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The useful of botulinum toxin Type-A in the treatment of chronic sixth ocular nerve palsy
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
L. Sabetti, L. D’Alessandri, K. Salvatori, E. Balestrazzi
Generally, before surgical treatment, it is necessary to wait at least for 6–8 months, that is the period after which the paralysis can be considered stable. It is rare a spontaneous recovery of this paralysis while it is frequent the occurrence of a contracture of the joint muscle antagonist, which may disguise the functional recovery of this last. Patients affected manifest esotropia with large angle and adults sees double and are forced to take a wrong position of the head in order to neutralise diplopia, or to use prismatic lenses. If diplopia is not adequately controlled it is required a surgical treatment.
Double Vision and New Onset Strabismus in an Adult
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Inflammatory: Such causes of diplopia can be secondary to thyroid eye disease, orbital myositis, or neuroinflammatory disorders, which can cause an internuclear ophthalmoplegia for example, and tends to be fairly constant.
Aircrew medicals
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Ophthalmology: Observe the eyes and surrounding structures.Assess eye movements and check for diplopia.Perform a field assessment by confrontation (or any other method used in routine optometry practice).Assess pupil size and reaction to light and perform fundoscopy.
Clinical Characteristics of Acquired Diplopia in Adults
Published in Journal of Binocular Vision and Ocular Motility, 2022
The certified orthoptist plays an important role in the nonsurgical treatment of acquired diplopia due to strabismus. Orthoptists are routinely required, as a standard component of daily outpatient care, to provide non-surgical treatment options for patients with symptomatic strabismus. Binocular diplopia (double vision) is a common symptom identified in older ophthalmological and neurological patients, frequently occurring in individuals with no prior history of strabismus who then develop an ocular misalignment after visual maturity.1 But the typical patient can also be an adult or young adult with symptomatic strabismus. Etiologies are varied, and can include mechanical strabismus from prior scleral buckling, glaucoma filtration surgery or complex eye muscle procedures,1,2 restrictive strabismus from orbital diseases such as Grave’s orbitopathy,3 orbital fracture with extra-ocular muscle entrapment,4 cranial nerve paresis from intracranial ischemic, inflammatory or neoplastic processes,5 local anesthetic injury or toxicity after ocular surgery,6,7 or strabismus following endoscopic sinus surgery.8 Adults may also present with long-standing, but decompensating, symptomatic heterophoria, or a recurrent deviation following eye muscle surgery earlier in life.9
Ocular myasthenia gravis: a review and practical guide for clinicians
Published in Clinical and Experimental Optometry, 2022
OMG may present to ophthalmic clinicians with diplopia and/or ptosis, often with diurnal variability and prominent fatigability. Clinical clues to the diagnosis should be sought, including looking for patterns of weakness and fluctuations not associated with other differential diagnoses. Simple office-based testing including looking for fatigable ptosis, lid twitch, ‘peek’ sign, and the ice test can help confirm the clinical diagnosis. Investigations should include serum autoantibodies, a search for associated autoimmune disease such as thyroiditis, and a CT chest to exclude thymoma, and when necessary electrophysiological testing such as SFEMG. Management of OMG should include an initial trial of pyridostigmine, as although this can prove insufficient in some patients (especially for diplopia), this medication has considerably lesser safety concerns compared to immunosuppression. However, early treatment with corticosteroids is often necessary, and starting at low doses with slow titration upwards prior to reduction to the minimally effective dose can prove both effective and safe. In order to minimise the risks from long-term high-dose corticosteroids, use of steroid-sparing agents such as azathioprine can be considered, as can thymectomy in selected cases. Non-pharmacological options such as occlusion/patching are often used acutely to relieve diplopia. Surgical correction of stable ptosis or strabismus can also be considered in appropriate circumstances. Ophthalmic clinicians have a critical role in the recognition, diagnosis, monitoring, and symptomatic management of patients with OMG.
OnabotulinumtoxinA injection towards the SPG for treating symptoms of refractory chronic rhinosinusitis with nasal polyposis: a pilot study
Published in Acta Oto-Laryngologica, 2021
Kent Are Jamtøy, Erling Tronvik, Daniel Fossum Bratbak, Joan Crespi, Lars Jacob Stovner, Irina Aschehoug, Wenche Moe Thorstensen
Nine out of 10 patients experienced AEs, none were serious (Figure 2). One patient experienced diplopia which moderately affected his daily activities. An ophthalmologist diagnosed a moderate paresis of the inferior rectus muscle with hypertropia in abduction. The symptoms slowly improved and resolved 4 weeks after injection. Two patients experienced nasolabial fold asymmetry, appearing 4 weeks after injection and resolving spontaneously 7 and 12 weeks after injection, respectively. The AE did not require any treatment and was not considered bothersome by the patients. Two patients had pain or swelling at the injection site that resolved within the first month after injection. One of them had to take additional analgesics on the day of injection. Seven patients reported discomfort in the jaw at maximal gaping, which did not interfere with chewing, eating, or speaking and there was no need for analgesics or further treatment. One patient experienced a burning sensation of the tongue that resolved spontaneously within 2 weeks after injection. One patient experienced blurred vision the same evening as the injection, assumed to be due to the local anaesthesia.