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PubMed1988

Management of facial spasm with Clostridium botulinum toxin, type A (Oculinum)

One hundred five patients received 391 graded injections of Clostridium botulinum type A toxin (Oculinum) to treat uncontrollable facial muscle spasm. Patients had essential blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration of the seventh cranial nerve (n = 20). Muscle spasms were reduced within two days of the first injection of toxin and, in most cases, the drug effect lasted three to four months. Control of facial muscle spasm was achieved in all patients. Complications related to treatment included transient blepharoptosis (n = 7), diplopia (n = 2), and altered facial expression (n = 11). Systemic side effects were not observed. Select chemodenervation of facial muscles with graded injections of botulinum toxin is a useful adjunct to control blepharospasm, hemifacial spasm, and facial spasm due to aberrant regeneration of the facial nerve.

Blepharoptosis↗

PubMed2003

Oculobulbar involvement is typical with Lambert-Eaton myasthenic syndrome.

Oculobulbar symptoms and/or signs were present in 18 of 23 (78%) of Lambert-Eaton myasthenic syndrome (LEMS) patients evaluated at the Lahey Clinic (Table). Sixty-five percent (15 of 23) of our patients had ptosis and/or diplopia, each present in 11 individuals. Bulbar signs and symptoms, including dysarthria in 10 and dysphagia in 8 patients, also were observed among our LEMS population. More than one prereferral oculobulbar feature occurred in 13 of our LEMS patients. Prereferral diagnostic considerations included myasthenia gravis, myopathies, and psychiatric disorders. These findings suggest that these atypical characteristics served to dissuade some colleagues from a diagnosis of LEMS. Thus, the presence of oculobulbar symptoms and signs cannot be used to exclude LEMS from the differential diagnosis.

Adult↗

PubMed1977

Brown's syndrome. An unusual manifestation of rheumatoid arthritis.

Two patients presented with an ocular complication of rheumatoid arthritis that was extraocular in location. Clinical manifestations include vertical diplopia, an intermittent nature, a clicking sensation, and apparent inferior oblique palsy. A stenosing tenovaginitis of the superior oblique tendon and its sheath is the probable underlying pathologic mechanism.

Adult↗

PubMed2007

Pediatric primary leptomeningeal lymphoma treated without cranial radiotherapy.

We report a case of primary leptomenigeal lymphoma (PLML) in an 11-year-old boy presenting with headache, vomiting, and diplopia. The patient was treated on an advanced non-Hodgkin lymphoma protocol with systemic/intrathecal chemotherapy without cranial radiotherapy. He remains in complete remission 33 months after treatment.

Antigens, CD↗

PubMed1982

Binocularity in comitant strabismus: binocular visual fields studies.

A critical review is made of the literature on binocular perimetry in strabismus. A broad range of results was obtained by various authors, because different testing techniques were used. The concept of sensory testing of strabismic patients in casual seeing condition should be introduced also into binocular perimetry. Therefore a series of experiments is presented in which patients with small-angle comitant strabismus were tested. It was shown that: a) in small-angle esotropia the areas of single vision previously thought to be due to suppression are, instead, areas of binocular vision sustained by anomalous retinal correspondence (ARC); b) this can be seen only when using fusable stimuli as test targets; c) no suppression scotomas were found in patients with small-angle strabismus in the whole visual field; d) appropriate control-marks for binocularity are necessary, i.e. monocularly presented items. They influence the results, as well e) the area of binocular single vision in strabismus (called pseudo-Panum's area) is wider than the Panum's area of normals. Moreover it is easier to disrupt binocular cooperation sustained by ARC causing diplopia than binocular cooperation in normals; f) ARC seems to be more deeply rooted in the center than in the periphery of the visual field; g) superimposable findings were obtained in small-angle constant exotropia; h) in large-angle exotropia wide suppression scotomas were found, which often override the midline. Hemianopic suppression scotomas in exotropia can be found only when 'dissociating' testing techniques are used; i) the same group of patients with small-angle esotropia was examined with the author's technique and with the classical method proposed by Harms. The results were strongly dependent on the method used and the same patient responded differently to the two tests. It is concluded that in small-angle strabismus there is an anomalous type of binocular single vision, which can be tested with binocular visual field techniques. This binocularity can only be found when non-artificial testing conditions are used. The usefulness of this anomalous binocular vision in the every day seeing condition of the patient is discussed.

Depth Perception↗

PubMed1984

Disturbances of ocular motility after retinal detachment surgery.

In a series of 562 patients who underwent surgery for retinal detachment, 17 (3.02%) had significant post-operative muscle imbalance. On the basis of the patients histories and clinical examinations, it is possible to classify the disturbances of ocular motility according to the symptoms (type, time of onset) and the pathogenesis (lesion of muscular sheats or bodies, capsulo-conjunctival cicatricial retractions, prolonged muscular compression, decompensation of pre-existing squints). If diplopia does not cease spontaneously, treatment consists of use of temporary prisms, but in some cases surgery is required.

