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PubMed1977

Analysis of trochlear nerve palsies. Diagnosis, etiology, and treatment.

At the McGill University neuro-ophthalmology unit, 52 patients with superior oblique palsy were seen during the 2-year period October 1973 to August 1975; these included patients with congenital, traumatic, vascular, and other more rare causes of trochlear paralysis. Half of the patients with congenital palsy had diplopia, requiring treatment, although surgery was rarely necessary. Patients with palsy due to trauma, the major cause in our series, included four with bilateral involvement. With the exception of recovery in a single muscle of one patient in this group with traumatic palsy, no spontaneous recoveries have been observed. Treatment modalities have been tried, including observation alone, occlusion for symptomatic relief of diplopia, use of prisms, and recession of the ipsilateral inferior oblique muscle. Four patients with palsy of presumed vascular cause recovered spontaneously within a 4-month period. All patients who were surgically treated improved.

Adolescent↗

PubMed1983

Extraocular muscle involvement in Wegener's granulomatosis.

A 44-year-old man with Wegener's granulomatosis involving the upper and lower respiratory tracts developed a diplopia with involvement of three extraocular muscles of one eye and one extraocular muscle of the other eye. The ocular and orbital examinations were otherwise normal, as were computerized tomography (CT) scans of the brain and orbits. The patient was treated with systemic Cytoxan and Prednisone and the respiratory and extraocular muscle abnormalities cleared within 1 month. Because of the bilateral extraocular muscle involvement, the absence of central nervous system or orbital findings, and the rapid and complete resolution after Cytoxan and Prednisone therapy, a diffuse vasculitis affecting the extraocular muscles was implicated as the etiology of the diplopia.

Adult↗

PubMed1984

[Cerebral infarction in the area of the anterior choroidal artery with oculomotor disorder].

A 84-year-old diabetic man had a complete right-sided hemiplegia with ipsilateral hypoesthesia and vertical diplopia, but no aphasia or hemianopia. The CT scan showed a low-density area in the posterior limb of the left internal capsule, in the territory of the anterior choroidal artery. The mechanism of diplopia is discussed and is attributed to the involvement of the mesencephalic territory of the anterior choroidal artery.

Aged↗

PubMed1984

Cyclic vertical deviation.

A 34-year-old Caucasian woman underwent craniofacial surgery for fronto-orbital fibrous dysplasia. She developed vertical diplopia for 10 months after surgery, which then disappeared for 1 month. The deviation returned with a circadian pattern, 24 hours of hypertropia and exotropia with diplopia alternating with 24 hours of straight eyes and fusion. Three months after the onset of this pattern, surgery was performed, resulting in straight eye position and fusion daily. The similarities to cyclic esotropia are discussed. The etiology of circadian strabismus remains unknown.

Adult↗

PubMed1983

Superior oblique tuck for superior oblique palsy.

Fifty-nine patients with a superior oblique palsy had a superior oblique tuck as part of their surgical treatment. The average size of the tuck was 12.0 mm. All cases had a decrease in the hyperdeviation in the primary position and some decrease in elevation in adduction in the operated eye (Brown's syndrome). Seventeen per cent of the patients required take-down of the tuck three to 24 months after surgery (average time for reoperation, 9.1 months). Symptoms forming indications for take down of the tuck were head tilt, vertical diplopia, torsional diplopia, and a tight feeling on elevation in adduction. No patient who had a tuck alone required take-down. Brown's syndrome was more likely to occur in cases with weakening of the antagonist inferior oblique and when a bilateral tuck of the superior oblique had been done. Taking down of the tucked tendon relieved the symptoms of Brown's syndrome in seven of 10 patients, without a recurrence of superior oblique underaction. After superior oblique tuck in all patients, a residual vertical deviation could be measured and in nearly every case a Brown's syndrome could be found.

Adult↗

PubMed1981

Internuclear ophthalmoplegia in Fabry's disease.

A 16-year-old boy with Fabry's disease had sudden onset of diplopia unassociated with any other neurologic symptoms. A right internuclear ophthalmoplegia characterized by optokinetic phenomena and ocular dysmetria was demonstrated. The diplopia resolved spontaneously in six weeks. This is the first reported case of internuclear ophthalmoplegia occurring with Fabry's disease and represents one of the youngest patients to have unilateral internuclear ophthalmoplegia presumably caused by vascular occlusive disease.

Adolescent↗

PubMed1995

[Principles and results of treatment in acquired paralysis of III, IV and VI nerves].

Between 1979-1994 120 patients with acquired paralysis of cranial nerves of ocular muscles were treated: 33 cases with paralysis of oculomotor nerve, 43 cases with paralysis of trochlear nerve, 44 cases with paralysis of abducens nerve. The majority of our patients were males (84-70.0%) aged 21-40 years (65-54.2%). The paralysis was most frequently caused by traffic accidents (45 cases--37.5%) and assaults (26 cases--21.7%). The most common symptom of paralysis was diplopia (109 patients--90.8%). Only 12 persons (10.0%) were admitted during the first month of paralysis and visual disorders caused by it. In our group 18 patients (15.0%) were treated conservatively. Sixteen patients (13.3%) were given injections of botulin toxin A into the eye muscles. Surgical treatment, usually of several ocular muscles, was performed in 83 cases (67.5%) when diplopia was not reduced after 6-12 months. The method of surgery and results are presented.

