-weighted and proton density-weighted images in the right ventral midbrain, compatible with infarction involving the fascicular oculomotor fibers. Complete resolution of the diplopia and normal ocular motility were noted 3 months after the onset of the diplopia. Focal ischemic midbrain lesions should be considered in cases of isolated partial oculomotor nerve paresis.

Aged↗
PubMed1995

[Role of topical anesthesia in strabismus surgery].

The use of topical anesthesia for strabismus surgery can be useful in selected, cooperative patients. This technique is always performed on an ambulatory basis, and the surgical time rarely exceeded 30 minutes. One of the major advantages of this type of procedure is the ability to adjust the sutures during the operation. The presence of diplopia is a major indication for topical anesthesia. The use of Gracis grids has proved extremely useful for assessing the dynamic evolution of the diplopia over the various visual fields during the operation. This allows the surgeon to better control his correction, with horizontal, vertical, or torsional diplopia. Finally, this study shows that a precise clinical examination allows excellent results while limiting surgery to a single muscle (in 12 of the 14 cases).

Administration, Topical↗
PubMed1997

[Interdural dermoid cyst of the cavernous sinus presenting with oculomotor palsy: case report].

A 19-year-old female was admitted to our hospital because of diplopia. Neurological examination showed slight anisocoria (right > left), disturbance of ocular movement in upward, downward and medial directions on the right side, and diplopia on upward gaze. Computed tomography (CT) scan demonstrated a well-demarcated cystic lesion in the right parasellar region. The lesion showed non-homogeneous low intensity with a high intensity margin on T1-weighted imaging and high intensity with a low intensity margin on T2-weighted imaging in magnetic resonance image (MRI). The lesion showed enhancement by contrast media on neither CT nor MRI. Cerebral angiography revealed no tumor stains. The lesion was approached via right fronto-temporal craniotomy. The right optic nerve, oculomotor nerve and internal carotid artery were compressed medially by the tumor. The tumor contents appeared to be flaky and greasy containing motor-oil-like fluid, mineralized body, and a few hairs. The tumor was attached to the lateral wall of the right cavernous sinus (inner membranous layer), but was totally resected with careful microscopic dissection. The histopathological examination confirmed the diagnosis of dermoid cyst. The patient's complaint of diplopia showed gradual improvement postoperatively. Supratentorial intracranial dermoid cyst is a rare congenital tumor and, to our knowledge, only one case arising within the lateral wall of the cavernous sinus and presenting oculomotor palsy has been reported. Total removal is ideal and may be possible even when the tumor arises from the lateral wall of the cavernous sinus.

Adult↗
PubMed1986

Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm.

In 12 patients with minimal oculomotor nerve deficits due to unruptured intracranial aneurysm, the nerve-related findings were incomplete and at least one element (ptosis, mydriasis, or extraocular muscle weakness) was spared in every patient. Although symptomatic, the affected cranial nerve III functions were only partially lost. Six patients had ptosis and mydriasis, three had ptosis and diplopia, two had mydriasis and diplopia, and one had mydriasis alone. Eleven patients had accompanying headaches that were remarkably variable and difficult to categorize. Cerebral angiography showed the aneurysms, but computed tomography missed one third of them. The symptomatic aneurysm arose from the internal carotid artery in six patients, and from the distal basilar artery in six. Fragments of a cranial nerve III palsy associated with recent onset and ipsilateral headache suggest an enlarging internal carotid or distal basilar artery aneurysm.

Adult↗
PubMed1999

Prospective evaluation of extraocular motility following double-plate molteno implantation.

