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 1,081 records · Page 60Linked to original sources
PubMed1976

Oribital floor fractures: a retrospective study.

A retrospective series of 365 orbital floor fractures was studied and many variables were analyzed. Some type of ocular or orbital adnexal damage was present in 32% of the patients. After a repair procedure there was a low incidence of decreased visual acuity, and there were no implant extrusions. Late enophthalmost and diplopia were found to be related to the type of orbital floor damage. The comminuted floor fractures and fractures associated with prolapse of orbital tissue into the maxillary antrum were more prone to demonstrate these late sequelae. Despite various surgical procedures there was a 19% incidence of late diplopia and an 11% incidence of late enophthalmos.

Adolescent↗
PubMed1998

[Extracranial trigeminal schwannomas with middle temporal fossa development].

Schwannomas of trigeminal nerve account for 0.07% to 0.36% of all intra-cranial tumors. We report three observations about Jefferson's type D tumors, mainly extra-cranial with only small intra-cranial extension, concerning two men and one woman, who were respectively 36, 60 and 63 years old. Two of them presented with facial pain and hypoesthesia in the same territory. The third one developed a diplopia. In all cases, CT scanner analysis evidenced a large hypodense tumor extending in the infratemporal fossa. Temporal lobe and cavernous sinus were pushed aside by the intra-cranial extension. Tumors were hypo intense in T1-weighted image with significant enhancement after gadolinium injection. One of the tumors was a cystic form and in that case, an hyper signal in T2-weighted image was detected in the middle of the lesion. A combined subtemporal and transmaxillary approach was performed in 2 cases. In the third case, the removal of the tumor was only performed by a transmaxillary approach. In this series, there was no surgical mortality. One patient presented a postoperative residual painful anesthesia. In conclusion, extra-cranial schwannomas with intra-cranial extension are specially rare lesions. The most common early symptoms are facial neuralgia, facial hypoesthesia or diplopia. Neuroradiologic investigations, including CT and MRI evidence the precise anatomic site of the lesions. With the help of these techniques, total surgical tumor removal is possible in the majority of cases.

Adolescent↗
PubMed1998

A protocol for extraocular muscle surgery after orbital floor fracture ("blow-out")

PURPOSE: If, after primary repair of an orbital fracture by maxillo-facial surgeons, diplopia persists, extraocular muscle surgery may be necessary. It was the purpose of this study to examine proposed surgical treatment in these cases to determine their efficacy. SUBJECTS AND METHODS: We analyzed, retrospectively, the files of 14 patients who were treated in our strabismological department for persistent diplopia caused by injury to the extraocular muscles and/or to the surrounding structures. The aim of our treatment protocol was to restore comfortable binocular single vision in primary position and downgaze. The selection of the surgical procedure depended on the deviation in primary position and on the degree of ocular muscle imbalance. Surgery consisted of recession of the inferior rectus muscle of the affected eye in 4 cases, resection of the inferior rectus muscle of the affected eye in 4 other cases, and large recessions of the vertical muscles of the contralateral normal eye in 6 cases. RESULTS: In all 14 patients, we obtained the desired comfortable field of binocular single vision, considered "good" (20 degrees up to 30 degrees downgaze) or "satisfactory" (a useful field). In 11 cases this was achieved in one procedure. Two patients needed a reintervention because of initial overcorrection, and one patient for an initial undercorrection. All 14 patients had a "good" or "satisfactory" final result (useful binocular single vision). CONCLUSIONS: When extraocular muscle surgery is necessary, we recommend in patients with limited forced elevation, recession of the taut rectus inferior muscle; in patients with the clinical characteristics of an inferior rectus palsy, a resection of this muscle; and in cases with a normal or only slightly limited forced duction test, weakening the contralateral synergists.

Diplopia↗
PubMed1998

[Traumatic bilateral paralysis of the abducens nerve without cervical fracture].

We report the case of a 75-year-old woman with an uneventful medical history who presented with sudden-onset diplopia immediately after neck trauma in a traffic accident. Clinical and ophthalmological examinations were consistent with bilateral abducens nerve palsy. The causal relationship, including the medicolegal implications and the pathophysiological mechanism are discussed. The case demonstrates that exceptionally benign trauma can cause severe diplopia. The delay to recovery may be very long, suggesting caution concerning the decision of surgical care.

Abducens Nerve Injury↗
PubMed1995

Disorders of ocular motility following head trauma.

