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At least 19 recordsLinked to original sources

Surgical management of persistent diplopia in blowout fractures of the orbit.

Persistent diplopia continues as a problem in a significant number of patients following the surgical management of a blowout fracture of the orbital floor even when repaired within 15 days of the traumatic incident. Inferior rectus and inferior oblique muscles which have been incarcerated in a blowout fracture for longer periods have a worse prognosis for adequate functioning postoperatively. There is some presumptive evidence to suggest a myogenic or neurogenic cause for such dysfunction. Experiments with posterior fractures clearly demonstrate that the nerve entering the inferior rectus can be damaged. Vertical diplopia which persists beyond 3 months following release of entrapped muscle tissue requires surgical correction depending upon the degree of vertical dissociation. Motility surgery was required in 18 of 20 patients with persistent diplopia. Multiple muscle combinations were frequently required to achieve success. The criterion for a successful result was elimination of vertical diplopia in the primary and reading position. The elimination of persistent diplopia in association with blowout fractures of the orbit is usually possible even in late treated cases when one uses specific criteria for success. Three cases were considered cured since there was no diplopia in any direction of gaze, while 17 cases developed single binocular vision in the primary and reading positions. In these latter patients, on extreme upward or downward gaze, diplopia could still be demonstrated in all patients, especially when the individuals were specifically requested to look for diplopia.

Diplopia

Diplopia following midfacial fractures.

Over a period of 2 years, 363 patients who had sustained a total of 438 midfacial fractures due to blunt trauma received a full ophthalmological examination within 1 week of injury. Of these, 72 patients (19.8%) developed diplopia. Diplopia was most common following road traffic accidents (31%) and least common with simple falls (10%). Blow-out fractures of the orbit led to double vision in 58% of cases. Eighty two percent of patients recovered from diplopia within 6 months of injury; only 1 patient required squint surgery for double vision. The principal risk factors for diplopia comprise road traffic accidents, blow-out fractures and comminuted malar fractures. Early surgical reconstruction of midfacial fractures with conservative management of concomitant motility disorders has, in our series, resulted in very few patients having diplopia in the long term.

Accidents, Occupational

[Diplopia frequency as a result of the surgical treatment of concomitant squint].

Postoperative diplopia in cases of congenital strabismus or early onset occured in 5% of patients operated on in 1977. We cannot calculate the frequency of diplopia in children operated on up to the age of 9 years old (290 cases) since no child suffered from diplopia. Its incidence-5% (9 out of 177 cases) relates to patients older than 9 years at the time of surgery, 6 patients out of 20 cases with consecutive exotropia complained of diplopia (following revision surgery). Amblyopia - foveal or eccentric fixation-alone seems to be a less important risk than consecutive exotropia. Preoperative wearing of prism to compensate the objective angle of squint over a few days can reduce but not exclude the general risk of postoperative diplopia.

Adolescent

Binocular diplopia in unilateral aphakia: the role of botulinum toxin.

We have treated 12 unilaterally aphakic patients, with a manifest squint and binocular diplopia, with botulinum toxin injection to the appropriate horizontal rectus muscle, in an attempt to reduce the angle of squint and thereby resolve the diplopia. In all cases a short-term reduction in the angle of squint was achieved. In nine patients, whose aphakia was corrected with a contact lens, and eight of whom had had their lenses removed because of trauma, this reduction was only temporary. In three patients, however, who had had a non-traumatic cataract removed, replaced with a posterior chamber implant, control of the deviation was maintained long after the acute effect of the toxin had disappeared, with the development of coarse binocular single vision, a fusion range, and abolition of all diplopia. The possible reasons for these different responses are discussed and it is suggested that in cases of binocular diplopia following lens extraction, botulinum toxin treatment should be considered prior to any extraocular muscle surgery, as temporary reduction of the deviation may be sufficient to allow recovery of binocular single vision.

Adolescent

[Monocular diplopia].

Monocular diplopia is a condition when a single object is seen double with one of the eyes. Fifty-seven cases of this condition are described. Traditional ophthalmologic methods, as well as examinations of the optic system aberrations and determination of diplopia type with a cross pattern were employed in examinations of the patients. A classification of monocular diplopia has been developed, including (1) refraction, (2) aberration, (3) pupillary, (4) retinal, and (5) neurogenic diplopia. Methods of examining this patient population are described and recommendations on the treatment of this condition presented.

Adolescent

Causes of diplopia.

A prospective study of 96 diplopia patients was analyzed concerning the common types and causes in order to develop early and proper management. Two-thirds (62) of the patients were male (64.6%). The average age was 34.5 +/- 15.7 years (+/- SD). The result revealed that the common types of diplopia were horizontal, vertical and torsional diplopia, respectively. The common causes of diplopia were head trauma (38.5%), systemic diseases from diabetes mellitus, hypertension (20.8%), undetermined group (15.6%), eye diseases (9.4%), and etc. Sixth cranial nerve paralysis was frequently found among the third, fourth and sixth cranial nerves. There were 13 cases of spontaneous fusion in the primary position. Only 7 of 12 surgical cases eventually achieved satisfactory alignment and fusion.

Adolescent

Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves' orbitopathy.

