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At least 1,207 records · Page 67Linked to original sources
PubMed2005

Sensory exotropia subsequent to senile cataract.

To evaluate the phacoemulsification and intraocular lens implantation in patients with sensory exotropia subsequent to senile cataract. The authors prospectively studied the role of phacoemulsification and intraocular lens implantation on 25 patients by observing visual acuity, ocular alignment, binocular vision and diplopia pre-, 1 month post- and 3 months post-operation. The patients underwent follow-up for three months. Postoperatively, one patient had a corrected visual acuity of 20/50, and 24 patients had 20/40 or better. The ocular alignment, binocular vision and diplopia were resolved spontaneously. Phacoemulsification and intraocular lens implantation performed together is effective on sensory exotropia subsequent to senile cataract.

Aged↗
PubMed2000

Primary malignant lymphoma of the cavernous sinus--case report.

A 59-year-old female presented with a very rare case of primary malignant lymphoma of the cavernous sinus manifesting as diplopia and right facial hypesthesia. Magnetic resonance (MR) imaging showed the tumor located in the right cavernous sinus as low intensity with marked enhancement by gadolinium. The tumor was partially removed by the transzygomatic extradural approach. The histological diagnosis was malignant lymphoma. Chest and abdominal computed tomography and gallium-67 scintigraphy revealed no other lesions in the body. The patient received conventional radiotherapy and her diplopia and right facial hypesthesia gradually improved. At 1 month after radiotherapy, MR imaging showed no evidence of residual tumor. Primary cavernous sinus malignant lymphoma is extremely rare, but should be considered in the differential diagnosis of cavernous sinus lesions. Histological confirmation of tumors in this region is essential for choosing the most appropriate treatment to achieve a better outcome.

Brain Neoplasms↗
PubMed2005

Pseudocapsule formation after gamma knife radiosurgery for trigeminal neurinoma--case report--.

A 38-year-old female presented with a trigeminal neurinoma manifesting as left facial paresthesia. The diagnosis was based on magnetic resonance (MR) imaging findings. Gamma knife radiosurgery (GKR) was performed at another hospital at her request. Fifteen months after the GKR, follow-up MR imaging revealed tumor regrowth causing extensive compression of the brainstem, and cyst formation in the tumor. Her clinical symptoms including facial pain and diplopia had worsened, so she was referred to our affiliated hospital for microsurgery. The tumor was totally resected, but the left trigeminal nerve had to be sacrificed because of pseudocapsule formation which covered both the tumor and the trigeminal nerve fibers. The diplopia disappeared, but her facial pain deteriorated after the operation. GKR can induce fibrosis or degenerative change in nearby structures, which may complicate subsequent surgery.

Adult↗
PubMedDate not supplied

[Surgical treatment of post-contusion orbital hematoma in the late phase].

OBJECTIVE: The object of the study was to present successfully performed decompression of the orbit in orbital hematoma. MATERIAL AND METHODS: Male, 51 years of age sustained the contusion injury of the right eye during his fall on the bath tap. It caused the development of a large orbital hematoma with protrusion, restricted movement of the eyeball, pain, diplopia, folding of the retina due to hemtoma compression to bulbus oculi and retinal hemorrhages, higher intraocular pressure and impaired visual acuity to 2/60. He was treated by medicaments for a month, but the results were not favorable. After one month from the injury, anterior-inferior transcutaneous orbitotomy was performed. During the surgical intervention, hematoma and a part of orbital fat tissue were removed. RESULTS: The globe of the eye was retracted and the exophthalmos disappeared immediately after the surgery, while the mobility of the eyeball, disappearance of retinal folds with gradual receding of hemorrhage, normal intraocular pressure, abatement of pain and diplopia as well as the restoration of visual acuity to normal ensued in a few subsequent days. CONCLUSION: This study illustrated that decompression of the orbit in orbital hematoma might be successful even in the late phase, e.g., one month following the injury. It is assumed that surgical intervention would be performed by experienced orbital surgeon.

Contusions↗
PubMed1991

Treatment of Graves' orbitopathy in 1990.

In a mechanical sense, we understand how the orbital changes and the symptoms of endocrine ophthalmopathy develop. Expansion of the retrobulbar tissues results in forward displacement of the globe beyond the protective cover of the eyelids. Lymphocytic infiltration, followed by fibrosis of the extraocular muscles and the eyelid retractors, leads to diplopia and corneal exposure. Glycosaminoglycans, which are water binding molecules, accumulate in the retrobulbar tissues of patients with orbitopathy and add to the bulk to the retrobulbar tissues. Proptosis at first serves to relieve retrobulbar pressure but eventually the restrictive action of the extraocular muscles and the orbital septum limits protrusion of the globe. As forward motion is restricted, pressure from the expanded tissues rises in the confined retrobulbar space, and the optic nerve may be compressed and functionally impaired. If one thinks of the central problem in orbitopathy as being a discrepancy between the volume of the bony orbit and the bulk of the tissues it is supposed to contain, then it follows that effective treatment must either shrink the swollen tissues or make more space available for them. Medical therapy attempts to shrink the swollen tissues by steroids, radiotherapy or cyclosporin. Surgery relies on making more space available for the swollen tissues and can be modified for each patient. Further rehabilitation for diplopia can be managed with prisms or extraocular muscle surgery. Non-urgent eyelid surgery follows completion of extraocular muscle surgery. Close collaboration with an interested endocrinologist is essential.