OBJECTIVE: To determine the types and frequency of symptomatic ocular motility disturbances following head trauma and their association with severity of trauma. DESIGN: Retrospective study of patients with (1) diplopia unless visual loss is present, (2) heterotropia for far or near targets, and (3) prior head injury. SETTING: Office and in-hospital consulting practice of a university neuro-ophthalmologist. SUBJECTS: Sixty patients with posttraumatic ophthalmoplegia. MAIN OUTCOME MEASURES: Paralytic and nonparalytic heterotropias were quantitated in prism diopters or percentage limitation of ductions. Convergence insufficiency was assessed by determining the near point of convergence. RESULTS: Fifty-one patients had nuclear or infranuclear findings, ie, trochlear palsies (n = 20), oculomotor palsies (n = 17), abducens palsies (n = 7), combined palsies (n = 5), and restrictive ophthalmopathy (n = 2). Nine patients had supranuclear dysfunction, including seven patients with convergence insufficiency. Bilateral ocular motor palsies and combined palsies were significantly (by means of chi 2 test) associated with head trauma of severity sufficient to cause corticospinal tract dysfunction. Individual or combined ocular motor palsies were not significantly (by means of chi 2 test) associated with intracranial hemorrhage and/or skull fracture or loss of consciousness. CONCLUSIONS: Trochlear palsy was the most common nuclear or infranuclear basis for traumatic diplopia, and convergence insufficiency was the most common supranuclear cause of double vision. Head trauma distinguished by upper motor-neuron signs was correlated with specific subsets of disordered ocular motility.

Adolescent↗
PubMed2003

Development of generalized disease at 2 years in patients with ocular myasthenia gravis.

BACKGROUND: Generalized myasthenia gravis will develop in more than 50% of patients who present with ocular myasthenia gravis, typically within 2 years. The optimal treatment of ocular myasthenia gravis, including the use of corticosteroids, remains controversial. In addition, the prevalence of thymoma and the optimal performance of the edrophonium chloride test for ocular myasthenia remain unknown. OBJECTIVE: To assess the effect of oral corticosteroid therapy on the frequency of development of generalized myasthenia gravis within 2 years, the incidence of thymoma, and the amount of edrophonium needed for a positive test result in patients with ocular myasthenia gravis. METHODS: We reviewed an ocular myasthenia gravis database of 147 patients. Patients underwent measurement of acetylcholine receptor (AChR) antibody levels and chest computed tomography. Unless contraindicated, patients with diplopia were recommended for therapy with prednisone, up to 40 to 60 mg/d, with the dosage tapered for 5 to 6 weeks. Most continued to receive daily or alternate-day doses of 2.5 to 10 mg to prevent diplopia. Patients not given prednisone (untreated group) received pyridostigmine bromide or no medication. After the diagnosis, we documented the signs and symptoms of ocular and generalized myasthenia gravis and performed 2-year follow-up in 94 patients. RESULTS: The mean dose of edrophonium chloride to give a positive response was 3.3 mg (SD, 1.6 mg) for ptosis and 2.6 mg (SD, 1.1 mg) for ocular motor dysfunction. Thymoma occurred in 1 patient (0.7%). Generalized myasthenia gravis developed within 2 years in 4 of 58 treated and 13 of 36 untreated patients. The odds ratio (OR) for development of generalized disease in the treated group was 0.13 (95% confidence interval [CI], 0.04-0.45) compared with the untreated group. The AChR antibody level was not predictive of development of generalized myasthenia gravis at 2 years, but the risk was greater in patients with abnormal AChR antibody levels (OR, 6.33; 95% CI, 1.71-23.42). Logistic regression that included age, abnormal AChR antibody level, and prednisone therapy yielded significance only for abnormal AChR antibody level (OR, 7.03; 95% CI, 1.35-36.64) and treatment (OR, 0.06; 95% CI, 0.01-0.30). CONCLUSIONS: At 2 years, prednisone treatment appears to reduce the incidence of generalized myasthenia gravis to 7% in contrast to 36% of patients who did not receive prednisone. Thymoma, although uncommon, occurs in ocular myasthenia gravis. Only small amounts of edrophonium are needed to diagnose ocular myasthenia gravis.

Administration, Oral↗
PubMed2006

Optimal size and location for corneal rotational autografts: a simplified mathematical model.

