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Binocular vertical diplopia.

The assessment of a patient with binocular vertical diplopia begins with a thorough history and neuro-ophthalmologic examination. The neuro-ophthalmologic examination includes observation for a compensatory head, face, or chin position; ocular ductions and versions in the nine cardinal positions of gaze; the three-step test; the double Maddox rod test; indirect ophthalmoscopy to observe the location of the fovea in relationship to the optic nerve head to determine cyclodeviation; and the forced ductions test. Binocular vertical diplopia may be due to supranuclear processes, ocular motor nerve dysfunction, neuromuscular junction disease, diseases of eye muscle, mechanical processes causing vertical eye misalignment, and even retinal disease. In this article, the differential diagnosis of these processes is outlined.

Diplopia↗

Ocular complications and visual outcome in juvenile chronic arthritis: a 25-year follow-up study.

OBJECTIVE: Assessment of longterm ophthalmic outcome in juvenile chronic arthritis (JCA) with emphasis on visual acuity and identification of disease-related parameters associated with rheumatic eye affection. MATERIAL: Sixty-five adults (52 females, 13 males) with a history of or still active JCA were assessed an average of 26.7 years after disease onset. METHODS: Cross-sectional, longterm, follow-up study including complete ophthalmological and rheumatological examinations. RESULTS: Evidence of ocular complications was found in 13 subjects (20%): 10 had had recurrent iritis, two band keratopathy, and one diplopia due to rheumatoid eye muscle involvement. The three single eyes with poor sight (<0.1) were all in the complication subgroup. Binocularly, all but one patient scored at least 6/9 as best corrected visual acuity; one, however, had severe glaucoma-impaired visual fields. The refractive range was -8.12 to +6.0 D. There were no cases of keratoconjunctivitis sicca. Iritis was associated with early disease onset (p = 0.02), longer disease duration (p = 0.02) and a positive antinuclear antibodies (ANA) (p = 0.02). CONCLUSION: Ophthalmic complications were recorded in 20% of the study group, primarily in ANA positive patients with pauciarticular onset JCA. In addition to the two patients with severely affected bilateral visual status (3%), one of the 65 patients had acquired unilateral blindness. Half of the complications were late in that they were first recorded after the age of 16 years. Otherwise, the findings were in keeping with other studies of visual prognosis using non-selected series.

Adult↗

The roles of target and eye motion in the production of the visual shift in prism adaptation.

Two experiments, with a total of 48 Ss, were performed to evaluate the possible determinants of the visual shift (VS) in prism adaptation. In Experiment 1 the effects of target movement and pursuit eye movements on resultant visual adaptation were investigated. Maximal VS was produced when both of these conditions were present. Experiment 2 was conducted to determine whether hypnotic anesthesia in and around the eyes and eye muscles reduces feedback from eye-position sensations and, consequently, the magnitude of the VS. This manipulation proved to be successful and virtually eliminated the production of VS. The results of the two experiments helped to identify two factors that contribute to the production of the VS: the presence of visual target movement during prism exposure and the accompanying eye movement which produces a change in the felt position of the eyes during target tracking.

Adaptation, Ocular↗

Tonic vestibular control of eye position in postnatal developing rabbits.

With head and body fixed, 22 rabbits aged between 1st and 54th postnatal day were rotated step by step in 47 experiments over 360 degrees around their transverse and their longitudinal body axis, and in some cases around the horizontally placed dorsoventral body axis, too. The position of one eye, marked by burning a cornea stamp, was photographed after each rotation step. The observed eye positions in different tilt positions are always a consequence of combined horizontal, vertical and rolling eye movements, though compensatory counterrolling and compensatory vertical deviations of the eye predominated. During postnatal development in the rabbit, typical eye movement patterns as a course of eye positions during step by step 360 degrees rotation were formed until the second month of life. By reason of the polarization directions of their sensory cells, utricular maculae are obviously able to generate an innervation pattern for the tonic eye muscle contractions causing the observed eye movements.

Age Factors↗

[Chronic myasthenia gravis mimicking muscular dystrophy, in eastern Colombia].

