Search

Neuro-optometric rehabilitation has a broad range of potential rehabilitative applications in neurological and developmental conditions affecting the eye. There is a dearth of evidence supporting its effectiveness, especially in adults. To address this issue, we systematically reviewed literature published in English between January 2000 and June 2022, obtained from search engines such as PubMed, EMBASE, Scopus, and CINAHL, using keywords including "neuro optometry," "rehabilitation" or a related term, and "oculomotor problem" or "neurological problem" or a related term. Duplicates were eliminated through Mendeley software, and the quality of the selected studies was evaluated using JBI's critical appraisal tools. Two authors independently reviewed six full-text articles. Relevant data were extracted to Microsoft Excel, and a third author reviewed it. Any uncertainties were resolved through consultation with the last author. Selected studies included adults who had oculomotor problems resulted either from traumatic brain injury/stroke/cerebrovascular accidents and managed with various rehabilitative therapies. Office-based, home-based, or combination therapies with duration ranging from 8 to 12 weeks with the frequency of 2-5 sessions/week were found effective in managing oculomotor problems in adults. However, there is a need for more clinical studies with a larger sample size in this regard. [ABSTRACT FROM AUTHOR]

Objective: Unusual clinical course. Background: Acquired synkinesis is a well-known phenomenon following oculomotor nerve injury. The abnormal movement appears within the distribution of 1 nerve, or other cranial nerves may be involved. The common misdirection of aberrant regeneration of oculomotor nerve involves the lid, extraocular muscles, or pupil. This report presents a case of aberrant connection between abducens and oculomotor nerve, which is quite rare. Case Report: A 21-year-old man with history of left-sided frontal, lateral orbital wall, and zygomatic fracture from head trauma in a motor vehicle accident presented for evaluation. He was comatose for 6 weeks in the intensive care unit. Six months later, he presented to the ophthalmology clinic for an eye examination. He had no history of eye problems prior to this accident. His best corrected visual acuity in the right eye was 20/20 and the left eye had no light perception. The right eye exam was normal, with normal ocular motility. The left eye exam showed small esotropia in primary position with markedly decreased adduction, elevation, and minimal depression, but on attempted abduction, the left eye would adduct instead. There was no globe retraction when left eye abduction was attempted. The abnormal movement seen resulted from third nerve function during sixth nerve stimulation, due to unusual ocular motility with abnormal connection between the sixth and third cranial nerves. Conclusions: The most likely pathophysiologic mechanism here is peripheral neuronal misdirection hypothesis after trauma. Careful and detailed examination of a patient presenting with unusual ocular motility after trauma is very important. The abnormal connection between the sixth and third cranial nerves is quite rare but can occur. [ABSTRACT FROM AUTHOR]

Posterior circulation stroke can present with dizziness/vertigo without other general neurological symptoms or signs, making it difficult to detect, and missed stroke can deteriorate. Therefore, a sign that can be easily identified during an examination would be helpful to improve the detection of this type of stroke. The objective of this review is to highlight an ocular sign that is seen in posterior circulation strokes called ocular lateral deviation (OLD). OLD is mostly seen in dorsolateral medullary strokes, and it is also seen in pontine and cerebellar strokes. OLD is detected by asking a patient to look straight ahead and then briefly close their eyes. Upon re-opening their eyes, the examiner will see that the eyes have deviated to one side; the patient's eyes will then make corrective saccade(s) to return to looking straight ahead. Complete eye deviation is a central sign of posterior circulation stroke. OLD is an under-recognized vestibular ocular sign of central vestibulopathies including posterior circulation stroke. The most common location is in the dorsolateral medulla, where one-third of such strokes have complete OLD. Eye deviation can also be appreciated on computed tomography or magnetic resonance imaging. OLD can be detected up to 6 months after a posterior circulation stroke. Checking for the sign of complete eye deviation in patients with dizziness/vertigo could be a simple, quick method for detecting posterior circulation stroke, and a means to improving the patients' outcome. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. Methods: Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. Results: Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22–81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0–28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. Conclusion: This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis. [ABSTRACT FROM AUTHOR]