OBJECTIVE: To calculate clinical guidelines for the optimal location and size of a rotational autokeratoplasty. METHODS: The ideal graft size and trephine decentration for a rotational autograft were calculated based on scar location using geometric models. Mathematical variables were set to maximize postoperative visual acuity and for generalization of the geometric model. This model was used in a rotational autokeratoplasty of a patient with a history of a corneal scar and diplopia. An 8-mm autograft was decentered 0.5 mm superiorly and rotated 180 degrees to relocate the scar to the superior aspect of the cornea, out of the patient's vision. RESULTS: For cases that satisfy the given variables, a graft diameter of 8 mm with a decentration of 0.5 mm balances maximization of scar removal and scar movement superiorly, with minimization of discrepancy in corneal thickness after rotation. For scars that are alpha degrees from horizontal, the graft should be rotated 180 - alpha degrees . By using these calculations, the autograft in this case successfully resolved the diplopia and improved visual acuity. CONCLUSIONS: A rotational autograft can be an effective alternative to standard penetrating keratoplasty for some patients with corneal scars. We establish a mathematical model for most clinical instances of a rotational autograft, in which an 8-mm graft with a decentration of 0.5 mm best satisfies the goals of surgery.

Adult↗
PubMed1984

Incomitant vertical strabismus. Treatment with posterior fixation of the inferior rectus muscle.

Three patients with evidence of inferior rectus muscle paresis were surgically treated for diplopia in downgaze following blowout fracture of the orbit or operative trauma. In each case, surgery involved the placement of two posterior fixation sutures 13 or 14 mm behind the physiologic insertion of the inferior rectus muscle in the contralateral eye. In one case, posterior fixation was combined with a small inferior rectus muscle recession. All three patients experienced relief of their diplopia and improvement in their binocular field of vision. There were no untoward sequelae and no surgically induced changes in primary position alignment.

Adult↗
PubMed1986

Primary-position hypotropia after anterior transposition of the inferior oblique.

Three patients with fourth cranial nerve palsy underwent a recession of the ipsilateral inferior oblique muscle. In all three cases, the inferior oblique muscle was anteriorly displaced to the temporal border of the inferior rectus muscle. In the immediate postoperative period, all three patients developed a hypotropia and diplopia in the primary position with limitation of upgaze. The hypotropia remained stable and required retrodisplacement of the inferior oblique muscle in order to eliminate the diplopia. We emphasize the power of the anterior transposition of the inferior oblique muscle and caution its use as a unilateral procedure in patients with central fusion.

Adult↗
PubMed1988

Monocular eye closure in intermittent exotropia.

Monocular eye closure in bright illumination is a common occurrence in intermittent exotropia. In a series of patients with intermittent exotropia with normal retinal correspondence and stereopsis while the eyes were in the straight position, monocular eye closure occurred in 90% of patients with normal retinal correspondence while exotropic and in only 35% of patients with abnormal retinal correspondence while exotropic. Monocular eye closure occurs in people with intermittent exotropia to avoid diplopia and visual confusion even though these are not usual complaints. The cortical adaptation of anomalous retinal correspondence prevents diplopia and visual confusion and obviates the need to close one eye in bright sunlight.

Exotropia↗
PubMed1998

Maxillary removal and reinsertion for anterior cranial base tumors: long-term results.

OBJECTIVE: To evaluate complications and sequelae of maxillary removal and reinsertion for anterior cranial base tumors. DESIGN: A retrospective review of patients who underwent maxillary removal and reinsertion from 1990 to 1996. SETTING: The Arthur G. James Cancer Hospital and Research Institute at The Ohio State University, Columbus. PATIENTS: A consecutive sample of 46 patients who underwent maxillary removal and reinsertion. The patients ranged in age from 11 to 77 years and were followed up for as long as 6 years after surgery. There were 16 benign and 30 malignant lesions. MAIN OUTCOME MEASURES: Intraoperative, postoperative (1-10 days), short-term (11 days through 3 months), and long-term (>3 months) complications; survival status of patients; and adjuvant therapy. RESULTS: Four patients (9%) had undergone previous radiotherapy; 9 (20%) received intraoperative radiation therapy; and 23 (50%) received planned postoperative radiotherapy. No intraoperative complications were noted. The most common short-term complication found was transient diplopia, affecting 9 patients (20%). Diplopia resolved within 3 months in all but 2 patients, in whom the condition was permanent. There were 4 patients (9%) who required removal of the nasal dorsum plate, and 4 (9%) who required removal of maxillary plates that were exposed intranasally. Midface asymmetry as reported by the patient or noted on the physical examination was documented in only 2 patients. The most common long-term complication was nasal asymmetry, affecting 13 patients (28%). CONCLUSIONS: Maxillary removal allows improved visualization and access to anterior skull base lesions, while reinsertion of the maxillary fragment provides functional preservation and excellent cosmesis with few short- or long-term complications, even when adjuvant radiotherapy is used.

