Restricted Eye Movements Research Articles

Open Reduction in Trapdoor-Type Blowout Fractures Using Absorbable Mesh Plates

In many cases of trapdoor-type orbital blowout fracture, the bony segment has a stable hinge consisting of a greenstick fracture and the sinus mucoperiosteum that is attached to the intact orbital wall. If the displaced bony segment opposite the hinge will be reduced into its original position and will be fixed onto the unaffected bone, the orbital fracture may be reconstructed via the internal fixation of the bony segment itself rather than requiring substitution with an alloplastic implant or a bone graft. A retrospective study was conducted from January 2008 to February 2010 in 34 patients with blowout fracture, via retrospective chart review, including detailed preoperative and postoperative evaluations, age, sex, symptoms, and signs, and based on the postoperative complications. The subciliary, transconjunctival, and transcaruncular approaches were used to expose the orbital floor under general anesthesia. The herniated orbital soft tissue was carefully reduced. The displaced bony segment was carefully pulled up and placed in its original anatomic position with a skin hook. A small absorbable mesh plate was inserted between the normal orbital wall and the bony segment, tangential to the edge of the bony defect at the dependent portion. Postoperative examinations such as the traction and forced duction tests showed no eye movement limitation and surgical complications. During the follow-up period, no complications occurred, and the orbital wall was accurately reconstructed in its original anatomic position, as confirmed by postoperative computed tomography scans. The advantages of internal fixation include anatomic reconstruction of the orbital wall, preservation of the original orbital bone and the mucoperiosteum of the sinus resulting in rapid wound healing and normal mucus drainage function of the sinus, simplicity of the procedure, and the absence of surgery-related complications. This technique is presented as one of the preferred treatments for trapdoor-type orbital blowout fracture.

Downward and lateral displacement of the globe with resulting diplopia after orbital roof fracture: a case report

Introduction: The orbital roof is involved in about 5% of all facial fractures. Blow-in fractures are defined as inward displacements of a fractured bony orbital wall resulting in decreased orbital volume. This type of fracture may cause proptosis, limitation of eye movement, inferior dystopia of the globe, diplopia and epiphora. Although surgery is not necessary for non-displaced and minimally displaced roof fractures, significant displacement may require early surgical treatment for appropriate orbital decompression.

Lamina-Specific Anatomic Magnetic Resonance Imaging of the Human Retina

Magnetic resonance imaging (MRI) of the human retina faces two major challenges: eye movement and hardware limitation that could preclude human retinal MRI with adequate spatiotemporal resolution. This study investigated eye-fixation stability and high-resolution anatomic MRI of the human retina on a 3-Tesla (T) MRI scanner. Comparison was made with optical coherence tomography (OCT) on the same subjects. Eye-fixation stability of protocols used in MRI was evaluated on four normal volunteers using an eye tracker. High-resolution MRI (100 × 200 × 2000 μm) protocol was developed on a 3-T scanner. Subjects were instructed to maintain stable eye fixation on a target with cued blinks every 8 seconds during MRI. OCT imaging of the retina was performed. Retinal layer thicknesses measured with MRI and OCT were analyzed for matching regions of the same eyes close to the optic nerve head. The temporal SDs of the horizontal and vertical displacements were 78 ± 51 and 130 ± 51 μm (±SD, n = 4), respectively. MRI detected three layers within the human retina, consistent with MRI findings in rodent, feline, and baboon retinas. The hyperintense layer 1 closest to the vitreous likely consisted of nerve fiber, ganglion cell, and inner nuclear layer; the hypointense layer 2, the outer nuclear layer and the inner and outer segments; and the hyperintense layer 3, the choroid. The MRI retina/choroid thickness was 711 ± 37 μm, 19% (P < 0.05) thicker than OCT thickness (579 ± 34 μm). This study reports high-resolution MRI of lamina-specific structures in the human retina. These initial results are encouraging. Further improvement in spatiotemporal resolution is warranted.

Dedifferentiated Orbital liposarcoma: a case report.

To report the abnormal type of the orbital liposarcoma-dedifferentiated subtype in a patient. A case report. A 23 years old Chinese woman with a recurrence of right-sided proptosis was evaluated. Ocular examination revealed proptosis of the right eye with chemosis, hyperemia and limitation of eye movements. Magnetic resonance imaging scanning showed an irregular shaped tumor in the right orbit. The tumor resection was done with a clinical diagnosis of malignant tumor. Histopathological findings revealed the diagnosis of dedifferentiated liposarcoma. The rare occurrence of this tumour should be kept in mind while dealing with orbital tumours.

