11/166. Large Bielschowsky head-tilt phenomenon and inconspicuous vertical deviation in the diagnostic positions in congenital superior oblique palsy.PURPOSE: To report a case of congenital superior oblique palsy with an unusually large Bielschowsky head-tilt phenomenon (BHP) and disproportional inconspicuous vertical deviation. methods: Case report. RESULTS: An 18-year-old woman presented with slight compensatory head tilting and a Bielschowsky head-tilt phenomenon of 50 Delta on left tilting. magnetic resonance imaging revealed atrophy of the left superior oblique muscle. A Hess screen test showed a slight underaction of the left superior oblique muscle, but neither an obvious overaction of the ipsilateral inferior oblique muscle nor inhibitory palsy of the contralateral superior rectus muscle was found. With a 3-mm recession of the ipsilateral superior rectus muscle, Bielschowsky head-tilt phenomenon decreased to 25 Delta. CONCLUSION: A large Bielschowsky head-tilt phenomenon was possibly caused by an increased gain of the otolith-ocular reflex affecting the vertical rectus muscle.- - - - - - - - - - ranking = 1keywords = vertical (Clic here for more details about this article) |
12/166. Correction of cyclovertical strabismus induced by limited macular translocation in a case of age-related macular degeneration.PURPOSE: To report a case of strabismus surgery performed to treat cyclovertical strabismus induced by limited macular translocation. methods: Case report. RESULTS: A 62-year-old man suffering with age-related macular degeneration and subfoveal choroidal neovascularization, RE, underwent limited macular translocation surgery. The fovea was rotated downward, and his visual acuity improved from 20/100 to 20/25 postoperatively. Cyclovertical diplopia persisted for 6 months after the operation. A Hess screen test revealed a pattern that simulated an underaction of the superior oblique muscle and inferior rectus muscle with an overaction of the ipsilateral inferior oblique muscle. To treat the diplopia, advancement of the superior oblique muscle tendon and resection of the ipsilateral inferior rectus muscle were performed. Binocular single vision with 140 seconds of arc for stereopsis was obtained. CONCLUSION: Cyclovertical strabismus after limited macular translocation is corrective with conventional surgery on the treated eye.- - - - - - - - - - ranking = 1.1666666666667keywords = vertical (Clic here for more details about this article) |
13/166. Spontaneous reversal of nystagmus in the dark.AIM: To report five children with horizontal jerk nystagmus in whom eye movement recordings in the dark revealed a spontaneous reversal in the direction of the nystagmus beat. Three patients were blind in one eye and were diagnosed as having a manifest latent nystagmus (MLN), and two patients had strabismus and congenital nystagmus (CN). methods: eye movements were recorded using DC electro-oculography with simultaneous video recording, including infrared recording in total darkness. RESULTS: Four patients had decelerating velocity slow phase jerk nystagmus when recorded under natural lighting conditions; the fifth case had accelerating velocity and linear slow phase jerk nystagmus. Under absolute darkness, nystagmus reversed in direction of beat with a mixture of linear and decelerating velocity slow phase waveforms. One child with unilateral anophthalmos could wilfully reverse the beat direction of his nystagmus by trying to look with his blind eye in the light and dark. CONCLUSIONS: These observations support the theory that LN/MLN beat direction is determined by the "presumed" viewing eye and may be consciously controlled. The spontaneous reversal of beat direction in the dark suggests eye dominance is predetermined. Eye movement recordings identified mixed nystagmus waveforms indicating that CN (accelerating velocity slow phases) and LN/MLN (linear/decelerating velocity slow phases) coexist in these subjects.- - - - - - - - - - ranking = 214.78404354466keywords = nystagmus, horizontal (Clic here for more details about this article) |
