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At least 1,297 records · Page 72Linked to original sources
PubMed2004

Pupil-sparing, painless compression of the oculomotor nerve by expanding basilar artery aneurysm: a case of ocular pseudomyasthenia.

BACKGROUND: Oculomotor nerve paresis may have relatively benign but also life-threatening causes. Distinguishing between these is of great clinical importance. OBJECTIVE: To reveal a potential pitfall of the clinical evaluation of oculomotor nerve paresis. PATIENT: Single case observation. RESULTS: A 56-year-old man had fluctuating diplopia and fatigable ptosis, promptly relieved by intravenous edrophonium, leading to the diagnosis of ocular myasthenia gravis. His pupillary function was intact. A few days after the initial diagnosis, he suffered a subarachnoid hemorrhage secondary to the rupture of a basilar artery aneurysm. His ocular symptoms were related to aneurysmal oculomotor nerve compression. CONCLUSION: Patients with oculomotor nerve dysfunction need more detailed evaluation because the underlying cause cannot be safely determined on a clinical basis.

Aneurysm, Ruptured↗
PubMed1999

Surgical treatment of paralysis of the inferior division of the oculomotor nerve.

BACKGROUND: Paralysis of the inferior division of the oculomotor nerve is relatively rare. Little has been written about its surgical treatment. METHODS: Five patients with paralysis of the inferior division of the oculomotor nerve were treated with transposition of the superior rectus muscle toward the insertion of the medial rectus muscle, transposition of the lateral rectus muscle toward the insertion of the inferior rectus muscle, and tenotomy of the superior oblique tendon in the affected eye. RESULTS: All 5 patients had a satisfactory outcome. They were free of diplopia in the primary position as of their last examination. Follow-up ranged from 3 to 10 years after surgery. CONCLUSION: Paralysis of the inferior division of the oculomotor nerve can be adequately treated by simultaneous transposition of the superior rectus muscle toward the insertion of the medial rectus muscle, transposition of the lateral rectus muscle toward the insertion of the inferior rectus muscle, and tenotomy of the superior oblique tendon in the affected eye.

Adult↗
PubMed2004

Comparing ocular muscle limitation tests for clinical trial use.

OBJECTIVE: To evaluate portable methods for documenting ocular muscle limitation that might be used at multiple sites in a clinical trial. METHODS: In a prospective consecutive case series, 2 examiners independently evaluated 3 methods of ocular muscle duction testing: a grading scale of 0 to -5 that is in clinical use, the Kestenbaum limbus test using a ruler to measure the millimeters of ocular movement, and an adapted cervical range of motion (CROM) device that measures ocular movement in degrees. Twenty consenting patients (mean age, 55 years) with diplopia, 8 with ocular myasthenia gravis, 11 with a cranial nerve III or VI palsy, and 1 with dysthyroid ophthalmopathy were studied. RESULTS: For Kestenbaum measures, between examiners the standard deviation of the difference for all ductions was 1.9 mm (r = 0.75, P =.01); 95% of differences were 4 mm or less. For the CROM device, the standard deviation of the difference was 7.1 degrees; 95% of differences were 15 degrees or less (r = 0.73, P =.01). For each examiner, the CROM standard deviation of the difference was less than 2 degrees (r = 0.98, P =.01). For the grading scale, the 2 examiners had the same score in 85% of ductions (r = 0.92, P =.01). CONCLUSIONS: The Kestenbaum test and the CROM device gave similar interexaminer repeatability. The repeatability for CROM measures for each examiner was high but was considerably less between examiners. The grading scale gave similar results between examiners.

Abducens Nerve Diseases↗
PubMed1978

Cryptogenic unilateral paralysis of the superior oblique muscle.

Fifteen patients spontaneously developed paralysis of one superior oblique muscle, which remained unexplained after an initial evaluation. Follow-up evaluation showed that all of the patients' conditions were improved. Twelve of the patients had enjoyed spontaneous, functional recoveries within four months. Three had residual diplopia that was relieved by prisms. No patient subsequently developed evidence of any local or systemic disease that could explain the ophthalmoplegia. One patient suffered a recurrence 3 1/2 years after his first episode that lasted three months and spontaneously cleared.

Adolescent↗
PubMed1979

Evaluation of Jensen procedures by saccades and diplopic fields.

A total of 15 eyes of 13 patients with lateral rectus palsies underwent Jensen procedures; one eye had a medial rectus recession and lateral rectus resection. It was arbitrarily decided to perform a Jensen procedure for patients with less than 40% normal abduction saccadic function. The patients' conditions were evaluated preoperatively and postoperatively by prism cover test. Versions, forced ductions, saccadic velocities, and diplopic field examinations were done. Postoperatively, all patients showed improved saccadic function; 12 of 13 patients acquired a functional range of diplopia-free vision; and 11 of 13 patients had aligned eyes with a good head position. By retrospective analysis we determined that the Jensen procedure gives good results for patients with severe lateral rectus palsy (less than 40% normal saccadic function).