Diagnosis, Differential↗
PubMed1992

Diagnosis and treatment of fractures of the orbital floor. A ten-year retrospective study.

In a retrospective study of 42 patients treated for fractures of the orbital floor at Södersjukhuset, different diagnostic methods and the final outcome of the treatment were evaluated. Motility evaluation and exphtalmometry were performed on all patients by the same ophtalmologist. Twenty patients underwent computed tomography with coronal scans. The prolapse and volume of the herniated soft tissue from the orbit and the degree of entrapment of the inferior rectus muscle were measured from the CT scans. All patients who developed enophtalmos had according to the CT scans herniated volumes exceeding 0.7 ml. Only 2 out of 9 patients, who did not develop enophtalmos had herniated volumes exceeding 0.7 ml. This difference was statistically significant. Of these patients 36 were operated, while 6 patients were only followed. The mean follow-up time was 6 months. Out of 39 patients followed for more than 3 months, 28 were symptom free. Six patients were moderately molested by diplopia or enophtalmos. Five patients suffered from a persistent clinically significant diplopia or enophtalmos.

Adult↗
PubMed1993

Resolution of longstanding symptoms of multiple sclerosis by application of picoTesla range magnetic fields.

Recent clinical reports have suggested that treatment with extremely weak magnetic fields (MF) in the picoTesla range is an efficacious modality for the symptomatic therapy in patients with multiple sclerosis (MS) during the remission and exacerbation periods of the disease. The present communication concerns a 64 year old woman with a 22 year history of MS of the chronic-progressive type who presented with a longstanding history of ataxia of gait, weakness in the legs, difficulties with swallowing, loss of bladder control, blurred vision, diplopia, chronic fatigue, and cognitive impairment. In this patient two 30 minute treatments with MF on two separate days resulted in a dramatic improvement of symptoms. Specifically, the patient experienced marked improvement in balance and gait as well as increased strength in the legs to the extent that she was able to abandon the use of a walker within 48 hours after initiation of magnetic treatment. In addition, there was complete resolution of diplopia, bladder dysfunction, and fatigue with improvement in mood and cognitive functions. The report attests to the unique efficacy of extremely weak MF in the symptomatic treatment of patients with MS including those patients with a chronic progressive course of the disease and supports the hypothesis that dysfunction of synaptic conductivity due to neurotransmitter deficiency specifically of serotonin rather than demyelination underlies the neurologic deficits of the disease.

Brain↗
PubMed1997

Nemaline myopathy: an unusual cause of ophthalmoparesis.

Ophthalmoparesis and ptosis are extremely rare in nemaline myopathy. A 45-year-old man with a long history of bilateral ptosis and a 1-year history of diplopia is reported. Leg and arm weakness and wasting had been present since childhood, with a very slow deterioration over time. On examination, there was nonfatigueable bilateral ptosis that was more marked on the right. There was diplopia on left gaze. Extraocular movements showed limitation of elevation and adduction of the right eye. There was bilateral facial weakness, as well as proximal and distal wasting and weakness in the arms and legs. Electromyography (EMG) showed a combination of myopathic and neurogenic changes. Triceps muscle biopsy showed small multiple collections of rod-like structures in > 50% of fibers. This patient presented with a clinical picture that did not primarily suggest nemaline myopathy. This case illustrates the heterogeneity of this disorder and the need for muscle biopsy to make an accurate diagnosis in patients with ptosis and progressive external ophthalmoparesis.

Biopsy↗
PubMed1991

Sixth nerve schwannomas. Report of two cases.

Two cases of sixth cranial nerve schwannoma are presented with a review of four other cases from the literature. The clinical spectrum, neuroradiological findings, and surgical outcome of the six cases are discussed. There are two distinct clinical presentations for sixth cranial nerve schwannomas. Type I sixth nerve schwannomas present with sixth nerve palsy and diplopia and arise from the cavernous sinus. In contrast, type II sixth nerve schwannomas have a more severe presentation with obstructive hydrocephalus, raised intracranial pressure, sixth nerve palsy, and diplopia. This type arises along the course of the sixth cranial nerve in the prepontine area. Cavernous sinus involvement in either type may preclude total surgical excision and indicate an increase possibility for recurrence.

