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Results for “Ocular Motility Disorders”

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At least 109 records · Page 6Linked to original sources
PubMed2002

Use of augmented rectus muscle transposition surgery for complex strabismus.

PURPOSE: Full tendon rectus muscle transposition surgery augmented with posterior fixation sutures has been shown to be effective in the treatment of abducens palsy and Duane's syndrome. The purpose of this study is to summarize our experience with the use of this procedure and a three fourths partial tendon transposition modification of this procedure for a variety of complex vertical and horizontal paralytic eye movement disorders. DESIGN: Retrospective noncomparative interventional consecutive case series. PARTICIPANTS: Eighteen patients with paralytic strabismus. INTERVENTION: Full tendon rectus muscle transposition procedure augmented with posterior fixation sutures (13 patients) or a three fourths partial tendon transposition augmented with posterior fixation sutures (5 patients). MAIN OUTCOME MEASURES: Resolution of diplopia in the primary position and improved ocular alignment. RESULTS: Comparing preoperative to postoperative status, presence of primary position diplopia decreased from 64% to 14%, anomalous head posture decreased from 56% to 6%, and primary position alignment improved in all patients. CONCLUSIONS: Full tendon rectus muscle transposition surgery augmented with posterior fixation sutures and the vessel-sparing three fourths partial tendon transposition modification of this technique are effective for the treatment of a variety of complex vertical and horizontal paralytic ocular motility disorders.

Adolescent↗
PubMedDate not supplied

Periodic alternating esotropia.

Periodic alternating esotropia (PAE) is a rare ocular motility disturbance observed in association with periodic alternating gaze deviation (PAG) or periodic alternating nystagmus. We examined a 9-month-old developmentally delayed girl who showed PAE occurring synchronously with PAG. The ocular motility disorder consisted of rhythmic alternating fixation with the right eye in abduction, a left face turn and esotropia of the left eye (90 seconds), a changeover phase (10 to 15 seconds) during which the eyes are straight and the head is upright, then fixation with the left eye in abduction, a right face turn, and esotropia of the left eye (90 seconds). There was no spontaneous jerk nystagmus present. These findings continued incessantly during a follow-up period of 18 months. Magnetic resonance imaging revealed pronounced cerebellar vermis hypoplasia. Only three clinically similar cases have been previously reported, but none had been studied with modern neuroimaging techniques.

Atrophy↗
PubMed1997

The efficacy of vision therapy for convergence excess.

BACKGROUND: Convergence excess is a commonly encountered non-strabismic ocular motility disorder. There are, however, very few research data that evaluate the effect of vision therapy for this condition in a clinical population. METHODS: The records of 83 consecutive patients with convergence excess who were treated with vision therapy were reviewed to assess the impact of treatment on clinical findings and patient symptoms. RESULTS: Statistically and clinically significant changes in direct and indirect measures of negative fusional vergence were seen, with 84% of patients reporting a total elimination of initial symptoms. Larger increases in negative fusional vergence were found than those previously reported. This may be a result of the more extensive and better controlled in-office treatment used in this study. CONCLUSIONS: Vision therapy was successful in enhancing negative fusional vergence and eliminating symptoms in the vast majority of patients with convergence excess and should be considered an effective treatment for this condition.

Adolescent↗
PubMed1995

Management of strabismus due to orbital myositis.

We report on 5 consecutive patients seen at the botulinum toxin clinic at Moorfields Eye Hospital with an ocular motility disorder secondary to orbital myositis. CT scans demonstrated involvement of one or both of the medial recti in the inflammatory process in all 5 patients. In addition 1 patient had involvement of both the lateral recti and the right superior rectus. Two patients had been treated with oral steroids, 3 with non-steroidal anti-inflammatory agents, and 1 with orbital radiotherapy. Prior to toxin injection 3 patients had an esotropia (ranging from 4 delta to 30 delta) and two an exotropia (52 delta and 85 delta). A vertical imbalance was present in 3, and all 5 patients had symptomatic diplopia. A total of six injections were given to 5 patients, 2 of whom later went on to have surgery. Toxin injection reduced the angle of the deviation to less than 10 delta in 4 patients, all of whom are now asymptomatic. The fifth patient has persistent diplopia despite two operations to correct a large exotropia. We discuss the role of botulinum toxin and surgery in the management of strabismus due to orbital myositis.