Adolescent↗
PubMed1997

Criteria for selective management of the orbital rim and floor in zygomatic complex and midface fractures.

OBJECTIVE: To develop objective criteria with which to identify patients with zygomatic complex (ZMC) or midface fractures who require a surgical exploration and treatment of the orbital component of their fracture to prevent postoperative enophthalmos, diplopia, or malar depression. DESIGN: Nonrandomized, prospective management of facial trauma patients. SETTING: Urban, university referral center. PARTICIPANTS: Ninety-seven patients with facial fractures (72 with ZMC fractures and 25 with midface fractures) who presented to the maxillofacial and oculoplastics trauma teams at the University of Cincinnati, Cincinnati, Ohio, for management. INTERVENTION: The decision whether to include an orbital exploration as part of the management plan was made based on a specific set of physical and radiological criteria that are detailed in the text. OUTCOME MEASURE: Patients were evaluated postoperatively for possible complications related to the orbital and periorbital portions of their fractures. RESULTS: Thirty-four percent of the study patients (30% of the patients with ZMC fractures and 44% of the patients with midface fractures) underwent orbital rim exposure and orbital floor exploration as part of their fracture management. Sixt-six percent of these patients (70% of the patients with ZMC fractures and 56% of the patients with midface fractures) were managed without orbital exploration. Postoperatively, none of the patients who did not undergo exploration experienced diplopia or enophthalmos and only 1 patient had a residual malar depression. CONCLUSIONS: The criteria reported herein allow surgeons to identify the minority of patients with midfacial and ZMC fractures who require an orbital exploration for optimal fracture management. Orbital exploration, and its potential complications, can be avoided in the majority of patients with ZMC and midface fractures without significantly increasing the risk of morbidity related to the orbital component of their fractures.

Adult↗
PubMed2000

Lamotrigine add-on for drug-resistant partial epilepsy.

BACKGROUND: Epilepsy is a common neurological disorder, affecting almost 0.5 to 1% of the population. Nearly 30% of patients with epilepsy are refractory to currently available drugs. Lamotrigine is one of the newer antiepileptic drugs and is the topic of this review. OBJECTIVES: To examine the effects of lamotrigine on seizures, side effects, cognition and quality of life, when used as an add-on treatment for patients with drug-resistant partial epilepsy. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trials register, the Cochrane Controlled Trials Register (Cochrane Library Issue 1, 2000), MEDLINE (January 1966 to December 1999) and reference lists of articles. We also contacted the manufacturers of lamotrigine (Glaxo-Wellcome). SELECTION CRITERIA: Randomized placebo controlled trials, of patients with drug-resistant partial epilepsy of any age, in which an adequate method of concealment of randomization was used. The studies may be double, single or unblinded. For crossover studies, the first treatment period was treated as a parallel trial. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included 50% or greater reduction in seizure frequency, treatment withdrawal (any reason), side effects, effects on cognition, and quality of life. MAIN RESULTS: We found three parallel add-on studies and eight cross-over studies, which included 1243 patients (199 children and 1044 adults). The overall Peto's Odds Ratio (OR) and 95% confidence intervals (CIs) across all studies for 50% or greater reduction in seizure frequency was 2.71 (1.87, 3.91) indicating that lamotrigine is significantly more effective than placebo in reducing seizure frequency. The overall OR (95%CI) for treatment withdrawal (for any reason) is 1.12 (0.78, 1. 61). The 99% CIs for ataxia, dizziness, nausea, and diplopia do not include unity, indicating that they are significantly associated with lamotrigine. The limited data available preclude any conclusions about effects on cognition and quality of life, though there may be minor benefits in affect balance (happiness) and mastery. REVIEWER'S CONCLUSIONS: Lamotrigine add-on therapy is effective in reducing the seizure frequency, in patients with drug-resistant partial epilepsy. Further trials are needed to assess the long term effects of lamotrigine, and to compare it with other add-on drugs.

Anticonvulsants↗
PubMed1994

Radiosurgical treatment of gliomas of the diencephalon.

