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Journal Francais D'ophtalmologie Oct 2016Neuro-ophthalmic emergencies can cause life-threatening or sight-threatening complications. Various conditions may have acute neuro-ophthalmic manifestations, including... (Review)
Review
Neuro-ophthalmic emergencies can cause life-threatening or sight-threatening complications. Various conditions may have acute neuro-ophthalmic manifestations, including inflammatory or ischemic processes, as well as tumoral, aneurysmal compression or metabolic and systemic diseases. Diplopia related to a partial third nerve palsy with pupillary involvement may reveal an intracranial aneurysm. Abnormalities of conjugate gaze may reveal an inflammatory or ischemic lesion, most often of the brainstem. An intracranial tumor may also manifest itself as a single or multiple oculomotor palsy, or causing various visual field defects, due to optic nerve, chiasm or retrochiasmal involvement. Arteritic anterior ischemic optic neuropathy may be the first manifestation of giant cell arteritis, prompting rapid treatment with steroids to prevent contralateral involvement. A (painful) Horner syndrome may be the presenting sign of carotid dissection, or it may be a sign of a central or thoracic sympathetic lesion. Beyond these classical emergencies, this non-exhaustive review will also present more rare clinical situations, describing novel algorithms for quick recognition and prompt intervention in acute neuro-ophthalmology.
Topics: Diagnosis, Differential; Diplopia; Emergencies; Giant Cell Arteritis; Humans; Oculomotor Nerve Diseases; Optic Nerve Diseases; Optic Neuropathy, Ischemic; Vision Disorders
PubMed: 27639495
DOI: 10.1016/j.jfo.2016.05.003 -
Journal of Binocular Vision and Ocular... 2018To determine the patient characteristics, patterns in presentation and incidences of the various etiologies in adult patients with the chief complaint of double vision.
PURPOSE
To determine the patient characteristics, patterns in presentation and incidences of the various etiologies in adult patients with the chief complaint of double vision.
DESIGN
Retrospective review.
SUBJECTS
All persons greater than 18 years of age who presented to a single provider (DG) in a nonacademic private practice over a 2-year period, from 2011 to 2013, with the chief complaint of double vision. The provider is part of a multispecialty eye care group practice with both ophthalmologists and optometrists. This group practice provides a large adult referral base.
METHODS
Examination for each patient included refraction, versions, alignment in different positions of gaze at distance and at near, binocular sensory testing, neuro-ophthalmologic examination, and dilated fundus examination if not recently documented. Alignment was measured with cover-uncover testing and alternate cover testing with prism bars or free prisms, using Snellen letters for fixation. Appropriate refractive correction was ensured. Alignment was measured in the primary position at distance and in gaze directed 20 degrees L, R, up, and down. The near deviation was measured in the reading position with the large letters on a near card for fixation. Sensory testing was performed with the Worth 4-dot at distance and near and with the Titmus stereopsis test. Vectograph testing was also performed at distance on many patients, particularly those with small-angle deviations. The prismatic correction necessary to correct diplopia subjectively at distance in the primary position and at near in the reading position was also recorded.
PRIMARY OUTCOME
Ocular alignment and etiology of diplopia. Management, response to treatment, and outcome were also recorded.
RESULTS
A total of 125 patients were included in the analysis. Subjects ranged from 18 to 93 years of age. Most cases of idiopathic strabismus were in the elderly, but the age range varied with category of underlying strabismus. Small-angle HT was the most common type of strabismus, comprising 21% of all subjects. ET, usually of the divergence insufficiency type (20%); XT (14%); and palsies not including trochlear palsy (12%) and trochlear palsy (8%) were the next most common etiologies. No strabismus was found in 11% of subjects.