Adolescent↗
PubMed1984

Acquired inflammatory superior oblique tendon sheath (Brown's) syndrome. Report of a case following frontal sinus surgery.

A case of acquired Brown's syndrome secondary to fibrous proliferation about the trochlea and the superior oblique tendon developed following frontal sinus surgery. This syndrome is a restrictive ocular motility disorder characterized by vertical diplopia and inability to elevate the affected eye above the midline on medial gaze. The purpose of this report is to bring to the attention of otolaryngologists this sequela of sinus surgery, to offer suggestions for modification of surgical technique to avoid this complication, and to emphasize the importance of identifying any signs or symptoms of eye muscle dysfunction prior to surgery.

Adult↗
PubMed1999

Episodic vertigo related to migraine (90 cases): vestibular migraine?

A retrospective study was conducted on 90 patients with episodic vertigo that could be related to migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the International Headache Society (IHS) for basilar migraine, the diagnosis was substantiated by disease course, medical efficacy in treating (ergotamines) and preventing (metoprolol, flunarizine) attacks, ocular motor abnormalities in the symptom-free interval, and careful exclusion of the most relevant differential diagnoses, such as transient ischemic attacks, Menière's disease, and vestibular paroxysmia. The following clinical features were elaborated. The initial manifestation could occur at any time throughout life, with a peak in the fourth decade in men and a "plateau" between the third and fifth decades in women. The duration of rotational (78%) and/or to-and-fro vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as vertigo associated with auditory symptoms in only 16%. Vertigo was not associated with headache in 32% of the patients. In the symptom-free interval 66% of the patients showed mild central ocular motor signs such as vertical (48%) and/or horizontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate positional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with other forms of migraine were found in 52%. Thus, migraine is a relevant differential diagnosis for episodic vertigo. According to the criteria of the IHS, only 7.8% of these patients would be diagnosed as having basilar migraine. However, to ensure that at least those presenting with monosymptomatic episodic vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term "vestibular migraine."

Adolescent↗
PubMed1987

CSF protein and cellular profiles in various stages of HIV infection related to neurological manifestations.

CSF protein and cellular profiles were studied in 28 HIV-infected patients. Twenty of them had neurological complaints, but only 6 patients had objective neurological deficits such as dementia, ocular motility disorders or polyneuropathy. The serum/CSF HIV antibody ratio was on average lowest in acquired immunodeficiency syndrome (AIDS) (4 patients) and highest or almost normal in lymphadenopathy syndrome (LAS) (11) and asymptomatic seropositivity (ASX) (7), while it varied between these extremes in AIDS-related complex (ARC) (6). However, low values of the ratio were also found in the HIV-infected patients free of neurological symptoms and even in one ASX patient. The CSF IgG index was elevated in all these 4 general stages of HIV infection without any significant differences between them. The CSF/serum albumin ratio was slightly increased in patients with neurological deficits, but this ratio showed no association with any other clinical factor analysed. CSF leucocytes were increased in the early stages of the disease, but later the cellular reaction subsided. HIV was isolated from post mortem brain tissue of two AIDS patients and from the CSF of one of them. The results suggest increased intrathecal virus-specific IgG synthesis, not only in patients with neurological deficits and at advanced stages of infection, but also in neurologically symptom-free subjects and at early infection. The lack of correlation between the increased virus-specific IgG synthesis within the CNS and the presence of neurological symptoms suggests that neurologically "silent" areas of brain white matter are often affected in HIV infection.

AIDS-Related Complex↗
PubMedDate not supplied

High myopia as an unusual cause of restrictive motility disturbance.

Endocrine ophthalmopathy is a common cause of restrictive ocular motility disorder associated with abnormal forced duction testing. We report ultrasonographic and computed tomographic findings in a highly myopic patient without thyroid abnormality in whom the restrictive findings of endocrine ophthalmopathy were simulated by contact between elongated globes and the bones of the orbital apices.

Endocrine System Diseases↗
PubMedDate not supplied

Brown's syndrome.