Objective: To identify eye conditions associated to social distancing and related increase in screen time exposure on children and teenagers. Methods: Observational, descriptive and analytical study, with a cross-section design, carried out between July and August 2021, by questionnaire survey. Results: Headaches related to excessive screen time exposure were reported by 26.51% of the students surveyed, while 38.8% reported suspect convergence insufficiency. Regarding the questionnaire about dry eye, 18.8% were symptomatic and 7.5% reported hard-to-manage symptoms. Computers were the devices most used for schoolwork (71.5%), followed by cellphones on second place (66.3%). Symptomatic cases of dry eye were mostly reported by participants that did not make use of computers (36.4%). It was not possible to establish a connection between convergence insufficiency and device usage time. Those participants that reported more screen time exposure also reported an increased percentage of hard-to-manage symptoms (42.9%), regarding dry eye. Conclusion: Dry eye and convergence insufficiency symptoms were more prevalent in the surveyed population. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to review the available scientific literature on the possible relationship between the visual system and motor development in children. Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement recommendations. The review protocol is available in PROSPERO (CRD42021245341). Four different databases, namely Scopus, PubMed, CINAHL and Web of Science, were assessed from April 2005 to February 2021. To determine the quality of the articles, we used the Critical Appraisal Skills Programme (CASP) Quality Appraisal Scale, and a protocol was followed to define the levels of evidence on the basis of the Centre for Evidence‐Based Medicine Levels of Evidence. The search strategy included terms describing motor development in children and adolescents with visual disorders. Results: Among the identified studies, 23 were included in the study. All selected articles examined the relationship between the visual system and development in children. The quality of most of the studies was moderate–high, and they were between evidence levels 2 and 4. Conclusions: Our systematic review revealed that all included studies established a relationship between the visual system and development in children. However, the methods for measuring the visual system and motor skills lacked uniformity. [ABSTRACT FROM AUTHOR]

Aging is a physiological process in which there is a continuous decrease in the individual's functionality. One factor that deserves attention is the vision, given that its performance is necessary to maintain balance. The purpose of the study was to evaluate the relationship between ocular convergence with balance and risk of falls in older adults. Cross-sectional study with 26 elderly people of both sexes. Ocular convergence was assessed through the Measure of the Near Point of Convergence and with the Convergence Insufficiency Questionnaire, the balance by the MiniBEST Test, and the risk of falls by the Quick Screen. The relationship between the variables was verified through Pearson/Spearman coefficient correlation with a level of significance of p<0,05. It was found a negative, strong and significant correlation between the near point of convergence with balance (ρ= -0,530; p=0,005). It was not found a relationship between the near point of convergence with risk of falls (r= 0,182; p=0,585) and between the symptoms of visual convergence insufficiency with balance (ρ= -0,253; p=0,213) and risk of falls (r= -0,253; p=0,212). It is concluded that there is a relationship between the ocular convergence and the balance of the elderly, where the greater the distance of the near point of convergence, the worse the balance. It is suggested that the measurement of the distance is more important than the assessment of the symptoms of ocular convergence. This variable must be incorporated into the assessment of different health professionals who work with this population. [ABSTRACT FROM AUTHOR]