Spontaneous orbital haemorrhage in a healthy young male

Dear Editor, Orbital haemorrhage usually occurs as a result of trauma or surgery of the orbit. It has been reported as an uncommon complication of intraorbital vascular anomalies such as arteriovenous malformation or lymphangiomas, idiopathic orbital inflammation, and blood dyscrasias [1]. Rarely, it has occurred due to barotraumas while scuba diving [2]. Spontaneous orbital haemorrhage without any referable cause, however, is extremely uncommon [3]. Variable prognoses have been reported in the literature, from complete recovery with conservative management to severe cases with poor visual outcome despite emergency surgical intervention [4]. We report a case of spontaneous orbital haemorrhage in a healthy young male who was alternatively treated with systemic corticosteroids. A 25-year-old healthy young male awoke with proptosis, haemorrhagic chemosis and ecchymosis of the upper and lower lids of the left eye (Fig.1a,b). He had had an episode of migraine attack with vomiting of mild severity 1 day previously. There was no history of trauma, blood dyscrasias, or use of medications. On examination, his visual acuity was 20/20, OD and 20/40, OS. There was left proptosis of 5 mm by Hertel measurements, which remained stable upon performing the Valsalva maneuver. His intraocular pressure by Goldmann applanation tonometry was 11 mmHg, OD and 21 mmHg, OS, while fundoscopy was normal. There was limitation of eye movement in all directions. A relative afferent pupillary defect was weakly positive in the left eye. Bruit or thrill over the orbit was negative. Colour vision as tested by the Ishihara plates was normal. Computerized tomography angiogram of the orbit and brain revealed an intraconal haematoma measuring 2.86 × 1.4 × 2.23 cm lying superior to the left lateral rectus muscle, displacing the optic nerve medially (Fig. 1c,d). There was no evidence of abnormal vascular lesions in the brain or orbit. Screening for bleeding disorders, which included platelet count, bleeding time, PT, and PTT, was normal. Treatment options including lateral canthotomy were discussed, but the patient denied any surgical intervention. Having informed the risks and benefits of corticosteroids, we decided to start treatment with oral prednisone 1 MKD tapered over 3 weeks. Daily improvement of proptosis and eye movement was noted, and visual acuity returned to 20/20 in 3 weeks with no evidence of rebleeding at 4 months. Orbital haemorrhage usually occurs as a result of trauma [4]. Patients with spontaneous orbital haemorrhage usually have an underlying cause or predisposing factor to which the haemorrhage could be attributed, most commonly arteriovenous malformations and lymphangioma in young patients [3, 5]. Computerized tomography angiogram (CTA) and magnetic resonance angiogram (MRA) are imaging modalities that can help detect these vascular anomalies. Colour Doppler imaging is another convenient diagnostic modality, which is quick and comfortable for the patient but was unfortunately unavailable at the time. Our patient had no significant predisposing factor other than vomiting, and no clear etiology was identified from systemic workup and CTA of the brain and orbit. Though the patient had volunteered that the degree of vomiting was only mild and occurred only once, we cannot conclude that this did not cause breakage of the orbital vessels. Treatment with high-dose oral corticosteroids yielded good results without need for further surgical treatment. The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review all data upon request. D. Wiwatwongwana :A. Wiwatwongwana (*) Department of Ophthalmology, Chiang Mai University, 110 Inthawarorot Street, Amphur Muang, Chiang Mai, Thailand 50200 e-mail: atchareeyaj@yahoo.com Graefes Arch Clin Exp Ophthalmol (2012) 250:1557–1558 DOI 10.1007/s00417-011-1747-0

Mitochondrial neurogastrointestinal encephalopathy in an Indian family with possible manifesting carriers of heterozygous TYMP mutation

