1/27. Intact sensory fusion in a child with divergence paresis caused by a pontine glioma.PURPOSE: To describe a child with divergence paresis esotropia caused by a brain tumor with intact sensory and motor fusion. METHOD: Case report. RESULTS: A 9-year-old boy who had one episode of double vision was initially seen with a small, variably present esophoria at near vision, an intermittent 10 prism diopter esotropia at distance, and stereopsis of 80 arc seconds. A magnetic resonance imaging examination disclosed a 4.0 x 4.5-cm pontine glioma. CONCLUSIONS: Ophthalmologists should recognize that the presence of intact sensory and motor fusion in a child with acute, comitant esotropia of the divergence paresis type does not preclude intracranial abnormality. If immediate neuroimaging is deferred, repeated thorough ocular motility examinations are warranted to detect progression.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/27. spasm of the near reflex mimicking deteriorating accommodative esotropia.PURPOSE: To describe a patient with accommodative esotropia who developed spasm of the near reflex. CASE REPORT: A 6-year-old girl with a history of successfully treated refractive, accommodative esotropia suddenly developed spasm of the near reflex after the death of a relative. The condition resolved after 2 months. CONCLUSION: spasm of the near reflex should be considered in children with accommodative esotropia who seem to deteriorate and become esotropic once again while wearing their hyperopic glasses.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
3/27. Spontaneous resolution of infantile esotropia.PURPOSE: To report the spontaneous resolution of infantile esotropia in 3 patients. methods: The clinical histories and the results of ophthalmologic examinations in 3 patients with infantile esotropia were reviewed and analyzed with reference to the literature. RESULTS: All 3 patients with infantile esotropia were diagnosed with 25 to 30 PD of esotropia before the age of 6 months. All of them had insignificant refractive errors. Against medical advice, they were not brought in for follow-up examinations. At the age of 34 months to 59 months, the esotropia of the patients had changed into exophoria, esophoria less than 4 PD, or orthophoria. All patients eventually showed dissociated vertical deviation and overaction of the inferior oblique muscles. Of the 2 cooperative patients, 1 consistently identified Titmus stereograms with 3000 seconds of arc and fused Worth 4 dots at near and at distance. The other patient could not identify stereo targets and suppressed one eye on Worth 4 testing at distance, though she showed no suppression at near. CONCLUSION: In these cases, infantile esotropia with a relatively small angle may spontaneously resolve without any treatment. However, all these patients showed poor stereoacuity, dissociated vertical deviation, and overaction of the inferior oblique muscles.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
4/27. Unusual presentations of accommodative esotropia.PURPOSE: Most patients with accommodative esotropia are first examined between the ages of 6 months and 2 years. This paper discusses unusual presentations of accommodative esotropia that occur outside of this age-group and/or have a precipitating event that triggered the esotropia. In a series of patients who were from 5 to 11 years of age, trauma was the precipitating event. In some of the patients under 6 months of age, high myopia, as well as a moderate to large amount of hyperopia, was the cause. In 1 teenager, diabetic ketoacidosis precipitated accommodative esotropia. methods: We reviewed all of our records for the past 25 years involving patients with a diagnosis of esotropia, and we found 17 patients who had unusual presentations of accommodative esotropia. Of 8 who were under the age of 6 months, 2 had high myopia and 6 had moderate to large amounts of hyperopia. Nine patients were older than age 5. Eight of the 9 had suffered trauma associated with the presentation of accommodative esotropia, and 1 patient's accommodative esotropia was associated with diabetes. The patients with myopia received their full myopic correction. The children under 6 months of age with hyperopia received their full cycloplegic refraction, and the children over age 5 received the most plus that they were able to accept in a noncycloplegic state consistent with good visual acuity (at least 20/30 in each eye). RESULTS: In 17 patients, accommodative esotropia was initially controlled with glasses. In a few of the trauma cases, bifocals were required for control of near deviation. Only 2 of the patients, in whom onset was under 6 months of age, came to surgery. One had hyperopia controlled for 2 years with glasses, and the other had myopia controlled for 3 years with glasses. CONCLUSIONS: Accommodative esotropia can occur prior to 6 months of age. It can also occur in older children (5 to 14 years of age) and can be precipitated by trauma or diabetic ketoacidosis.