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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.
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.
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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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 treated one patient with bilateral internuclear ophthalmoplegia and another with skew deviation with extraocular muscle botulinum toxin injection. Both patients had pre-injection symptomatic diplopia in primary position, one for 1 month and the other for 12 months. Resolution of diplopia and complete and permanent binocular fusion in primary position was obtained within 3 to 4 days in both cases.
Motility disturbances after retinal detachment surgery are rare complications. This retrospective study examined 2427 cases from the University Eye Hospital in Münster (1/84-6/89). All cases underwent scleral buckling procedures for retinal detachment. Twelve patients developed persistent diplopia. The scleral buckle needed to be removed in all cases; however, additional strabismus surgery had to be done in 5 cases to restore binocular single vision. Evaluation of the 12 cases suggested that the complications were caused by hypertrophic scarring rather than by the buckles, suturing material or muscular decompensation.
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The superiority of magnetic resonance imaging (MRI) of the posterior fossa over x-ray computed tomography is demonstrated by four patients with neuro-ophthalmologic disorders. Advantages of this technique include lack of ionizing radiation, direct multiplanar imaging, increased sensitivity to pathology, increased tissue contrast, and no known adverse effects. It is concluded that MR, when available, should be the imaging modality of choice in patients with neuro-ophthalmologic disorders of suspected brainstem origin.
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The disorders of ocular motility seen in association with brainstem or cerebellar disorders may point to rather specific anatomical or pathological correlations. Pontine gaze palsy reflects involvement of the pontine paramedian reticular formation. Internuclear ophthalmoplegia signifies a lesion in the medial longitudinal fasciculus. Skew deviation may result from a lesion anywhere in the posterior fossa. Ocular bobbing typically results from a pontine lesion. The Sylvian aqueduct syndrome is characteristic of involvement in the upper midbrain-pretectal region, usually a pinealoma. Cerebellar lesions may be manifested by gaze paresis, skew deviation, disturbances of saccadic or smooth pursuit movements, ocular myoclonus, or several characteristic forms of nystagmus. Familiarity with these disorders may be of great help to the physician dealing with a patient with a possible posterior fossa lesion.
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Injections of botulinum toxin into the oculomotor muscles was used in incorrectible diplopia, ocular torticollis, Duane's syndrome and congenital nystagmus. Favourable results were obtained and the sole complications which could be observed were a transitory ptosis and subconjunctival haemorrhages. Frequently 2 to 3 injections were sufficient for a permanent effect.
High myopia may produce a masquerade syndrome, exhibiting clinical findings similar to those found in endocrine ophthalmopathy. Several hypotheses have been proposed as an explanation: sixth nerve paresis, structural changes in oculomotor muscles, contact between elongated globes and the bones of the orbital apices. These hypotheses are discussed after the presentation of a case with electroneuro-oculographic and tomodensitometric findings.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.