Double elevator palsy(DEP) is characterized by monocular limitation of upgaze in both abducted and adducted position. It is often associated with hypotropia, blepharoptosis, and pseudoblepharoptosis of the affected eye. The authors experienced a case of primary inferior rectus restrictive type of DEP, which has showed hypotropia of 40 prism diopters, and blepharoptosis on the right eye. Examinations revealed poor Bell's phenomenon, and forced duction test showed the limitation of elevation on the right eye. Surgery was performed with 6mm recession of the right inferior rectus. Postoperatively the elevation of glove was satisfactory, Bell's phenomenon was improved and primary position was also orthophoric. Correction of blepharoptosis with frontalis slinging could safely performed in the presence of adequate Bell's phenomenon after the inferior rectus recession.
Blepharoptosis* ; Elevators and Escalators* ; Paralysis*

After direct superior rectus muscle injection of BtA in rabbit eyes, we examined the ultrasructural changes of the muscles from 1 day to 8 weeks after injection. The most profound changes seen at electron microxcopic levels after BtA injedtion were early vacuolization of the sarcoplasmic structure, extensive damage of myofibril, degeneration of the postjunctional fold and widening of the synaptic cleft. Myofiber changes were reversible with no apparent long-term consequence. However, most of the degenerations of myoneuronal junction were still present in 8 weeks post-injedtion. Comparing myotoxic effects according to rabbit age, the botulinum toxin seems to make more severe histologic damage in the fibers of the two-month old than six-month old or older. AchE activity of injection group is mildly decrease in number of positive fibers rather than control group, which was not statistically significant in the quantitative analysis. In conclusion the early vacuolization and degeneration of the sarcoplasmic structure, and degeneration of the postjunctional folds after toxin injection in the muscles are most likely due to a direct myotoxic effect of BtA.
Botulinum Toxins* ; Botulinum Toxins, Type A ; Muscles ; Myofibrils

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with nonrefractive accommodative esotropia in comparison to refractive accommodative esotropia and normal groups. METHODS: A total of 43 subjects were divided into 3 groups: the nonrefractive accommodative esotropia group (group 1), the refractive accommodative esotropia group (group 2) and the normal group (group 3). Age, sex, age of onset, and refractive errors were recorded. The deviation angle was measured near and at distance by using a prism cover test. The AC/A ratio was calculated using a gradient method. RESULTS: Refractive errors were 2.3 +/- 1.7 D (OD) and 2.4 +/- 2.1 D (OS) in group 1, 4.8 +/- 0.9 D (OD) and 4.6 +/- 1.1 D (OS) in group 2, and -0.3 +/- 1.5 D (OD) and -0.5 +/- 1.5 D (OS) in group 3. Group 2 had higher mean refractive errors than groups 1 and 3, while the difference in refractive error between group 1 and group 3 was not statistically significant. The AC/A ratio was 5.5 in group 1, 2.1 in group 2 and 2.2 in group 3; there was no significant difference between groups 2 and 3, while group 1 had a significantly higher AC/A ratio than both of these groups. CONCLUSIONS: AC/A ratio in patients with nonrefractive accommodative esotropia is higher than that of refractive accommodative esotropia or normal children. It could be used for bifocal lens as non-surgical treatment.
Age of Onset ; Child ; Esotropia* ; Humans ; Methods ; Refractive Errors

After retrobulbar, peribulbar and direct muscle injection of 2% lidocaine in rabbit eyes, we examined the ultrastructural changes of superior and inferior rectus muscles from 30 minutes to 30 days after injections. Physiologic saline was injected in control group as the same method. The purpose of this study is as followings : (1) to determine the myotoxic effect of the anesthetic and subsequent regeneration of muscle fibers; (2) to compare the myotoxic effects among retrobulbar, peribulbar and direct muscle injection; and (3) to evaluate toxic effect to optic nerve. The lesions of retrobulbar and peribulbar injection resulted in the degeneration of the muscle fibers on the surface of extraocular muscles. In contrast, large internal lesion were frequently observed in the muscles that received direct injections of 2% lidocaine. No ultrastructural damages of optic nerve were observed. With these anesthetic methods, initial damages were restored by regeneration up to 30 days. The myotoxic effects of retrobulbar and peribulbar injection seem to be less harmful than that of direct muscle injection of 2% lidocaine in rabbits. This results suggest that the intentional or accidental direct muscle injection of local anesthetics during surgery may cause strabismus especially in elderly patients who have poor muscle regeneration capacity.
Aged ; Anesthesia, Local* ; Anesthetics, Local ; Humans ; Lidocaine ; Muscles ; Optic Nerve ; Rabbits ; Regeneration ; Strabismus