We intend to investigate the indications, complications, and final results of amniotic membrane (AM) transplantation in ocular motility restrictions. Surgeons have tried to prevent restrictive adhesions between the extraocular muscles and surrounding tissues because they cause unpredictable results. AM transplantation wrapping extraocular musculature has been proposed as a technique with good results for this purpose. A search was carried out in Medline, Embase, Cochrane Library and Clinicaltrial, Lilac and Ibecs databases, using the indexed terms" amnion", "strabismus," "strabismus-subheading-surgery" and "ocular motility disorders." The only exclusion criteria were studies conducted in non-humans or studies with insufficient data on eye motility. No study was discarded for analysis because of language, age or methodology. This review includes 165 patients (223 eyes), with a mean follow-up of 11.49 months. The mean age was 21 years old, 47% were males and 57% were children. 14 studies conducted in humans were eligible: 4 single case, 8 case series, 1 cohort study and 1 randomized clinical trial. In the vast majority of these papers, use of AM transplantation to treat (12 out of 14 papers) or either to prevent (2 out of 14 papers) motility restrictions or restrictive strabismus secondary to muscular adhesions. All the studies except one presents very favorable results improving postsurgical eye motility. The cryopreservation method was more widely used, presenting a good safety profile with few adverse effects in the short and medium term. Significant improvement was reported in most patients after the use of amniotic membrane transplantation to treat or prevent ocular motility limitations. Very few complications or adverse effects were documented. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is an aggressive glioma that is infrequently diagnosed in the paediatric population. GBM and other primary brain tumours have rarely been associated with paraneoplastic syndromes. We report an unusual case of an 8-year-old boy presenting with an inability to abduct his left eye and almost complete ophthalmoplegia of his right eye, prior to any radiological evidence of GBM. This is the first documented case of paediatric GBM presenting with bilateral asymmetric ophthalmoplegia. [ABSTRACT FROM AUTHOR]

To review home- and office-based vergence and accommodative therapies for treatment of convergence insufficiency (CI) in children and young adults up to 35 years of age. Literature searches were conducted through October 2020 in the PubMed database for English-language studies. The combined searches yielded 359 abstracts, of which 37 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and assigned a level of evidence rating by the panel methodologist. Of the 12 studies included in this assessment, 8 were graded as level I evidence, 2 were graded as level II evidence, and 2 were graded as level III evidence. Two of the level I studies included older teenagers and young adults; the remainder of the studies exclusively evaluated children. Two randomized controlled trials found that office-based vergence and accommodative therapies were effective in improving motor outcomes in children with symptomatic CI. However, the studies reported conflicting results on the efficacy of office-based therapy for treating symptoms of CI. Data were inconclusive regarding the effectiveness of home-based therapies (including pencil push-ups and home computer therapy) compared with home placebo. In young adults, office-based vergence and accommodative therapies were not superior to placebo in relieving symptoms of CI. Level I evidence suggests that office-based vergence and accommodative therapies improve motor outcomes in children with symptomatic CI, although data are inconsistent regarding symptomatic relief. Evidence is insufficient to determine whether home-based therapies are effective. [ABSTRACT FROM AUTHOR]

The bedside examination associated with their clinical history remains the most critical means to accurately diagnose the cause for most of the signs and symptoms related to pathology of the cerebellum and vestibular system in patients presenting with dizziness and imbalance. This paper focuses on those critical bedside examinations, suggests when laboratory testing might be useful to confirm the clinical suspicion, and considers the shared neural circuitry within the visual and vestibular systems to offer an algorithmic approach in conducting the clinical bedside examination. [ABSTRACT FROM AUTHOR]

Background: Acquired brain injury affects many brain areas and causes a range of dysfunctions including vision‐related issues. These issues can have negative impacts on rehabilitation progress and activities of daily life but may easily be overlooked. There is no common recommendation about how to assess visual impairments after ABI. The purpose of this study was to estimate the frequency of objectively measures oculomotor dysfunctions, and also how these findings are related to two inventories intended to support detection of visual impairment. Methods: The study was cross‐sectional and included 73 outpatients. In addition to the standard evaluation program, the patients went through a comprehensive optometric examination. The inventories used were the Vision Interview (VI) and the Convergence Insufficiency Symptom Survey (CISS). Results: All three types of examinations showed a high proportion vision‐related symptoms. Fusion vergence was the most common objectively measured finding, 83%. There were seven statistically significant associations between five VI items and five visual deficits. The strength of associations was moderate (Phi 0.261–0.487, p <.05). The sensitivity and specificity of the CISS were moderate. Conclusion: We found high percentages of the patients with visual symptoms and dysfunctions. Due to the complexity of visual symptoms and functional deficits in ABI, we find it necessary to combine both symptom assessment and vision examination in order to capture visual function issues. [ABSTRACT FROM AUTHOR]