Abducens Nerve↗
PubMed1993

Intracranial chordomas: a clinicopathological and prognostic study of 51 cases.

Fifty-one patients with intracranial chordomas who were surgically treated between 1960 and 1984 were studied. Median patient age was 46 years, and 73% presented with diplopia or headache. Nineteen tumors were classified as the "chondroid" type. The extent of surgical removal was a biopsy in 11 patients and subtotal removal or greater in 40. Thirty-nine patients received postoperative radiation therapy. At the time of analysis, 17 patients were alive, and the estimated 5- and 10-year survival rates were 51% and 35%, respectively, for the group of 51 patients. Univariate analysis showed that: 1) patients undergoing resection lived longer (the 5-year survival rate was 36% for the 11 biopsy patients compared with 55% for the 40 patients who had resection; 2) patients who underwent postoperative radiotherapy tended to have longer disease-free survival times; and 3) overall and disease-free survival data were the same for patients with chondroid tumors and those with typical chordomas. Multivariate analysis showed that: 1) age was the factor most strongly associated with longer overall and disease-free survival; 2) diplopia was associated with longer survival; and 3) tumoral mitotic activity tended to be associated with shorter disease-free survival. One tumor metastasized to the cervical cord, and two tumors underwent anaplastic transformation. These data suggest that the prognosis in patients with chordomas is unfavorable, young age is the single factor most strongly associated with longer survival, surgical resection is beneficial, and postoperative radiotherapy may prolong disease-free survival.

Adult↗
PubMed1994

Lymphocytic hypophysitis. Case report.

A case of lymphocytic hypophysitis is described in a patient presenting with panhypopituitarism 8 years after her last childbirth. The patient developed headache, vomiting, and diplopia (due to palsy of the right lateral rectus muscle) 7 months after delivery of her last baby. The diplopia disappeared after a few days with symptomatic treatment, and the headache and vomiting decreased in intensity with analgesic therapy. Eight years later the patient developed symptoms suggestive of hypoadrenalism, hypothyroidism, and amenorrhea. Investigations revealed panhypopituitarism with a pituitary mass lesion. Repeat evaluation 1 year later demonstrated no change in the size of the pituitary gland. The patient underwent transsphenoidal surgery with a provisional diagnosis of pituitary adenoma. Histological examination of the resected gland revealed evidence of lymphocytic hypophysitis. Symptoms suggestive of a pituitary mass lesion were noted during the peripartum period, but features of hypopituitarism developed much later. Such a long latent period has not been reported before. This report also highlights the fact that glandular enlargement may persist for many years after the onset of lymphocytic hypophysitis.

Adult↗
PubMed2004

Transient isolated trochlear nerve palsy associated with Rathke's cleft cyst.

We report the case of a 52-year-old woman who developed vertical diplopia of 1-days duration. Neuro-ophthalmological testing revealed left trochlear nerve palsy, and sellar MRI revealed a 1.5 cm-sized pituitary mass lesion, a Rathke's cleft cyst. The diplopia disappeared spontaneously after 6 days.

Central Nervous System Cysts↗
PubMedDate not supplied

The blind spot syndrome: does it exist?

The absence of sensory adaptations in patients who have an esotropia of 12 to 18 degrees constitutes what has been described as the blind spot syndrome. Here, the physiological blind spot is said to provide the means of avoiding diplopia and confusion. The small size of the optic disc and variations of the angle of deviation at different positions of gaze and fixation distances make it implausible that the blind spot is the mechanism by which diplopia and confusion are relieved. Moreover, there is no known mechanism for continuous oculomotor readjustment with the purpose of locking a retinal image onto the optic nerve head. When tested under almost casual seeing conditions, these patients have an anomalous retinal correspondence. The blind spot syndrome, therefore, does not exist.

Adult↗
PubMedDate not supplied

Monocular eye closure in sunlight.

Monocular eye closure in sunlight is often noted in patients with intermittent exotropia. Neither the reason for eye closure nor its frequency of occurrence in other populations is known. We questioned 147 consecutive nonoperated patients (and/or their parents) ages 1-45 years, 93 with strabismus with onset prior to 7 years of age and 54 without strabismus, for a history of closing one eye in sunlight. Monocular eye closure in sunlight was reported most frequently by patients with intermittent exotropia but was also reported by those with other forms of strabismus as well as by nonstrabismic normals. Cooperative subjects were studied further to determine the cause for eye closure. Each subject was exposed to a source of intense illumination while fixating a target. All who closed one eye under these conditions reported photalgia associated with the high light intensity, most noting less discomfort after closing one eye. None reported diplopia prior to eye closure. Monocular and binocular photophobia thresholds were then measured for each subject. The mean monocular photophobia threshold was significantly higher than the binocular threshold. In addition, binocular photophobia thresholds were significantly lower in those reporting eye closure compared with those who did not. Monocular eye closure in sunlight is a mechanism used to reduce photophobia and is not related to avoidance of diplopia.

