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Missouri Medicine 2022Thyroid eye disease (TED) is an immune mediated infiltration and inflammation of the orbital and periorbital soft tissues leading to facial disfigurement. Classically...
Thyroid eye disease (TED) is an immune mediated infiltration and inflammation of the orbital and periorbital soft tissues leading to facial disfigurement. Classically broken into two "phases," active inflammatory and quiescent, disease modifying therapy and surgical intervention are used to improve a number of clinical aspects of TED. Many medical modalities have been utilized to halt the inflammatory phase of the disease including steroids, orbital radiation, and targeted steroid-sparing chemotherapy. Teprotumumab is currently the only Federal Drug Administration approved therapy for the treatment of TED. Significant improvements in proptosis, diplopia and quality of life are noted following its 24-week course of therapy.
Topics: Antibodies, Monoclonal, Humanized; Diplopia; Graves Ophthalmopathy; Humans; Quality of Life
PubMed: 36033157
DOI: No ID Found -
La Revue Du Praticien May 2023
Topics: Humans; Diplopia
PubMed: 37309799
DOI: No ID Found -
Current Opinion in Ophthalmology Nov 2022We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We... (Review)
Review
PURPOSE OF REVIEW
We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus.
RECENT FINDINGS
Efferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described.
SUMMARY
Observed neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.
Topics: COVID-19; Cranial Nerve Diseases; Diplopia; Humans; Nystagmus, Pathologic; Ocular Motility Disorders
PubMed: 36165417
DOI: 10.1097/ICU.0000000000000904 -
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 -
Tidsskrift For Den Norske Laegeforening... Jan 2021Syphilis is a sexually transmittable infectious disease caused by the spirochaete Treponema pallidum, which classically causes symptoms in three stages.
BACKGROUND
Syphilis is a sexually transmittable infectious disease caused by the spirochaete Treponema pallidum, which classically causes symptoms in three stages.
CASE PRESENTATION
A previously healthy male in his thirties was admitted to our department after suffering from diplopia and unilateral ptosis for two days. Clinical examination revealed a left-sided oculomotor palsy with an ipsilateral ptosis. Supplementary cerebral computer tomography with angiography and magnetic resonance imaging was normal except for lymphadenopathy in the neck and mediastinum. As the patient was homosexual, we chose to test for HIV. The doctor on duty, being from Belarus where syphilis was recognised as endemic during her studies, also screened for syphilis. The HIV test was negative, while the syphilis test was positive. Lumbar puncture showed moderate pleocytosis and positive serology for syphilis, confirming the diagnosis of neurosyphilis. The patient recovered fully after a course of penicillin.
INTERPRETATION
Even though syphilis remains uncommon in Norway, the incidence has been increasing in recent decades, especially in male homosexual communities. Patients may subsequently present with a diversity of symptoms.
Topics: Diplopia; Female; Humans; Male; Neurosyphilis; Norway; Syphilis; Syphilis Serodiagnosis; Treponema pallidum
PubMed: 33433108
DOI: 10.4045/tidsskr.19.0728 -
Medicine Jan 2023To investigate the clinical features of ocular myasthenia gravis (OMG) in ophthalmology. A total of 28 patients with ptosis or diplopia who were followed for at least 6...
To investigate the clinical features of ocular myasthenia gravis (OMG) in ophthalmology. A total of 28 patients with ptosis or diplopia who were followed for at least 6 months between March 2016 and February 2022 were included in this study. The clinical symptoms of the patients and test results were analyzed. According to the positivity of serologic or electrophysiologic test, these patients were divided into 2 groups (positive and negative OMG results) and according to the clinical symptoms of diplopia or ptosis for comparison. Ptosis, diplopia, and both ptosis and diplopia were present in 6 (21.43%), 14 (50.0%), and 8 (28.57%) patients, respectively. Acetylcholine receptor auto-antibody (AchR Ab) was positive in 16 (57.14%) of 28 patients and the ice test was positive in 13 (92.86%) of 14 patients with ptosis. Abnormal thymic lesions were presented in 7 (25.0%) patients, and a definite improvement in response to pyridostigmine was observed in 27 (100.0%) patients. Both ptosis and diplopia were significantly higher in the group with positive results than that in the negative results group (P = .025). In addition, both horizontal and vertical diplopia was significantly higher in the group with AchR Ab titer > 5.0 than that in the group with AchR Ab titer < 5.0 (P = .041). After excluding cranial nerve palsy, if there is ptosis and diplopia, especially vertical diplopia, the possibility of OMG should be considered.
Topics: Humans; Diplopia; Ophthalmology; Retrospective Studies; Myasthenia Gravis; Blepharoptosis; Receptors, Cholinergic; Autoantibodies
PubMed: 36637960
DOI: 10.1097/MD.0000000000031972 -
Journal of AAPOS : the Official... Apr 2021To evaluate the characteristics of diplopia in children at a single tertiary eye care center.
PURPOSE
To evaluate the characteristics of diplopia in children at a single tertiary eye care center.
METHODS
The medical records of patients with diplopia onset at age 18 years or younger presenting during the period 2015-2018 were reviewed retrospectively. Demographic information, clinical characteristics, diagnoses, treatment, and outcome data were collected. The exact χ test was used to compare groups and select post hoc analyses were performed using the Fisher exact or exact χ tests.
RESULTS
A total of 244 patients (average age, 12.2 years at presentation) were included. The most common clinical diagnoses were nonparalytic strabismus (49.2%), trauma (9.4%), and cranial nerve palsies (9%). There was no statistically significant difference in median age of diplopia onset in those with nonparalytic strabismus, cranial nerve palsies, and vision- or life-threatening conditions. There was a statistically significant difference in timing of onset of diplopia at presentation in vision- or life-threatening conditions compared to nonparalytic strabismus (P < 0.0001) and cranial nerve palsies (P = 0.01) and for neurologic symptoms in vision- or life- threatening conditions compared to nonparalytic strabismus (P = 0.032) and cranial nerve palsies (P = 0.0051). In patients with more than one neurologic symptom, the majority (58.3%) had a vision- or life-threatening condition. Initial interventions included observation (28.7%), prisms (18.4%), updating refractive correction (14.3%), and strabismus surgery (11.1%). In patients with follow-up data, 5.3% had resolution of diplopia prior to their clinic visit, and 46.6% had resolution after initial intervention.
CONCLUSIONS
In our study cohort, most children who presented with diplopia had nonemergent conditions. In those with life-threatening conditions, diplopia tended to have an acute onset and associated neurologic signs and visual symptoms.
Topics: Adolescent; Child; Diplopia; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Retrospective Studies; Strabismus
PubMed: 33857602
DOI: 10.1016/j.jaapos.2020.10.015 -
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 -
Clinical & Experimental Ophthalmology Mar 2021Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a... (Review)
Review
Thyroid eye disease (TED) is a debilitating, vision threatening disease that dramatically alters patients' quality of life. Until recently, the management of TED is a long arduous course with supportive therapy, followed by an extensive surgical treatment plan to reverse the disease endpoints. Teprotumumab offers an early, safe therapeutic intervention to help reverse disease end points such as diplopia and proptosis and improve quality of life.
Topics: Diplopia; Exophthalmos; Graves Ophthalmopathy; Humans; Quality of Life
PubMed: 33484076
DOI: 10.1111/ceo.13899 -
Annals of Emergency Medicine Nov 2023
Topics: Female; Humans; Diplopia
PubMed: 37865488
DOI: 10.1016/j.annemergmed.2023.05.021