Abstract
Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud's syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.
Highlights
Ocular motility problems are reported commonly following stroke in up to 68% of cases [1,2,3,4,5]
The Vision In Stroke (VIS) group consists of local investigators from twenty UK hospital trusts who are responsible for assessing stroke patients and collecting patient data
Of all patients referred with suspected visual impairment, 54% had ocular motility abnormalities and of these 41.5% were due to gaze abnormalities
Summary
Ocular motility (eye movement) problems are reported commonly following stroke in up to 68% of cases [1,2,3,4,5]. These problems can include cranial nerve palsy [6], vergence and accommodative dysfunction [3], strabismus [2, 7], and nystagmus [8]. Such eye movement abnormalities can cause symptoms of diplopia, blurred vision, compensatory head. We sought in this paper to evaluate the profile of ocular gaze abnormalities following stroke in a large, prospective, observation study of stroke survivors with visual impairment
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