INTRODUCTION. Myasthenia gravis is an apparently well-defined neuromuscular disease with some variants, including one recently described as chronic myasthenia gravis. CASE REPORT. We present a 22 year old Columbian woman who complained of progressive weakness for the previous four years, affecting her pelvic and shoulder girdles but with no clinical involvement of the extra-ocular muscles. Repetitive stimulation of the neuro-muscular junction of the abductor digiti quinti muscle was negative, but positive for myasthenia gravis in the trapezius muscle and the right orbital eye muscles. Her symptoms improved and the clinical neurophysiological studies were normal again after treatment with pyridostigimine, which confirmed the diagnosis.

Adult↗

[Regulation of metabolic activity of intracerebellar nuclei].

The metabolic activity of the intracerebellar nuclei was studied in the cat, using the radioautographic method of marking active brain structures with 14C-2-deoxyglucose. Electrical stimulation of afferent fibers in the muscle nerve of an extrinsic eye muscle was used to activate mossy and climbing cerebellar afferents. A heavy bilateral labelling of the posterior parts of the fastigial nuclei was consistently obtained compared to controls. This result could no longer be obtained after ablation or inactivation of the cerebellar cortex overlying this part of the fastigial nuclei.

Afferent Pathways↗

[Ophthalmomimics. Polygraphic EMG study on oculo-facial simultaneous movements and functions of the autochthonous ear muscles].

Ophthalmomimic is the interaction between the extraocular eye muscles and the mimic muscles. Beside their original phylogenetic assisting function in looking and hearing, the ophthalmomimic muscles now serve in psychological communication: The play with the white of the eye ball can be interpreted as devotion ("to turn a blind eye to"); attention ("to be all eyes"); caution ("to have small eyes and to prick up one's ears"). Further on are examined function and innervation of the involuntary M. retro-auricularis (M. transversus auriculae) of the external ear, so far neglected. Practical diagnostic use could be shown, among others, in early ocular forms of myasthenic syndromes and by the help of the oculoauricular phenomenon for the differentiation between nuclear and peripheral-distal pareses of the abducens nerve.

Abducens Nerve↗

Congenital muscular dystrophy with eye and brain malformations in six Dutch patients.

From four Dutch families six patients, who have congenital muscular dystrophy, involvement of the central nervous system and of the eyes, or the so-called "muscle, eye and brain disease" (MEB-D), are reported. Two patients are still alive, in four autopsy could be performed. The clinical and morphological data of our patients are compared to those described in recent literature. The progression of the disease was rapid in five of our six patients. Our study supports the idea that within the MEB-D syndrome there are at least two different types of clinical expression, one with a rapid progression as described by Dobyns et al 1989 (9) and one with a slower progression as described in most patients of Santavuori et al 1989 (23). The study also confirms the autosomal recessive mode of inheritance of MEB-D.

Brain↗

[Facts for the muscle-reflex-hypothesis of squint. (The importance of asymmetry in the structure of the eyes for the pathogenesis of concomitant squint) (author's transl)].

Concomitant squint is regarded as result of a congenital dissymmetry in the structure of the eyes or of the oculomotor apparatus and of an insufficiency of the optomotor reflexes. Squint develops, when 1. the anomalies of the structure of the eye-muscles or of their insertions are so considerable that binocular vision cannot be maintained by fusional and convergence-reflexes; 2. the optomotor reflexes are too weak in order to compensate functionally even insignificant structural deviations of the extraocular muscles or 3. the optomotor reflex-mechanisms are disturbed to such a degree that binocular cooperation becomes impossible although the anatomical conditions are normal. Children with the symptoms of "potential squint" (ametropia, heterophoria, pseudo-ectopia of the macula) need special ophthalmological care. Using prisms early and operating in time one can stop the monocular vision becoming established.