Graves' orbitopathy can be associated with horizontal, vertical, and torsional diplopia. Of 428 patients treated with transantral orbital decompression, 21 had incycloduction (mean, 12.8 degrees; range, 5 to 20 degrees) and five had excycloduction (mean, 12 degrees; range, 5 to 20 degrees). All 26 patients had had recessions of the medial or inferior rectus muscle (or both) before onset of torsional diplopia. Mean recession was 5.5 mm (range, 4 to 10 mm) and 5.3 mm (range, 2 to 10 mm) of medial rectus muscle and inferior rectus muscle, respectively. An A pattern was often associated with the condition. Superior oblique tenectomy and inferior oblique myectomy were performed most frequently for incycloduction and excycloduction, respectively. Superior oblique tenectomy induced a mean incycloduction decrease of 7.1 degrees (range, 0 to 12 degrees). Exotropia in downgaze was decreased, and a small ipsilateral hyperdeviation was induced. Bilateral inferior oblique myectomy in one patient decreased excycloduction 10 degrees without inducing new deviation. At follow-up (mean, 63.7 months) after last strabismus operation, 15 patients with incycloduction and two with excycloduction had no diplopia.

Adult

Monocular central-field occlusion for intractable diplopia.

This report describes several methods of degrading imagery through the central portion of a spectacle lens to provide a cosmetically acceptable means of obtaining single vision in the central field of patients with intractable diplopia. For 2 strabismic patients with annoying diplopia, we applied to 1 spectacle lens a centrally placed disc (about 1 inch diameter) consisting of (1) translucent tap,a (2) a +7 D Fresnel lens,b or (3) stippled, clear lacquer. For 1 patient, the lacquer was the most acceptable; for the other, the tape was best. We present here the case reports for these 2 patients, showing why they preferred different image-degrading methods and how these and other methods of central-field image degrading can be advantageous even when diplopia is present across most of the visual field.

Adolescent

Bilateral monocular diplopia secondary to occult diabetes mellitus.

A 68-year-old man presented with transient, bilateral, vertical, monocular diplopia as an initial manifestation of diabetes mellitus. The diplopia was determined to be of lenticular origin, but was not found to be secondary to the usual refractive changes. Rather, it is presumed to be due to prismatic alterations caused by index of refraction differences within the crystalline lenses. It is not known what other factors relate to the development of this type of diplopia in the diabetic patient.

Aged

[Some clinical aspects concerning diplopia after retinal detachment surgery with cryopexy and episcleral silastic sponge (author's transl)].

The aetiology of diplopia following retinal detachment surgery after the Lincoff-Custodis method is examined. Of 140 patients operated, 16 (i.e. 11.4%) developed diplopia. The authors believe that this diplopia is due to a fixation of the eyeball at the point of the silastic sponge placement. As responsible factors, which depend on the manner of sponge fixation and the size of the sponge, they regard: Alteration of the bulb curvature, shortening of the Tenon's capsule placed over the sponge, and changes in the conditions of muscular action.

Adolescent

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

Corneal topography and monocular diplopia following near work.

Monocular diplopia, reported by a subject following near work, was shown to be caused by changes in the corneal topography. Prior slit lamp biomicroscopy had revealed no corneal abnormality. The degree of corneal distortion and ray tracing calculations confirmed the presence and position of the resultant diplopia.

Adult

[Diplopia in monocular aphakia].

In monocular aphakia, diplopia results from disparities between the two retinal images in form, size, outline, luminous intensity and colour. If one wishes to give the best binocular vision possible to a monocular aphake, it is important to recognize the different factors which may give rise to diplopia.

Aniseikonia

Persistent sensory disturbances and diplopia following fractures of the zygoma.

In a follow-up study of 124 patients with fractures of the zygoma, 100 of whom had undergone surgery, sensory disturbances of the intraorbital nerve, mostly to a very moderate degree, were found in 46% of those operated on. Slight imperfections of the fracture reduction had no influence on the results, and no substantial difference in outcome was found between the different surgical methods employed. The diplopia that persisted in five patients was due to reduced motility of the globe, without any displacement or sign of loss of orbital contents.

Diplopia

Monocular diplopia in flying personnel.

Fifteen cases of monocular diplopia or polyopia in U.S. Air Force flying personnel appeared due to optical aberrations of physiologic variations within the refracting elements of the eye. In most cases, this symptom was compatible with excellent visual acuity and was not regarded as a detriment to safe and accurate visual performance.

Adult

The effect of pupil size on chromostereopsis and chromatic diplopia: interaction between the Stiles-Crawford effect and chromatic aberrations.

Several studies have reported that the magnitude of chromostereopsis changes as the pupil size changes. Einthoven's theory, that chromostereopsis is determined by interocular differences of monocular transverse chromatic aberration, can not easily explain this change. Therefore, several alternative hypotheses have been introduced, most notably by Vos [(1960) Vision Research, 6, 105-107], who argues that shifts in chromostereopsis with pupil size are due to decentration of the peak of the Stiles-Crawford effect (SCE) with respect to the pupil. We tested this hypothesis by measuring chromostereopsis under both scotopic (no SCE) and photopic conditions with centered and decentered artificial pupils. The results show that the SCE plays an important role in the effect of pupil size on chromostereopsis. Similar changes were also measured in monocular chromatic diplopia which supports the hypothesis that the effect of pupil size on chromostereopsis is due to monocular mechanisms.

Adult