Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Diplopia”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMedDate not supplied

Isolated lesion of the medial orbital wall following endonasal surgery. Isolated fractures of the medial orbital wall.

BACKGROUND: Isolated fractures of the medial orbital wall are infrequent. The diagnostic triad includes: adduction block, exotropia with diplopia in all directions of gaze, positive passive duction in abduction. Sometimes a slight enophthalmos is present. Computed tomography shows the extension and the seat of the fracture. CASE REPORT: The authors illustrate the case of a 60 year old male who presented with a breach of the medial orbital wall following endonasal surgery. RESULTS: The patient was successfully operated using an iliac bone graft inserted via an eyebrow-nasal cutaneous approach, after a previous attempt with a transconjunctival approach performed in another hospital had failed. A good functional and aesthetic result was observed within the first year after surgery. After almost 11 years a full adduction is still present and diplopia is absent. CONCLUSION: The authors underline the importance of an early diagnosis and prompt surgical treatment. The fat-muscle entrapment should be removed and the bone defect closed. A close cooperation between ophthalmologist and plastic surgeon is suggested.

Bone Transplantation↗
PubMed1991

Treatment of strabismus after retinal detachment surgery with botulinum neurotoxin A.

Thirty-one consecutive patients were treated with injections of Botulinum Neurotoxin A to rectus muscles for strabismus following retinal detachment surgery. In 14 cases the presenting problem was diplopia and in 17 cases the presenting problem was cosmetic appearance. A total of 67 injections was given. Twenty-seven cases had nine months or more follow-up. Of these, four of 11 cases with diplopia had fusion restored, four were shown to have no fusion potential, and three had temporary improvement only. In 16 cases with a primary cosmetic problem there was no useful effect in two, three had surgery as an alternative, three were realigned long-term, and eight had continuing maintenance therapy with toxin. Over half the series had undergone multiple detachment surgery, often for giant tears and other complex pathology.

Adult↗
PubMed1995

Management of strabismus due to orbital myositis.

We report on 5 consecutive patients seen at the botulinum toxin clinic at Moorfields Eye Hospital with an ocular motility disorder secondary to orbital myositis. CT scans demonstrated involvement of one or both of the medial recti in the inflammatory process in all 5 patients. In addition 1 patient had involvement of both the lateral recti and the right superior rectus. Two patients had been treated with oral steroids, 3 with non-steroidal anti-inflammatory agents, and 1 with orbital radiotherapy. Prior to toxin injection 3 patients had an esotropia (ranging from 4 delta to 30 delta) and two an exotropia (52 delta and 85 delta). A vertical imbalance was present in 3, and all 5 patients had symptomatic diplopia. A total of six injections were given to 5 patients, 2 of whom later went on to have surgery. Toxin injection reduced the angle of the deviation to less than 10 delta in 4 patients, all of whom are now asymptomatic. The fifth patient has persistent diplopia despite two operations to correct a large exotropia. We discuss the role of botulinum toxin and surgery in the management of strabismus due to orbital myositis.

Adolescent↗
PubMed2001

Rectus muscle trauma complicating sub-Tenon's local anaesthesia.

PURPOSE: To describe three cases of rectus muscle trauma in patients undergoing phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia via the inferonasal quadrant. METHODS: Retrospective review was carried out of 3 cases from 1080 patients who underwent phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia in our unit over a 3 year period up to April 2000. RESULTS: Two patients complained postoperatively of vertical diplopia and were shown to have restriction of elevation of the eye, which was found at surgical exploration to be due to inferior rectus muscle restriction. One patient had post-operative horizontal diplopia due restriction of abduction and exploration of the medial rectus muscle was planned. CONCLUSION: Rectus muscle trauma is proposed as a complication of sub-Tenon's local anaesthesia and caution is advised to operators to clearly identify the sub-Tenon's space for injection of local anaesthetic.

Aged↗
PubMed2002

Bilateral third and unilateral sixth nerve palsies as early presenting signs of metastatic prostatic carcinoma.

