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At least 919 records · Page 51Linked to original sources
PubMed2002

Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation.

PURPOSE: To report a case of acute comitant esotropia successfully treated with suboccipital decompression in a 9-year-old male patient with Chiari I malformation. DESIGN: Interventional case report. METHODS: A 9-year-old male with Chiari I malformation had acute onset of diplopia, headache, and comitant esotropia. RESULTS: About 9 months after suboccipital decompression, diplopia resolved and there was near orthophoria on examination 15 months after surgery. CONCLUSION: In view of our case and after a review of literature, we advocate primary suboccipital decompression to treat acute comitant esotropia in patients with Chiari I malformation. A follow-up period of at least 1 year rather than 6 months seems necessary to assess surgery effects.

Acute Disease↗
PubMed1996

Pseudotumor cerebri associated with cyclosporine use.

PURPOSE: An 11-year-old boy had a one-month history of horizontal diplopia. Three years earlier, he had undergone allogeneic bone marrow transplantation complicated by graft versus host disease. METHODS: The patient had esotropia and bilateral optic disk edema. A magnetic resonance imaging scan disclosed no intracranial lesion. The opening pressure of the lumbar puncture was 500 mm of water. Pseudotumor cerebri secondary to cyclosporine was diagnosed. RESULTS: The patient improved with resolution of his esotropia and diplopia within five days of discontinuing his cyclosporine. The optic disk edema resolved within three months. CONCLUSION: Cyclosporine must be added to the list of medications with a known association with pseudotumor cerebri.

Bone Marrow Transplantation↗
PubMed1985

Ocular deviation after retinal detachment surgery.

Thirty patients with untreated rhegmatogenous retinal detachments underwent complete ocular muscle examinations before scleral buckling procedures. The examination was repeated three weeks, six weeks, three months, and six months after surgery. We found a high incidence of heterotropia after surgery; in most cases this resolved during the first six postoperative months. This resolution progressed from heterotropia to heterophoria to orthophoria. We believe this change results from phoria adaptation. Diplopia occurred in three patients. We found no statistically significant association between this diplopia and the type of surgery used.

Adult↗
PubMed1988

The effect of omitting botulinum toxin from the lower eyelid in blepharospasm treatment.

We randomly selected 26 patients with essential blepharospasm to receive either botulinum toxin or saline injection in their lower eyelids to evaluate the necessity of lower eyelid injection to relieve blepharospasm. As diplopia may occur from botulinum toxin injections for blepharospasm, most commonly from injection of the lower eyelid, and surgical relief of blepharospasm is often achieved by excision of only the upper eyelid protractors, omission of toxin from the lower eyelid seemed both desirable and possible. All patients received botulinum toxin in the upper eyelids, above the eyebrows, across the glabella, and near the lateral canthus. Thirteen of 15 patients who received saline in their lower eyelids had relief of spasm, with the same spasm-free interval as those who received toxin. We recommend avoiding injection of toxin in the medial two thirds of the lower eyelid in order to diminish the likelihood of diplopia from inferior oblique muscle paresis.

Blepharitis↗
PubMed1994

Inferior rectus muscle overaction after cataract extraction.

PURPOSE/METHODS: I reviewed the motility of two patients who had binocular vertical diplopia after cataract operations with peribulbar anesthesia. RESULTS/CONCLUSIONS: The binocular diplopia in these patients was a result of inferior rectus muscle overaction in the absence of restriction or weakness of the antagonist muscle. The mechanism could be related to myotoxicity of the anesthetic agents.

Aged↗
PubMed1998

Pneumo-orbital cyst after orbital fracture repair.

PURPOSE: To report a case of a respiratory epithelial-lined, air-filled orbital cyst as a late complication of orbital fracture repair. METHOD: Case report. RESULTS: Recurrent episodes of diplopia and hyperophthalmia developed secondary to pneumatic inflation of a respiratory epithelial-lined orbital cyst 6 months after orbital fracture repair. This cyst remained in communication with an ethmoidal air cell and became inflated during pressurization of the ethmoid sinus. Removal of the cyst and orbital implant was curative. CONCLUSION: Air-filled, respiratory epithelial-lined orbital cyst is a rare cause of episodic diplopia and globe displacement after orbital trauma.

