Extraocular Movement Disorder Research Articles

Secondary Repair of Posttraumatic Enophthalmos and Extraocular Movement Disorders.

AbstractEnophthalmos, or recession of the eye posteriorly and inferiorly, is a potential sequela of orbital trauma and a source of significant cosmetic and functional concern. Late enophthalmos occurs when early reconstruction of the bony orbit fails to completely restore normal orbital shape and volume, resulting in aesthetic deformity and persistent diplopia. In this article, we provide a framework for evaluation of posttraumatic enophthalmos and outline the surgical principles of secondary repair necessary to optimize globe position. With implementation of proper craniofacial exposure, osteotomy, and orbital reconstruction, surgeons may achieve significant improvement in both the aesthetic and functional sequelae of enophthalmos.

Clinical-Radiologic Correlation of Extraocular Eye Movement Disorders: Seeing beneath the Surface.

Extraocular eye movement disorders are relatively common and may be a significant source of discomfort and morbidity for patients. The presence of restricted eye movement can be detected clinically with quick, easily performed, noninvasive maneuvers that assess medial, lateral, upward, and downward gaze. However, detecting the presence of ocular dysmotility may not be sufficient to pinpoint the exact cause of eye restriction. Imaging plays an important role in excluding, in some cases, and detecting, in others, a specific cause responsible for the clinical presentation. However, the radiologist should be aware that the imaging findings in many of these conditions when taken in isolation from the clinical history and symptoms are often nonspecific. Normal eye movements are directly controlled by the ocular motor cranial nerves (CN III, IV, and VI) in coordination with indirect input or sensory stimuli derived from other cranial nerves. Specific causes of ocular dysmotility can be localized to the cranial nerve nuclei in the brainstem, the cranial nerve pathways in the peripheral nervous system, and the extraocular muscles in the orbit, with disease at any of these sites manifesting clinically as an eye movement disorder. A thorough understanding of central nervous system anatomy, cranial nerve pathways, and orbital anatomy, as well as familiarity with patterns of eye movement restriction, are necessary for accurate detection of radiologic abnormalities that support a diagnostic source of the suspected extraocular movement disorder. ©RSNA, 2016.

A Case of Anti-GQ1b Antibody Syndrome Associated with Pure Bilateral Adie's Pupils

A 37 year-old Japanese male felt photophobia of both eyes one week following the onset of the common cold. His neurological examination revealed bilateral Adie's tonic pupils, no extraocular movement disorder, normal deep tendon reflexes, and no cerebellar signs. Based on markedly increased blood levels of anti-GQ1b IgG and anti-GT1a IgG antibodies, we diagnosed him as anti-GQ1b antibody syndrome. Bilateral Adie's tonic pupils were improved by IVIg drip infusion and methylprednisolone pulse therapy. This case suggests that we need to investigate anti ganglioside antibody when a patient presents with bilateral Adie's tonic pupils.

Customized Orbital Decompression Surgery Combined with Eyelid Surgery or Strabismus Surgery in Mild to Moderate Thyroid-associated Ophthalmopathy.

PurposeTo evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO).MethodsTwenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0).ResultsForty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ± 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5 mm postoperatively.ConclusionsThe customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.

Neurosyphilis Presenting Unilateral Oculomotor Nerve Palsy and Bilateral Pupil Involvement

Of the symptomatic disorders associated with neurosyphilis, the earliest manifestation is syphilitic meningitis. Approximately 5% of patients with secondary syphilis develop associated meningitis. Headaches, meningismus, cranial nerve palsies (chiefly, in descending order of frequency, VII, VIII, VI, and II. Here, we report a case of neurosyphilis presenting as unilateral oculomotor nerve palsy with bilateral pupil involvement (Argyll-Robertson pupil). A 43-year-old male presented with diplopia in both eyes at a neurology clinic 2 weeks before. He had right paralytic blepharoptosis, and both pupils were fixed and both pupils were not observed direct and indirect reflex and anisocoric. We observed Argyll Robertson pupil. He had 35 prisms of right exotropia, 2 prisms of right hypertropia at near and distance in the state of primary deviation and 60-prism right exotropia and 4- prism hypertropia in the state of secondary deviation. He had extraocular movement disorder in all gazes except abduction. We considered oculomotor nerve palsy associated with neurosyphilis based on the Argyll Robertson pupil. His orbit MRI suggested right oculomotor neuritis due to the presence of diffuse thickening of the right oculomotor nerve with enhancement. Finally, he was diagnosed with syphilis as a result of CSF protein 96.0, VDRL 7.5, and FTA-ABS (+) and was administered penicillin (4,000,000 units) and oral steroid (50 mg). One week after, his intraocular pressure was in the normal range. Extraocular movement examination findings were favorable as a result of 20-prism right exotropia at near and distance in the state of primary deviation and 35-prism right exotropia in the state of secondary deviation. He had extraocular movement disorder only in upper gaze. A diagnosis of neurosyphilis should be considered in patients with serologic evidence of syphilis and one or more of the following cerebrospinal fluid abnormalities; mononuclear pleocytosis, elevated protein, increased immunoglobulin G, or the presence of oligoclonal bands.

Inferior Blow-Out Fracture Reduction Using Two Urinary Balloon Catheters.