PURPOSE: To report four cases of cranial nerve palsy, which presented to the ophthalmologist as the only or one of the earliest manifestations of prostatic carcinoma. This is an infrequent complication of metastatic prostatic carcinoma usually only occurring late in the disease process in those with a history of prostatic carcinoma. METHODS: The case records of four patients with a history of a cranial nerve palsy who attended the ophthalmology department and who had a recent or subsequent diagnosis of prostatic carcinoma were reviewed. RESULTS: Diplopia caused by lesions affecting the third and sixth nerves sometimes in association with sensory symptoms may be a manifestation of metastatic prostatic carcinoma. These findings are consistent with base of the skull metastases from the condition. Two patients are still alive 54 months and 12 months after the diagnosis. One of the patients died 13 months after the diagnosis of prostatic carcinoma was made and the other died 21 months after the diagnosis from an unrelated hypertensive brain haemorrhage. CONCLUSIONS: Any patient presenting with diplopia must have an adequate past medical history taken and in an elderly gentleman this should include symptoms of prostatic disease. If indicated urological referral and measurement of prostate specific antigen may be performed. In patients whose cranial nerve palsy is complicated by other sensory signs or those in whom no sign of recovery occurs in 2 months, a contrast CT scan asking for bone windows to be included may be helpful in delineating any pathology. Radiotherapy may be useful for the treatment of metastatic prostatic carcinoma causing cranial nerve palsies with some patients experiencing either complete or partial resolution of their symptoms. The effect of newer hormonal agents or chemotherapy on this aspect of the disease is not well documented in current literature.

Abducens Nerve Diseases↗
PubMed2003

Relationship between longitudinal behaviour of some markers of eye autoimmunity and changes in ocular findings in patients with Graves' ophthalmopathy receiving corticosteroid therapy.

OBJECTIVE: To investigate whether variations over time of TSH-receptor antibodies (TRAb) and antibodies against G2s (G2sAb) and extraocular muscles (EMAb) can predict worsening of ophthalmopathy in Graves' patients treated with intravenous glucocorticoid (IVGC) therapy. PATIENTS: Of 65 consecutive patients with treated Graves' disease and severe and active ophthalmopathy (GO) chosen to undergo IVGC treatment, only 57 patients, persistently euthyroid under methimazole therapy, were studied longitudinally for ocular parameters, TRAb, G2sAb and EMAb before therapy, at the end of therapy and, subsequently, every month for 21 months. MEASUREMENTS: TRAb was detected by radioimmunoassay (RIA), G2sAb by enzyme-linked immunosorbent assay (ELISA) and EMAb by indirect immunofluorescence. RESULTS: Forty-three out of 57 patients (75.4%, group 1) responded positively to therapy [improvement in diplopia and decrease in proptosis and clinical activity score (CAS)] but 14 (24.6%) did not (group 2). During follow-up after IVGC therapy, 12 out of 43 patients in group 1 (28%) showed a worsening in GO (group 1a), while 31 (72%) had stable ocular conditions or further improvement (group 1b). At the start of the study, TRAb, G2sAb and EMAb were not significantly different among the three groups. At the end of IVGC therapy TRAb levels decreased significantly with respect to starting values in all three groups of patients, whereas G2sAb and EMAb decreased significantly in groups 1a and 1b but not in group 2. During the subsequent follow-up, 10 patients in group 1a one/two months before and all 12 patients at the time of GO worsening showed an increase in G2sAb and EMAb but not in TRAb, which were consistently absent or present at low titre in all patients in this group. In group 1b TRAb, G2sAb and EMAb further decreased or became negative during the follow-up period. In all patients, TRAb were positively correlated with both CAS and proptosis only at the start of the study; by contrast, a significant correlation between both G2sAb and EMAb and diplopia was observed in groups 1a and 1b at all the times during the study, except one/two months before the worsening of GO in group 1a. CONCLUSIONS: Our results indicate that TRAb, G2sAb and EMAb can be considered sensitive markers of Graves' ophthalmopathy during the initial stages of ophthalmopathy, but that only G2sAb and EMAb seem to be good predictive markers of the outcome in patients after corticosteroid therapy. Thus, taking into account the cost/benefit ratio, a longitudinal evaluation of either EMAb or G2sAb could be useful in monitoring the intravenous glucocorticoid therapy in patients with severe and active ophthalmopathy to predict a possible worsening of Graves' ophthalmopathy.

Adult↗
PubMed2000

Endonasal endoscopic reduction of blowout fractures of the medial orbital wall.

