Humans ; Botulinum Toxins, Type A/therapeutic use* ; Esotropia/drug therapy* ; Neuromuscular Agents ; Injections ; Treatment Outcome ; Oculomotor Muscles

PURPOSE: To report two cases of abducens nerve palsy that occurred after the administration of chemotherapeutic agents. CASE SUMMARY: (Case 1) A 49-year-old woman with breast cancer presented with acute onset of diplopia 6 weeks after the beginning of combination chemotherapy with cyclophosphamide, doxorubicin, and paclitaxel. She had a left esotropia of 30 prism diopters (PD) with a mild decrease in abduction of the left eye. She was diagnosed with left abducens nerve palsy. (Case 2) A 29-year-old man with non-Hodgkin's lymphoma presented with diplopia 7 weeks after beginning combination chemotherapy including cyclophosphamide, adriamycin, vincristine, and prednisolone. He had a 20PD esotropia in the primary position with a slight decrease in abduction of both eyes. He was diagnosed with bilateral abducens nerve palsy. The chemotherapy regimen of both patients was changed, and they were followed up without treatment. In case 1, diplopia improved 2 months after change of chemotherapy regimen with complete recovery within 4 months. In case 2, diplopia improved 2 months after a change of chemotherapy regimen with complete recovery within 3 months.
Abducens Nerve ; Abducens Nerve Diseases ; Adult ; Breast Neoplasms ; Cyclophosphamide ; Diplopia ; Doxorubicin ; Drug Therapy, Combination ; Esotropia ; Eye ; Female ; Humans ; Lymphoma, Non-Hodgkin ; Middle Aged ; Paclitaxel ; Prednisolone ; Vincristine

An 11-year-old female presenting diplopia only at distance was found to have comitant esotropia of 20 prism diopters (PD) at distance and normal alignment at nearer proximity. Other ocular movement, including abduction, was normal and a thorough neurologic examination was also normal. The deviation angle of esotropia was increased to 35 PD in 6 months, and a brain magnetic resonance imaging with venogram at that time demonstrated no intracranial lesion. A lumbar puncture showed increased opening pressure but the cerebrospinal fluid composition was normal. The patient was diagnosed as having idiopathic intracranial hypertension and treated with oral acetazolamide. Three months after treatment, the deviation angle decreased to 10 PD. This is a case report of divergence insufficiency in pediatric idiopathic intracranial hypertension, with an increasing deviation angle of esotropia. Although sixth cranial nerve palsy is a common neurologic manifestation in intracranial hypertension, clinicians should be aware of the possibility of divergence insufficiency. Also, ophthalmoparesis may not be apparent and typical at first presentation, as seen in this case, and therefore ophthalmologists should be aware of this fact, while conducting careful and proper evaluation, follow-up, and intervention.
Acetazolamide/administration & dosage ; Administration, Oral ; Child ; Diagnosis, Differential ; Diuretics/administration & dosage ; Esotropia/diagnosis/*etiology/physiopathology ; Exotropia/diagnosis/*etiology/physiopathology ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Pseudotumor Cerebri/*complications/diagnosis/drug therapy ; Spinal Puncture/methods ; Vision, Binocular ; Visual Acuity