Spinocerebellar ataxias (SCAs) represent a large group of heredodegenerative diseases, with great phenotypic and genotypic heterogeneity. However, in the clinical neurological practice, some symptoms and signs might help differentiate the SCAs. This study's aims were to evaluate the frequency of upward gaze palsy (UGP) and investigate its role in assisting in the clinical differentiation of SCAs. We included 419 patients with SCAs (248 with SCA3, 95 with SCA10, 38 with SCA2, 22 with SCA1, 12 with SCA7, and 4 with SCA6). This study compared UGP with other known markers of disease severity—age of onset, disease duration, SARA score, and size of CAG expansion, and also other semiologic features, as bulging eyes. This sign was significantly more prevalent in SCA3 (64.11%), compared with SCA10 (3.16%; p < 0.001) and other SCAs (SCA1, SCA2, SCA7–11.84%; p < 0.001). UGP showed very high sensibility ins SCA3 (92.9), although lacking of specificity (64.1%). The odds ratio (OR) of UGP were also very high, 23.52 (95% CI 12.38–44.69), and was significantly correlated with larger CAG expansions, age, and disease duration in SCA3 patients, but not with age of onset or severity of the ataxic syndrome. This study showed that UGP is highly suggestive of SCA3 and has high sensitivity for the differential diagnosis among SCAs, and it could be of great value for bedside semiologic tool. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to evaluate the incidence of consecutive strabismus after infantile nystagmus surgery and its potential risk factors. Methods: A retrospective study including 89 patients was conducted. Patients presented infantile nystagmus (idiopathic or ocular disease–associated nystagmus) without previous or coincidental strabismus. Sex, age at surgery, amblyopia, botulinum toxin (BT) injection before surgery, spherical equivalent, anisometropia, surgery procedure (Anderson's or retroequatorial recessions of four horizontal recti), and follow-up were analyzed. Kaplan-Meier and univariate Cox regression were performed. Results: The median age at surgery was 5 years. The median follow-up was 36 months. The incidence of consecutive strabismus was 11.2%. There were eight patients with exotropia and two patients with esotropia. Consecutive strabismus was associated with severe bilateral amblyopia (p = 0.036), previous treatment with BT injection (p = 0.025), and large recessions of the four horizontal muscles (p = 0.001). The hazard ratio for patients with severe bilateral amblyopia was 5.4 (95% CI 1.1–25.8), and for patients previously treated with BT was 6.1 (1.3–29.3). The survival rate was 95.4% at 6 months and 88.5% at 3 years. Conclusion: Severe bilateral amblyopia, previous BT treatment, and type of surgery seem to be associated with consecutive strabismus after infantile nystagmus surgery. Most cases appear within the first months after surgery. [ABSTRACT FROM AUTHOR]

Fatigue is one of the most common and disabling symptoms in multiple sclerosis (MS), but challenging to quantify. This prospective study investigated if repeated saccadic eye movements enable measurement of oculomotor fatigability and can reflect on perceived fatigue in MS. A standardized infrared oculography protocol (DEMoNS) was used for quantifying saccades in MS patients and healthy controls which included a first and a repeated pro-saccadic task (FPT and RPT). Saccadic peak velocity, latency, gain, area under the curve (AUC) and peak velocity divided by amplitude (Pv/Am) were calculated in both tasks. Perception based fatigue was assessed using the Checklist Individual Strength and the Neurological Fatigue Index (NFI). Linear regression models were used for assessing the relation between saccadic parameters and perceived fatigue. This study included 181 MS patients and 58 healthy controls subjects. From FPT to RPT, there were significant changes in saccadic parameters. Latency of both tasks was significantly related to NFI summary score (FPT: β = 0.022, p =.049, RPT: β 0.023, p =.021). These relationships were weakened after adjustment for Expanded Disability Status score (p >.05). There was however no significant group difference in changes in saccadic parameters. This study presents an objective and reproducible method for measuring saccadic fatigability. Saccadic fatigability was found to be of limited use in MS, and should be tested in conditions affecting ocular muscles or the neuromuscular junction. • Significant changes of saccadic parameters over time can be evoked • The saccadic changes are more pronounced in MS patients than in healthy controls, but not significantly different • Saccadic changes are not related to perceived fatigue in MS patients • Latency of saccades is related to perceived fatigue in MS patients • The relation of latency and perceived fatigue is influenced by disability status [ABSTRACT FROM AUTHOR]