PURPOSE: This article describes the endonasal endoscopic reduction (EER) of blowout fractures (BOFs) of the medial orbital walls and reports the clinical results. PATIENTS AND METHODS: Sixteen patients who underwent EER for a BOF of the medial orbital wall were analyzed. The surgical indications for treatment were diplopia, limitation of eye movements, and significant enophthalmos. They were followed-up for at least 3 months after the surgery. Surgical techniques, surgical results, and postoperative complications were reviewed. RESULTS: There were no significant intraoperative or postoperative complications. Fourteen patients showed complete resolution of symptoms after the surgery. One patient, who had persistent diplopia and remaining enophthalmos, underwent medial wall reconstruction with a Medpor surgical implant (Porex Surgical Inc, College Park, GA) by a transorbital approach. Another patient, who had residual enophthalmos, had correction of enophthalmos after insertion of a Medpor implant. Both patients are now symptom-free. CONCLUSION: The results indicate that EER is a safe and effective technique for the treatment of BOFs of the medial orbital wall.

Adolescent↗
PubMed2002

Evaluation of computer-based area and volume measurement from coronal computed tomography scans in isolated blowout fractures of the orbital floor.

PURPOSE: In this retrospective study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from coronal computed tomography (CT) scans and their relationship to ophthalmologic findings. PATIENTS AND METHODS: Fracture area and volume of displaced tissue of blowout fractures in 38 patients were measured from coronal CT scans. Measurement was performed by identifying distances (for area calculation) of the fracture and identifying areas (for volume calculation) of the displaced tissue in each CT slice. The calculated data were then compared with the amount of enophthalmos, presence of diplopia, and limitation of ocular motility. RESULTS: Orbital floor area (mean +/- SD) was 5.72 +/- 1.07 cm(2); fracture area, 2.63 +/- 1.20 cm(2); and the volume of displaced tissue, 1.15 +/- 0.91 mL. The average proportion of the fracture within the orbital floor was 45.3 +/- 17.6%. Fracture area and volume of displaced tissue were significantly positively correlated with enophthalmos and diplopia and not correlated with the limitation of ocular motility. For enophthalmos of 2 mm or greater, mean fracture area (mean +/- SD) was 4.08 +/- 1.09 cm(2) and volume of displaced tissue was 1.89 +/- 1.19 mL; for less than 2-mm enophthalmos, 1.98 +/- 0.83 cm(2) and 0.83 +/- 0.58 mL, respectively. Enophthalmos of 2 mm can be expected with 3.38 cm(2) of fracture area and 1.62 mL of displaced tissue. CONCLUSIONS: Region-of-interest measurement from coronal CT scan has an application in the assessment of patients with pure blowout fractures of the orbital floor and adds useful information in posttraumatic evaluation of orbital fractures.

Adolescent↗
PubMed2000

[Strabismus, hemianopsia and the sundial of Mawas and Franceschetti].

UNLABELLED: THE ARTIFACT: The artifact is a light rectangular slate of black cardboard showing two white lines at 40 degrees angle. It provokes physiological diplopia in lateral vision. BACKGROUND: In normal subjects, the right oblique line stimulates the right nasal hemiretina, perceived as an oblique line, and the left temporal hemiretina, perceived as a vertical line, both lines being on the right hand side. Likewise, the left oblique line is seen as two lines on the left hand side. The 4 lines form and M and a W combined. The strabismus subject sees 3 lines for he neutralizes one; the alternating squint sees only 2; the heterophoric sees 4 lines, two of which blurred, and the hemianopic sees only part of the dial. RESULTS: The subject must select the image he sees from an array of possibilities shown on the back of the dial. From 5 years of age on, normal subjects select the [symbol: see text] or the "butterfly"; hemianopic subjects correctly describe the loss of either the left or right field. CONCLUSIONS: The sundial facilitates both the screening and the treatment of binocular vision disorders. Bangerter's hemifilter will be used in association with exercises for physiological diplopia at home under monthly orthoptic control. All this made it possible to obtain useful peripheral fusion in early onset strabismus.

Diplopia↗
PubMed2004

[Diagnostic value of mitochondrial DNA analysis in chronic progressive external ophthalmoplegia (CPEO)].