Background Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a distinctive autosomal recessive disorder with mitochondrial alterations due to mutations TYMP gene encoding thymidine phosphorylase. Materials and methods Study of clinical and biochemical characteristics of a family with MNGIE. Results Index case was a 32 year old man presenting with recurrent vomiting, early satiety and progressive weight loss. He had ptosis, restricted eye movements, generalized muscle wasting, and absent tendon reflexes. Lactate levels were elevated in venous blood and CSF lactate. MRI brain showed diffuse leucoencephalopathy. Barium swallow showed near total obstruction at mid portion of vertical limb of duodenum with ileus. Esophageal manometry suggested myopathy. Muscle biopsy revealed moderate numbers of ragged blue and ragged red fibers as well as cytochrome c oxidase deficient fibers. An elder brother had similar symptoms and expired after a surgical procedure and a 28 year old brother has similar illness. The father had asymptomatic bilateral ptosis with mild ophthalmoparesis. The paternal grandfather and paternal aunt also had bilateral ptosis. Clinical diagnosis of MNGIE was confirmed in the two living brothers by demonstrating severe defects of thymidine phosphorylase activity in buffy coat, elevated thymidine and deoxyuridine in plasma, and a homozygous TYMP c.893 G > A mutation. Conclusions This family with biochemically and genetically confirmed mitochondrial neurogastrointestinal encephalopathy syndrome uncharacteristically included heterozygous TYMP mutation carriers manifesting extra-ocular weakness. It is important to identify MNGIE patients early because therapeutic options are emerging.

Orbital apex syndrome after tooth extraction in an immunocompromised patient.

A 60 year-old man presented with acute on set of left eye proptosis and ptosis. It was associated with poor vision, eye pain and restriction of eye movement of the same eye after 5 hours post left upper molar tooth extraction. The visual acuity in the left eye was hand movement. There was severe ptosis and proptosis of the left eye. The conjunctiva was chemotic with quite anterior chamber. The pupil was mid dilated and sluggished to light. The ocular movement was restricted in all directions. Fundoscopy of the left eye revealed features of central retinal artery occlusion with hyperaemic disc and subretinal exudates at posterior pole. The right eye appeared normal. Urgent MRI brain and orbit revealed severe left paranasal sinusitis with anterior displacement of the left globe and presence orbital abscess. Patient was managed with Otorhinolaryngology and Neurosurgery teams. He underwent emergency transnasal drainage of abscess. Histopathological examination of unhealthy sinus mucosa showed evidence of fungal infection. However, the culture and sensitivity result was inconclusive. Patient was treated with amphotericin B, ceftriaxone, amoxicillin clavulanate and metronidazole. Patient was detected to have high blood sugar level and was managed accordingly. The proptosis improved with treatment. However, his vision, ptosis and ophthalmoplegia remained static. Assessing the immunocompromised status is important for the management of patient presented as acute orbital apex syndrome to avoid fatal outcome.

Hemifacial presentation of mitochondrial myopathy

Chronic progressive external ophthalmoplegia (CPEO) is a common presentation of mitochondrial disease and is typically bilaterally symmetric. We present an unusual case of CPEO that remained unilateral and, therefore, eluded diagnosis for nearly 30 years. A 39-year-old woman presented with horizontal diplopia. She had a long standing right partial ptosis from her early twenties. There were no other neurological symptoms or relevant features in the history. Examination showed a right mild, non-fatigable ptosis, with limited adduction, elevation and depression of the right eye. The left eye and remaining ophthalmic and neurological examination were normal. Computer tomography (CT) imaging of brain and orbits was unremarkable and conservative management was pursued. Seven years later (age 46 years) the patient developed a droop of the right lower eyelid and mouth. Examination confirmed new facial weakness and the previous ptosis and ophthalmoplegia, all confined to the right side of the face (Fig. 1). There were no other neurological findings and no response to intravenous edrophonium test. Cranial CT and magnetic resonance imaging (MRI) were once again normal and the diagnosis remained elusive. Two years later, however (age 48), a limitation of depression and abduction developed in the left eye. Bilateral ophthalmoplegia now suggested the possibility of CPEO. Left triceps muscle biopsy was performed. Although there were no ragged red fibres, histochemistry demonstrated occasional cytochrome-C oxidase (COX)deficient fibres. Electron microscopy showed peripheral collections of glycogen-rich cytoplasm, containing small aggregates of mitochondria. Screening of the mitochondrial DNA for deletions using long range PCR followed by Southern blotting revealed the presence of a single large scale deletion of the mitochondrial genome. Sequencing across the deletion breakpoint confirmed the presence of the ‘‘common’’ deletion of 4,977 base pairs, with break points in the flanking repeats between nucleotide (nt) 8,470 and 8,482, and nt 13,447 and 13,459. CPEO is characterised by bilateral ptosis and global restriction of eye movements [1]. It is the commonest ocular manifestation of the mitochondrial myopathies and can occur in isolation or with additional non-ocular features [2, 3]. Diagnosis is often delayed for many years [4, 5]. In our case, two atypical features failed to suggest the diagnosis (1) the strict unilaterality of the ptosis and ophthalmoplegia for decades, and (2) the additional feature of unilateral facial weakness. Bilateral ptosis is a hallmark of CPEO and is the presenting complaint in up to 90% of cases [1]. The ptosis can be asymmetric, however [2]. Unilateral or asymmetric ptosis was noted in 11 patients out of 27 in a recent CPEO series [6]. Although unilateral or asymmetric ptosis may occur in early disease, bilateral ptosis becomes the norm as the disease progresses. Our case was very atypical because the ptosis remained unilateral throughout. Ophthalmoplegia in CPEO is usually symmetric and, in advanced cases, often complete [1]. Although asymmetric ophthalmoplegia does occur in a minority of CPEO patients [1, 7], accurate measurements of ocular motility have shown that the extent of asymmetry is very small [8]. The marked asymmetry of ophthalmoplegia in our case is therefore surprising. N. Ali (&) J. Acheson Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK e-mail: nadeem.ali@nhs.net