Diplopia↗
PubMed1982

Combined use of neostigmine and ocular motility measurements in the diagnosis of myasthenia gravis.

Forty-four patients with diplopia caused by myasthenia gravis, ocular myopathies, and ocular motor nerve palsies underwent complete orthoptic evaluations before and after intramuscular injection of neostigmine (Prostigmin) methylsulfate. A test score combining the results of binocular and uniocular measurements was developed that allowed correct correct classification of 70% (31) of patients studied.

Diagnosis, Differential↗
PubMed1983

Suppression in strabismus and the hemiretinal trigger mechanism.

A perimeter and a modified Lees screen were used to determine the area of visual field that is suppressed in strabismus. Strabismic patients without fusion suppress the whole area of the visual field of the deviating eye that could have correspondence with the dominant eye. In the monofixation syndrome, suppression only involves the fovea and the diplopic point of the deviating eye. Diplopia, if present, is appreciated throughout the visual field shared by the two eyes, except for the blind spots. No evidence of hemiretinal suppression was found in any type of horizontal strabismus, including exotropia. However, there is a hemiretinal trigger mechanism for suppression. Once suppression has been triggered by this mechanism, it involves the whole visual field of the deviating eye, except for the monocular temporal crescent.

Adolescent↗
PubMed1985

Rat extraocular muscle regeneration. Repair of local anesthetic-induced damage.

Local anesthetics that are commonly used in ophthalmic surgery (0.75% bupivacaine hydrochloride, 2.0% mepivacaine hydrochloride, and 2.0% lidocaine hydrochloride plus 1:100,000 epinephrine) were injected into the retrobulbar area of rat eyes. Controls were injected with physiological saline. All three anesthetics produced massive degeneration of the extraocular muscles. Muscle degeneration is followed by regeneration of the damaged muscle fibers. In addition to muscle damage, severe damage was also seen in harderian glands, especially after exposure to mepivacaine and lidocaine plus epinephrine. With these findings in rats, it is hypothesized that the temporary diplopia sometimes seen in patients after ophthalmic surgery might be due to anesthetic-induced damage to the extraocular muscles.

Anesthetics, Local↗
PubMed1990

Discrete metastasis of solid tumors to extraocular muscles.

We report five cases of discrete solid tumor metastasis to extraocular muscles. Computed tomography confirmed that orbital involvement in all cases was confined to the extraocular muscles; there was no tumor in the bony orbit or in the adjacent paranasal sinuses or intracranial space. In two of our five cases, ophthalmic signs were the first evidence of metastatic disease; in the three other cases, there was a known history of cancer prior to orbital involvement. Pain, diplopia, and proptosis were the most common presenting manifestations. Neuroimaging demonstrated bilateral focal, nodular enlargement of multiple extraocular muscles in three cases. Diffuse enlargement of a single muscle occurred in the two other cases, inclusive of the tendinous insertion in one instance. Fine-needle aspiration biopsy provided a diagnosis of undifferentiated malignancy in all four cases in which it was performed.

Adenocarcinoma↗
PubMed1991

Neuro-ophthalmic complications of interleukin 2 therapy.

We describe three patients who experienced several types of visual problems while receiving interleukin 2 therapy for melanoma or lymphoma. Their symptoms included diplopia, binocular negative scotomata, scintillating scotomata, and palinopsia. All symptoms eventually resolved following discontinuation of therapy. It appears that focal neurologic deficits that affect the visual system may complicate interleukin 2 administration.

Adult↗
PubMed1993

Strabismus following implantation of Baerveldt drainage devices.

OBJECTIVE: To describe the clinical features of strabismus following implantation of a Baerveldt glaucoma seton. DESIGN: Case series of four patients with a minimum follow-up of 6 months. SETTING: Specialized glaucoma referral center at Bascom Palmer Eye Institute/Ann Bates Leach Eye Hospital, Miami, Fla. PATIENTS: Consecutive sample of four patients with persistent binocular diplopia following implantation of a 350-mm2 Baerveldt glaucoma seton in the superotemporal quadrant. RESULTS: Each patient presented with a characteristic pattern of either exotropia or hypertropia, or both. The deviation increased with gaze opposite the ipsilateral superior and lateral muscles and decreased in the field of action of the involved muscles. All patients demonstrated a convergence insufficiency type of exotropia. CONCLUSION: These patients presented with a similar type of restrictive strabismus. Proposed mechanisms include an increase in the length-tension curve of the muscle induced by the underlying bleb and a posterior fixation effect as a result of scarring behind the implant.

Aged↗
PubMed1993

Remitting sixth nerve palsy in skull base tumors.