BACKGROUND: Chronic progressive external ophthalmoplegia (CPEO) is a mitochondrial cytopathy presenting with ptosis and external ophthalmoparesis. Mitochondrial disorders are characterized by a broad clinical spectrum and genetic background with marked genotype/phenotype variability. The routine diagnostic work-up usually includes clinical and laboratory examinations as well as histological and histochemical analysis of skeletal muscle biopsy. In our case only an additional molecular biological examination allowed the diagnosis of CPEO. PATIENT AND METHODS: We report a 35-year-old woman with a 7-years history of slowly progressive diplopia due to impaired ocular motility and bilateral ptosis. We performed ophthalmological and neurological examinations, laboratory testing, lower limb skeletal muscle biopsy including histological and histochemical investigations, biochemical analysis of respiratory chain enzymes in skeletal muscle homogenate and molecular genetic testing of skeletal muscle DNA. RESULTS: Although clinical, laboratory, histological and biochemical analyses did not give any hints suggesting a mitochondrial cytopathy, molecular genetic testing of total DNA from skeletal muscle tissue by Southern blot analysis finally revealed a 3.8 kb mitochondrial DNA deletion with a degree of heteroplasmy of 45 %. CONCLUSIONS: In patients with unexplained binocular diplopia , oculomotor deficits and/or acquired ptosis, an underlying mitochondrial cytopathy should be considered. Even in the case of inconspicuous skeletal muscle histology and biochemistry, molecular genetic testing of skeletal muscle DNA is advisable in order to establish the diagnosis.

Adult↗
PubMed1998

[Orthoptic problems after macular rotation with and without muscle surgery].

BACKGROUND: In spite of new therapeutic approaches the treatment of age related macular degeneration remains unsatisfying. Macular rotation is so far only a rarely employed surgical procedure, where the macula is translocated to an area with intact retinal pigment epithelium. The aim of this study was to elucidate the orthoptic problems of macular rotation and describe possible treatment modalities. PATIENTS AND METHOD: Between February and July of 1997 a macular rotation was performed in 8 patients with exsudative macular degeneration, followed by silicone oil removal and implantation of an intraocular lens. In 3 out of 8 patients the oblique muscles were transposed at the beginning of the surgery to produce an excylotropia. In all patients visual acuity for distance and near was determined pre- and postoperatively along with a complete orthoptic status including measuring of cyclotropia. Mean postoperative follow-up was 5.5 months. RESULTS: Due to the unilateral ectopia of the macula all patients presented with a postoperative strabismus with vertical deviation of 2 degrees to 10 degrees. The change of the visual axis resulted in a displacement of the pupillary reflex. The patients described a cyclotropia of 12 degrees to 45 degrees corresponding to the ophthalmoscopically estimated angle of retinal rotation. Patients after surgery of the oblique muscles showed less cyclotropia with an angle of 12 degrees to 20 degrees. They were less disturbed by diplopia and tilted visual impression than those without muscle surgery. All patients exhibited an abnormal head position with chin up and tilt to the side of the operated eye. CONCLUSION: Macular rotation always causes diplopia because of the unilateral ectopia with cyclotropia and vertical deviation. These problems can be considerably reduced by combining macular rotation surgery with oblique muscles surgery. It may well be that in the future these problems can be completely resolved by additional surgery on the rectus muscles.

Aged↗
PubMed1996

[Reflections on expert assessment of double vision and forced head position].

Visual impairment in patients with diplopia can be assessed using a scoring method in front of a tangent screen. The primary position is the starting position for these measurements. For medicolegal judgement the scoring is based on a suggestion of Haase and Steinhorst, ranging from a disability of 0% to 25%. A new proposal for scoring the field of binocular single vision (BSV) is made here: A field between 30 degrees right and left gaze, 20 degrees upgaze and 40 degrees downgaze is defined as used under every day conditions. It is divided such that diplopia in one lateral half field corresponds to 13% disability, in the upper half 10% and in the lower 18%. Patients suffering from a unilateral superior oblique palsy often show a slight torticollis. In these cases the habitually assumed head position should be taken as the starting posture for the tangent screen measurements.

Abducens Nerve↗
PubMed1992

[Results of conventional retinal detachment surgery. III. Orthoptic results].

In a comparative study we examined orthoptic side effects in 117 patients following conventional retinal detachment surgery. Of these, 54 had had a segmental scleral buckle, 18 a simple encircling band and 45 encircling band combined with a radial buckle. Persistent diplopia was found in 6% of cases following segmental buckles, in 11% following simple encircling procedures and in 20% following combined operations with encircling bands and segmental buckles. The incidence of diplopia was more than 30% in cases with high encircling buckles.