BackgroundThe reduction of orbital blowout fracture primarily aims to normalize the extra-ocular movement by returning the herniated orbital soft tissue into the original position, and to prevent enophthalmos by normalizing the orbital cavity volume. We introduce a balloon catheter-assisted orbital floor reduction technique.MethodsA retrospective review was performed for all patients with orbital floor fracture who underwent the technique described in the main body of this text. Medical records were reviewed for demographic data, clinical presentation and course, degree of enophthalmos, intraorbital volume on computed tomography scan, and postoperative outcomes. The enophthalmos and intraorbital volume of the injured site were compared to the uninjured eye and orbit.ResultsThe review identified 14 patients (11 male, 3 female). The mean preoperative difference in en-exopthalmos was 2.13 mm, while the mean orbital volume was 116%. The mean postoperative difference in en-exophthalmos had improved to 0.61 mm with a mean orbital volume of 101.85%. At the time of catheter removal at 10 days, three patients experienced diplopia (n=1), extra-ocular movement disorder (1), or enophthalmos (1). All of these had resolved by the 6-month follow-up visit.ConclusionBalloon catheter-assisted reduction of the orbital floor fractures was associated with improvements in intraorbital volume and enopthalmos in the 14 patients. Notable complications included diplopia, enophthalmos, and limited extra-ocular movement, all of which were transient in the early postoperative period and had resolved by 6-month follow up.

PReS-FINAL-2124: Electromyography assessment in localized scleroderma

Localized Scleroderma (LS) has been associated with central and peripheral nervous system involvement. Facial palsy, extra-ocular movement disorders, trigeminal neuralgia and hemi-masticatory spams are described as primary neurologic involvement. Romberg hypothesized that sympathetic regulation has pathogenic relevance in facial hemiatrophy, which was reproduced experimentally by superior cervical ganglion ablation (Resende LA et al. 1991).

Orbital Dermoid Cyst With Intratumoral Inflammatory Hemorrhage -Case Report-

An 85-year-old female presented with a 3-month history of worsening hyperlacrimation and blurred vision following blunt head injury. Her past medical history was unremarkable. Her blood examination identified no abnormal findings. Neuroophthalmological inspection revealed extraocular movement disorder and mild exophthalmos on the affected side. Her visual acuity was not disturbed. Neuroimaging showed a cystic mass located extraconally in the superolateral compartment of the anterior orbit, without enhancement by contrast medium. Surgical exploration resulted in escape of chocolate-colored, liquefied hematoma during dissection. No vascular lesion was found. A grayish-white cyst wall was found adhering strongly to the lateral and superior rectus muscles. The lacrimal gland was not identified. The mass was totally resected. Histological examination indicated dermoid cyst with inflammatory interstitial hemorrhage. No component of vascular malformation or atypia was found. Hyperlacrimation and extraocular movement improved postoperatively. We thought that the previous blunt head injury might have induced intratumoral hemorrhage in the preexisting dermoid cyst and that the escaped contents caused inflammatory irritation, resulting in the hyperlacrimation. Dermoid cyst may show atypical presentation with intratumoral hemorrhage and should always be included in the differential diagnosis of orbital tumor.

Factors predicting 30-day mortality in the Warsaw stroke registry

Poland has high mortality and morbidity due to stroke. Our prospective population-based study conducted in Warsaw in 1991-1992 showed a stroke incidence similar to other European countries. However, 30-day case mortality rates were much higher. Our aim was to explore factors predicting 30-day mortality in Warsaw. The study population consisted of all patients with first-ever-in-a-lifetime strokes admitted to the Department of Cerebrovascular Diseases during the 2-year prospective population-based stroke registry. Cases with uncertain stroke type were excluded from analysis. During the 2-year study period, 633 patients with stroke were registered (462 with first-ever-in-a-lifetime stroke); 351 of them completed full diagnostic procedures, and 297 were diagnosed with ischemic stroke (IS) and 54 with intracerebral hemorrhage (ICH). A logistic regression model for IS identified 7 independent variables predicting 30-day mortality: increasing age, decreased consciousness at the onset of stroke, extraocular movement disorder, severity of motor weakness, congestive heart failure, kidney diseases, and chronic obstructive pulmonary diseases (COPD). A logistic regression model for ICH identified two independent predictor variables: extraocular movement disorders and decreased consciousness. Comparison of the Warsaw Stroke Registry with the Stroke Data Bank (SDB) revealed higher prevalences of heart disease (angina and atrial fibrillation) and COPD in the Warsaw population. Comorbidity of medical diseases with stroke probably contributed to higher mortality in the Warsaw as opposed to U.S. Disorders of consciousness at the onset of stroke were more severe in Warsaw than in the U.S. Stroke type, severity of weakness score, and severity of stroke scale were similar for the SDB and Warsaw populations. In Poland, high levels of medical comorbidity rather than stroke severity probably account for poor short-term prognosis in stroke.

Pseudo-sixth-nerve palsy with thalamo-mesencephalic junction lesion Report of two cases

Unilateral pseudo-six sign is a rare extraocular movement disorder. In this study, the authors present the clinical symptoms and CT scans of two cases with pseudo-six sign due to a metastatic lesio...