OBJECTIVE: Spontaneous recovery of a sixth nerve palsy is thought to rule out a neoplastic origin. We reviewed cases of sixth nerve palsy that improved without treatment but that ultimately proved to be caused by a tumor at the base of the skull. DESIGN: Case series. SETTING: Hospital-based, neuro-ophthalmology referral practice. PATIENTS: Seven patients with an age range from 7 to 61 years had sixth nerve palsy secondary to a slow-growing neoplasm at the skull base. MAIN OUTCOME MEASURES: Return of lateral rectus function and resolution of diplopia without intervention. RESULTS: Seven patients with sixth nerve palsy caused by skull base tumors experienced spontaneous improvement of their deficit. Recovery time ranged from 1 week to 18 months. No patient was diabetic or had evidence of vascular disease. In one patient, the palsy improved once prior to becoming a fixed deficit, and spontaneous improvement occurred on two to five occasions in the other patients. CONCLUSION: Spontaneous recovery of a sixth nerve palsy can occur in the presence of an extramedullary compression by a tumor at the base of the brain. Possible mechanisms for recovery include remyelination, axonal regeneration, relief of transient compression (eg, resorption of hemorrhage), restoration of impaired blood flow, slippage of a nerve previously stretched over the tumor, or immune responses to the tumor.

Abducens Nerve↗
PubMed1993

Alveolar rhabdomyosarcoma that metastasized to the orbit.

A 22-year-old woman with a history of hyperthyroidism and a paravaginal alveolar rhabdomyosarcoma developed diplopia 3 months after successful autologous bone marrow transplantation. Results of computed tomographic scan showed apparent enlargement of the right inferior rectus muscle, and thyroid eye disease was suspected. However, results of further evaluation revealed an alveolar rhabdomyosarcoma that metastasized to the orbit.

Adult↗
PubMed1996

Angiosarcoma metastatic to the orbit.

Angiosarcoma is a rare malignant endothelial cell tumor. Few reports of primary orbital angiosarcoma exist in the literature. A 46-year-old woman had a 3-month history of progressive diplopia and right-sided exophthalmos. Magnetic resonance imaging showed a right intraconal mass, consistent with a cavernous hemangioma. Ultrasound examination showed a isolated mass with moderate vascularity, consistent with a metastatic lesion. Subtotal excision through a lateral orbitotomy was performed. Tissue was stained with hematoxylineosin, periodic acid-Schiff, and immunohistochemical stains for factor-VIII-related antigen and Ulex europaeus agglutinin I lectin. Lateral orbitotomy biopsy specimens showed an angiosarcoma, similar to a primary breast angiosarcoma that had been resected 2 years previously. The patient initially underwent orbital exenteration for her only known metastasis. Despite a multidisciplinary and aggressive approach to this tumor, the tumor recurred, and the patient died.

Breast Neoplasms↗
PubMed1982

Surgical treatment of orbital floor fractures.

This study retrospectively examines 551 patients with 597 orbital floor fractures for sequelae of enophthalmos and diplopia. Ocular injuries are associated with 6.9% of the fractures. Nondisplaced orbital floor fractures have been treated with observation alone, resulting in an incidence of sequelae of zero in 263 patients. Displaced fractures that had not undergone surgery have resulted in an incidence of sequelae of 18 (34%) in 53 patients. Displaced fractures that had undergone orbital floor exploration have resulted in an incidence of sequelae of 29 (10.3%) in 281 patients. Only one mild loss of visual acuity has complicated the 281 surgical procedures. It is concluded that orbital floor exploration is not indicated in patients with nondisplaced fractures of the orbital floor and that orbital floor exploration is a safe and effective means of reducing the complications associated with displaced fractures of the orbital floor.

Adolescent↗
PubMed1984

Acquired inflammatory superior oblique tendon sheath (Brown's) syndrome. Report of a case following frontal sinus surgery.

A case of acquired Brown's syndrome secondary to fibrous proliferation about the trochlea and the superior oblique tendon developed following frontal sinus surgery. This syndrome is a restrictive ocular motility disorder characterized by vertical diplopia and inability to elevate the affected eye above the midline on medial gaze. The purpose of this report is to bring to the attention of otolaryngologists this sequela of sinus surgery, to offer suggestions for modification of surgical technique to avoid this complication, and to emphasize the importance of identifying any signs or symptoms of eye muscle dysfunction prior to surgery.

Adult↗
PubMed1985

Medial orbital blow-out fracture with entrapment.

Blow-out fracture of the medial orbital wall, concomitant with tissue entrapment, is a rare condition occurring in those sustaining blunt trauma. Clinical signs of swelling, ecchymosis, enophthalmos, or diplopia during medial or lateral gaze is suggestive of the condition. Diagnostic confirmation is obtained by forced duction testing and computed tomography. Treatment with medial orbital decompression and limited ethmoidectomy is recommended in order to obtain optimum return of function with minimal risk.

Adult↗
PubMed1988

Evaluation of the orbital floor in zygoma fractures.

Displaced fractures of the zygoma require reduction to prevent malunion. The indications for concomitant orbital floor exploration are controversial. In a retrospective review, the preoperative clinical findings, roentgenographic findings, and mode of injury in 106 patients with zygoma fractures who had their orbital floors explored was compared with surgical findings. The finding of preoperative diplopia was correlated with a surgically significant floor defect. The finding of trismus correlated with the absence of a significant defect. No other clinical or roentgenographic finding was correlated to a significant degree with the presence or absence of a significant defect.

Diplopia↗