Accommodation, Ocular↗

Redefinition of dystrophin isoform distribution in mouse tissue by RT-PCR implies role in nonmuscle manifestations of duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is caused by a defect in a 427-kDa membrane-associated protein: dystrophin. The DMD gene also encodes several shorter isoforms which are believed to participate in nonmuscle manifestations of DMD, including abnormal retinal electrophysiology, dilated cardiomyopathy, mental retardation, and hearing defects. The purpose of this work was to determine the normal tissue expression of full-length dystrophin (Dp427) and the dystrophin isoforms Dp260, Dp140, Dp116, and Dp71, to aid in understanding what roles these isoforms might play in DMD nonmuscle manifestations. RT-PCR was performed on mRNA isolated from wild-type C57BL/6J mouse tissues, including brain, cardiac muscle, eye, intestine, kidney, liver, lung, skeletal muscle, spleen, stomach, testis, thymus, and uterus. RT-PCR amplification demonstrated that the isoforms were in a number of tissues which had not been revealed by previous Western and Northern blot analyses. Dp427 was expressed at equal levels in all tissues. Dp260 and Dp140 were present in all tissues tested, but the levels of expression varied. Dp116 was expressed in a subset of tissues and levels of expression varied. Dp71 was constitutively expressed in all tissues, suggesting that this isoform plays a basic role in normal tissue function. The expanded tissue distribution supports the hypothesis that dystrophin isoforms serve essential and unique functions, necessitating further investigation into their potential roles in DMD nonmuscle manifestations.

Actins↗

A brain-warming function for REM sleep.

During REM sleep, arterial blood flow, neuronal firing rates, metabolism, and temperature increase in many parts of the CNS. Eye muscle tone also increases, and the eyes exhibit bursts of rapid movements. If one of the functions of sleep is to conserve energy, then it is curious that energy is so conspicuously expended in the vicinity of the CNS during REM sleep. The author hypothesizes that homeotherms use REM sleep to produce heat in order to maintain a high, stable temperature in a restricted CNS core during sleep. The fact that several of the active features of REM sleep heat the CNS, and the fact that REM sleep propensity increases when core temperature physiologically decreases, seem consistent with the hypothesis that REM sleep is a regulated mechanism for warming the CNS.

Animals↗

Gating of retinal transmission by afferent eye position and movement signals.

Vision in most vertebrates is an active process that requires the brain to combine retinal signals with information about eye movement. Eye movement information may feed forward from the motor control areas of the brain or feed back from the extrinsic eye muscles. Feedback signals elicited by passive eye movement selectively gate retinal outflow at the first relay, the dorsal lateral geniculate nucleus. The gating predominantly facilitates retinogeniculate transmission immediately after eye movement and inhibits transmission when a new steady-state eye position is achieved. These two gating effects are distributed in a complementary fashion across the dorsal lateral geniculate nucleus such that the spatiotemporal activity profile could contribute to object detection and localization.

Action Potentials↗

[Tendency of the brain to sharp images and geometry of visual illusions].

Usually, to shift the gaze, our will is needed, which the brain realizes by giving an order to the corresponding eye muscles. However, under some conditions, the eye movement and the shift of the gaze to perspective can be accomplished by non-forced methods, without any active interference of our consciousness.

Brain↗

[The theory of floating eye model].

Analytical construction of the eye floating was carried out. Buoyancy equations were deduced including the equation for dynamic equilibrium at various eye (head) orientations in space. Design formulae were derived for evaluating buoyancy force on the eye, negative pressure, stability and compensational (heeling) forces of the eye muscles.

Eye↗

Changes of visual localization induced by eye and neck muscle vibration in normal and strabismic subjects.