Brown's syndrome is a well-recognized clinical disorder of ocular motility manifesting most notably a restriction of active and passive elevation in adduction. The original name, "superior oblique tendon sheath syndrome," is no longer appropriate, since it has been shown that the tissue surrounding the anterior superior oblique tendon is blameless as a restrictive force. "True" and "simulated" as descriptive modifiers should also be discarded, as they relate to the disproven sheath concept. Brown's syndrome occurs as a congenital or acquired, constant or intermittent condition; the common link is restriction of free movement through the trochlea pulley mechanism. The various etiologic theories are reviewed and the spectrum of medical and surgical treatments are described and evaluated. Evidence suggests that subtypes of Brown's syndrome lie on a single continuum and that spontaneous resolution occurs in each group, probably more often than previously recognized. A simplified classification scheme is encouraged and possible future directions in Brown's syndrome research are introduced.

Cranial Nerves↗
PubMed2006

The influence of pulleys on the quantitative characteristics of medial rectus muscle recessions: the torque vector model.

PURPOSE: To develop a new pulley-based torque vector mathematical model for medial rectus muscle recessions and compare it based on known clinical characteristics, to the currently accepted nonpulley length-tension model. METHODS: The following quantitative characteristics of the results of bilateral medial rectus muscle recessions were chosen for study to see whether the new torque vector model or the classic length-tension model would better predict these characteristics: (1) larger bilateral medial rectus muscle recessions produce more effect per millimeter, with the dose-response curve approximating an exponential shape; (2) the exact location of the preplaced medial rectus muscle suture prior to muscle disinsertion in recessions has minimal effect on the postoperative ocular alignment; and (3) medial rectus muscle recessions of more than eight mm are likely to produce an early consecutive exotropia. RESULTS: Based on the documented location of the medial rectus muscle pulley, the change in the torque vector per millimeter of medial rectus muscle recession was calculated and shown to have an exponential shape. For all three of the quantitative characteristics chosen, the torque vector model appears to better predict the results of medial rectus muscle recessions when compared with the length-tension model. CONCLUSIONS: Many quantitative characteristics of medial rectus muscle recessions are better explained by the torque vector model, instead of the classical length-tension model, and support the presence, location, and function of the medial rectus muscle pulley. This new understanding of ocular motility mechanics may influence surgical technique and introduce new surgical considerations for correction of ocular motility disorders.

Humans↗
PubMed2006

Superior oblique muscle paresis and restriction secondary to orbital mucocele.

Mucoceles are chronic cystic lesions of the paranasal sinuses lined by respiratory epithelium. Their extension into the adjacent orbit may result in proptosis, ocular motility disorders, and diplopia. Brown syndrome secondary to extension of a mucocele into the orbit has been reported previously. Superior oblique (SO) muscle weakness, either isolated or in combination with an ipsilateral limitation to elevation in adduction, has not been previously reported in patients with orbital mucocele.

Diagnosis, Differential↗
PubMed1999

Vertical fusional amplitudes in patients wearing vertical anisometropic correction.

OBJECTIVE: To examine the relationship between vertical anisometropic spectacle correction and vertical fusional amplitudes in patients. DESIGN: Comparative observational case series. PARTICIPANTS: Twenty-one patients exposed to greater than 0.5 diopters of vertical anisometropic spectacle correction were compared with 46 patients not exposed to anisometropic correction. METHODS: Vertical fusional amplitudes were recorded in all patients using a prism bar. MAIN OUTCOME MEASURES: Vertical fusional amplitudes and vertical anisometropia. RESULTS: In patients exposed to greater than 0.5 diopters of vertical anisometropic spectacle correction, vertical fusional amplitudes measured 5.2+/-1.4 prism diopters. Patients not exposed to anisometropic correction had vertical fusional amplitudes of 2.7+/-1.2 prism diopters (P < 0.0001). CONCLUSION: Patients with vertical anisometropic correction have increased vertical fusional amplitudes. This finding is relevant when evaluating patients with ocular motility disorders, especially with regard to distinguishing acquired versus longstanding deviations.

Anisometropia↗
PubMed1997

Absence of oculomotor and trochlear motoneurons leads to altered extraocular muscle development in the Wnt-1 null mutant mouse.

