Occurrence of Oculomotor Dysfunctions in Acquired Brain Injury: a Retrospective Analysis
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Essay Treating the Trinity of Infantile Vision Development: Infantile Esotropia, Amblyopia, Anisometropia W.C. Maples,OD, FCOVD 1 Michele Bither, OD, FCOVD2 Southern College of Optometry,1 Northeastern State University College of Optometry2 ABSTRACT INTRODUCTION The optometric literature has begun to emphasize One of the most troublesome and long recognized pediatric vision and vision development with the advent groups of conditions facing the ophthalmic practitioner and prominence of the InfantSEE™ program and recently is that of esotropia, amblyopia, and high refractive published research articles on amblyopia, strabismus, error/anisometropia.1-7 The recent institution of the emmetropization and the development of refractive errors. InfantSEE™ program is highlighting the need for early There are three conditions with which clinicians should be vision examinations in order to diagnose and treat familiar. These three conditions include: esotropia, high amblyopia. Conditions that make up this trinity of refractive error/anisometropia and amblyopia. They are infantile vision development anomalies include: serious health and vision threats for the infant. It is fitting amblyopia, anisometropia (predominantly high that this trinity of early visual developmental conditions hyperopia in the amblyopic eye), and early onset, be addressed by optometric physicians specializing in constant strabismus, especially esotropia. The vision development. The treatment of these conditions is techniques we are proposing to treat infantile esotropia improving, but still leaves many children handicapped are also clinically linked to amblyopia and throughout life. The healing arts should always consider anisometropia. alternatives and improvements to what is presently The majority of this paper is devoted to the treatment considered the customary treatment for these conditions. -
Sixth Nerve Palsy
COMPREHENSIVE OPHTHALMOLOGY UPDATE VOLUME 7, NUMBER 5 SEPTEMBER-OCTOBER 2006 CLINICAL PRACTICE Sixth Nerve Palsy THOMAS J. O’DONNELL, MD, AND EDWARD G. BUCKLEY, MD Abstract. The diagnosis and etiologies of sixth cranial nerve palsies are reviewed along with non- surgical and surgical treatment approaches. Surgical options depend on the function of the paretic muscle, the field of greatest symptoms, and the likelihood of inducing diplopia in additional fields by a given procedure. (Comp Ophthalmol Update 7: xx-xx, 2006) Key words. botulinum toxin (Botox®) • etiology • sixth nerve palsy (paresis) Introduction of the cases, the patients had hypertension and/or, less frequently, Sixth cranial nerve (abducens) palsy diabetes; 26% were undetermined, is a common cause of acquired 5% had a neoplasm, and 2% had an horizontal diplopia. Signs pointing aneurysm. It was noted that patients toward the diagnosis are an who had an aneurysm or neoplasm abduction deficit and an esotropia had additional neurologic signs or increasing with gaze toward the side symptoms or were known to have a of the deficit (Figure 1). The diplopia cancer.2 is typically worse at distance. Measurements are made with the Anatomical Considerations uninvolved eye fixing (primary deviation), and will be larger with the The sixth cranial nerve nuclei are involved eye fixing (secondary located in the lower pons beneath the deviation). A small vertical deficit may fourth ventricle. The nerve on each accompany a sixth nerve palsy, but a side exits from the ventral surface of deviation over 4 prism diopters the pons. It passes from the posterior Dr. O’Donnell is affiliated with the should raise the question of cranial fossa to the middle cranial University of Tennessee Health Sci- additional pathology, such as a fourth fossa, ascends the clivus, and passes ence Center, Memphis, TN. -
Congenital Oculomotor Palsy: Associated Neurological and Ophthalmological Findings
