Converging Cars: Adult Acute Onset Diplopia and the Treatment and Management with Fresnel Prism - Jessica Min, OD • Shmaila Tahir, OD, FAAO 3241 South Michigan Avenue, Chicago, Illinois 60616 Illinois Eye Institute, Chicago, Illinois ABSTRACT DISCUSSION FIGURE 1a FIGURE 2a FIGURE 2b Herpes simplex keratitis is an ocular condition which possesses a The question of whether this patient had a decompensation of an standard protocol for treatment and management. This case report existing esophoria that was exacerbated by the uncontrolled diabetes highlights the use of Prokera Cryopreserved Amniotic Membranes was largely considered. No prior eye exams were performed at the (PCAM) to treat herpes simplex keratitis and examines its unanticipated, same clinic, strabismus was denied, and old photos were not provided previously unreported, anti-viral effect. to support this. Interestingly, the Fresnel prism could have helped increase his fusional vergences similar to the effects of vision therapy so that he could compensate the residual amount of 12▵ IAET. BACKGROUND Adult patients with an acute onset diplopia all share the same problem CONCLUSION of functional disability. When appropriate, prism can be a great tool to minimize symptoms and restore binocularity. This can improve quality It is important for clinicians to realize the value in utilizing prism of life. This case explores the treatment and management of an adult compared to occlusion. When fitting the Fresnel, choose the patient’s patient with an acute acquired esotropia with Fresnel prism. most useful direction of gaze, set realistic expectations, and closely monitor with frequent follow- up exams CASE SUMMARY REFERENCES A 55 year old male presented with a sudden onset of constant horizontal diplopia. This was related to his uncontrolled diabetes and 1. Brooks CW, Borish IM: System for Ophthalmic Dispensing, 3rd ed. was confirmed by several specialists. Initially, he had a 25▵ intermittent Missouri: Butterworth- Heinemann; 2007. alternating esotropia (IAET) that was noncomitant with an A pattern 2. Caloroso EE, Rouse MW: Clinical Management of Strabismus. eso posture (Figure 1a, 1bv). His versions/ductions were full with no TREATMENT AND Massachusettes: Butterworth- Heinemann; 1993. restrictions. With a 25▵ base out Fresnel Prism, fusion was achieved FIGURE 1b FIGURE 3 3. Chen J, Deng D, Sun Y: Acute Acquired Concomitant Esotropia. in primary gaze (Figure 2a, 2b). He was followed every 3-4 weeks to MANAGEMENT Medicine (Baltimore) 2015; 23:400-404 reduce the amount of prism. The angle of deviation was not resolving 4. Fraine L: Nonsurgical Management of Diplopia. American Orthoptic as one would expect from a vascular etiology, but the patient was At the initial visit prior to treatment the patient measured 25▵ IAET. At Journal 2012; 62:16 able to fuse with lower amount of prism each visit. At his last visit, the his final visit after treatment, the patient measured 12▵ IAET. See Figure 5. Gunton KB, Brown A: Prism use in adult diplopia. Current Opinion patient was asymptomatic and discontinued the use of prism even 3 for management with prism. Ophthalmology 2012; 23:400-404 though he measured 12▵ IAET. 6. Gupta PK, Bhatti MT, Rucker JC: A sweet case of bilateral sixth nerve palsies. Surv Ophthalmol.2009; 54 (2): 305-310 7. Rutstein RP, Daum KM. Anomalies of binocular vision: diagnosis and management. St. Louis: Mosby 1998: 234-237, 288-295, 300-303, 314-316. CONTACT INFORMATION Jessica Min, OD [email protected] www.ico.edu .