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At least 145 records · Page 8Linked to original sources
PubMed2003

Torsional diplopia in Graves' orbitopathy. Three case reports.

Torsional diplopia may frequently accompany Graves' orbitopathy and is often not recognized. Some patients with manifest cyclotorsion do not complain of torsional diplopia because it is concealed by the large vertical and/or horizontal deviation. Torsional diplopia can occur spontaneously or appear after decompression or strabismus surgery. We discuss some interesting points arising from three cases. This will be followed by a discussion of the literature on the pathogenesis of cyclodeviation in Graves' orbitopathy.

Aged↗
PubMedDate not supplied

Allergic fungal sinusitis presenting with proptosis and diplopia: a review of ophthalmologic complications and treatment.

Allergic fungal sinusitis is a noninvasive, but vigorous, inflammatory response to mold that occurs in immunocompetent patients with chronic sinusitis and nasal polyposis. It typically occurs in patients who have a history of atopic disease. Occasionally, the patients with allergic fungal sinusitis present with ophthalmic signs and symptoms--most commonly proptosis and diplopia. We report the case of a 23-year-old man with right-sided proptosis, diplopia, and nasal obstruction. He had a history of sinusitis in the past. On presentation, sinus computed tomography scan showed pansinusitis. Subsequent workup revealed elevated immunoglobulin E and positive skin testing to several molds including Bipolaris spicifera and Aspergillus fumigatus. Functional endoscopic sinus surgery was performed, and the surgical specimen revealed allergic mucin with eosinophils, Charcot-Leyden crystals, and a silver stain showing fungal elements. His symptoms, including proptosis and diplopia, improved after surgical debulking and use of systemic corticosteroids.

Adult↗
PubMed2005

[Botulinum toxin injection to the lateral rectus for the treatment of intractable diplopia].

The aim of the study is to evaluate the use of botuline A (BTXA) as a form of treatment for squinting patients with onerous diplopia. Two patients with exotropia and one patient with esotropia had injections of BTX A to the lateral rectus muscles of the affected side. The number of injections ranged from 1 to 2. Two patients went on to have surgery. All patients in our study found that BTX A improved their symptoms of diplopia. We conclude that BTX A has an important role in the treatment of squinting patients with burdensome diplopia.

Adolescent↗
PubMed1982

Diplopia in autoimmune thyroid disease.

Diplopia without obvious exophthalmos, caused by infiltrative endocrine ophthalmopathy, developed in 12 patients with clinical and laboratory confirmation of autoimmune thyroid disease. In eight patients, the diplopia alone prompted medical attention, which led to the diagnosis of autoimmune thyroid disease. A hypotropia secondary to restrictive tightening of the inferior rectus muscle, producing vertical diplopia, was the most common manifestation of the disorder. The ocular muscle imbalance in autoimmune thyroid disease is caused by mechanical orbital restriction of the extraocular muscle, not by an innervational defect. Evidence of orbital restriction of the eye muscles can establish the diagnosis, regardless of the patient's thyroid function.

Adult↗
PubMed1982

Familial intermittent diplopia: a report of two cases.

The presence of sufficient muscle balance and bifovial fixation to prevent a break in fusion resulting in diplopia, even under conditions of hypoxia, fatigue, stress, and peripheral gaze, has been of concern in aviation medicine since 1917. Considerable resources are still expended obtaining, reporting, and storing test results, using procedures that undoubtedly exceed the skills of many examiners, when denials are rare, few inflight breaks in fusion have ever been reported, and most known cases of diplopia are from the history. We have recently examined a 54-yr-old employee with a 5-yr history of several daily episodes of incapacitating diplopia, and we have information about his 48-yr-old brother who has a similar history. When asymptomatic, both have normal vision test results. Detection was from the histories; the diagnosis remains uncertain. The ease of concealment, rare test value, and prevalent examiner skills are of concern. The importance of the history is reaffirmed.

Diplopia↗
PubMed1995

The relationship between duration of superior oblique palsy and vertical fusional vergence, cyclodeviation, and diplopia.