CONGENITAL OCULOMOTOR PALSY: ASSOCIATED NEUROLOGICAL AND OPHTHALMOLOGICAL FINDINGS M. D. TSALOUMAS1 and H. E. WILLSHA W2 Birmingham SUMMARY In our group of patients we found a high incidence Congenital fourth and sixth nerve palsies are rarely of neurological abnormalities, in some cases asso associated with other evidence of neurological ahnor ciated with abnormal findings on CT scanning. mality, but there have been conflicting reports in the Aberrant regeneration, preferential fixation with literature on the associations of congenital third nerve the paretic eye, amblyopia of the non-involved eye palsy. In order to clarify the situation we report a series and asymmetric nystagmus have all been reported as 1 3 7 of 14 consecutive cases presenting to a paediatric associated ophthalmic findings. - , -9 However, we tertiary referral service over the last 12 years. In this describe for the first time a phenomenon of digital lid series of children, 5 had associated neurological elevation to allow fixation with the affected eye. Two abnormalities, lending support to the view that con children demonstrated this phenomenon and in each genital third nerve palsy is commonly a manifestation of case the accompanying neurological defect was widespread neurological damage. We also describe for profound. the first time a phenomenon of digital lid elevation to allow fixation with the affected eye. Two children demonstrated this phenomenon and in each case the PATIENTS AND METHODS accompanying neurological defect was profound. The Fourteen children (8 boys, 6 girls) with a diagnosis of frequency and severity of associated deficits is analysed, congenital oculomotor palsy presented to our paed and the mechanism of fixation with the affected eye is iatric tertiary referral centre over the 12 years from discussed. -
Anatomy of the Extraneural Blood Supply to the Intracranial
British Journal of Ophthalmology 1996; 80: 177-181 177 the extraneural blood to the Anatomy of supply Br J Ophthalmol: first published as 10.1136/bjo.80.2.177 on 1 February 1996. Downloaded from intracranial oculomotor nerve Mark Cahill, John Bannigan, Peter Eustace Abstract have since been classified as extraneural vessels Aims-An anatomical study was under- as they arise from outside the nerve and ramify taken to determine the extraneural blood on the surface ofthe nerve. In 1965, Parkinson supply to the intracranial oculomotor attempted to demonstrate and name the nerve. branches of the intracavernous internal carotid Methods-Human tissue blocks contain- artery.3 One of these branches, the newly titled ing brainstem, cranial nerves II-VI, body meningohypophyseal trunk was seen to pro- of sphenoid, and associated cavernous vide a nutrient arteriole to the oculomotor sinuses were obtained, injected with con- nerve in the majority of dissections. The infe- trast material, and dissected using a rior hypophyseal artery was also seen to arise stereoscopic microscope. from the meningohypophyseal trunk. Seven Results-Eleven oculomotor nerves were years earlier McConnell had demonstrated dissected, the intracranial part being that this vessel provided a large portion of the divided into proximal, middle, and distal pituitary blood supply.4 (intracavernous) parts. The proximal part Asbury and colleagues provided further of the intracranial oculomotor nerve anatomical detail in 1970.5 They set out to received extraneural nutrient arterioles explain the clinical findings of diabetic oph- from thalamoperforating arteries in all thalmoplegia on a pathological basis. Using a specimens and in six nerves this blood serial section technique, they demonstrated an supply was supplemented by branches intraneural network of small arterioles within from other brainstem vessels. -
Clinical Anatomy of the Cranial Nerves Clinical Anatomy of the Cranial Nerves
Clinical Anatomy of the Cranial Nerves Clinical Anatomy of the Cranial Nerves Paul Rea AMSTERDAM • BOSTON • HEIDELBERG • LONDON NEW YORK • OXFORD • PARIS • SAN DIEGO SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Academic Press is an imprint of Elsevier Academic Press is an imprint of Elsevier 32 Jamestown Road, London NW1 7BY, UK The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK Radarweg 29, PO Box 211, 1000 AE Amsterdam, The Netherlands 225 Wyman Street, Waltham, MA 02451, USA 525 B Street, Suite 1800, San Diego, CA 92101-4495, USA First published 2014 Copyright r 2014 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangement with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. -
Botulinum Toxin in the Treatment of Strabismus. a Review of Its Use and Effects