Adult↗

PubMed1980

Treatment of (recurrent) pterygium oculi by lamellar keratoplasty.

Apart from cosmetic problems, pterygium oculi can cause functional disturbances, especially when it recurs after (repeated) operative removal: diplopia and/or reduced visual acuity. The results we obtained with the treatment of these functional disturbances by various types of lamellar keratoplasty in 20 patients (22 eyes) are good.

Adult↗

PubMed1976

Sensorial anomalies in strabismus. (suppression, anomalous correspondence, amblyopia).

Some concepts regarding suppression, anomalous correspondence and amblyopia are revised according to the sensorial findings obtainable from esotropic patients directly in casual seeing (with the aid of the striated glasses test) and by grading a sensorial dissociating effect (with the aid of a bar of optical filters). The following points are emphasized: 1. Suppression appears to be minimal in small angle strabismus where diplopia seems mainly to be avoided by an anomalous correspondence mechanism. On the contrary, suppression is the prevalent mechanism in large angle strabismus. 2. The anomalous correspondence mechanism may lead to a weak type of anomalous binocular vision which is easily interrupted by light optical filters or by dissociating tests. 3. The subjective space of patients with anomalous binocular vision resembles that of normal binocular vision in some aspects. 4. The development of amblyopia is interpreted in the light of these new concepts on suppression and anomalous binocular vision. 5. Postoperatively, anomalous correspondence rapidly re-adapts to the smaller angle deviation and may normalize if the deviation is completely eliminated. This is evident only in casual seeing; for a certain time, dissociating tests reveal the preoperative correspondence status. This behaviour of correspondence in casual seeing has led to attempts at normalizing anomalous correspondence by prism therapy. Newly observed sensotio-motorial obstacles, however, have been found to frequently hamper treatment in casual seeing.

Amblyopia↗

PubMed1986

The effects of pretectal and superior collicular lesions on binocular vision.

Monkeys with mid-brain lesions involving the pre-tectum and superior colliculi often have an odd stare, as if the visual axes were parallel and the animal was looking into the distance. Such a visuomotor abnormality could lead to double-vision for objects close to the animal. The experiments reported here were designed to test this hypothesis of diplopia in monkeys with combined bilateral ablations of the colliculi and frontal eye-fields (area 8). These animals performed better on a task of visually-guided reaching, and in a series of visual pattern discriminations, when they viewed stimuli monocularly rather than binocularly. Monkeys with other cortical lesions showed no such monocular superiority. We propose that an abnormality of vergence eye movements provides a simple explanation for some of the so-called perceptual impairments that follow damage to the mid-brain visual pathways in monkeys.

Animals↗

PubMed1990

Divergence paralysis associated with the ingestion of diazepam.

A case of divergence paralysis associated with diazepam ingestion is reported. The cerebrospinal fluid findings and the computed tomographic scan of the brain were unremarkable. The time of ingestion of diazepam and the occurrence of diplopia were so closely related that it is likely that diazepam caused the divergence paralysis an association which is thought not to have been reported previously.

Aged↗

PubMed1997

Horizontal transposition of vertical rectus muscles for treatment of excyclotropia.

BACKGROUND: Horizontal transposition of the vertical rectus muscles has been performed for treatment of excyclotropia associated with congenital absence of the superior oblique, and for residual excyclotropia after the Harada-Ito operation. However, the amount of excyclotropia that can be corrected and whether this technique alters the vertical muscle balance is not well known. We report the surgical results of three patients with pure excyclotropia who underwent unilateral one-half tendon width horizontal transpositions of vertical rectus muscles. METHODS: A one-half muscle width temporal transposition of the superior rectus and nasal transposition of the inferior rectus muscles of one eye was performed in three patients with pure excyclotropia and no associated hypertropia. All three had intermittent torsional diplopia before surgery. RESULTS: Postoperatively, excyclotropia decreased significantly in all fields of gaze, with 8 degrees of reduction by synoptophore and 12.3 degrees of reduction by fundus photography on average. There was no associated vertical or horizontal deviation. All three patients reported improvements of cyclofusion. CONCLUSION: One-half muscle width temporal transposition of the superior rectus and nasal transposition of the inferior rectus muscles was effective in ameliorating excyclotropia and corrected subjective complaints without altering vertical muscle balance.

Adult↗

PubMed1994

Binocular enhancement of the visual evoked potential in patients with Duane's syndrome.

Monocular and binocular visual evoked potentials were recorded in eight patients with Duane's syndrome who used an abnormal head posture to maintain binocular single vision. With their abnormal head posture, all patients had stereoscopic vision, although with mildly reduced stereoacuity, and the visual evoked potential showed binocular enhancement (mean binocular to monocular ratio, 1.44). Without their head posture, the patients experienced diplopia or suppressed vision in one eye. Binocular visual evoked potentials recorded under these conditions were of lower amplitude (mean binocular to monocular ratio, 1.05). However, without the abnormal head posture, a manifest strabismus was present and the deviating eye was not fixating the stimulus screen. Monocular visual evoked potentials recorded with the eye fixating just to one side of the screen gave little or no response, and this lack of fixation may account for the loss of binocular enhancement of the visual evoked potential in strabismus.