BACKGROUND: The purpose of this study was to explore the relationship between the duration of superior oblique palsy (SOP) and relevant clinical findings. METHODS: We studied 39 patients with SOP and 14 patients with normal binocular vision (NBV). Vertical fusional vergences and cyclodeviations were measured through the habitual prescription. Each patient was asked if he or she currently experienced diplopia. To establish duration of SOP, those patients were asked and grouped according to whether they were diagnosed within the past 5 years, within the past 6 to 15 years, or more than 15 years ago. RESULTS: The SOP patients were significantly different from the NBV patients on every measure except the infra recovery value. Among the SOP patients, the infra break value and the total break amplitude (infra plus supra) were the measures that were significantly different for the three SOP groups, increasing with the duration of the deviation. Since the infra break value was measured relative to any corrective prism in place, the total break amplitude proved to be the best distinguishing feature of duration of the SOP. There was no monotonic relation between the duration and the magnitude of the cyclodeviation. Likewise, there was no significant difference among the SOP groups in the frequency of reported diplopia even though there was a monotonic decrease in the percentage of diplopic patients with increasing duration of SOP. CONCLUSIONS: While an increased vergence amplitude and the presence of both diplopia and excyclodeviation distinguish patients with SOP from those with NBV, the total break amplitude is the only significant distinguishing feature of the duration of SOP.

Adolescent↗
PubMedDate not supplied

Diplopia: the role of the ophthalmic medical assistant.

1. One of the roles of the Ophthalmic Medical Assistant (OMA) is to provide the physician with as much clinical information as possible to assist in the diagnosis and management of patients whose chief complaint is "double vision". 2. Because diplopia can be associated with a variety of medical causes, it is important to obtain a very detailed medical, neurologic, and ocular history, along with examination of ocular motor function. 3. The OMA plays an important role in the evaluation of diplopia. The evaluation of diplopia can be complex, but, with proper assessment of the patient, most causes can be identified in the office.

Cranial Nerve Diseases↗
PubMed1997

Bilateral monocular diplopia associated with lid position during near work.

PURPOSE: To describe a common pattern of topographic changes and clinical signs of six patients presenting with a complaint of monocular diplopia after reading and to investigate the cause of this topographic disturbance. METHODS PATIENT POPULATION: Subject group of six patients with monocular diplopia complaints after reading and 20 patients without such complaints. Examinations performed before and after a reading period of 30 min: videokeratoscopic examination, red reflex examination, position of the lids in primary gaze and in reading position. DATA ANALYSIS: inspection of keratoscopic rings, qualitative analysis of topography maps, comparison of SAI and SRI of control and subject groups before and after reading, comparison of lid position of control and subject group. RESULTS: Half of the subject group and none of the control group developed subtle ring distortions of keratoscopic rings. SAI and SRI values increased significantly in the subject group compared with the control group (p = 0.02 and p < 0.001, respectively) corresponding to the development of a focal distortion in the entrance pupil of the videokeratoscopic image. Each subject developed a horizontal band on red reflex located at the superior, middle, or inferior aspect of the pupil after near work. Two controls developed faint bands in the red reflex outside the entrance pupil. The interpalpebral fissure in down gaze was narrower in the subject group compared with the control group (p = 0.001). CONCLUSIONS: Some individuals may develop monocular diplopia after reading. We hypothesize that during near work these corneal topographic alterations occur primarily related to the position of the lids and tear film interaction with the corneal surface.

Adult↗
PubMed1998

[A case of renal cell carcinoma with metastasis in clivus presenting as diplopia].

We report a rare case of renal cell carcinoma presenting as diplopia which was caused by a metastasis to the clivus. A 58-year-old man was admitted to our hospital with the chief complaint of diplopia. Head magnetic resonance imaging showed a mass in the clivus accompanied by bone destruction. Metastatic tumor to the skull base was suspected. Further examinations for the primary lesion revealed left renal cell carcinoma. He was relieved of diplopia by radiotherapy to the clivus and subsequently underwent left radical nephrectomy.

Carcinoma, Renal Cell↗
PubMed1985

Postoperative diplopia and ptosis. A clinical hypothesis based on the myotoxicity of local anesthetics.

Postoperative diplopia and ptosis can be temporary or permanent complications in patients who have undergone ophthalmic surgery while under local anesthesia. We encountered six patients with such complications and hypothesize that some cases of postoperative diplopia and ptosis could be attributed to myotoxic effects of local anesthetics. These effects may cause the degeneration and subsequent regeneration of muscle fibers of the levator or extraocular muscles and result in temporary or permanent muscle weakness.

Aged↗
PubMed1976

An orbital roof fracture causing diplopia.