BACKGROUND: It has been reported that vibratory activation of eye- and neck-muscle proprioception can induce eye position changes in normal and strabismic subjects. This study investigated the effects of proprioception in the eye and neck muscles on space localization. METHOD: Vibration was applied to either the eye or neck muscle in normal subjects, intermittent exotropes, and constant exotropes/esotropes. The subjects pointed at the immediately remembered position of an extinguished visual target with the hand both before and immediately after vibration of the muscles under binocular and monocular viewing conditions. The hand-pointing performance in darkness was recorded by an infrared camera, and the pointing shifts were analyzed qualitatively and quantitatively. RESULTS: With vibration of the vertically moving muscles of the eye and neck, the direction of the pointing shifts was the same in all groups of the subjects and under all viewing conditions. With vibration of the horizontally moving muscles of the eye and neck, the directions were the same in the normals and in most of the intermittent exotropes. However, in the constant exotropes and esotropes, the directional shifts were dependent on which eye was vibrated, and the directions were more variable, always directed only to one side. CONCLUSION: Proprioception in the eye and neck muscles participates in visual space localization, but the effects of proprioceptive activation were differed in normal subjects from those in patients having constant strabismus. The differences may be related to the level of binocular function.

Adaptation, Ocular↗

The lactate dehydrogenase isoenzyme pattern in the overacting inferior oblique muscle.

The lactate dehydrogenase (LDH) isoenzyme pattern in normal eye muscles of fetuses, children, and adults in overacting inferior oblique muscles of children was studied and compared. No significant differences were found between LDH isoenzyme activity in the horizontal and vertical recti. Isoenzyme fractions, by percentage, were distributed in these muscles in the order of III greater than IV greater than II greater than V greater than I. A significant difference, however, was noted between the LDH isoenzyme patterns of the inferior oblique muscle in normal adults and children. The percentages were in the orders of III greater than II greater than IV greater than V greater than I, and III greater than IV greater than II greater than V greater than I, respectively. The isoenzyme pattern in the overacting inferior oblique muscles of children was in the order of III greather than II greater than IV greater than V greater than I, identical to that of the adult control group. In addition, the overacting inferior oblique muscle of the children contained more H than M subunit than did the rectus muscle or the normal inferior oblique muscle of children by comparison.

Adult↗

Congenital muscular dystrophy.

We report the cases of 18 patients with congenital muscular dystrophy, six of whom also have involvement of the central nervous system, corresponding to the Fukuyama type of congenital muscular dystrophy. In four patients, both the central nervous system and the eyes are involved, and the diagnosis of "muscle, eye and brain disease" was made. A comparative study of these patients with those whose cases were recently reported indicates that there is a wide variability of clinical and laboratory expression of the dystrophy, but a constant feature in all patients is a progression of motor disability. The association of congenital muscular dystrophy with brain abnormalities indicates a poor clinical prognosis. At present it remains an open question whether the three variants of the disease are separate diseases or only different expressions of the same syndrome, but our study tends to support the latter hypothesis.

Brain↗

Site-dependent effects of experimental hypo- and hyperthyroidism on resident macrophages in extraocular muscles of rats: a quantitative immunohistochemical study.

It has been suggested that the effects of dysthyroidism on resident immunocompetent cells of the extraocular muscles may play a role in the pathogenesis of Graves' ophthalmopathy. The distribution of such cells was therefore studied in extraocular muscles of rats that were made hyper- or hypothyroid by the oral administration of thyroxine or propylthiouracil respectively. Skeletal muscles were studied for comparison. The cell distributions were analysed in cryostat cross-sections subjected to a two-step immunoperoxidase method using well-characterized monoclonal antibodies against T cells, B cells, macrophages and MHC class II antigens. The extraocular muscles of control (euthyroid) rats contained numerous macrophages, fewer MHC-II positive cells and T cells and no B cells. Differences in the distribution of immunocompetent cells were found in control rats, between skeletal and extraocular muscles as well as within the various recti eye muscles. This particular tissue distribution resembles that previously reported for human extraocular and skeletal muscles. Quantitative analysis showed that experimental dysthyroidism only affected cell populations in the extraocular muscles. Significant effects on the number of macrophages were observed in the inferior rectus muscle of both hypo- and hyperthyroid rats, this was most pronounced in the orbital layer of the muscles. Both hyper- and hypothyroidism appear to affect local cell distributions in a tissue-specific manner. The presently observed site-dependent effects of dysthyroidism on local immunocompetent cell populations may have relevance for the differential involvement of muscular tissues in Graves' ophthalmopathy.

Animals↗