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PubMed1979

Early identification of multiple sclerosis through ocularly manifested symptoms.

Eye care professionals can play an important role in the early detection of multiple sclerosis (MS) since the disease often has ocular manifestations such as optic neuritis. In conjunction with optic neuritis, symptoms such as ocular pain, acuity reduction, visual field loss, blurred or edematous discs, nystagmus, and diplopia may be present. Although MS still has no cure, early identification can aid in beginning the treatment of the symptoms.

Diplopia↗
PubMed1979

[Occlusion contact lenses (author's transl)].

A reliable inconspicuous occlusion therapy is achieved by fitting different, specially manufactured contact lenses. Based on a study of a number of cases, the author discusses the indications for a occlusion contact lens. These lenses provide a means for treating amblyopia in schoolchildren and adults, as well as for eliminating diplopia, photophobia and metamorphopsia.

Age Factors↗
PubMed1979

[Analysis and treatment of eye motility disorders following retinal detachment surgery].

Despite the most careful retinal detachment surgery saving the eye muscles and the fascial structures, an extraocular muscle imbalance may occur. This can be expected especially when for scleral buckling procedures large implants or exoplants were used, or had to be placed under a rectus muscle. In some cases, however, postoperative diplopia results from decompensation of preexisting heterophoria or congenital ocular motor imbalance. A clear-cut differential diagnosis to separate these entities is essential for therapeutic considerations.

Aged↗
PubMed1977

Cooperative study of hospital frequency and character of transient ischemic attacks. V. Symptom analysis.

All patients (1,328) suspected of having transient ischemic attacks (TIA) who came to six institutions during a 21-month period were identified. Symptoms and symptom complexes were related to the clinical diagnoses by cross-tabulation, factor analysis, and discriminant analysis. The diagnoses obtained by the discriminant analysis program were comparable to those of reviewing clinical neurologists. Symptoms of importance in the vertebral-basilar system (VBS) were bilateral visual blurring, diplopia, ataxia, and dizziness; In either carotid system (CAS), ipsilateral monocular visual disturbance anc contralateral weakness or sensory complaints; in the left CAS, language disturbances; and in those whose ultimate diagnosis was not TIA, loss of consciousness, confusion, and bilateral leg weakness. Patients with VBS TIAs have symptoms common to conditions that are not TIA and have a greater variety of symptoms and more combinations of symptoms than CAS TIA.

Aphasia↗
PubMed1977

[Ophthalmological long-term effects of malar fractures (author's transl)].

In the years 1964 to 1974 138 patients with malar fractures were treated by operation. After follow-up examination on an average of 3 years and 10 months after the operations the occuring complications in 61 patients were revealed. On the first stationary admission to hospital 14 patients complained of diplopia; on the follow-up examination only 5 paresiae were found. On the first examination after the accident 35 patients had hypoaesthesiae, anaesthesiae or paraesthesiae in the area of supply of the ophthalmic and maxillary nerves. It is remarkable that in the follow-up examination 29 patients complained still of these disturbances. Perforating injuries were not found in these patients. 2 patients had however traumatic macular foramina. 2 further patients had partial optic atrophy, a result of fracture in the region of the optic canal.

Accidents, Traffic↗
PubMed1981

Periodic alternating skew deviation.

A 78-year-old hypertensive woman suddenly developed blurred vision, followed shortly by dizziness, difficulty walking with a tendency to veer to the left, and vertical diplopia. Examination 3 weeks later revealed a unique neuro-ophthalmologic motility pattern, which may be described as periodic alternating skew deviation. This previously unreported motility disturbance was associated with downbeat nystagmus in our patient, and a focal lesion at the level of the interstitial nucleus of Cajal was demonstrated on computed tomography. The spectrum of physiologically related motility patterns--including periodic alternating nystagmus, cyclic oculomotor paralysis, see-saw nystagmus, periodic alternating gaze deviation, "ping-pong" gaze, and intermittent aperiodic alternating skew deviation--has been considered and is helpful in topical neuro-ophthalmologic diagnosis.

Aged↗
PubMed1983

Superior oblique myokymia. A misnomer.

Clinical examination of a 26-year-old, white man with episodic vertical diplopia and oscillopsia led to the diagnosis of "superior oblique myokymia." The dissimilarity between the observed superior oblique movements and myokymia as defined in other nervous system disorders is striking. Therefore, we suggest that superior oblique microtremor may be a better term to describe these superior oblique movements.

Adult↗
PubMed1982

Cryptococcal meningitis. An atypical presentation.

A previously healthy 23-year-old white female presented with a history of horizontal diplopia prior to any other symptoms. Physical examination revealed bilateral sixth cranial nerve palsies, papilledema, right Horner's syndrome, and right hemiparesis. Cryptococcus neoformans was isolated from the cerebrospinal fluid. This is the first documented case of Horner's syndrome associated with cryptococcal meningitis.

Abducens Nerve↗
PubMed1982

Ocular myasthenia presenting as superior oblique weakness.

We diagnosed ocular myasthenia in a 39-year-old man whose presenting symptom was vertical diplopia. Unrecognized weakness of the right superior oblique and secondary overaction of the right inferior oblique caused a right hypertropia, which was worse on left gaze. One week later left blepharoptosis, right medial rectus weakness, and bilateral obicularis oculi weakness were found on ocular examination. All findings were partially reversed by the injection of Tensilon. Superior oblique muscle palsy simulating a fourth cranial nerve palsy is infrequently reported in patients with ocular myasthenia. Pseudofourth nerve palsy is another sign of myasthenia gravis.