Accidents, Traffic↗
PubMed1999

Isolated inferior rectus paresis secondary to a mesencephalic cavernous angioma.

PURPOSE: To report a case of recurrent binocular, vertical diplopia presenting as an isolated, unilateral inferior rectus paresis occurring in a patient with a mesencephalic tegmental cavernous angioma. METHOD: Case report. A 30-year-old man with recurrent vertical diplopia underwent neuro-ophthalmic examination, laboratory examination, pharmacologic testing, and magnetic resonance imaging and angiography. RESULTS: Magnetic resonance imaging disclosed a lesion in the mesencephalon consistent with a cavernous angioma. Magnetic resonance angiography was negative. CONCLUSIONS: Isolated inferior rectus paresis is a rare phenomenon. This unique case involved a patient with recurrent inferior rectus paresis secondary to a mesencephalic cavernous angioma. The disparity between the extent of the lesion and the neuro-ophthalmologic consequences is remarkable.

Adult↗
PubMedDate not supplied

Optic nerve involvement in neuro-Behcet's disease.

BACKGROUND: To report the ocular manifestations of neuro-Behcet's disease. CASES: A 34-year-old woman had recurrent meningitis. She developed diplopia, headache, and ataxia, and was diagnosed as having neuro-Behcet's disease. OBSERVATIONS: Imaging revealed two infarct foci in the transitional midbrain and pons. After treatment with prednisolone and colchicine, the diplopia resolved. Two years later, a scotoma developed in the right eye, in which the best-corrected visual acuity was 4/200. Papillitis and a prepapillary vitreous opacity were seen in the right fundus. These findings disappeared 11 days after subconjunctival steroid injections and increased colchicine. Her vision gradually improved to 20/20 two months later. CONCLUSION: Neuro-Behcet's disease may manifest with transient optic neuritis and prepapillary vitreous opacity.

Adult↗
PubMedDate not supplied

Pseudotumor cerebri induced by minocycline therapy for acne vulgaris.

BACKGROUND: We report a case of a young girl who developed pseudotumor cerebri while taking minocycline for acne vulgaris. CASE: A 16-year-old girl without a history of menstrual irregularity, weighing 60 kg (body mass index: 26.0%) presented with a history of 1 week of headache and sudden onset of a horizontal diplopia. OBSERVATION: Examination revealed bilateral papilledema and an abduction deficit in her right eye. Her cerebrospinal fluid had an opening pressure of 400 mm H(2)O and a normal composition. Following normal findings on computed tomography and magnetic resonance imaging, a diagnosis of pseudotumor cerebri was made. She reported receiving minocycline to treat acne vulgaris during the previous 3 weeks. The headache resolved with withdrawal of minocycline. The diplopia and papilledema resolved after two lumbar punctures, although the visual field defects persisted. The minocycline concentrations in the serum and cerebrospinal fluid taken after cessation of the drug were below the detectable level. CONCLUSION: The role of minocycline should be considered and routine ophthalmologic examination during minocycline treatment should be performed when pseudotumor cerebri occurs in patients treated for acne vulgaris.

Acne Vulgaris↗
PubMed2005

[Endoscopically assisted retro-caroncular approach for medial wall fracture of the orbit: preliminary study].

PURPOSE: The purpose of this study was to present our experience of endoscopically assisted retro-caruncular approach of medial wall fracture of orbital bone, notably concerning the accessibility and visibility. METHODS: Five consecutive patients (4 men and 1 woman) with recent fracture (1 to 3 days), underwent medial wall reconstruction with a polydioxanone plate, endoscopically assisted via a retro-caruncular approach. The surgical technique and its results are described. Helpful hints are discussed. RESULTS: The plate did not have to be bent for introduction. Operative time was less than an hour for all patients. All patients were discharged the day after surgery. All experienced a mild degree of postoperative edema-related diplopia. None had persistent or secondary diplopia or enophthalmos at the one and six-month follow-up visits, respectively. Other postoperative complications, such as hematoma, nerve injury, or infection were not observed. All patients were satisfied with the outcome and especially the cosmetic result. DISCUSSION: The retro-caruncular approach with adjunctive endoscopic surgery should be the gold standard for posttraumatic isolated medial wall reconstruction of the orbit.