A Case of Posterior Reversible Encephalopathy Syndrome Presenting with Isolated Diplopia

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinical entity characterized by a unique pattern of vasogenic brain edema mainly caused by eclampsia, immune suppressing drugs, or severe hypertension. The disease typically affects parieto-occipital lobe as the nomenclature indicates. Here we report a man with isolated concomitant strabismus, who was initially suspected as having glioma but was finally diagnosed with PRES. Methods: A 43-year-old man complained of horizontal double vision for a week. He had no other neurological symptom, including headache or confusion. He had a history of hypertension but had no medication. On examination, he showed 10 to 12 prism diopter of exotropia in all gaze directions without any restriction of eye movement. The sudden onset of the symptom and the history of hypertension urged us to take head MRI, which showed poorly-demarcated T2-high intensity area in extensive brainstem and bilateral cerebellum. The image suggested a plausible diagnosis of brainstem glioma. Results: He was admitted for planning brain biopsy. Since his systolic blood pressure was over 240 mmHg, he was to undergo blood pressure control before the biopsy. As the pressure decreased to around 180 mmHg, his symptom improved gradually. The lesion diminished in 2 weeks. Finally, he was diagnosed with PRES due to hypertension judged from the clinical course. Conclusions: PRES can affect any locations in central nervous system including brainstem as shown in the present case. And of note, the patients with brainstem variant of PRES may present only minimal symptoms such as diplopia in the present case. Differentiation from tumors or infarction is very important to avoid unnecessary and invasive interventions. One useful characteristic is the clinical radiologic dissociation. Once brainstem variant of PRES is diagnosed, to monitor and control blood pressure is important because it is often caused by severe secondary hypertension.

Primary Orbital Hydatid Cyst

ABSTRACTThe authors want to highlight the importance of clinical, radiological and histopathological evaluation in unilateral proptosis. A 17-yearold male presented with left progressive nonpulsatile proptosis, lateral gaze diplopia and decreased visual acuity. It was diagnosed as orbital hydatid cyst on CT scan and MRI. The patient was successfully operated with near total recovery of the vision. Radiological investigation showed a circumscribed cystic lesion lateral to orbit separate from the lacrimal gland. Intraoperative cysts and postoperative histopathology confirmed the primary orbital hydatid cyst.Although rare there is always a possibility of a primary hydatid in patients with unilateral proptosis, restricted eye movements and lateral decreased visual acuity. This is possible even when the Casoni's test is negative. Surgical excision with postoperative albendazole is the effective treatment for the cure of disease.