Adult↗

PubMed1977

[Binocular triplopia induced by weak prisms (author's transl)].

The prescription of weak prisms may induce monocular diplopia or binocular triplopia. The monocular double image is due to internal reflexion at the glass-air interface. The intensity of the secondary image is very weak (0.2% of the primary image). The prismatic deflection of the secondary image is six times the deflection of the primage image.

Diplopia↗

PubMed2005

Pseudotumor cerebri with transient oculomotor palsy.

Pseudotumor cerebri is a clinical syndrome characterized by raised intracranial pressure with normal ventricular size, anatomy and position. Headache, vomiting and diplopia are the most common symptoms. Signs include those of raised intracranial pressure including papilledema and absence of focal neurological signs. A secondary cause is identifiable in 50% of children; the most common predisposing conditions are otitis media, viral infection and medications. Management is mainly directed towards identifying and treating the cause and measures to reduce the raised intracranial pressure. Though it is mostly a self limited condition, optic atrophy and blindness can occur. Oculomotor nerve palsy is very rarely associated with pseudotumor cerebri. We report a unique case of pseudotumor cerebri who had left Oculomotor palsy with sparing of the pupillary fibres, which resolved following treatment with oral acetazolamide.

Child↗

PubMed1990

Myxoma of the orbit: a clinicopathologic report.

A 27-year-old white man developed proptosis of his left eye over a period of 2 years. It was associated with vertical diplopia and displacement of the left globe down and laterally. Ultrasonography showed a cystic mass in the superior orbital region. Computed tomography (CT) demonstrated a solid, well-defined lesion behind the globe displacing the optic nerve medially. A transfrontal craniotomy revealed a nodular mass in the posterior and superior orbit, which extended anteriorly up to the globe. Histopathology, immunohistochemistry, and transmission electron microscopy proved the tumor to be a myxoma.

Adult↗

PubMed1985

Radiotherapy of severe ophthalmic Graves' disease.

The effects of orbital irradiation on Ophthalmic Graves' Disease (OGD) were evaluated in 24 patients. All patients were irradiated after a median duration of eye symptoms of 12 months (range 3-36 months). Irradiation therapy was performed for loss of visual acuity, progressive diplopia and/or keratitis due to recent progression of eye symptoms. During a follow up period of 2-4.5 years, in 11 patients after irradiation, a mean decrease in proptosis oculi of 5.1 mm was found while 8 of these patients showed a mean increase in visual acuity of 0.26. Apparently, a decrease of activity of the inflammatory process in retrobulbar tissues can be achieved after irradiation, over a longer period of time in many patients. Furthermore concomitantly administered corticosteroids could be tapered off completely in all patients. Treatment of severe OGD of recent onset with irradiation, in combination with a short course of prednisone is very effective. This study also shows that prednisone treatment alone is not very successful because of the high recurrence rate of eye sings after decrease of the dose and the many side effects of the drug.

Adult↗

PubMed2000

Vertical and cyclotorsional deviations following peribulbar anesthesia.

BACKGROUND: Motility disorders may occur consecutive to peribulbar anesthesia. The underlying pathology is still debated. The aim of the study was to contribute to the discussion by a meticulous orthoptic examination of a series of patients. METHODS: In a series of 16 patients with diplopia after peribulbar anesthesia, measurements of the angle of squint in the nine directions of gaze, Bielschowsky's headtilt test and motility analysis were performed. The findings were discussed with regard to the possible types of muscular lesions. RESULTS: Hypotropia and deorsoadduction accompanied by relatively small cyclotropia were found in all cases. Bielschowsky's head-tilt test mostly revealed neutral findings. CONCLUSION: The findings were discussed under the hypothesis of a fibrotic muscular change in the superior oblique and inferior rectus muscle. This hypothesis turned out to be concordant with the orthoptic measurements, implying that treatment of the disorder should consist in low-dosage recession of the fibrotic muscles, which in our experience was rewarding.

Aged↗

PubMed2005

[Ocular tilt reaction. A rare complication after acoustic neuroma surgery].

Visual disturbances after acoustic neuroma surgery are very rare complications. We present a patient with diplopia after a middle fossa approach for resection of an acoustic neuroma. The patient presented ocular torsion and tilts of subjective visual vertical which is typical for the ocular tilt reaction. It is generally agreed that this reaction is secondary to a dysfunction of the tonic bilateral vestibular inputs that stabilize the eyes and head in a normal upright position in the roll plane. It has also been described after denervation of the utricle and injury of the brain stem.

Adult↗