Adult↗
PubMed2003

Clinical outcomes in patients with Chiari I malformation: a review of 27 cases.

BACKGROUND: Chiari I malformation is a congenital maldevelopment defined as downward herniation of the cerebellar tonsils through the foramen magnum. It has been treated using a variety of surgical procedures. Surgical outcomes have been reported with varying results throughout the literature. METHODS: We retrospectively reviewed 27 patients with Chiari I malformation operated at the University Hospital during a 9-year period from 1988 to 1997. We assessed preoperative and postoperative signs and symptoms in all the patients including headache, neck pain, nystagmus, vertigo, weakness, spasticity, atrophy, numbness, pain and temperature dissociation, diplopia, dysphagia, and sphincter dysfunction. Each patient was analyzed to determine if there was an arrest in the progression of the disease after surgical intervention. RESULTS: Syringomyelia was present in 59% of the patients. Only 1 patient who presented with neck pain improved. One patient reported new onset headache, and one patient described his headache resolved. Vertigo resolved in three patients; two patients stated mild improvement, and one patient reported worsening. Nystagmus improved or resolved in six patients. Weakness improved in only two patients who did not have syringomyelia. Dysphagia improved in two patients, and in the others it remained unchanged. Diplopia, spasticity, atrophy, and numbness remained unchanged. CONCLUSIONS: Our study provides evidence that the main benefit of the surgical management in patients with Chiari I malformation with or without syringomyelia is to arrest the progression of the disease.

Adolescent↗
PubMed2002

Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis.

PURPOSE: To assess the quality of information in the literature and suggest guidelines for repair of isolated orbital floor fractures. CLINICAL RELEVANCE: Orbital floor fractures are a common result of orbital injury. Enophthalmos, diplopia resulting from extraocular muscle dysfunction, and infraorbital nerve hypesthesia may occur. The indications and timing for fracture repair are still controversial. LITERATURE REVIEWED: A MEDLINE literature review was performed using PubMed. Articles published from 1983 to the present were retrieved using the key words, "orbital floor fracture, orbital trap-door fracture, and orbital blow-out fracture." Suggested indications and timing for repair of isolated orbital floor fractures were extracted from selected articles. Each recommendation was rated according to its importance in the care process and strength of evidence supporting the given recommendation. RESULTS: No prospective randomized clinical trials on the treatment of orbital floor fractures have been performed. Despite this, most recommendations were rated as most important to patient care (A) and had strong support for treatment (level I). CONCLUSIONS: The timing and treatment indications for orbital floor fractures are evolving. Nonresolving oculocardiac reflex, the "white-eyed" blowout fracture, and early enophthalmos or hypoglobus are indications for immediate surgical repair. Surgery within 2 weeks is recommended in cases of symptomatic diplopia with positive forced ductions and evidence of orbital soft tissue entrapment on computed tomography examination or large orbital floor fractures that may cause latent enophthalmos or hypo-ophthalmos.

Diplopia↗
PubMed2002

Use of augmented rectus muscle transposition surgery for complex strabismus.

PURPOSE: Full tendon rectus muscle transposition surgery augmented with posterior fixation sutures has been shown to be effective in the treatment of abducens palsy and Duane's syndrome. The purpose of this study is to summarize our experience with the use of this procedure and a three fourths partial tendon transposition modification of this procedure for a variety of complex vertical and horizontal paralytic eye movement disorders. DESIGN: Retrospective noncomparative interventional consecutive case series. PARTICIPANTS: Eighteen patients with paralytic strabismus. INTERVENTION: Full tendon rectus muscle transposition procedure augmented with posterior fixation sutures (13 patients) or a three fourths partial tendon transposition augmented with posterior fixation sutures (5 patients). MAIN OUTCOME MEASURES: Resolution of diplopia in the primary position and improved ocular alignment. RESULTS: Comparing preoperative to postoperative status, presence of primary position diplopia decreased from 64% to 14%, anomalous head posture decreased from 56% to 6%, and primary position alignment improved in all patients. CONCLUSIONS: Full tendon rectus muscle transposition surgery augmented with posterior fixation sutures and the vessel-sparing three fourths partial tendon transposition modification of this technique are effective for the treatment of a variety of complex vertical and horizontal paralytic ocular motility disorders.

