-
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 -
JAMA Neurology Sep 2022
Topics: Aged; Blepharoptosis; Diplopia; Female; Humans
PubMed: 35877088
DOI: 10.1001/jamaneurol.2022.1982 -
Survey of Ophthalmology 2019A 74-year-old woman experienced chronic painless progressive binocular horizontal diplopia for 2 years. Initial examination showed a visual acuity of 20/20 OU. External...
A 74-year-old woman experienced chronic painless progressive binocular horizontal diplopia for 2 years. Initial examination showed a visual acuity of 20/20 OU. External and slit lamp examination was unremarkable. Orthoptic evaluation showed an incomitant esotropia, a small vertical strabismus, and a large degree of excyclotorsion. Investigation revealed a diagnosis of diffuse large B-cell lymphoma.
Topics: Aged; Diplopia; Esotropia; Eye Neoplasms; Female; Humans; Lymphoma, Large B-Cell, Diffuse; Strabismus
PubMed: 30385270
DOI: 10.1016/j.survophthal.2018.10.006 -
Current Opinion in Ophthalmology Nov 2020To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19), documented in the literature thus far. (Review)
Review
PURPOSE OF REVIEW
To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19), documented in the literature thus far.
RECENT FINDINGS
A small but growing literature documents cases of new onset neuro-ophthalmic disease, in the setting of COVID-19 infection. Patients with COVID-19 have experienced acute onset vision loss, optic neuritis, cranial neuropathies, and Miller Fisher syndrome. In addition, COVID-19 increases the risk of cerebrovascular diseases that can impact the visual system.
SUMMARY
The literature on COVID-19 continues to evolve. Although COVID-19 primarily impacts the respiratory system, there are several reports of new onset neuro-ophthalmic conditions in COVID-infected patients. When patients present with new onset neuro-ophthalmic issues, COVID-19 should be kept on the differential. Testing for COVID-19 should be considered, especially when fever or respiratory symptoms are also present. When screening general patients for COVID-19-associated symptoms, frontline physicians can consider including questions about diplopia, eye pain, pain with extraocular movements, decreased vision, gait issues, and other neurologic symptoms. The presence of these symptoms may increase the overall probability of viral infection, especially when fever or respiratory symptoms are present. More research is needed to establish a causal relationship between COVID-19 and neuro-ophthalmic disease, and better understand pathogenesis.
Topics: Animals; Betacoronavirus; COVID-19; COVID-19 Testing; Clinical Laboratory Techniques; Coronavirus Infections; Diplopia; Eye Pain; Humans; Optic Neuritis; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 33009081
DOI: 10.1097/ICU.0000000000000707 -
Military Medicine Jun 2020Diplopia and strabismus are known complications after corneal refractive surgery (CRS). Within the U.S. Armed Forces, refractive surgery is used to improve the...
INTRODUCTION
Diplopia and strabismus are known complications after corneal refractive surgery (CRS). Within the U.S. Armed Forces, refractive surgery is used to improve the operational readiness of the service member, and these complications could cause significant degradation to their capability. This study was performed in order to identify the incidence of strabismus and diplopia following CRS within the U.S. Military Health System.
METHODS
A retrospective review of all patients who underwent photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) in the Department of Defense from January 2006 through September 2013 was designed and approved by the Naval Medical Center Portsmouth Institutional Review Board. The military health system data mart was queried for all patients who underwent one of these procedures and subsequently had an International Classification of Disease-9 code for any strabismus or diplopia through 2014 allowing at least 1 year of follow-up. We then calculated the incidence of both diplopia and strabismus for these procedures as the primary measure and the overall prevalence as a secondary measure.
RESULTS
A total of 108,157 patients underwent PRK or LASIK during our study period with 41 of these patients subsequently having a diagnosis of diplopia or strabismus. After chart review, 16 of these patients were excluded resulting in 25 patients for inclusion in either the strabismus (23 patients, 0.02%) or diplopia (3 patients, 0.003%) cohorts with one patient having both. Of the 23 patients with postoperative strabismus, 4 were new cases giving an incidence of 0.004% and 2 new cases of diplopia for an incidence of 0.002%.
CONCLUSION
Diplopia and strabismus are rare complications after CRS in the U.S. military population. These procedures continue to increase the operational readiness of our service members with minimal risk of these potentially debilitating complications. Overall, this study provides support for the continued use of PRK and LASIK despite study limitations related to the use of large databases for retrospective review. Future prospective studies using delineated preoperative and postoperative examinations with sensorimotor testing included may be able to resolve the limitations of this study.
Topics: Cornea; Diplopia; Humans; Keratomileusis, Laser In Situ; Lasers, Excimer; Photorefractive Keratectomy; Prospective Studies; Retrospective Studies; Strabismus
PubMed: 31808933
DOI: 10.1093/milmed/usz395 -
Revue Medicale de Liege Jul 2020We report the story of an 11-year-old girl admitted to the emergency room for diplopia and divergent squint. Promptly apparead a fluctuating ptosis, a nasal voice and...
We report the story of an 11-year-old girl admitted to the emergency room for diplopia and divergent squint. Promptly apparead a fluctuating ptosis, a nasal voice and swallowing disorders, evoking the diagnosis of autoimmune myasthenia. The latter has been confirmed with electromyogram. Treatment with corticoids, plasmapheresis and pyridostigmine allowed symptoms control. Thymectomy by left thoracoscopy, non-robot assisted, was performed 6 months after the appearance of the first clinical signs for the purpose of remission.
Topics: Adrenal Cortex Hormones; Child; Diplopia; Female; Humans; Myasthenia Gravis; Thoracoscopy; Thymectomy
PubMed: 32779904
DOI: No ID Found -
Journal of AAPOS : the Official... Oct 2022The postoperative diplopia test (PODT) is used to assess the risk of postoperative diplopia in older children and adults prior to strabismus surgery for nonfunctional...