OBJECTIVE: To determine the incidence and type of extraocular motility disturbance after double-plate Molteno implantation. METHODS: In a prospective clinical series, we evaluated preoperative and postoperative ocular motility at 3 and 6 months in 24 eyes of 24 patients undergoing double-plate Molteno implantation. Visual acuity, motility testing, and subjective and objective diplopia were evaluated at each examination. RESULTS: Within the first 6 months postoperatively, new or worse strabismus developed in 11 (46%) of the 24 study patients. Three of the 11 patients had a generalized restriction of the superior rectus and the superior oblique muscles, all of which persisted 6 months after surgery. Four patients had clinical features consistent with an acquired Brown syndrome, and 6 months after surgery, 3 of the 4 patients had a residual deviation, although the deviation in 1 patient resolved. A superior oblique palsy developed in 3 patients, and a lateral rectus palsy developed in 1 patient. All 4 of the muscle palsies resolved or were resolving during the follow-up period, which ranged from 6 to 12 months. CONCLUSIONS: Extraocular motility disturbances are not rare after double-plate Molteno surgery. Muscle palsies, acquired Brown syndromes, and generalized restrictions occurred in similar proportions. CLINICAL RELEVANCE: Patients should be counseled before Molteno surgery concerning the risk of strabismus and diplopia.

Adult↗
PubMed1989

Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy.

Ten adult patients developed sixth-nerve palsy after trauma or a cerebral tumor. No clinical evidence of recovery of function was noted by at least 8 months after onset. All patients underwent total transposition of the superior and inferior rectus muscle insertions to the area of the lateral rectus insertion, accompanied by botulinum toxin (Oculinum) injection of the ipsilateral medial rectus. These patients developed a mean diplopia-free field of 51 degrees, with a diplopia-free field in the abducted field of 20 degrees. This procedure involved surgery on only two rectus muscles, but the results compared favorably with surgical strategies involving three rectus muscles. Thus, the risk of developing anterior segment ischemia was greatly reduced.

Abducens Nerve↗
PubMed1992

'V' esotropia and excyclotropia after surgery for bilateral fourth nerve palsy.

Six patients had residual diplopia at near in the downgaze position after surgery for bilateral fourth nerve palsy. They all showed a large excyclotropia in the downgaze position that was associated with a "V"-pattern esotropia and could not fuse in the reading position because of the size of the excyclotropia. They were treated with bilateral recessions of the inferior recti, which resulted in an expansion of the single binocular field of vision in downgaze, with an elimination of diplopia in the reading position. None experienced a deterioration in their alignment in the primary position.

Adult↗
PubMed1995

Radiotherapy for thyroid orbitopathy. Effects on extraocular muscle balance.

OBJECTIVE: To investigate the effects of radiotherapy on the restrictive ophthalmopathy and strabismus that occur with Graves' orbitopathy. DESIGN: A prospective study of patients with motility disturbances due to thyroid orbitopathy, followed by serial quantitative measurements of ocular restrictions and deviations, both before and at 1 and 6 months after treatment with high-energy radiotherapy. SETTING: Urban subspecialty private practice. PATIENTS: Thirty-three consecutive patients with restricted extraocular movements and diplopia secondary to thyroid orbitopathy who were treated with radiotherapy were seen during an 8-year period. MEASURES: Maximal horizontal and vertical ductions, plus ocular deviations in primary and reading positions of gaze, were quantitatively evaluated by one clinical investigator to ensure consistency. RESULTS: Statistically significant improvement in gaze restriction on supraduction and improvement of vertical and horizontal strabismus were demonstrated at follow-up visits after treatment. CONCLUSIONS: Although statistically significant improvement of motility disturbances were demonstrated after radiotherapy, there was less than desirable functional improvement of restrictive ophthalmopathy and strabismus; thus the usefulness of radiotherapy was limited when it was used alone to treat diplopia.

Adult↗
PubMed1975

Medial orbital wall fracture with rectus entrapment.

Two cases of medial orbital fracture with medial rectus muscle entrapment are reported, one a bona fide blowout fracture. Review of the literature reveals six previous cases. Clinically, patients complain of diplopia with lateral gaze and forced duction tests confirm medial rectus entrapment. Radiographic confirmation is best obtained with hypocycloidal tomography. Surgical therapy is indicated for diplopia or enophthalmus.

Adult↗
PubMed1977

Duane's uniocular micro-tremor or superior oblique myokymia of Hoyt and Keane.