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/27. Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation.PURPOSE: To report a case of acute comitant esotropia successfully treated with suboccipital decompression in a 9-year-old male patient with Chiari I malformation. DESIGN: Interventional case report. methods: A 9-year-old male with Chiari I malformation had acute onset of diplopia, headache, and comitant esotropia. RESULTS: About 9 months after suboccipital decompression, diplopia resolved and there was near orthophoria on examination 15 months after surgery. CONCLUSION: In view of our case and after a review of literature, we advocate primary suboccipital decompression to treat acute comitant esotropia in patients with Chiari I malformation. A follow-up period of at least 1 year rather than 6 months seems necessary to assess surgery effects.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/27. Divergence insufficiency and demyelinating disorder.PURPOSE: To describe a divergence insufficiency in a young woman. methods: Case report. RESULTS: A 38-year-old woman presented with a episode of homonymus horizontal diplopia at distance. She was orthophoric at near but had esotropia at distance. Neurological evaluation was normal but multiple demyelinating lesions were shown in the magnetic resonance scan, with increased intrathecal Ig G production. Double vision improved after corticosteroid mega-doses. CONCLUSIONS: An acute onset of diplopia due to divergence insufficiency in a young adult may be associated with a demyelinating disorder.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/27. spasm of the near reflex associated with head injury.spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
8/27. presbyopia complicating pre-existing strabismus.BACKGROUND: presbyopia may affect pre-existing sensory adaptations or aggravate previously asymptomatic heterophoria. We describe the presentation, underlying problem and management of 11 patients with pre-existing strabismus or heterophoria who presented with new symptoms of double vision attributable to presbyopic change, an association not previously reported. methods: patients with new strabismic symptoms attributable to presbyopia were recruited prospectively over a 1-year period. RESULTS: The 11 patients had had a recent decrease of accommodative amplitude that resulted in blurred vision at near with a breakdown of pre-existing heterophoria (2 patients), alteration of fixation pattern (6 patients), symptomatic alternating fixation (2 patients) or intolerance to correction owing to restrictive strabismus (1 patient). INTERPRETATION: At the onset of presbyopia, symptoms may be varied and subtle. Ophthalmologists and orthoptists should carefully determine the exact nature of the symptoms. Any pre-existing fixation pattern should then be established from the history, old photographs or suppression characteristics. Refractive or surgical management should be aimed at returning the patient to his or her long-standing sensory adaptation. Other important issues, such as incomplete correction of hypermetropia by refractive surgery and problems using bifocals with vertical restrictive strabismus, should be noted.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/27. 'V' esotropia and excyclotropia after surgery for bilateral fourth nerve palsy.Six patients had residual diplopia at near in the downgaze position after surgery for bilateral fourth nerve palsy. They all showed a large excyclotropia in the downgaze position that was associated with a "V"-pattern esotropia and could not fuse in the reading position because of the size of the excyclotropia. They were treated with bilateral recessions of the inferior recti, which resulted in an expansion of the single binocular field of vision in downgaze, with an elimination of diplopia in the reading position. None experienced a deterioration in their alignment in the primary position.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/27. Vertical diplopia onset with first-time bifocal.A 39-year-old white female presented with symptoms of constant diplopia onset with a first bifocal correction. The association of these conditions required a careful differential diagnosis and special management considerations. Testing indicated an esotropia with a longstanding nonconcomitant superior oblique paresis which became manifest when she began wearing bifocals. A regimen of horizontal vergence range training in combination with a relieving vertical prism in a near correction were prescribed. An amount of prism which allowed comfortable sensory-motor fusion through both the distance and near portion of a bifocal spectacle correction was eventually ascertained. Information regarding etiology, etiologic incidence, differential diagnosis, and management of superior oblique paresis is also presented.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
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