BACKGROUND
The postoperative diplopia test (PODT) is used to assess the risk of postoperative diplopia in older children and adults prior to strabismus surgery for nonfunctional reasons. The purpose of this study was to evaluate the test-retest and interobserver reliability of the PODT and its predictive value in assessing diplopia risk.
METHODS
In the first phase of this study, the repeatability of the PODT method was prospectively assessed with two groups of patients (group 1, test-retest; group 2, interobserver). In the second phase, notes were reviewed retrospectively to evaluate the predictive value of the PODT.
RESULTS
For phase 1, 39 participants were recruited. In group 1, 12 participants showed agreement in the area of suppression for both near and distance fixation; 8 showed variability. In group 2, 10 showed agreement for near, and 9 showed variability; 9 showed agreement for distance, and 10 showed variability. Group 1 differences ranged from 0 to 9 points (median, 0.5; IQR, 0-3); group 2, from 0 to 36 points (median, 1; IQR, 0-4.5). In phase 2, outcomes of 39 strabismus surgeries were reviewed: none of the patients without diplopia on PODT and 2 of 14 patients with diplopia on PODT had persistent diplopia 3 months after surgery.
CONCLUSIONS
Many patients develop diplopia postoperatively, but this generally resolves spontaneously. Current testing procedures have excessive test-retest and interobserver variability and insufficient predictive value to be useful in predicting postoperative diplopia.
Topics: Adult; Child; Humans; Diplopia; Strabismus; Retrospective Studies; Reproducibility of Results; Oculomotor Muscles; Treatment Outcome; Ophthalmologic Surgical Procedures
PubMed: 36156298
DOI: 10.1016/j.jaapos.2022.07.011 -
European Journal of Ophthalmology Jul 2023To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and...
PURPOSE
To compare the surgical outcomes of endoscope-navigation (EN)-assisted orbital decompression and non-EN-assisted orbital decompression for Graves' orbitopathy (GO) and to assess the potential clinical advantage of EN in orbital decompression surgery.
METHODS
This retrospective cohort study was performed on 227 orbits of 147 GO patients who underwent EN-assisted orbital decompression (185 orbits) or non-EN-assisted orbital decompression (42 orbits). Assessment included proptosis reduction, best-corrected visual acuity (BCVA), diplopia, ocular restriction and surgical complications.
RESULTS
The proptosis reduction in the EN group was 0.9 mm greater than that in the non-EN group in the entire cohort ( = 0.004) and 1.0 mm greater than that in the non-EN group in the propensity score matching cohort ( = 0.025) at 2 years postoperatively. In all, 78.2% of orbits with sight-threatening GO in the EN group and 52.6% of orbits in the non-EN group showed BCVA improvement ( = 0.026). The proportion of patients with improvement in diplopia was significantly greater in the EN group than in the non-EN group ( = 0.026).
CONCLUSIONS
EN offers anatomical localization and deep-seated tissue visualization in orbital decompression and significantly improves the surgical outcomes for GO.
Topics: Humans; Graves Ophthalmopathy; Diplopia; Retrospective Studies; Treatment Outcome; Decompression, Surgical; Orbit; Exophthalmos; Endoscopes
PubMed: 36718496
DOI: 10.1177/11206721231152628 -
Journal of AAPOS : the Official... Dec 2020To investigate the likelihood of surgeons performing lower blepharoplasties having cases of diplopia persisting for more than 1 week after surgery.
PURPOSE
To investigate the likelihood of surgeons performing lower blepharoplasties having cases of diplopia persisting for more than 1 week after surgery.
METHODS
An anonymous survey (13 questions) on the frequency and characteristics of persistent diplopia (lasting >1 week) after lower blepharoplasty was sent to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery.
RESULTS
Of 703 members, 371 (52.8%) responded to the survey. Of these, 86 (23.2%) had at least 1 case of persistent diplopia following lower blepharoplasty. Complete data were available for 84 of the 86 physicians. The inferior oblique muscle was involved in 51 cases (61%), the inferior rectus muscle in 7 cases (8%), both the inferior oblique and inferior rectus muscles in 4 cases (5%), and the muscle involved was not identified in 22 patients (26%). The diplopia was paretic in 49 patients (58%) and restrictive in 35 (42%). The diplopia persisted in primary position in 7 patients (8%), in gaze positions other than primary position in 16 patients (19%), and resolved completely in 61 patients (73%).
CONCLUSIONS
There is a significant chance of surgeons performing lower blepharoplasties having at least 1 case of diplopia lasting over a week postoperatively. Our survey results indicate that this complication may be more common than is suggested by the medical literature.
Topics: Blepharoplasty; Diplopia; Eyelids; Humans; Oculomotor Muscles; Surveys and Questionnaires
PubMed: 33246110
DOI: 10.1016/j.jaapos.2020.07.017 -
Journal of Binocular Vision and Ocular... 2022The evaluation and management of vertical strabismus is more challenging and nuanced than that of horizontal strabismus. Vertical strabismus often results from a variety...
The evaluation and management of vertical strabismus is more challenging and nuanced than that of horizontal strabismus. Vertical strabismus often results from a variety of restrictive or paretic causes, which can be further characterized as either acquired or congenital. In some cases, identifying the correct etiology of the strabismus can mean uncovering a potentially life-threatening condition, such as a brain tumor or stroke. The keys to identifying the correct diagnosis are, first and foremost, a careful history, and secondly, a detailed examination. The characteristics, etiologies, and evaluation of vertical strabismus will be reviewed here.
Topics: Humans; Diplopia; Strabismus
PubMed: 36279479
DOI: No ID Found