Adolescent↗
PubMed1979

Strabismus in the aphakic patient.

Fifty patients with aphakia and strabismus were studied. The chief complaint was diplopia following full optical correction. Prism therapy was recommended if the diplopia persisted after 3 to 4 months. When prism therapy was ineffective or impractical, surgery was recommended. The result of therapy was not influenced by the cause of the cataract treatment was considered successful in approximately 80% of patients. Patients who had convergence insufficiency did well with prism therapy alone. Half of the patients who had divergence excess needed extraocular-muscle surgery. One fourth of the patients had esotropia, nearly half associated with lateral rectus palsy. While prism therapy resulted in fusion, a reduction in prism power was not tolerated in this group. For this reason, surgery was suggested for all patients who had esotropia.

Adolescent↗
PubMed1981

Diagnosis and treatment of thyroid myopathy.

Twenty-five patients with thyroid myopathy were referred to our Strabismus Clinic for treatment of diplopia. Prism treatment was effective in only three. When the remaining 22 patients' ocular motility problems and thyroid states were stable, surgical management was undertaken. The preoperative evaluation included visual fields, iris angiograms, binocular diplopia fields, intraocular pressures in different positions of gaze and A-scan echography. The goal of surgery was to produce as large a binocular visual field from primary as possible. Supramaximal recessions of the involved muscles were often needed and adjustable sutures were an important part of the surgical management. The complications encountered included limitation of movement into the field of the recessed muscle, inducement of an A-pattern in downgaze, and postoperative instability.

Diplopia↗
PubMed1982

Current treatment of blow-out fractures.

Blow-out fracture repair and its timing have been controversial. Originally all x-ray proven fractures were repaired regardless of size or symptoms. Later a controversial report of a large series of cases indicated repair to be unnecessary. Today, x-ray proven fractures with enophthalmos justify surgery, but double vision alone is insufficient. Observation of improving diplopia for several days is suggested. Evaluation of x-rays, enophthalmos, diplopia with restriction, and facial anesthesia are recommended before surgery. Recognition of diagnostic signs and symptoms, as well as potential severe cosmetic and functional complications, have aided the approach to the decision for or against fracture repair.

Diplopia↗
PubMed1982

Traumatic superior oblique palsies.

The differences in the clinical and diagnostic characteristics of 33 consecutive traumatic unilateral (21 patients, 62%) and bilateral (12 patients, 38%) superior oblique palsies were studied. The unilateral palsies had a large hypertropia in primary position, more vertical than torsional diplopia, a compensatory head tilt to obtain fusion, and a positive Bielschowsky head tilt test. In contrast, the bilateral palsies had small hypertropias in primary gaze that alternated on right and left gaze, a large V-pattern esotropia with excyclotorsion that was frequently bilateral, and a compensatory head position with fusion in upgaze. The results of the study indicate that a V-pattern in excess of 25 prism diopters, an excyclotorsion of greater than 10 degrees, or head trauma severe enough to cause loss of consciousness should also signal bilateral involvement. Torsional diplopia was present in only 20% of unilateral palsies vs 75% of bilateral palsies. The Bielschowsky head tilt test was diagnostic in 100% of the patients with unilateral palsy and 83% of the patients with bilateral palsy. It was undiagnostic in the supine position in all patients. Spontaneous resolution occurred in 65% of the unilateral palsies but in only 25% of the bilateral palsies. Surgical correction was successful in relieving persistent symptoms.

Adult↗
PubMed1983

The surgical management of intermittent exotropia in adults.

Most studies of intermittent exotropia deal primarily with children. However, the manifestations of this disorder in adults differ considerably from those in children. The case records of 44 adults (ages 15-70) who underwent surgery for intermittent exotropia were analyzed. These patients experienced a variety of preoperative symptoms including diplopia, headache, difficulty with reading, and ocular fatigue or pain. Cosmesis was a rare presenting complaint. The authors recommend that surgery in adults be conservative, aiming at slight undercorrection. Surgical management was successful in 41 of 44 patients. All patients with postoperative exodeviations under 15 delta had complete resolution of symptoms. Most patients with larger residual exodeviations did not improve symptomatically; patients with postoperative exodeviations tended to experience persistent diplopia.

Adolescent↗