Two cases of intermittent unilateral motor disturbance of the superior oblique muslce are presented and compared with cases reported previously by Duane, Clark and Hoyt & Keane and briefly mentioned by Duke-Elder in his System of Ophthalmology. The first case is a girl with longstanding history of oscillopsia, vertical and tortional oscillatory diplopia. No abnormal eye movements were observed but objective evidence of the disturbance was obtained in the form of electromyography during which relationship of the superior oblique was established. In contrast, the second case experienced episodes of static vertical and tortional diplopia similar to the case reported to by Clark. Again the relationship in the condition was unilateral involving the superior oblique muscle. There was no corroboratory evidence to support the diagnosis of an intermittent superior oblique tendon sheath syndrome. Hoyt & Keane's theory based on their electromyography findings that the lesion is in the lower motor neuron unit is reported and the significance of the oscillopsia as corroboratory evidence is discussed.

Adult↗
PubMed1982

The ocular signs and symptoms of myasthenia gravis.

Myasthenia gravis is a chronic disease characterized by a fluctuating weakness of voluntary muscles, with a preference for the muscles innervated by the cranial nerves. Ocular symptoms (ptosis, diplopia) were present at onset in 65% of 432 own patients and in 10% of these patients the disease remained confined to the extrinsic eye muscles. A complete remission occurred in 30% of the purely ocular cases within 10 years of onset. The diagnosis depends upon the pattern of weakness, the spontaneous or provoked fluctuation of the symptoms and the favourable response to anticholinesterases. The presence of antibodies against acetylcholine receptor protein is the most recent tool to confirm the diagnosis, but they are absent in 10-20% of the patients with generalized MG and in 20-50% of the purely ocular cases. As the reaction to anticholinesterases in ocular MG is sometimes equivocal or even absent auxillary investigations (electromyography, tonography, nystagmography, curaretest) may be necessary. Oral anticholinesterases (Pyridostigmin, Prostigmin, Ambenomium) usually have a moderate effect on the ptosis and a poor effect on the diplopia so that other measures (ptosishooks, covering one eye) are necessary. In selected patients alternate-day Prednisone is the therapy of choice.

Adolescent↗
PubMed1991

Ocular pseudo-myasthenic reaction induced by interferon in an AIDS patient.

A 32-year-old, HIV-positive homosexual with Kaposi's sarcoma was given subcutaneous interferon-A (IFN) for two- and a-half months. The patient complained of ocular symptoms (ptosis of the left eyelid and intermittent diplopia) after the application of IFN-A. These symptoms persisted for the period of treatment and subsided after therapy was stopped. However after IFN-A was resumed, ptosis and diplopia recurred. Intensive serological and neurological diagnostic investigations failed to present any reason for these ocular symptoms. From data and the clinical appearance we suppose that in this case the patient suffered a pseudo-myasthenic reaction to IFN-A.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Lymphocytic hypophysitis: its expanding features.

Lymphocytic hypophysitis is classically defined as an inflammatory disorder confined to adenohypophysis. However, it has recently been indicated that infundibuloneurohypophysitis underlies some subsets of central diabetes insipidus (DI). Therefore, lymphocytic hypophysitis can be considered a syndrome including disorders of both the anterior pituitary (lymphocytic adenohypophysitis) and the posterior pituitary (lymphocytic infundibuloneurohypophysitis). We describe a 77-yr-old woman with lymphocytic hypophysitis presenting with headache, diplopia, general malaise and appetite loss. Head magnetic resonance imaging (MRI) demonstrated pituitary swelling and dura mater thickening on the dorsum sella. Endocrinological investigations revealed both anterior and posterior pituitary dysfunction associated with primary hypothyroidism due to Hashimoto's thyroiditis. Headache and diplopia spontaneously disappeared, and anterior pituitary dysfunction, general malaise and appetite loss improved after taking 10 mg hydrocortisone daily, although ACTH hyposecretion persisted. Pituitary swelling was thereafter reduced but the dura mater thickening persisted. We suggest that this case may represent a variant of lymphocytic hypophysitis in which chronic inflammatory process involves both the anterior and the posterior pituitary gland, infundibulum, dura mater on the dorsum sella and cavernous sinus. Regarding expanding features of lymphocytic hypophysitis, it may be considered a syndrome including heterogeneous disorders, of which the pathogenesis remains to be elucidated.

Aged↗