Wnt-1 null mutant mice lack midbrain somatic motor nuclei. Primordial migration and spatial patterning of the extraocular muscles, however, was preserved, but myogenesis was disrupted in aneural muscles. Some muscles normally innervated by oculomotor and trochlear nuclei received aberrant innervation, which proved sufficient to maintain prenatal stages of myogenesis. The absence of motoneurons followed by innervation from inappropriate motoneuron pools is a viable candidate mechanism in ocular motility disorders, including Duane retraction syndrome and congenital fibrosis of extraocular muscle.

Alleles↗
PubMed2001

Repair of traumatic inferior orbital wall defects with nasoseptal cartilage.

PURPOSE: This study evaluated the effectiveness of nasoseptal cartilage for repairing traumatic orbital floor defects. PATIENTS AND METHODS: Autogenous septal cartilage was used in 20 patients. They were evaluated for the presence or absence of diplopia, enophthalmus, infraorbital nerve paresthesia, and ocular motility disorders. Surgical indications for orbital exploration included entrapment of orbital tissues, large orbital defect (greater than 50% of the orbital floor or more than 8 mm), or orbital floor defects with involvement of other zygomaticofrontal complex fractures. RESULTS: All patients were successfully treated by restoration of the orbital wall continuity. Follow-up at 1 week to 6 months showed 1 patient with postoperative enophthalmos and 1 patient with lower lid edema. There were no donor site and graft infections or graft extrusion. CONCLUSIONS: Nasal septal cartilage is a readily accessible autogenous tissue that should be considered when an autogenous graft is needed for orbital floor defect reconstruction.

Adolescent↗
PubMed1990

[Genetic aspects of esotropia in homozygous twins].

The present paper reports on 14 pairs of monozygotic twins with ocular motility disorders. Eight pairs were concordant and two partially concordant, while four pairs were discordant. Four pairs were born prematurely; two pairs were born by cesarean section, one of them also prematurely. Of the 24 patients with motility disorders, 10 had congenital squint syndrome, nine microtropia, one accommodative esotropia, two esophoria, and two orbital strabismus due to premature synostosis of the coronal suture. Genetic and exogenic factors and the forms of strabismus are discussed.

Adolescent↗
PubMed2002

Selective lesions of rabbit extraocular muscles injected with the anti-AChR immunotoxin saporin-mAb 73.

PURPOSE: To evaluate the effects on extraocular muscles of a skeletal muscle-specific immunotoxin, saporin-mAb 73, as an alternative to botulinum toxin to induce a permanent correction of oculo-facial dystonias or some forms of ocular motility disorders. METHODS: An immunotoxin was prepared with a monoclonal antibody (mAb 73) against acetylcholine receptors of skeletal muscle, linked to saporin, a type 1 ribosome-inactivating protein (RIP) from Saponaria officinalis. Sixteen New Zealand white rabbits were treated with a single injection of immunotoxin directly into the medial rectus muscle of one eye. Four different dosages of 2, 5, 20, or 50 ng saporin-mAb 73 were used. The rabbits were sacrificed at two, 7 and 14 days post-injection. The medial rectus muscle and the retractor bulbi muscle of both the injected and the fellow eyes were taken and serial sections were examined by light microscopy in a blinded manner. RESULTS: Saporin-mAb 73, even at the dosage of 2 ng, brought about focal damage in the extraocular muscles of rabbits without histological changes in adjacent muscles. The histological examination revealed necrotic/apoptotic lesions restricted to the sites of inoculation and largely infiltrated by macrophages. No evident inflammatory reaction was detected at any time and neutrophils were substantially absent. At 14 days after injection, necrosis/apoptosis was still evident and the sclerotic reaction was minimal. CONCLUSIONS: The immunotoxin saporin-mAb 73 injections into the extraocular muscles of rabbits caused focal damage to the muscles. There was no significant inflammatory reaction and muscle fiber loss was present even at the lower doses. Although the lesions were followed for only 14 days, our results suggest that saporin-mAb 73 has potential to cause safe focal muscle damage but longer-term follow-up are needed to investigate the persistence of muscle weakness.

Animals↗