Adolescent↗
PubMedDate not supplied

The surgical overcorrection of intermittent exotropia.

Many strabismus surgeons recommend an initial surgical overcorrection for intermittent exotropia. Others caution against overcorrection because of possible nasal suppression and amblyopia in children, or because of possible diplopia in adults. We reviewed the records of 69 patients who were initially overcorrected following surgery for an intermittent exotropia. The mean postoperative follow-up was 3.1 years. Eight patients (11.6%) had a persistent overcorrection of 3 prism diopters or more and three patients (4.3%) had persistent diplopia. Patients with a persistent overcorrection had a greater mean age (P less than .02) and a greater mean initial overcorrection (P less than .005) compared with the patients who were not overcorrected 3 delta or more. No child lost stereoacuity or developed amblyopia due to the overcorrection.

Adolescent↗
PubMedDate not supplied

Results of a single lateral rectus resection for divergence and partial sixth nerve paralysis.

A single 5.5-millimeter to 8.0-millimeter lateral rectus resection eliminated diplopia in five of six adult patients with divergence paralysis and in all three patients with a sixth cranial nerve paresis. Preoperative distance esotropia ranged from 11 to 20 prism diopters in primary gaze. Prism therapy failed in seven of nine patients. Lateral incomitance was reduced in three patients with a mild limitation of abduction preoperatively, but was not induced in the six patients with divergence paralysis. Significant overcorrection of the near esodeviation did not occur. A single lateral rectus resection can effectively eliminate diplopia in selected patients with divergence and partial sixth nerve paralysis.

Abducens Nerve↗
PubMedDate not supplied

Aberration-sensing and wavefront-guided laser in situ keratomileusis: management of decentered ablation.

PURPOSE: To clarify the feasibility of aberration-sensing and wavefront-guided laser in situ keratomileusis (LASIK) to manage grossly decentered ablation and to discuss the limitations of the technology. METHODS: Three patients with previous decentrations of the ablation zone between 1.5 to 2.0 mm were scheduled for wavefront-guided LASIK. All patients reported monocular diplopia and halos. Wavefront aberrations were measured with a Tscherning-type aberrometer. Laser ablation was done with a WaveLight Allegretto in a one-step procedure with ablation profiles calculated only from the individual wavefront map. Decentrations were determined from corneal topography. RESULTS: Three months after surgery, patient WM and patient SU had gained uncorrected and best spectacle-corrected visual acuity. The root mean square-wavefront error decreased up to 61% and 33%, respectively, for total and higher order aberrations (Zernike modes of 3rd order and higher). There was significant enlargement of the optical zone determined by corneal topography, and both patients no longer reported diplopia and halos at 3 months postoperatively. The optical aberration of the third patient (RE), after a 5.00-D overcorrection with a 2-mm decentration, was too high for aberration-sensing; retinal images obtained from the wavefront device were too smeared and not of sufficient contrast. In addition, this patient had a residual corneal thickness of 416 microm and thus wavefront-guided LASIK was not done. CONCLUSIONS: Wavefront-guided LASIK offers a new way of managing grossly decentered laser ablations. Unfortunately, there are still patients who have aberrations too large for wavefront sensing or with other clinical limitations such as a residual corneal thickness too thin for further treatment.

Adult↗
PubMed2005

[Isolated sphenoid sinus lesions: a clinical analysis of 44 cases].

OBJECTIVE: We reviewed isolated sphenoid sinus lesion (ISL), a relatively uncommon entity found mostly in departments other than otolaryngology. STUDY DESIGN: We retrospectively studied 44 cases of ISL at the Department of Otolaryngology, Kagoshima City Hospital, Kagoshima, Japan, for the 5 years between 1999 and 2003. METHODS: Data was obtained for each patient regarding age, present symptoms, first department visit, pathological classification, and therapy. RESULTS: Eighty percent of patients first visited departments other than otolaryngology. Of these, 32 had inflammatory disease, 8 mucocele, 1 a benign tumor, and 3 malignant tumors. The most common symptoms were headache at 59% followed by ocular symptoms at 27%. Ocular symptoms included ocular pain in 60% of those with inflammatory disease, visual disturbance in 63% of those with mucocele, and diplopia in all of those with neoplasms. CONCLUSION: The type of ocular symptom largely depends on ISL pathology. Patients with headaches and diplopia have a high ratio of malignant neoplasms. Endoscopic sinus surgery was useful in diagnosing and treating ISL in cases in which conservative therapy was ineffective. It is most important to differentiate pathological disease that requires early diagnosis and therapy such as acute inflammatory disease, mucocele with visual disturbance, and malignant tumors.

Humans↗