14/166. Outcome of surgery for congenital fibrosis of the inferior rectus muscle.PURPOSE: To report clinical findings and surgical outcome in a large series of patients with fibrosis of the inferior rectus muscle. MATERIALS AND methods: Subject Cases: A total of 17 cases were diagnosed with unilateral fibrosis of the inferior rectus muscle during the past 27 years at our institution. They were aged from 5 months to 17 years, with 15 cases under 10 years of age. No differences were present regarding the laterality or gender. Findings: All the cases showed hypotropia with restricted eye elevation. Forced duction test showed resistance to upward eye movement. A horizontal deviation in primary eye position was also present in 10 cases (59%). The affected eye was amblyopic in the majority of cases. Binocular vision was absent in 15 of the 17 cases. RESULTS: Surgical Outcome: All the cases received either recession or free tenotomy of the inferior rectus muscle. Resection of the ipsilateral superior rectus muscle was additionally performed to correct residual hypotropia. fibrosis of the inferior rectus was present as intraoperative finding in all the 17 cases. Hypotropia disappeared in 10 cases and decreased in 7 cases. Restoration of satisfactory binocular alignment was obtained in all the 17 cases. CONCLUSION: Recession of the inferior rectus muscle was effective treatment for fibrosis of the inferior rectus. Additional resection of the ipsilateral superior rectus muscle was useful to correct residual hypotropia. Free tenotomy is not recommended.- - - - - - - - - - ranking = 0.27727030776762keywords = horizontal (Clic here for more details about this article) |
15/166. Anomalous medial rectus muscle insertion in a child with craniosynostosis.INTRODUCTION: Oblique and vertical rectus muscle anomalies have been commonly reported in patients with craniofacial syndromes, while horizontal rectus muscle anomalies have been uncommonly reported. methods: Case report of a child with Crouzon's syndrome who was found to have an anomalous medial rectus muscle insertion at surgery. RESULTS: A bifid left medial rectus muscle insertion was found at surgery, requiring a small modification of the planned surgical procedure. CONCLUSION: Anomalies of extraocular muscles may be present in patients with craniofacial syndromes and strabismus surgeons should be prepared to modify their surgical plan when anomalous extraocular muscles are found.- - - - - - - - - - ranking = 0.44393697443429keywords = horizontal, vertical (Clic here for more details about this article) |
16/166. Two types of foveation strategy in 'latent' nystagmus: fixation, visual acuity and stability.The authors studied the foveation dynamics of two individuals with latent/manifest latent nystagmus (LMLN) to test the hypothesis that oscillopsia suppression and good visual acuity require periods of accurate target foveation at low slip velocities. Congenital nystagmus (CN) waveforms contain post-saccadic foveation periods; the LMLN waveform does not and yet allows for both oscillopsia suppression and good acuity. During fixation with both eyes open, there were intervals when the eyes were still and correctly aligned; at other times, there was esotropia and nystagmus with slow-phase velocities less than /- 4 deg/sec and each fast phase pointed the fovea of the fixating eye at the target. However, cover of either eye produced LN and a different strategy was employed: the fast phases carried the fixating eye past the target and the fovea subsequently reacquired it during the slowest parts of the slow phases. The authors confirmed this in both subjects, whose high acuities were made possible by foveation occuring during the low-velocity portions of their slow phases. A nystagmus foveation function (NFF), originally developed for CN, was calculated for both LN and MLN intervals of fixation and it was found to track visual acuity less accurately for individuals with high acuity. Individuals with LMLN exhibit two different foveation strategies: during low-amplitude LMLN, the target is foveated immediately after the fast phases; and during high-amplitude LMLN, target foveation occurs towards the end of the slow phases. Therefore, the saccadic system can be used to create retinal error rather than eliminate it if this strategy is beneficial. Individuals with LMLN foveated targets with the same eye-position and -velocity accuracy as those with CN and the NFF provides a rough estimate of acuity in both. Current calibration methods for both infrared and search-coil techniques need to be altered for subjects with LMLN.- - - - - - - - - - ranking = 132.00416814578keywords = nystagmus (Clic here for more details about this article) |