Adult↗
PubMed1980

Multiple myeloma with bilateral orbital infiltration and polyneuropathy.

Orbital involvement is a rare complication of myeloma usually presenting as unilateral proptosis without pain. A case is reported of a woman with bilateral orbital infiltration without proptosis, who became blind within three months of the onset diplopia. The blindness was due to visual field obstruction, with eyelids covering both corneas; the eyes themselves remained normal. This is the first case of orbital myeloma reported in Australia and only the second case of bilateral primary orbital infiltration with myelomatosis to be reported in the world literature.

Blindness↗
PubMed1983

Granular cell tumor of the orbit: a case report.

A 42-year-old woman had vertical diplopia secondary to a palpable mass located in the left inferior orbit. At surgery, the mass was adherent to the globe, encapsulated, and seemed to arise from the inferior rectus muscle. Frozen section diagnosis was granular cell tumor. The tumor was removed in toto. No recurrence was apparent six years after surgery.

Adult↗
PubMed1983

Ocular muscle paresis and cranial arteritis--an unusual case.

A 72-year-old woman had biopsy-proven cranial arteritis together with previously unreported findings of fluctuating mild ocular muscle paresis which had continued over the course of 4 1/3 years despite treatment with systemic corticosteroids. There was no optic nerve or central retinal artery involvement. This patient is unique in that muscle paresis is usually transient, lasting several days to a few weeks rather than 4 1/3 years. Response to steroids is usually prompt, and optic nerve or central retinal artery involvement is often associated. Therefore, we stress the importance of considering cranial arteritis in all patients over 55 years old who have transient or persistent diplopia, since immediate treatment may prevent optic nerve or central retinal artery involvement, which often follows within a few days.

Adrenal Cortex Hormones↗
PubMed1984

[Frontal osteoma with orbital extension. Apropos of a case].

Fronto ethmoidal osteoma are rare slow growth benign tumors. Exceptional ophthalmological and neurological complications can occur. The authors report a case of 32 years old man with eye compression by a giant frontal sinus osteoma. This lesion was responsible for a vertical diplopia and moderate proptosis. Plain skull X-Ray show a well defined opacity filling the whole left frontal sinus and C.T. scan delimited precisely orbital extension. Neurosurgical exposure enabled a complete extraction of the tumor and satisfying recovery. The authors have compared this case to those described in literature and insist on the importance of the pre-operative C.T. scan.

Adult↗
PubMed1978

Late complications vs. method of treatment in a large series of mid-facial fractures.

The late presence of contour defects, as well as one eye being lower than the other, were directly related to a lack of interosseous wire fixation in this series of mid-facial fractures. In orbital floor fractures, the use of alloplastic material was found to give more satisfactory long-term results than bone grafts. The direct approach through the lower lid produced no complications of its own in this series. Associated injuries and preexisting disease were found in 61 percent of these patients, supporting the thesis that an M.D. should direct their care. The late presence of diplopia and/or enophthalmos was directly related to an underestimation and undertreatment of orbital floor fractures, or to treatment with bone grafts. The use of a shoulder strap, in conjunction with the lap belt, seems to almost completely prevent the occurrence of mid-facial fractures in automobile accidents.

Accidents, Traffic↗
PubMed1983

Blow-out fractures.

Twenty-one cases of blow-out fractures were treated at Osaka University Hospital between June 1979 and February 1982. 52% of the patients were teenagers. The most important cause of a blow-out fracture was a fist-fight (48%). Most of the patients had diplopia caused by the disturbance of the eyeball movement, mainly in the upward or downward rotations. 19 of 21 patients were surgically treated. The prognosis was much more related to the severity of the fracture than the period between the injury and the surgical treatment.

Adolescent↗
PubMed1984

Divergence excess: characteristics and results of treatment with orthoptics.

This paper retrospectively examines the results of the treatment of 18 subjects (11 males, seven females) with divergence excess, using orthoptics. The mean age of the subjects was 15.8 years, which was significantly younger than the population from which this group was referred. Diplopia (89%) and asthenopia (56%) were the most frequently reported symptoms. Seventy-two per cent of the subjects had intermittent deviations of the eyes. Over the mean necessary course of treatment of 5.2 weeks, the distance angle of deviation (slightly) and the positive vergences at distance and near were found to have changed significantly. The near angle of deviation, the negative vergences, the near point of convergence, the amplitude of accommodation, and the threshold of stereopsis were found to have remained stable over the treatment period. Further results of the study are presented and the implications of these results with regard to the treatment of divergence excess are briefly discussed.

Adolescent↗
PubMed1984

Orbital pseudotumor in Crohn's colitis.

A 17-year-old woman presented with orbital pain, diplopia, ptosis, and upper lid swelling due to an orbital pseudotumor involving the superior rectus-levator complex. Although she had no prior symptoms of chronic inflammatory bowel disease, diagnostic evaluation revealed Crohn's colitis. Diagnostic evaluation of patients with "idiopathic" orbital pseudotumor should include testing to rule out chronic inflammatory bowel disease.

Adolescent↗