Disability and Rehabilitation, December 2007; 29(23): 1823 – 1831 Botulinum Toxin in the treatment of strabismus. A review of its use and effects LIONEL KOWAL1,2, ELAINE WONG1,2 & CLAUDIA YAHALOM3 1Ocular Motility Unit, Royal Victorian Eye and Ear Hospital, Melbourne, 2Centre for Eye Research, Australia, and 3Ophthalmology, Hadassah Hospital, Jerusalem, Israel Abstract Botulinum Toxin as a medical therapy was introduced by Dr Alan Scott more than 20 years ago. The first clinical applications of Botulinum Toxin type A (BT-A) were for the treatment of strabismus and for periocular spasms. Botulinum Toxin type A is often effective in small to moderate angle convergent strabismus (esotropia) of any cause, and may be an alternative to surgery in these cases. Botulinum Toxin type A may have a role in acute or chronic fourth and sixth nerve palsy, childhood strabismus and thyroid eye disease. The use of BT-A for strabismus varies enormously in different cities and countries for no apparent reason. Botulinum Toxin type A may be particularly useful in situations where strabismus surgery is undesirable. This may be in elderly patients unfit for general anaesthesia, when the clinical condition is evolving or unstable, or if surgery has not been successful. Botulinum Toxin type A can give temporary symptomatic relief in many instances of bothersome diplopia irrespective of the cause. Ptosis and acquired vertical deviations are the commonest complications encountered. Vision-threatening complications are rare. Repeated use of BT-A is safe. Keywords: Strabismus, Botulinum Toxin type A, ocular Motility disorders There are a small number of centres where BT-A is Introduction used frequently in the treatment of strabismus. -
Cranial Nerves
Cranial Nerves Cranial nerve evaluation is an important part of a neurologic exam. There are some differences in the assessment of cranial nerves with different species, but the general principles are the same. You should know the names and basic functions of the 12 pairs of cranial nerves. This PowerPage reviews the cranial nerves and basic brain anatomy which may be seen on the VTNE. The 12 Cranial Nerves: CN I – Olfactory Nerve • Mediates the sense of smell, observed when the pet sniffs around its environment CN II – Optic Nerve Carries visual signals from retina to occipital lobe of brain, observed as the pet tracks an object with its eyes. It also causes pupil constriction. The Menace response is the waving of the hand at the dog’s eye to see if it blinks (this nerve provides the vision; the blink is due to cranial nerve VII) CN III – Oculomotor Nerve • Provides motor to most of the extraocular muscles (dorsal, ventral, and medial rectus) and for pupil constriction o Observing pupillary constriction in PLR CN IV – Trochlear Nerve • Provides motor function to the dorsal oblique extraocular muscle and rolls globe medially © 2018 VetTechPrep.com • All rights reserved. 1 Cranial Nerves CN V – Trigeminal Nerve – Maxillary, Mandibular, and Ophthalmic Branches • Provides motor to muscles of mastication (chewing muscles) and sensory to eyelids, cornea, tongue, nasal mucosa and mouth. CN VI- Abducens Nerve • Provides motor function to the lateral rectus extraocular muscle and retractor bulbi • Examined by touching the globe and observing for retraction (also tests V for sensory) Responsible for physiologic nystagmus when turning head (also involves III, IV, and VIII) CN VII – Facial Nerve • Provides motor to muscles of facial expression (eyelids, ears, lips) and sensory to medial pinna (ear flap). -
Diplopia and Torticollis in Adult Strabismus
Case Report JOJ Ophthal Volume 1 Issue 5 - January 2017 DOI: 10.19080/JOJO.2017.01.555572 Copyright © All rights are reserved by Dora D Fdez-Agrafojo Diplopia and Torticollis in Adult Strabismus Dora D Fdez-Agrafojo1*, Hari Morales2 and Marta Soler2 1Doctor in medicine and surgery, Teknon Medical Center, Spain 2Optometrist, Teknon Medical Center, Spain Submission: November 11, 2016; Published: January 16, 2017 *Corresponding author: Dora D Fdez-Agrafojo, INOF Center, Teknon Medical Center, Barcelona, Spain, Tel: 933933156; Email: Abstract Objective: To expose the diagnosis of an adult patient with vertical and unilateral divergent strabismus and to approach the surgical treatment in order to remove the symptoms of diplopia and signs of torticollis. Method: The measurement of the angle of deviation, the Lancaster test, the Bielchowsky test and the study of ocular motility, both in resolvingexamination the room deviation (versions) of both and directions in the surgery in only room one surgical (test of intervention.ductions), demonstrated the diagnosis: right eye hipertropia (HTR) and right eye exotropia (XTR). Surgical intervention was performed on the right upper rectus muscle and on the right inferior oblique muscle, with the aim of Results: The intervention was satisfactory for both the patient and the medical team, because we were minimized the signs and symptoms. After 4 months the residual deviation angle was minimal and allowed the ability of fusion. Conclusion: The diagnostic and treatment protocol performed in this case show the optimal resolution of the diplopia and torticollis that the patient suffered. Keywords: Strabismus; Torticollis; Diplopia; Lancaster test Introduction c. Refraction (cycloplegic) right eye = +1.50-0.50x170° We believe that, in some cases, in strabismus surgery there may be more than one option in the choice of surgical protocol, d. -
Management of Strabismus in Thyroid Eye Disease
Eye (2015) 29, 234–237 & 2015 Macmillan Publishers Limited All rights reserved 0950-222X/15 www.nature.com/eye CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM Management of R Harrad strabismus in thyroid eye disease Abstract superior rectus.2 Involvement of extra-ocular muscles may be bilateral or unilateral. Thyroid eye disease is an auto-immune Sometimes only one muscle is affected. It is not condition characterised by an acute known why some muscles are more commonly inflammatory phase followed by a fibrotic involved than others. The inferior rectus is the phase, which sometimes leads to restricted bulkiest and most tonically-active extra-ocular eye movements and diplopia. Medical muscle; it may be that the degree of muscle treatment with systemic steroids with or activity and hence blood supply is a factor. without orbital radiotherapy and immunosuppression can control the inflammatory response. Strabismus surgery should be carried out only after the Clinical assessment and non-surgical inflammation is no longer active and after management any decompression surgery. Surgery The presence of lid-lag or lid retraction in an comprises recession of tight muscles using adult presenting with a recent onset of adjustable sutures so as to maximise the area strabismus is highly suggestive of TED. Thyroid of binocular single vision. There is debate as function tests are usually diagnostic, but a small to whether adjustable sutures should be used proportion of patients with TED have normal for the inferior rectus muscle. Patients should thyroid function tests. Patients with TED are be encouraged to have realistic expectations, assessed for disease severity and activity, and as binocular single vision may not be treatment in the form of immunosuppression is achievable in all directions of gaze and lid given depending on the degree of disease retraction may be made worse by surgery. -
What Causes Microvascular Cranial Nerve Palsy? It Is Not Always Clear What Causes the Blockage in the Tiny Blood Vessels to the Cranial Nerves
MICROVASCULAR CRANIAL NERVE PALSEY Microvascular Cranial Nerve Palsy (MCNP) is one of the most common causes of acute double vision in the older population. It occurs more often in patients with diabetes and high blood pressure. MCNP is sometimes referred to as a “diabetic” palsy. This condition almost always resolves on its own without leaving any double vision. Six muscles move your eyes. Four of these muscles attach to the front part of your eye (just behind the iris, or the colored portion of the eye). The two muscles that attach to the back of your eye are responsible for some of the up-and-down (vertical) movement and most of the twisting movement of each eye. These six muscles receive their signals from three cranial nerves that begin in the brain stem. What is Microvascular Cranial Nerve Palsy? A nerve cannot function properly when its blood flow is blocked. If the 6th cranial nerve (also called the abducens nerve) is affected, your eye will not be able to move to the outside and you will be aware of double vision, seeing side-by-side images. If the 4th cranial nerve (also called the trochlear nerve) is affected, you will be aware of vertical double vision (one image on top of another). You may be able to eliminate or decrease the double vision by tilting your head towards the opposite shoulder. The 3rd cranial nerve (also called the oculomotor nerve) supplies four of the six eye muscles. These are some of the muscles that control the eyelid and the size of the pupil. -