Parinaud's oculoglandular syndrome consists of a special form of granulomatous conjunctivitis, often related to cat scratch disease, whose classic presentation is characterized by a fever, conjunctival granuloma and ipsilateral lymph node enlargement. Diseases associated with this syndrome are cat-scratch disease, herpes simplex infection, sporotrichosis, blastomycosis and coccidioidomycosis, among others. We report the case of a patient with a unilateral conjunctival enanthema on the right eye and nodules on the ipsilateral eyelid. Complementary examinations including culture confirmed the diagnosis of sporotrichosis. The patient was treated with itraconazole and got cured. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of visual discomfort and convergence failure in professors. Methods: A cross-sectional study was done, consisting of 60 teachers of both sexes, of the Centro Universitário FAG, which used the Convergence Insufficiency Symptom Survey, validated for the Brazilian population. Results: Of those surveyed 55.0% are female. 48.3% respondents spend less than two hours a day reading, with 40.0% of respondents said they do 30-minute breaks for one hour during reading and 63.3% said they spend between 2-5 hours a day in front of the computer. With regard to research on diseases of the visual system, 25.0% reported having myopia, with 55.0% of individuals use these glasses and 41.7% use it frequently. The research of the prevalence of convergence insufficiency, gave an average of 12.4(1.8) %. Conclusion: It was found that most respondents presented with visual discomfort and small percentages were affected by CI. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of visual discomfort and convergence failure in professors. Methods: A cross-sectional study was done, consisting of 60 teachers of both sexes, of the Centro Universitário FAG, which used the Convergence Insufficiency Symptom Survey, validated for the Brazilian population. Results: Of those surveyed 55.0% are female. 48.3% respondents spend less than two hours a day reading, with 40.0% of respondents said they do 30-minute breaks for one hour during reading and 63.3% said they spend between 2-5 hours a day in front of the computer. With regard to research on diseases of the visual system, 25.0% reported having myopia, with 55.0% of individuals use these glasses and 41.7% use it frequently. The research of the prevalence of convergence insufficiency, gave an average of 12.4(1.8) %. Conclusion: It was found that most respondents presented with visual discomfort and small percentages were affected by CI. [ABSTRACT FROM AUTHOR]

Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case. [ABSTRACT FROM AUTHOR]

Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case. [ABSTRACT FROM AUTHOR]

Background: Children diagnosed with some forms of strabismus were recently found to have an increased risk of developing mental illness by early adulthood. The purpose of this case-controlled study was to determine if adults with non-paralytic forms of strabismus are similarly at an elevated risk for developing mental illness. Methods: The medical records of all patients diagnosed as adults (≥19 years of age) with convergence insufficiency (CI) (n = 118), divergence insufficiency (DI) (n = 80), and small angle hypertropia (HT (n = 99) from January 1, 1985, through December 31, 2004, were retrospectively reviewed. Each case was compared with a sex- and birth date-matched non-strabismic control. The medical records were reviewed for mental health diagnoses, including inpatient and outpatient encounters, psychiatric ER visits, and medication use. Results: Mental health disorders were diagnosed in 65 (55.1%) patients with CI compared to 54 (45.8%) controls (p = 0.15), in 51 (63.8%) patients with DI compared to 42 (52.5%) controls (p = 0.15), and in 63 (63.6%) patients with HT compared to 57 (57.6%) controls (p = 0.38). CI patients were not more likely to have mental health disorders than their controls (p = 0.15). Mental health hospitalizations (p = 0.02), psychiatric medication use (p = 0.04), and unspecified anxiety disorders (p = 0.03) were higher in DI patients compared to controls. HT patients were found to have more generalized anxiety disorders (p = 0.003) than controls. Conclusions: Adults with some forms of strabismus (DI and HT) appear to have an increased risk of mental illness and its comorbidities, compared to age- and gender-matched non-strabismic controls. [ABSTRACT FROM PUBLISHER]