Fractures of the orbital floor are frequently accompanied by diplopia. There are other bony injuries that may produce similar symptoms; however, these are rare. We will describe a case in which a fracture of the roof of the orbit, essentially involving the anterior cranial fossa, produced entrapment with diplopia. A six-month follow-up demonstrated excellent surgical and functional results.

Accidents, Traffic↗
PubMed1996

Squints and diplopia seen after brain damage.

The aim of this study was to investigate the incidence of squint after brain damage. We performed an observational study on 239 consecutive patients admitted to a specialist neurological rehabilitation unit: 129 with stroke, 84 with head injury and 26 with other conditions. Standard orthoptic measures, including visual acuity, cover test, eye movement recording and tests of binocular function were performed. Of all the patients, 89 (37%), were found to have squints, but only 32 of these (36%) experienced double vision. Brain stem lesions causing peripheral ocular motor impairment were found in a high proportion of patients after head injury (56%). Squints were found in 27 of 95 (28%) patients with cortical strokes, many with no other signs of brain stem involvement. Left was just as likely as right hemisphere damage to be associated with squint, but right-sided lesions seemed to protect against diplopia. We conclude that squint is common after brain damage, even if the brain stem is not obviously affected, but only a minority of these patients with acquired squint suffer diplopia.

Brain Damage, Chronic↗
PubMed1988

Intractable diplopia: a clinical perspective.

Eight patients with intractable diplopia are presented. A classification of intractable diplopia is proposed, as well as a possible unifying view of its pathogenesis. Currently available treatment modalities are reviewed.

Adolescent↗
PubMed1989

Intractable diplopia after vision restoration in unilateral cataract.

Twenty-four patients lost their ability to fuse when their binocular function was disrupted for at least 2 1/2 years by a unilateral traumatic cataract or a unilateral traumatic cataract followed by uncorrected aphakia. Three patients were 6 years old, one was 8 years old, and the remaining 20 patients were aged 10 years or older at the time of the injury. All patients had intractable diplopia when the cataract was removed and the aphakia corrected. Aniseikonia was not the cause of this inability to fuse and the insertion of an intraocular lens provided no relief. The prognosis for the elimination of diplopia, other than by occlusion of one eye, was poor.

Adolescent↗
PubMed1993

Diplopia caused by orbital floor blowout fracture.

Diplopia caused by orbital floor blowout fractures is one of the major complications of orbital injuries. The records of 48 patients who had incurred orbital injuries were reviewed; 23 had a history of a pure orbital blowout fracture. Surgery was indicated when the vertical movement of the eye was impaired, and it was performed after complete resolution of orbital hemorrhage and edema. The maximal time before the first surgical procedure was 14 days. Two patients required a second procedure because of persistent diplopia and enophthalmos.

Adolescent↗
PubMedDate not supplied

Monocular diplopia.

Monocular diplopia may be of external, optical, neurological, neuromuscular, or psychogenic origin. It may develop spontaneously or it may be induced by surgery or trauma. Because treatment is usually directed toward the cause, determination of the etiology is important. Useful diagnostic techniques are described, as are treatment modalities for monocular diplopia of various origins.

Astigmatism↗
PubMed1991

An unusual cause of diplopia in a cancer patient.

A 47-year-old woman with metastatic infiltrating lobular carcinoma of the breast developed diplopia. Computed tomography of the orbits showed enlargement and irregularity of the right inferior rectus and inferior obliques muscles. Biopsies of these muscles contained breast carcinoma cells. This case report discusses the causes of diplopia in cancer patients, with special attention to the diagnostic problems of metastasis in extraocular muscles. The possible combined occurrence of metastasis in the leptomeninges and extraocular muscles is also to be borne in mind if the latter diagnosis is not to be missed.

Breast Neoplasms↗
PubMed2006

Resolution of diplopia after repair of the deep orbit.

The degree of resolution of diplopia after repair of a blow-out fracture of the orbital floor varies and depends on many factors. We present six patients, each of whom had extensive fractures of the floor of the orbit that extended posteriorly to its anatomical limit. The mean (range) time for the resolution of diplopia after reconstruction was 4.4 (1-7) months. We think that its slow resolution in these patients may require preoperative counselling, and also the postoperative management of patients with extensive disruptions of the floor of the orbit posterior to the anterior limit of the inferior orbital fissure (within the deep orbit) must be carefully planned.

Adult↗