17/166. Superior oblique overaction from local anesthesia for cataract surgery.Traumatic superior oblique dysfunction from cataract surgery appears to be rare, with only 3 reported cases of postoperative Brown syndrome and 1 reported case of postoperative superior oblique weakness. We are not aware of any prior reports of superior oblique overaction occurring after cataract surgery. We describe a patient with acquired superior oblique overaction as a cause of vertical strabismus after cataract surgery. Ocular torsion analysis was essential in localizing the malfunction to the superior oblique muscle. The most likely etiology is myotoxicity from inadvertent intramuscular injection of local anesthetic before cataract surgery.- - - - - - - - - - ranking = 0.16666666666667keywords = vertical (Clic here for more details about this article) |
18/166. Rectus muscle trauma complicating sub-Tenon's local anaesthesia.PURPOSE: To describe three cases of rectus muscle trauma in patients undergoing phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia via the inferonasal quadrant. methods: Retrospective review was carried out of 3 cases from 1080 patients who underwent phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia in our unit over a 3 year period up to April 2000. RESULTS: Two patients complained postoperatively of vertical diplopia and were shown to have restriction of elevation of the eye, which was found at surgical exploration to be due to inferior rectus muscle restriction. One patient had post-operative horizontal diplopia due restriction of abduction and exploration of the medial rectus muscle was planned. CONCLUSION: Rectus muscle trauma is proposed as a complication of sub-Tenon's local anaesthesia and caution is advised to operators to clearly identify the sub-Tenon's space for injection of local anaesthetic.- - - - - - - - - - ranking = 0.44393697443429keywords = horizontal, vertical (Clic here for more details about this article) |
19/166. Skew deviation and inferior oblique palsy.PURPOSE: To describe ocular motility and neuro-ophthalmologic findings in six patients with an ocular tilt reaction (OTR) that mimicked an inferior oblique palsy (IOP). DESIGN: Observational Case Series. methods: Series of six patients presenting to tertiary care pediatric or neuro-ophthalmologist. RESULTS: Five patients had ocular motility and three-step test results suggesting an IOP; one patient had a suspected bilateral IOP. All six patients had excyclotorsion of the hypotropic eye, and four had incyclotorsion of the hypertropic eye. This is contrary to that expected with an IOP (incyclotorsion of the hypotropic eye). In addition, all six patients had other neurologic findings in the history or examination that were associated with neurologic insult rather than an isolated IOP. Two patients had surgery consisting of a superior rectus recession; this was successful in eliminating diplopia in both patients and in eliminating the vertical deviation and head posturing in one patient. CONCLUSION: While many vertical deviations that appear to be due to an inferior oblique palsy based on the results of the three-step test may be caused by inferior oblique weakness, skew deviation should also be considered in any patient with a history of head trauma, or other neurologic findings. The cyclotorsion observed in IOP is opposite that seen with OTR, and differentiates the two entities clinically. We postulate that these deviations are caused by damage to the otolithic projections that correspond to those from the ipsilateral posterior semicircular canal (on the side of the hypotropic eye).- - - - - - - - - - ranking = 0.33333333333333keywords = vertical (Clic here for more details about this article) |
20/166. Bilateral asymmetric dissociated vertical deviation masquerading as unilateral double elevator palsy. A report of four cases.PURPOSE:To illuminate this difficult clinical situation and assist and improve in its diagnosis and management. methods AND STUDY: Record review. All 4 patients had a unilateral DEP and increased hyperdeviation upon tilting the head to the contralateral shoulder. Two patients had surgery to the eye with the presumed diagnosis of DEP, consisting of recession of the inferior rectus muscle in one patient and a Knapp procedure in the second patient. The other two patients had weakening surgery of the superior rectus muscle of the contralateral eye. RESULTS: The marked limitation of elevation in the eye with pseudo- DEP was either restored to normal or very satisfactorily improved. Bilateral DVD appeared in all four patients immediately after surgery. CONCLUSION: Bilateral asymmetric DVD can masquerade as unilateral DEP due to inhibitional palsy of the elevators. Meticulous diagnostic tests can reveal the DVDs.- - - - - - - - - - ranking = 0.66666666666667keywords = vertical (Clic here for more details about this article) |
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