Objective: To delineate an algorithm of actuation designed for the attention to children and adolescents with acute torticollis and to offer them an efficient and opportune medical assistance. Development: The attention of children and adolescents with acute torticollis requires that the physician may consider a group of disorder s with different outcomes. Previously he should have a strategy for diagnosis that it may let him to arrive to quick and correct conclusions. Here is presented a proposition about the assistance to patients with acute torticollis. The principles are organized and in the first line are considered evolution characteristic of events. Next, is important the inclusion of patients in groups with common characteristics that allow to carry out an approach to a cluster of illnesses. Lastly, should be included some suggestions about key investigations in occasion of suspicion of one specific disorder or even when there is not sufficient clear orientation of what happens. Conclusions: The delineated algorithm of actuation in children and adolescents with acute torticollis may to facilitate the correct and opportune action although this proposition only constitutes an orientation. With the professional experience and knowledge, the algorithm may be modified according different situations during the attention of one pediatric patient affected by acute torticollis. [ABSTRACT FROM AUTHOR]

A 48-year-old patient with blunt periorbital trauma presented with vertical strabismus and diplopia secondary to inferior rectus muscle avulsion. After ophthalmologic and CT scan evaluation, early surgical treatment with anatomical restoration led to improvement in motility deficits with resolution of diplopia. [ABSTRACT FROM AUTHOR]

Introduction: Schwannomas of the central nervous system usually originate from the vestibular nerve and occasionally from the trigeminal nerve. Those that originate within the cavernous sinus are extremely rare and the literature is scanty. Case report: We present the report of the first case managed at our neurosurgery service of Hospital México (Costa Rica). We review the pertinent anatomy, and also the pre and post-operatory images. Conclusions: Spheno-cavernous sinus schwannomas are rare and should surgically approach by trained surgeons with a great knowledge of microsurgical anatomy and skull base surgery and also with the availability of a microsurgical lab. [ABSTRACT FROM AUTHOR]

Two female (aged 12 and 14 years) patients with horizontal gaze palsy and progressive scoliosis (HGPPS) from two different Turkish families were evaluated through ophthalmic, neurological, radiological, and orthopaedic examinations. Each proband had one affected sibling with HGPPS. Both patients had absence of horizontal eye movements and simultaneous adduction of both eyes on attempted horizontal gaze associated with miosis. One proband was observed to have this finding at age 9, which had not been present at 5 years old. Neuroradiological imaging revealed brainstem hypoplasia (split pons sign) and scoliosis. The two index patients harboured different homozygous mutations that were heterozygous in the parents, who are obligate carriers. The emergence of convergence and presence of miosis during lateral gaze suggests that simultaneous adduction occurs as a result of the convergence substitution phenomenon. Substituted convergence in cases with HGPPS may occur with different mechanisms than substituted convergence in cases with pontine lesions. [ABSTRACT FROM AUTHOR]

Horizontal conjugate gaze deviation (h-CGD) in acute vestibular syndrome (AVS) may be detected clinically or radiographically. While upright clinical ocular lateropulsion (OL) predicts central lesions, supine radiographic h-CGD does not. We sought to investigate the cause for this discordance by comparing upright to supine OL in AVS. We prospectively recorded clinical and radiographic h-CGD in 17 AVS patients. Horizontal eye position after brief eyelid closure was tested clinically following postural shifts. Radiographic h-CGD was assessed on axial magnetic resonance imaging (MRI) or computerized tomography (CT) images. All maintained central fixation with eyes open in light. OL was present in 8 (7 strokes, one central demyelination) and radiographic h-CGD in 14 (including all 6 with peripheral lesions). OL was unchanged after static postural testing. OL predicts central pathology and does not vary with postural shifts, regardless of lesion location. Radiographic h-CGD does not help localize, and this is not a positional effect. [ABSTRACT FROM AUTHOR]