Adolescent↗
PubMed1985

[Measurement of coaxial position in lens implants].

Intraocular lens implantation occasionally causes binocular diplopia resistant to prismatic correction. Present methods of examination cannot determine the cause of this incurable diplopia. Therefore, a new method based on keratometry has been invented to allow qualitative and quantitative analysis of biomicroscopically undetectable decentration of intraocular lens implants producing asthenopic complaints. The present study investigates the type and frequency of intraocular lens decentration relative to the visual axis.

Diplopia↗
PubMed1980

[Is there a typical motility disturbance in orbital wall fractures (author's transl)].

In case of motility disturbances due to orbital fractures generally a vertical diplopia -- that means a vertical restriction of the motility of the globe -- is found. The classification into four types according to Friemel allows a differentiation between mechanical motility disturbances and those of other origin; furthermore a prediction can be made about the extent of the field of diplopia and about the involved position of gaze. In addition the urgency of a primary reconstruction of the orbit and the prognosis of a late eye muscle surgery can be estimated by this classification. It is of differential diagnostic importance that isolated injuries of the eye muscles and the check ligaments, an intraorbital haemorrhage and a subtotal paresis of the oculomotor nerve can show a similar clinical picture as usually found with orbital fractures. The early diagnosis of ocular motility disturbances caused by orbital trauma is of essential importance for the proper treatment and the recovery of binocular single vision.

Diplopia↗
PubMed2003

"Balanced" orbital decompression for severe Graves' orbitopathy: technique with treatment algorithm.

BACKGROUND: Graves' orbitopathy can produce proptosis, compressive optic neuropathy, and extraocular motility abnormalities; symptoms result from an increase in orbital volume due to expansion of intraorbital fat, with or without extraocular muscle involvement. STUDY DESIGN: We conducted a chart review of patients who underwent orbital decompression to treat Graves' orbitopathy. Twenty-two orbits (13 patients) underwent orbital bone decompression, of which 17 orbits (9 patients) underwent the combined medial and lateral "balanced" decompression. RESULTS: All patients had significant improvement with an average decrease in proptosis of 5.9 mm in the balanced decompression group. Restoration of normal optic nerve function was achieved in all patients with compressive optic neuropathy. Diplopia was noted in 4 patients (30.7%) preoperatively. Two patients had new postoperative diplopia (15.35%). CONCLUSION: In our experience, "balanced" decompression results in a reduction of proptosis and improved optic nerve function and has a low incidence of complications.

Adult↗
PubMed2000

Divergence insufficiency.

PURPOSE: Divergence insufficiency is an unusual form of strabismus with esotropia and diplopia only at distance and single binocular vision at near. This retrospective case series describes the diagnosis and treatment of 7 patients and differentiates this clinical entity from other conditions. METHODS: Seven healthy patients aged 9 to 41 years who developed acquired esotropia only at distance were treated with unilateral or bilateral medical rectus recession. RESULTS: All patients had resolution of diplopia, although one patient initially treated with unilateral medial rectus recession required a second recession of the other medial rectus muscle. CONCLUSIONS: Divergence insufficiency is a distinct clinical entity in otherwise healthy patients, which can be successfully treated by unilateral or bilateral medial rectus recession.

Adolescent↗
PubMed2001

Early reoperation after vertical rectus muscle surgery.

PURPOSE: Adjustable suture strabismus surgery has a success rate between 90% and 94%. In some patients, undesirable deviations are noted in the first week after surgery. In this article, we describe a method of reoperation in the first week of the initial repair in an outpatient clinical setting. METHODS: A retrospective review of clinical records from 1990 to 1998 identified 7 patients who underwent reoperation of the original surgical procedure in a clinic setting. All patients had vertical deviations that were overcorrected and had a reversal of their diplopia. RESULTS: Follow-up ranged from 3 months to 59 months. All patients were free of diplopia and were either orthophoric or had small phoric deviations. CONCLUSIONS: Proper identification of patients with strabismus as a result of overcorrected adjustable sutures and prompt reoperation in the first week after surgery are possible and prevent the need for repeat anesthesia in the operating suite.

Adolescent↗