A Study of Etiology and Prognosis of Oculomotor Nerve Paralysis
Edorium J Neurol 2014;1:1–8. Kumar et al. 1 http://www.edoriumjournalofneurology.com ORIGINAL ARTICLE OPEN ACCESS A study of etiology and prognosis of oculomotor nerve paralysis Maraiah Pradeep Kumar, Undrakonda Vivekanand, Shashikiran Umakanth, Yashodhara BM ABSTRACT How to cite this article Aims: To study the etiological pattern and Kumar MP, Vivekanand U, Umakanth S, Yashodhara prognosis of oculomotor nerve palsy in a medical BM. A study of etiology and prognosis of oculomotor college hospital in South India. Methods: This nerve paralysis. Edorium J Neurol 2014;1:1–8. study comprises 40 cases of oculomotor nerve palsy presenting to medical college hospital between March 2004 to September 2005. Details Article ID: 100001N06MK2014 of various modes of presentation, aetiologies, pupillary involvement and recovery were documented and analysed. Conclusion: Isolated ********* oculomotor nerve palsy which is a predominant mode of presentation has a good recovery rate. doi:10.5348/n06-2014-1-OA-1 We recommend that patients with oculomotor nerve palsy be carefully examined clinically in close collaboration with other specialists, especially where sophisticated complementary investigations are impossible. INTRODUCTION Keywords: Oculomotor nerve palsy, Outcome, Etiological trends of oculomotor nerve palsy have Partial, Management remained fairly consistent over the decades, although there is a changing disease pattern worldwide and the current focus is on etiologies like diabetes, trauma and Maraiah Pradeep Kumar1, Undrakonda Vivekanand2, orbital inflammatory diseases which are emerging as 3 4 Shashikiran Umakanth , Yashodhara BM frequent causes of third cranial nerve paralysis [1, 2]. 1 Affiliations: Associate Professor, Department of Thus a collaborative approach with other specialties Ophthalmology, Shimoga Institute of Medical Sciences, Karnataka, India; 2Associate Professor, Department of is essential to enhance the diagnostic accuracy. -
Acquired Palsy of the Oculomotor, Trochlear and Abducens Nerves
ACQUIRED PALSY OF THE OCULOMOTOR, TROCHLEAR AND ABDUCENS NERVES l 2 P. A. C. TIFFIN\ C. J. MacEWEN\ E. A. CRAIG and G. CLAYTON Dundee SUMMARY commonly than trochlear nerve palsy. In addition, There have been few studies primarily concerned with although the major cause of ocular palsy was the relative frequencies, aetiologies and prognoses of consistently classified as undetermined (25%), a ocular motor palsies. Those published have emanated relatively high proportion of cases were recorded as largely from neurological tertiary referral centres rather secondary to sinister pathology: neoplasia (18%) and than primary ophthalmology departments. We have aneurysm (7%). performed a retrospective study of all patients with There have been several studies relating to series acquired III, IV or VI cranial nerve palsy who were of patients seen in the more general setting of both s 9 seen in the orthoptic department at Ninewells Hospital, orthoptic and ophthalmic clinics. - However, these Dundee, over the 9 year period from 1984 to 1992. A have concentrated on groups of patients presenting total of 165 cases were identified. VI nerve palsies with the somewhat broader diagnosis of diplopia accounted for the majority of patients (57%), with IV rather than only those with acquired nerve palsies nerve palsies (21%) occurring more frequently than III per se. Acquired ocular motor nerve palsy accounted nerve palsies (17%) and multiple palsies (5%). Thirty for 40-60% of patients presenting with binocular five per cent of cases were of unknown aetiology and diplopia. Although abducens nerve palsy occurred 6 8 9 32% of vascular aetiology. The incidence of sinister most frequently in most of these reports, , , oculo s pathology - neoplasia (2%) and aneurysm (1%) - was motor nerve palsy was found most often in one and surprisingly low.