CONCLUSIONS
Most cases of diplopia in adults presenting as an outpatient can be classified into a few categories based on their type of strabismus. These categories of strabismus share typical age ranges and features. While diplopia in adults is usually idiopathic, diplopia can be the presenting sign of serious underlying pathology. Thus, a thorough history; examination; and, in some cases, diagnostic testing is necessary.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Depth Perception; Diplopia; Female; Humans; Incidence; Male; Middle Aged; Refraction, Ocular; Retrospective Studies; Risk Factors; Vision, Binocular; Visual Acuity
PubMed: 30196786
DOI: 10.1080/2576117X.2018.1481265 -
Journal of Neurology Feb 2023The etiologic distribution and clinical features of diplopia may differ according to the specialties involved in the management. This study aimed to establish the... (Review)
Review
BACKGROUND AND OBJECTIVES
The etiologic distribution and clinical features of diplopia may differ according to the specialties involved in the management. This study aimed to establish the clinical features and underlying etiologies of diplopia by recruiting patients from all departments.
METHODS
We reviewed the medical records of 4127 patients with diplopia as the chief complaint, who had been recruited from all departments at Seoul National University Bundang Hospital, Seongnam, Republic of Korea, from 2003 to 2020.
RESULTS
Diplopia was binocular in 3557 (94.2%) and monocular in 219 (5.8%) patients. The common causes of binocular diplopia included microvascular (n = 516, 14.5%), strokes (n = 412, 11.6%), neoplastic (n = 304, 8.5%), myasthenia gravis (n = 253, 7.1%), traumatic (n = 240, 6.7%), and decompensated phoria (n = 232, 6.5%), and comprised more than a half of the causes. Patients with binocular diplopia were usually managed by neurologists (2549/3557, 71.7%), followed by ophthalmologists (2247/3557, 63.2%), emergency physicians (1528/3557, 43.0%), neurosurgeons (361/3557, 10.1%), and others (271/3557, 7.6%). The etiologies of binocular diplopia differed markedly according to the patients' age and the specialties involved in the management (p < 0.001).
CONCLUSIONS
Given the differences in the etiologic distribution of diplopia according to the patients' age and the specialties involved in the management, the results of previous reports on the characteristics and etiology of diplopia, primarily performed in a single specialty department, should be interpreted with a possible selection bias.
Topics: Humans; Diplopia; Vision, Binocular; Strabismus; Referral and Consultation; Hospitals
PubMed: 36355187
DOI: 10.1007/s00415-022-11471-7 -
Current Opinion in Neurology Feb 2023To review several etiologies of nonneurologic diplopia that the neurologist should be familiar with. The pathophysiology, clinical presentation, neuroimaging findings,... (Review)
Review
PURPOSE OF REVIEW
To review several etiologies of nonneurologic diplopia that the neurologist should be familiar with. The pathophysiology, clinical presentation, neuroimaging findings, and treatment options are briefly summarized for each condition.
RECENT FINDINGS
Certain etiologies for diplopia can be associated with life-threatening neurologic conditions and should be investigated thoroughly for proper localization and immediate management of the underlying disease. However, nonneurological causes of binocular diplopia are very common and disabling, but are often nonemergent and may not require in-depth investigation or neuroimaging. Some of the etiologies of nonneurologic diplopia mimic cranial nerve palsies, making them confusing to evaluate when the physician is not familiar with these etiologies. Unfamiliarity with these diagnoses can lead to unnecessary neuroimaging, inefficient utilization of medical resources, and undue alarm to the patient. Recent advances in clinical diagnostic tools and neuroimaging have clarified our understanding of the diverse underlying mechanisms of nonneurologic binocular diplopia.
SUMMARY
Diplopia can be a difficult symptom for the neurologist to evaluate. A systematic approach to the evaluation of diplopia can help establish the urgency and necessity of an extensive workup.This review will help to familiarize the neurologist with nonneurological causes of binocular diplopia, minimize expensive and unnecessary evaluations, and reassure patients and physicians alike.
Topics: Humans; Diplopia; Neurologists; Neuroimaging
PubMed: 36630211
DOI: 10.1097/WCO.0000000000001129 -
La Revue Du Praticien May 2023
Topics: Humans; Diplopia
PubMed: 37309799
DOI: No ID Found -
Current Opinion in Neurology Feb 2021Thyroid eye disease (TED) is a disfiguring disease that can lead to neuro-ophthalmic manifestations including diplopia and optic neuropathy. The aim of this review is to... (Review)
Review
PURPOSE OF REVIEW
Thyroid eye disease (TED) is a disfiguring disease that can lead to neuro-ophthalmic manifestations including diplopia and optic neuropathy. The aim of this review is to shed light on the diagnosis of TED based on clinical examination findings and diagnostic imaging. We will also discuss gold standard as well as newly emerging therapies for TED.