Clinical Study in 10 Surgical Cases of Paranasal Sinus Disease with Visual Prognosis

Orbital complications in sinus infections occur due to the anatomical proximity of the paranasal sinuses and orbit. Delayed diagnosis and treatment may involve unfavorable morbidity and mortality. We report 10 cases—7 men and 3 women—of acute rhinosinusitis and acute exacerbation of chronic sinusitis complicating orbital symptoms in the last 5 years. Mean age at consultation was 64.6 years (54-75). Seven had undergone previous sinus surgery. The posterior ethmoid and sphenoid sinus were mainly affected. Mean preoperative visual acuity of 0.07 became 0.53 postoperatively. Restricted eye movement occurred in 1 case of good recovery. Of antibiotics, second- or third-generation cephem was used in 8 cases and carbapenem in 2. Corticosteroids were administered by pulse therapy in 5 and by tapering schedule in 4. Visual recovery occurred in 7. Unrecovered cases were likely to receive delayed surgery. We recommend initial 3-day steroid pulse therapy in subject with decreased vision, discontinued on vision recoveries. Pulse therapy should be continued in case of incomplete or poor recovery.

Orbital Floor Fracture Reconstruction Using Conchal Auricular Cartilage Graft

Orbital Floor Fracture Reconstruction Using Conchal Auricular Cartilage Graft

Orbital Floor Fracture Reconstruction using Conchal Auricular Cartilage Graft

Orbital Floor Fracture Reconstruction using Conchal Auricular Cartilage Graft

Clinical Outcome of Mild Head Injury with Isolated Oculomotor Nerve Palsy

Isolated oculomotor nerve palsy after mild head injury is rare. Only a few case reports have described the clinical presentation of these patients, and clinical and functional outcome have not been discussed in depth. The outcome of 10 patients with mild head injury in whom imaging studies ruled out other possible causes of oculomotor palsy was assessed during follow-up using the Glasgow Outcome Scale-Extended (GOSE). We suggest that limited eye movement is a major factor that negatively affects functional status after mild head injury.

Muscimol inactivation caudal to the interstitial nucleus of Cajal induces hemi-seesaw nystagmus.

Hemi-seesaw nystagmus (hemi-SSN) is a jerk-waveform nystagmus with conjugate torsional and disjunctive vertical components. Halmagyi et al. in Brain 117(Pt 4):789-803 (1994), reported hemi-SSN in patients with unilateral lesions in the vicinity of the Interstitial Nucleus of Cajal (INC) and suggested that an imbalance in projections from the vestibular nuclei to the INC was the source of the nystagmus. However, this hypothesis was called into question by Helmchen et al. in Exp Brain Res 119(4):436-452 (1998), who inactivated INC in monkeys with muscimol (a GABA(A) agonist) and induced failure of vertical gaze-holding (neural integrator) function but not hemi-SSN. We injected 0.1-0.2 microl of 2% muscimol into the supraoculomotor area, 1-2 mm dorso-lateral to the right oculomotor nucleus and caudal to the right INC. A total of seven injections in two juvenile rhesus monkeys were performed. Hemi-SSN was noted within 5-10 min after injection for six of the injections. Around the time the hemi-SSN began, a small skew deviation also developed. However, there was no limitation of horizontal or vertical eye movements, suggesting that the nearby oculomotor nucleus was not initially compromised. Limitations in eye movement range developed about (1/2)-1 h following the injections. Clinical signs that were observed after the animal was released to his cage included a moderate to marked head tilt toward the left (contralesional) side, consistent with an ocular tilt reaction. We conclude that hemi-SSN can be caused by lesions just caudal to the INC, whereas lesions of the INC itself cause down-beat nystagmus and vertical gaze-holding failure, as demonstrated by Helmchen et al. Combined deficits may be encountered with lesions that involve several midbrain structures.