The results of Leksell Gamma Knife treatment of diencephalic gliomas are presented. Eight tumours in seven patients form the basis of this report. 7 patients, 4 males and 3 females. The age range was 7.5 to 33 years with a mean of 18 years. Mean follow-up was 21 +/- 12 months. In 4 patients the tumour had been reduced in volume by an open internal decompression procedure. The location of the tumour will determine the risks of treatment. With anterior lesions there is risk of endocrinological and visual pathway damage. With a pineal region lesion there is a risk of diplopia. In this series no tumour has increased in volume. Four have decreased and one has disappeared. Two patients suffered temporary diplopia. No visual disturbance has been observed to date. No hypothalamic disturbance has been observed yet. These tumours are dangerous not so much because of their biological nature as because of their location. However, the biological nature of the tumours, with the close concordance between the radiological and actual extent make them appropriate targets for radiosurgery as a primary treatment. The present study gives preliminary support to this line of treatment.

Adolescent↗
PubMed1984

Multiple cerebral hydatid cysts.

A 39-year-old woman was admitted to hospital with headaches, vomiting, psychic impairment and diplopia. Three hydatid cysts of the lung had been previously removed. An avascular mass in the left hemisphere with left-to-right displacement of the anterior cerebral arteries was noted during a brain angioscintigraphy. A computed tomography (CT) brain scan showed two cystic lesions situated in the left-frontal and occipital regions. A CT abdominal scan showed multiple cysts in the liver, spleen and both kidneys. At operation, two brain cysts were totally extirpated without rupture. The definite pathological diagnosis was secondary hydatid cysts. The headaches, vomiting and diplopia were persistent in the post-operative period. Seven days after the operation, a CT brain scan showed an infratentorial cyst. The patient rejected any surgical intervention.

Adult↗
PubMed1988

Pulmonary barotrauma including orbital emphysema following inhalation of toxic gas.

Severe pulmonary barotrauma occurred following smoke and toxic gas inhalation in a 20-year-old male. He developed pneumothorax, pneumomediastinum, and extensive facial subcutaneous emphysema which intensified during treatment with positive pressure ventilation. Following the appearance of diplopia and exotropia, orbital emphysema was demonstrated radiologically. The diplopia and exotropia were manifestations of mechanical interference in extra-ocular muscle function by the intra-orbital air, an unusual expression of pulmonary barotrauma.

Adult↗
PubMed1990

Hematoma of the inferior colliculus: uncommon cause of trochlear nerve deficit and contralateral sensory hemisyndrome.

A 57 year old man consulted us for sudden onset of acuphenes in the right ear, followed by diplopia on forward and downward gaze and paresthesias on the right side of the body. Examination of ocular movements revealed a deficit of the superior oblique muscle of the left eye. CT and MR brainscans imaged a punctate bleed of the left inferior colliculus. The patient was discharged after 16 days still complaining of diplopia on forward and downward gaze. There was no change in neurological status at follow-up. It is rare for an intracerebral hematoma to be located in the midbrain. The case we report is distinguished by the smallness of the lesion and the uncommon neurological deficit it caused.

Cerebral Hemorrhage↗
PubMed2006

Slow-release lanreotide in Graves' ophthalmopathy: A double-blind randomized, placebo-controlled clinical trial.

SS analogs are an attractive alternative in treating Graves' ophthalmopathy (GO). Most of the previous studies were uncontrolled and enrolled few patients. The present study was conducted as a larger scale, prospective, randomized controlled study to determine the effectiveness of a slow-release formulation of lanreotide in GO. Sixty patients with active GO received an im injection every two weeks of either lanreotide 30 mg or placebo for 12 weeks. They were then followed and further treated in the traditional way if necessary. The Clinical Activity Score (CAS) was the primary efficacy criterion. Proptosis, diplopia, corneal erosion or ulcer, visual acuity, extraocular muscle movement and intraocular pressure were also evaluated. At the end of the 12 weeks, the mean CAS was not significantly decreased in the lanreotide group compared to the placebo group. The overall mean difference of proptosis between these two groups also did not reach significance at 12 weeks. Only diplopia at downward gaze had significant improvement for the lanreotide- treated group vs placebo group (p = 0.03). No differences were observed between the two groups compared to other outcome measures. During the 24-month follow-up after the clinical trial, 14 patients received eye surgery in the placebo group compared with 10 patients in the lanreotide group (p = 0.29). Six patients received methylprednisolone pulse therapy in the placebo group and two patients in the lanreotide group (p = 0.25). In conclusion, lanreotide treatment had no significant effects on GO compared with placebo.

Adolescent↗