Abducens Nerve Injury↗

PubMed1995

[A case of abducens nerve palsy after whiplash injury].

We report a patient who developed abducens nerve palsy after whiplash injury. The patient was a 61-year-old man who was involved in a traffic accident on May 15, 1993. After the accident, he developed severe neck pain. Four days later, he still had neck pain and vertigo. On the fifth day after the accident, he noted diplopia on left gaze and visited our hospital. Neurologic examination revealed an isolated abduction deficit of the left eye. Head magnetic resonance imaging and angiography showed no abnormal findings. Ten days later, the ocular movements of the patient were full and the diplopia disappeared. About two months later, his neck pain and vertigo also resolved. In this patient, the abducens nerve palsy was caused by whiplash injury and was in full recovery.

Abducens Nerve↗

PubMed1993

Pseudotumor cerebri induced by vitamin A combined with minocycline.

A 16-year-old girl complained about a headache of one-month's duration, accompanied by vertical diplopia that had appeared ten days earlier. The girl reported receiving vitamin A and minocycline to treat acne vulgaris for the previous six weeks. An examination revealed bilateral optic disc edema. Normal computed tomographic and magnetic resonance imaging examinations enabled a diagnosis of pseudotumor cerebri to be made. Soon after discontinuation of those medications, the headaches and diplopia diminished. We suggest a periodic ophthalmologic examination during systemic therapy with vitamin A combined with minocycline to detect the early occurrence of pseudotumor cerebri.

Acne Vulgaris↗

PubMed1993

Prescribing for marksmen and hunters.

Marksmen and hunters present unique challenges to the prescribing optometrist. History-taking must be thorough, to discover the specific interests of the patient, the weapon used, and the level of skill. Appropriate protective eyewear should be prescribed for all hunters and marksmen, with well-designed frames and polycarbonate lenses. Providing excellent distance acuity is an obvious requirement for these persons, and not only Snellen charts but also contrast sensitivity may be used to measure acuity. The most demanding patient is a presbyopic pistol shooter, who may require the use of apertures, low plus lenses or adds, or special design eyewear to provide the acuity needed for the alignment of front and rear sights. Another problem is eye dominance, which may be a consideration for left-eye (crossed) dominant individuals. Physiological diplopia may be a concern for beginning marksmen, and occlusion of the nonsighting eye or training to learn to ignore the diplopia may be necessary. Optometrists should be prepared to offer these and other services to this interesting class of patients.

Diplopia↗

PubMed1993

Secondary correction of traumatogenic enophthalmos with auto- and alloplastic implants.

In 23 patients with traumatogenic enophthalmos and diplopia autologous (rib cartilage, iliac crest bone), heterologous (lyophilized dura), and alloplastic (Silastic, P.D.S., HA-blocks) material was implanted into the orbit in a late secondary intervention. The results were encouraging as for the improvement of the diplopia as well as the enophthalmos. If rib cartilage should not or cannot be used a hydroxyapatite ceramic block is the best alloplastic implant material due to its stability, inertia, and availability.

Adult↗

PubMed1993

Soft opaque contact lenses in binocular vision problems.

Soft opaque contact lenses may be useful in certain recalcitrant vision problems. When the full central area is opaque, contact lenses eliminate the visual image, provide acceptable cosmesis, and may be useful in cases of intractable diplopia as well as in the treatment of amblyopia. Artificial iris contact lenses eliminate para-axial rays in monocular diplopia, aniridia, and albinism.

Albinism, Oculocutaneous↗

PubMed1977

Motility disturbances induced by operations for retinal detachment.

Study of the incidence and characteristics of motility alterations following various operations for retinal detachment. Diplopia and asthenopia following retinal surgery are rare, despite relatively frequent muscular imbalance, because of: (a) suppresion (which war frequently found even in orthophorics with good postoperative vision in both eyes); (b) compensation owing to fusional power, and (c) probable role of the sensory factor for the compensation of the subjective experience of cyclotropia. However, asthenopia and diplopia may occur and may be hard to deal with. It is felt that these disorders could be avoided in many cases since they are frequently the result of technical errors.

Diplopia↗

PubMed1996

[5 conventional radiographic projections are necessary and sufficient for the study of the zygoma. Technics and results].