Retinal manifestations of mitochondrial encephalomyopathy

Objective To observe the retinal manifestations and classification of mitochondrial encephalomyopathy,and explore the relationship between retinopathy and systemic manifestations. Method The clinical data of 88 in-patients with mitochondrial encephalomyopathy were retrospectively analyzed,in whom 12 patients (24 eyes) with retinal manifestations who diagnosed by ophthalmology consultation and complete medical records were collected. There were nine males and three females aged from 14 to 33 years with the mean age of(20. 1±7. 0)years. The disease duration ranged from 2. 5 to 20 years,with the mean of (9. 5±6. 8)years. All the patients had the eye symptoms of the different degree,such as limbs weakness, hearing decline and central nervous system symptoms. Ophthalmologic examination including best corrected visual acuity, slit lampa microscope, indirect ophthalmoscopy, non-contact Tonometer, ptosis, ocular movement,pupillary reflex and color fundus photography. Among the patients, three, one, two and five patients had undergone fundus fluorescein angiography (FFA), optical coherence tomography (OCT), lectroretinogram(ERG)and visual field examination respectively. Diabetic retinopathy were divided into salt and pepper, retinitis pigmentosa(RP), retinal pigment epithelium ( RPE), choroidal capillary atrophy and simplex optic atrophy according to the inspection results. Results All the patients' both eyes were involved,the disease degree of bilateral eyes was accordant. The ptosis and(or)eye movement limitation were found in nine patients(75.0%) ,and decreased visual acuity was in six patients(50. 0%). Salt and pepper was found in six patients(12 eyes) ,presenting retinal granular pigmentation and depigmentation;the visual acuity was 0. 4-1. 2;no central nervous system symptoms were found in patients, such as hearing decline, twitch,ataxia and hypophrenia. RP was found in one patient(two eyes) ,presenting retinal cells sample pigmentation, retinal vessel shrink, optic atrophy (the vision were light perception in both eyes;hypophrenia, hearing decline, bilateral lower limbs pain and onset twitch were also found in them. RPE and choroidal capillary atrophy were found in three patients (six eyes), the choroidal great vessels and flake pigment accumulation surrounding the retina were observed;the visual acuity was hand movement-0. 7;limbs weakness was found in two patients;hearing decline was found in three patients;barylalia and hypophrenia were found in two patients;somnolence was found in one patient. Simplex optic atrophy was found in two patients(four eyes);the vision was 0. 1-0. 7;central nervous system symptoms were found in patients,such as limbs weakness, twitch, hypophrenia and headache. Conclusion Retinopathy types is concerned with visual prognosis and central nervous system symptoms. Key words: Retinal disease/etiology; Mitochondrial encephalomyopathies/complications; Mitochondrial encephalomyopathies/diagnosis

Surgical Management of Orbital Trapdoor Fracture in a Pediatric Population

Orbital trapdoor fractures are pure orbital floor fractures with herniation and entrapment of the orbital contents, leading to restricted eye movement and diplopia. Trapdoor fractures in children have been discussed widely in published reports; however, the treatment policy and outcome remain controversial, although early treatment has been advocated. Our retrospective study analyzed the long-term results of pediatric patients undergoing surgery for trapdoor fractures to determine the outcome in relation to the type of fracture and the timing and technique of intervention. The present study included 24 patients (age range 6 to 16 years) who underwent surgery for trapdoor fractures from 1998 to 2007. The demographic, etiologic, radiologic, and surgical findings, interval between trauma and surgery, surgical techniques, and complications were recorded. Diplopia, ocular motility, dysesthesia, and scar quality were recorded at follow-up. The follow-up duration averaged 36 months. At follow-up, 1 (8.3%) of 12 patients who underwent surgery within 24 hours (urgent treatment) had residual diplopia. In contrast, 3 (37.5%) of 8 patients who underwent surgery 24 to 96 hours (early treatment) and 4 (100%) of 4 who underwent surgery after 96 hours (late treatment) had diplopia. No sensory deficit of the skin or unesthetic eyelid scar was noted. We found a correlation between the outcome and the timing of surgery for trapdoor fractures in the pediatric population. The success rate was significantly better when the fractures were treated within 24 hours of the injury. The results of the present study have strengthened the assertion that trapdoor orbital fractures pose a true surgical emergency.

Integrating central and peripheral information during object categorization

The integration of visual information across saccades when processing a complex scene is affected by many factors. A large amount of high resolution information at the center of fixation is sequentially added to the stored results of recent fixat ions. In addition, contextual knowledge of the coherent image as well as peripheral visual information influences this process. We began to investigate this integration of visual information by reducing the complexity of the task in three ways. First, we eliminated contextual information by showing random pairs of object images. Second, we restricted eye movements with short presentation times. Third, we restricted the access to peripheral information away from fixation by sequential presentation of information.

The effects of limited eye movements on judgments of emotion of band pass filtered faces

The effects of limited eye movements on judgments of emotion of band pass filtered faces

The effects of limited eye movements on judgments of emotion of band pass filtered faces

The effects of limited eye movements on judgments of emotion of band pass filtered faces