Abstract: Whipple''s disease is a rare multisystemic infection caused by the intracellular bacteria Thropheryma whippelii. Central nervous system (CNS) involvement is not rare. The most frequent CNS manifestations are cognitive and behavioural changes, sopranuclear ophtalmoplegia, myoclonus, epilepsy, ataxia, meningitis and focal cerebral palsy. We report one case of cerebral localization of Whipple''s disease with a clinical presentation of recurrent endocranic hypertension and hydrocephalus, and uncommon neurological symptoms, successfully treated by endoscopic third ventriculostomy and antibiotic therapy with ceftriaxone and Trimethoprim–Sulfamethoxazole. [Copyright &y& Elsevier]

Eye movements let us fixate on and follow a moving visual target. These movements are performed by the ocular motor system that is divided according to anatomic location into infranuclear, nuclear, internuclear, and supranuclear components. It is important to distinguish supranuclear and internuclear from nuclear and infranuclear disturbances. Internuclear ophthalmoplegia is due to a lesion of the medial longitudinal fasciculus, caused by multiple sclerosis in younger patients, particularly when the ophthalmoplegia is bilateral, and usually of vascular origin in the elderly. Supranuclear disorders of eye movements are characterized by gaze palsies, tonic gaze deviation, saccadic and smooth pursuit disorders, vergence abnormalities, nystagmus, and ocular oscillations. Supranuclear disorders result from lesions above the level of the ocular motor nerve nuclei, and they account for almost 10% of all patients with disorders of eye movements. If oculocephalic maneuvers move the eyes appropriately, the lesion causing the gaze palsy is supranuclear; if oculocephalic maneuvers do not move the eyes, the lesion may be internuclear, nuclear, or infranuclear. [ABSTRACT FROM AUTHOR]

Background/Aim. Elevation in adduction is the most common pattern of vertical strabismus, and it is mostly treated with surgery. The results of weaking of inferior oblique muscle are very changeable. The aim of this study was to evaluate binocular vision using sensory tests before and one and six months after the surgery. Methods. A total of 79 children were divided in two groups: the first, with inferior oblique muscle of overaction (n = 52), and the second with dissociated vertical deviation (DVD), and primary inferior oblique muscle overaction (n = 27). We tested them by polaroid mirror test (PMT), Worth test at distance and near, fusion amplitudes on sinoptofore, Lang I stereo test and Wirt-Titmus stereo test. We examined our patients before and two times after the surgery for vertical strabismus. Results. Foveal suppression in the group I was found in 60.5% of the patients before, and in 56.4% after the surgery. In group II Foveal suppression was detected in 64.7% of the patients before, but in 55.6% 6 months after the surgery with PMT. Worth test revealed suppression in 23.5% of the patients before, and in 40.7% after the vertical muscle surgery. Parafoveal fussion persisted in about 1/3 of the patients before the surgery, and their amplitudes were a little larger after the surgery in the group I patients. Lang I stereo test was negative in 53.9% before and 51.9% after the surgery in the group I, and in 48.2% of the patients before and after the surgery in the group II patients. Wirt-Titmus stereo test was negative in 74.5% of the patients before and in 72.9% after the surgery in the group I, but in the group II it was negative in 70.8% before and in 68.0% of the patients 6 months after the surgery. Conclusion. Binocular responses were found after surgery in 65.7% of the patients the group I and in 55.6% patients the group II. There was no significant difference between these two groups, but binocular responses were more often in the patients of the group I. [ABSTRACT FROM AUTHOR]

The Harms tangent screen is used to measure incomitant ocular deviations in various positions of gaze. The test simplifies and improves the examination of complicated patterns of strabismus. Interpretation of the charted measurements provided by the test helps to plan and execute the therapy of paralytic or other incomitant strabismus. [ABSTRACT FROM AUTHOR]

Abnormal insertions are the commonest cause of congenital defects in ocular motility. In this paper, a patient with a bifid right lateral rectus muscle is presented and discussed. To the best of our knowledge this patient is the first known case of an abnormal bifid lateral rectus muscle with no systemic association. [ABSTRACT FROM AUTHOR]

