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Demonstration of monitoring of pathological eye movements by standardized Video Documentation. The Patient is positioned in front of a circle (diameter 80 degrees or 60 degrees) with individual fixation bulbs in the secondary and tertiary gaze directions. Tapes and immediately printable freeze-pictures make precise follow-ups and therapy control possible.
Ocular muscle disturbances (strabismus) are common disorders affecting two to four per cent of the population. Until recently, CT and MRI have not been used extensively in the diagnosis of congenital and acquired conditions causing strabismus. In this article the value of these scanning techniques in terms of more appropriate therapeutic intervention and further insight into the pathophysiology of these conditions is detailed.
Disorders of ocular motility usually present with double vision which may be accompanied by ptosis and pupillary changes. The differential diagnosis comprises supranuclear, nuclear and infranuclear palsies and diseases of the myoneural junction. Accurate assessment is important, since the aetiological possibilities include neurosurgical emergencies such as intracranial aneurysm and systemic problems such as diabetes mellitus.
OBJECTIVE: Our aim was to evaluate a novel means of assessing ocular motility disorders using MRI. MATERIALS AND METHODS: A GE image of the orbit was acquired in a set plane each time the patient fixed on a series of points spread across the field of view. The images were transferred in sequence to a video recorder to create a cineloop of ocular movement. The technique was used in 33 patients with a range of ocular motility disorders including thyroid eye disease, posttraumatic diplopia, and Duane syndrome. RESULTS: In addition to anatomical detail, functional information could be derived from motion of the globe, motion of the optic nerve, and contractility of individual muscles. This is of particular use to the ophthalmic surgeon in disorders of ocular motility following eye surgery. CONCLUSION: A method of recording eye movements using MRI is described that offers useful functional information in the evaluation of disorders of ocular motility.
Patients with supranuclear and internuclear ocular motility disorders may have nystagmus and oscillopsia, or need to adopt an abnormal head posture to either fixate or maintain binocularity. Many have a cosmetically unsatisfactory appearance. In addition, because of lesions involving ocular motor nuclei or nerve fascicles, double vision is also a common problem. The usual management of these patients is symptomatic with occlusion or prisms. We report on 11 patients who underwent extraocular muscle surgery with the aim of reducing symptoms and restoring or improving binocular single vision. Three patients had bilateral internuclear ophthalmoplegia with exotropia, 3 had dorsal midbrain syndrome, 2 had residual upgaze palsies after cerebral vascular accidents, 2 had oculopalatal myoclonus and one skew deviation. After surgery, symptoms, visual function and cosmesis improved in nearly all patients. We recommend that surgery should be considered more readily in the rehabilitation of these patients.
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One hundred normal Caucasian eyes and 29 eyes with restrictive disorders of ocular motility were studied in order to delineate intraocular pressure changes in secondary positions of gaze. Applanation tonometry was performed in the primary position and at an angle of 22 degrees. In patients with restrictive syndromes the changes of intraocular pressure in the secondary positions of gaze were significantly higher (p less than 0.0001) than in normal subjects. The range of variation in normal subjects was 0, +3 mmHg for supraduction and -3, +1 mmHg for abduction. Patients with restrictive syndromes showed changes between +1 and +15 mmHg for supraduction and between +3 and +10 mmHg for abduction. Results obtained in the two groups showed the existence of false negatives. This test is thus a practical and useful diagnostic tool, but its results must be evaluated cautiously.
Sinus surgery has multiple potential ocular complications including visual loss, diplopia, infection, hemorrhage, and epiphora. We report six patients with ocular motility problems secondary to sinus surgery, review the literature on ocular motility disorders secondary to sinus surgery, and propose an approach for management of those ocular motility problems following sinus surgery. Intranasal sinus surgery was found to be the most common procedure resulting in injury to an extraocular muscle and the ethmoid sinus the most common structure being operated on when injury occurred. The medial rectus was the muscle most commonly injured and it had the poorest prognosis for recovery of functional vision free of diplopia. Optimal timing for repair depends on the structure injured, but early recognition and management appear to be a key to the best outcome for these injuries.
Ocular motility, refraction and visual acuity (VA) were evaluated at the age of 4 years in 136 preterm infants with gestational ages (GAs) at birth of less than 32 weeks. Group 1 (non-retinopathy of prematurity, ROP) included 87 children that had never developed ROP. Group 2 contained 19 children whose ROP had regressed spontaneously. Group 3 (cryo-ROP) was composed of 30 patients who had undergone cryotherapy for severe ROP. Strabismus was found in 13.9% of the total population. chi(2) analysis revealed that strabismus was significantly (p < 0.01) associated with prematurity (i.e. GA <29 weeks), ROP and cryotherapy. Myopia of more than 3 dpt was significantly (p < 0.001) more common in the cryo-ROP infants than in the regressed-ROP and non-ROP groups. The distribution of hypermetropia was similar in all three groups. VA was measured with the E chart. Of the 272 eyes examined, 251 (92.3%) displayed VA of more than 20/25. The majority of these eyes were from the non-ROP group (65.4%), 15.3% had regressed ROP and 21.1% belonged to the cryo-ROP group. Fifteen eyes (8 non-ROP, 3 regressed ROP and 4 cryo-ROP) presented VAs between 20/25 and 20/60. VA of less then 20/60 was found in 6 eyes (2 non-ROP, 1 regressed ROP, 3 cryo-ROP). Cryotherapy did not appear to preclude the development of good VA.
A 24-year-old woman with multiple sclerosis had frequent episodes of an ocular motility disorder and a crossed corticospinal tract deficit. This symptom complex illustrates a distinctive form of paroxysmal disorder in multiple sclerosis.
Thirty eight extraocular muscle biopsies obtained from thirty patients (1 normal and 29 affected with various kinds of ocular motility disorders such as strabismus, Duane's syndrome, paralysis), were studied by electron microscopy. Except for the control biopsy considered as normal, they showed: atrophy, disorganization of myofilaments, double Z-disks, rods, curving arrays of myofibrils, concentrically disposed electron-dense sarcotubules, clusters of mitochondria with numerous modifications of their cristae, and subsarcolemmal inclusions, such as dense bodies, laminated bodies, lipofuscin granules and lipid droplets. In addition, subsarcolemmal granulo-fibrillar aggregates, characterized by periodic granulated foci spaced at about 120 nm intervals, were seen in all the biopsies, even in that of the control case. The authors stress the pecularity of the granulo-fibrillar aggregates which, up to now, have never been described in skeletal muscles and the function of which in the extraocular muscles fibers is impossible to define. They point out the difficulty in determining if the motility disturbances may be related to the various changes observed in extraocular muscles of squinting eyes.
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Explore the source record for details and available documents.
Knowledge of the occurrence of visual and ocular problems in children is important when eye health care systems are designed. We have studied the prevalence of ocular changes in all children born prematurely during 1976-1981 in Stockholm county and compared the findings with those obtained in a random sample of full-term children from the same period and area.
We describe a case of neurologic manifestations including coma, convulsion and eye movement disorders, associated with hypomagnesemia and hypocalcemia in a patient treated with cisplatin for an ovarian adenocarcinoma. Pathophysiological mechanisms involve renal tubular damage leading to renal magnesium wasting and related hypocalcemia.
High temporal and spatial resolution has recently been achieved by rapid magnetic resonance imaging techniques. This offers the opportunity to perform dynamic magnetic resonance imaging in addition to topographic imaging and tissue analysis. Using sequences obtained by turbo-fast low-angle shot imaging we have reduced temporal resolution to 1 s per image.