RECENT FINDINGS
We discussed diagnostic criteria for TED and differentiating TED from other causes of binocular diplopia. We also reviewed the pathophysiology and differential diagnoses for dysthyroid optic neuropathy as well as recent developments on controversial causes. New imaging techniques are available for evaluation and prognosis of TED comorbidities. Most of the recent developments in TED have been focused on new treatment modalities that have thus far had promising results. We reviewed recently approved and novel potential therapies that are helpful in treating both diplopia and dysthyroid optic neuropathy.
SUMMARY
TED is a complicated disorder with many clinical manifestations as well as treatment modalities. Our aim of this review was to outline new developments in the diagnosis and management of TED.
Topics: Diagnostic Techniques, Ophthalmological; Diplopia; Graves Ophthalmopathy; Humans; Optic Nerve; Optic Nerve Diseases; Therapies, Investigational
PubMed: 33278144
DOI: 10.1097/WCO.0000000000000894 -
PloS One 2023To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)).
PURPOSE
To analyze epidemiology, clinical features, and surgical outcomes of type III acute acquired concomitant esotropia (Bielschowsky esotropia (BE)).
METHODS
The medical charts of patients diagnosed with acquired concomitant esotropia between 2013 and 2021 were reviewed. Assessed data were age, gender, age at diplopia onset, age at the diagnosis, refraction, visual acuity, neuroimaging, diplopia onset, angle of deviation, stereopsis, surgical procedure, amount of surgery, and relapse of diplopia after surgery. Moreover, we investigated the correlation between the use of electronic devices and the onset of diplopia.
RESULTS
One hundred seventeen patients (mean age 35.07 ± 15.81 years) were included in the study. The mean delay to the diagnosis was 3.29 ± 3.62 years. Myopia range was 0 to 17 diopters spherical equivalent. 66,3% spent more than 4 hours a day using laptops, tablets, or smartphones at the onset of diplopia, and 90,6% presented a subacute onset. None showed neurologic signs or symptoms. Patients who underwent surgery were ninety-three, with a rate of surgical success of 93.6%, and a relapse rate of 17.2%. A negative correlation resulted between pre-operative deviation and age at diagnosis (ρ = -0.261; p<0.05), whereas factors associated with surgical failure were older age at diplopia onset (p = 0.042) and longer delay between onset and diagnosis (p = 0.002).
CONCLUSION
We registered an outstanding increase in prevalence of BE, which could be related to the exponential increase in the use of electronic devices for professional, educational, and recreational purposes. A prompt diagnosis and an augmented dose of surgery allows good motor and sensory results.
Topics: Humans; Young Adult; Adult; Middle Aged; Esotropia; Diplopia; Oculomotor Muscles; Retrospective Studies; Ophthalmologic Surgical Procedures; Myopia; Acute Disease; Recurrence; Treatment Outcome
PubMed: 37200284
DOI: 10.1371/journal.pone.0280968 -
BMJ (Clinical Research Ed.) Nov 2015
Topics: Diagnosis, Differential; Diplopia; Humans; Vision, Binocular; Vision, Monocular
PubMed: 26581615
DOI: 10.1136/bmj.h5385 -
Annals of Emergency Medicine Nov 2023
Topics: Female; Humans; Diplopia
PubMed: 37865488
DOI: 10.1016/j.annemergmed.2023.05.021 -
Journal of Binocular Vision and Ocular... 2022Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of... (Review)
Review
Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of the condition is due to prolapse of the supero-temporal aspect of the myopic globe causing displacement of the lateral and superior rectus muscles inferiorly and nasally, respectively. Treatments for heavy eye syndrome often target this anatomical defect and seek to re-place the globe within the extraocular muscle cone. This review will discuss current theories of pathogenesis and treatment of heavy eye syndrome.
Topics: Adult; Humans; Esotropia; Diplopia; Magnetic Resonance Imaging; Oculomotor Muscles; Strabismus; Ocular Motility Disorders; Syndrome
PubMed: 36279483
DOI: No ID Found