PURPOSE To elucidate the etiology of an acquired, restrictive motility disorder in patients with high myopia. METHODS Thirty-three orbits were imaged using a Siemens Magnetom or Siemens Vision (both 1.5 Tesla) MRI (magnetic resonance imaging) scanner, applying a head coil. Coronal T1-weighted, spin-echo images were obtained. Orbits of three different patient groups were analyzed. Group 1 ( n = 14): patients with high axial myopia and restricted eye motility (average axial length = 31.4mm; refractive error more than - 15D). Group 2 (n = 8): subjects with high axial myopia and normal eye motility (average axial length = 29.2mm). Controls (n = 11): emmetropic subjects with normal eye motility. RESULTS Highly myopic patients showed significant displacements of recti EOMs in comparison to the controls. Mean displacements as measured in the plane 3mm anterior to the globe-optic nerve junction in primary gaze were, in group 1:lateral rectus (LR) 2.9mm (2.5 downward, 1.4 medial), medial rectus (MR) 1.3mm downward. In group 2: LR 1.4mm (1.3 downward, 0.6 medial) and MR 1.2mm downward. In both groups 1 and 2, the inferior rectus (IR) was displaced 1.3mm medially and upwards. In both groups of myopic patients the superior rectus (SR) was displaced 1.5mm medially and downwards. CONCLUSIONS In patients with high axial myopia, displacements of all recti EOMs can be detected by MRI. However, displacement of the LR into the lateral and inferior quadrant of the orbit is significantly greatest. We therefore assume LR displacement to be a major pathophysiological factor for the restrictive motility disorder in high myopia. EOM dislocations can be explained by myopia-associated alterations in the orbital connective tissues confining EOM positions in relation to the orbital wall. [ABSTRACT FROM AUTHOR]

Duane retraction syndrome is an ocular motility disorder with which an increasing number of congenital abnormalities appear to be associated. In the present paper the authors report a case of bilateral Duane retraction syndrome with an extraordinary hand abnormality. Numerous theories concerning the etiology and pathogenesis of Duane retraction syndrome and its relationship to the associated findings have been proposed, but the exact mechanism is still under investigation. Further multi-centered studies and the classification of the associated clinical findings in an organized manner may help to explain this mechanism. [ABSTRACT FROM AUTHOR]

A video technique is described to record ocular motions and positions of both eyes simultaneously in all degrees of freedom. This non-invasive method allows a 3-D positional analysis with free gaze directions and head tilts for measuring all ocular degrees of freedom, including torsion. [ABSTRACT FROM AUTHOR]

Strabismus is a condition in which the eyes are not properly aligned with each other. This article discusses various types of strabismus including esotropia, exotropia, isolated cranial nerve palsy, diplopia, thyroid eye disease, and sensory strabismus. [ABSTRACT FROM PUBLISHER]

The authors report a new anesthetic technique that is especially suitable for the surgery of complicated disorders of ocular motility. Analgesia is achieved by an intravenous dose of Remifentanil, an opioid that is normally used together with propophol as a form of total intravenous anesthesia (TIVA) for general anesthesia. The advantage of Remifentanil is a rapid increase (1-2 min.) and decrease (3-4 min.) of the effect. Eye muscle surgery can then be performed on a patient who is free of pain and slightly sedated. After the planned eye muscle surgery, while the patient is still under anesthesia, the muscle sutures are tied provisionally. Afterwards, the squint angle can be measured with a cover test and the patient is questioned about the presence of diplopia. If the position of the eye is not satisfactory, the knots can be loosened and the muscle can be fixated in another position. [ABSTRACT FROM AUTHOR]

We report the case of a 38-year-old woman with AIDS who developed opsoclonus-myoclonus-ataxia syndrome during a period different from other cases reported in literature. Opsoclonus-myoclonus-ataxia syndrome had already been reported as the initial neurological presentation of AIDS, as well as at the time of HIV-seroconversion and immune reconstitution syndrome. Our case is unique since the patient had an elevated CD4 count and negative viral load in the period when the opsoclonus-myoclonus-ataxia syndrome occurred. [ABSTRACT FROM AUTHOR]