Though clinic examination gives us much information, radiology still is essential in head trauma. Many standard radiographic projections have been described in the past and yet since the eighties it appears that C.T. scanner (C.T.) has become absolutely necessary to a great number of us. In fact, C.T. is indispensable when there is a matter of vital urgency or when a functional problem appears (diplopia). But most of the time high quality standard radiographic projections are sufficient. We have selected five radiographic projections: the occipito-mental's such as Mahoney's or Blondeau or Louisette, the submento-vertical's, the rotated occipito-mental's. For each of these radiographic projections we have specified the angular definition, the realization techniques, the criterions of quality and the results. The use of conventional radiology gives us images of which the quality is high enough to allow a precise topographical diagnosis and is far cheaper than C.T. So we can assert that standard radiographic projections are necessary and sufficient and that the use of C.T. becomes indispensable only in the few cases of diplopia or enophthalmia or complicated maxillary fracture. In the case of a lateral head trauma, our strategy of radiographic exploration will be represented as indicated on picture n degrees 20.

Craniocerebral Trauma↗

PubMed1997

[A case of partial fascicular oculomotor paresis].

We report a case of partial fascicular oculomotor paresis in a 22-year-old woman. The patient noticed sudden onset diplopia which had transiently occurred twice in the past two months for several hours. She also had left blepharoptosis. Neurological examination revealed left blepharoptosis and diplopia caused by paresis of the left inferior oblique and superior rectus muscles. No other focal neurological signs were detected. Laboratory data, CSF examinations, ABR, SEP and VEP studies were all normal. Brain MRI revealed a high-signal-intensity lesion of about 7 mm in diameter in the left paramedian area of the midbrain at superior colliculus level on T2-weighted images. Cerebral angiography showed no significant findings. The lesion was limited to the left oculomotor fascicles. Either demyelinating or vascular lesion might be responsible for her oculomotor paresis. The symptomatic differences between this and previously reported cases suggest that the topographical organization of the oculomotor fascicles for the superior rectus, levator palpebrae superioris, inferior oblique, medial rectus, and inferior rectus muscles and the sphincter muscles of the pupils consists of fibers that lie in a lateromedial order.

Adult↗

PubMed1998

Ocular neuromyotonia: three case reports with eye movement recordings.

The objective of this article was to evaluate the etiologies, findings, and treatment of ocular neuromyotonia (ONM) in three case reports. The etiologies of ONM were determined by the histories, neuroradiologic tests, or biopsies. Clinical observations, videotaping, and electronic eye movement recordings documented the eye movement abnormalities. Intermittent diplopia developed several years after myelography with thorium dioxide (Thorotrast), radiation treatment for a pituitary tumor, and radiotherapy for medulloblastoma of the posterior fossa. All of the patients had intermittent, variable tropias that occurred spontaneously or were induced by eccentric gaze. One patient had a partial third nerve palsy, and another had a unilateral internuclear ophthalmoplegia (INO). ONM involved the paretic third nerve, extraocular muscles, and ipsilateral lateral rectus muscle in one patient, the paretic medial rectus muscle (INO) in one patient, a lateral rectus muscle (INO) in one patient, and a lateral rectus muscle in the last patient. Eye movement recordings were consistent with spasms of the involved muscles. Carbamazepine (Tegretol) abolished the ONM in two patients. The other patient had been taking carbamazepine for seizures and developed ONM when the dose was decreased. Increasing the dose abolished the ONM. ONM is an unusual cause of intermittent diplopia and strabismus, but its distinctive history and signs identify it easily. Damage to the peripheral cranial nerves might produce segmental demyelination, axonal hyperexcitability, and a self-perpetuating, reverberating circuit that causes spasms of the extraocular muscles.

Aged↗

PubMed1998

The use of occluding tinted contact lenses.

PURPOSE: We explored the clinical issues surrounding the use of tinted contact lenses for vision occlusion in cases of debilitating vision disturbance, such as intractable diplopia. METHODS: We report the results with four patients fit with occluding tinted contact lenses. RESULTS: Vision occlusion by contact lenses provided a suitable comfortable occlusion method with improved cosmesis compared to occlusion by spectacles. Lens parameters and tint specifications were ordered for each patient. Correct lens care and handling were necessary to avoid contact lens related ocular inflammation. CONCLUSION: Provided that lens care is satisfactory and the patient does not have unreasonable expectations, a tinted contact lens can be a useful alternative to a covered spectacle lens or eye patch when occluding one eye, such as in cases of intractable diplopia, severe vision distortion, or intolerable photophobia.

Adult↗

PubMedDate not supplied

[Pseudotumor cerebri: a pediatric case report].

We describe a case of pseudotumor cerebri (PTC) in a five years old child. Pseudotumor cerebri is a not very common syndrome in the pediatric age. The incidence rate in about 1:100.000. The prognosis of PTC is usually good. Sometimes however, PTC could be complicated by eye diseases such as reduction of visual field. Our case is a child with diplopia and with a bilateral oedema of the papilla. The diagnosis of PTC was possible after the physical examination and the instrumental exams (EEG, brain NMR and others). During the staying in the hospital the child performed a therapy with betamethasone and acetazolamide; the diplopia improved and the bilateral oedema of the papilla started to be less evident. The child was discharged in good health and with a planned ocular follow-up. We think that the Pediatrician must considered the possibility of the presence of a PTC; that is an important syndrome not only for the Neurologist.

Acetazolamide↗