Optic disc hemangioma is very uncommon and may be presented as a part of angiomatosis retinae or itself as an isolated entity. The authors have experienced a case of bilateral optic disc hemangiomas with the juxtapaillary retinal involvement in 32 years old male. At his first visit, visual acuity was 0.5 in the right eye and 0.08 in the left eye. Ophthalmoscopic examination of both eyes revealed reddish-yellow, spherical, highly vascularized tumors, measuring 1.5 disc diameter in the right eye and 2.0 disc diameter in the left eye, located in the temporal portion of the disc and its adjacent retina and the exudative retinal detachments around the tumors were also noted. The fluorescein angiograms showed the rapid filling of the tumors in early arterial phase and diffuse leakage of fluorescein into the subretinal space and surrounding tissue in the late phase. The authors report this case with the review of the literature.
Adult ; Fluorescein ; Hemangioma* ; Humans ; Male ; Retina ; Retinal Detachment ; Retinaldehyde ; Visual Acuity ; von Hippel-Lindau Disease

PURPOSE: We encountered a patient with right medial rectus muscle injury and optic nerve transection that had developed during functional endoscopic sinus surgery(FESS) and thus, report the present case with a literature review. METHODS: A 59-year-old woman was transferred to the present hospital due to the inability to adduct the right eye to the midline, exotropia, and loss of vision after she had underwent functional endoscopic sinus surgery due to bilateral chronic paranasal sinusitis and polyps in a local ENT clinic. RESULTS: The right eye could not perceive the light. The patient showed 40 exodeviation by the Hirschberg's test and marked limitation on adduction. Flame-shaped retinal hemorrhages and a cherry-red spot were present in the posterior pole on the fundus examination using slit-lamp biomicroscopy. Orbital computerized tomography showed the evidence of medial rectus muscle injury and complete transection of the optic nerve. Postoperative endoscopic paranasal sinus examination showed the evidence of complete transection of the ophthalmic artery and vein. CONCLUSIONS: Clinicians should have thorough understanding of the anatomy of the paranasal sinus, especially, the ethmoid sinus and orbit in order to prevent serious complications as in our case. Endoscopic examination of the nasal cavity and orbital computerized tomography must be performed before surgery for accurate diagnosis. Furthermore, experienced surgeons who would perform this type of surgery with great precision could prevent permanent loss of vision through extraocular muscle injury or optic nerve transection.
Diagnosis ; Ethmoid Sinus ; Exotropia ; Female ; Humans ; Middle Aged ; Nasal Cavity ; Ophthalmic Artery ; Optic Nerve Injuries* ; Optic Nerve* ; Orbit ; Polyps ; Retinal Hemorrhage ; Sinusitis ; Veins

Pneumatic retinopexy(PR) is an alternative procedure to treat an uncomplicated rhegmatogenous retinal detachment with the retinal tear(s) within the superior 8 clock hours of the retina. To determine the efficacy of the PR, the authors treated 45 consecutive retinal detachment not exceeding proliferative vitreoretinopathy grade C2 with PR(PR group) and compared the results with those of 63 similar cases treated with scleral buckling procedure(SB group). Initially, 87% of PR group and 91% of SB group were reattached. However, overall cure rates with single operation decreased to 789,6 and 83%, respectively. With subsequent procedures, retinas were finally reattached in 98% and 94%, respectively. In eyes with preoperative macular detachment, vision was similarly improved 2 lines or more in 73% of PR group and in 77% of SB group after surgery. The incidence of the new breaks was higher in PR group than in SB group(9% vs 5%). Other postoperative complications including reopening of original tear, proliferative vitreoretinopathy, and delayed resorption of subretinal fluid were also noted with similar frequency in both group. These data suggest that PR would be a good alternative procedure in the selected cases of retinal detachments and initial failure with this procedure does not adversely affect the final retinal attachment.
Incidence ; Postoperative Complications ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Scleral Buckling* ; Subretinal Fluid ; Vitreoretinopathy, Proliferative

The macula may be displaced by retinal scarring or fibrous strands, often as a result of retrolental fibroplasia. The displacement is usually temporal and may occur bilaterally but may also be superior or inferior and unilateral after severe retinitis(Toxocara canis). Ectopic macula causes a displacement of the visual line and thus occasionally produces a large positive angle kappa that simulates exotropia. Displacement of the macula also may be congenital. Ocular toxocariasis is recognized to be an important cause of childhood blindness. It usually results as a sequela of systemic infestation with the second or third stage larva of T. canis(visceral larval migrans). The roundworm Toxocara canis is an intestinal parasite of dogs. Humans are infected accidentally by ingesting infective ova from contaminated soil. Only on rare occasions has ocular involvement been reported in visceral larva migrans. Ocular toxocariasis can assume a variety of clinical forms. The authors experienced a case of ectopic macula in presumed ocular toxocariasis which was diagnosed on the basis of the clinical appearance and a history of exposure to puppy. A review of this subject is provided, with emphasis upon pathogenesis, clinical features, diagnostic approaches and therapeutic techniques.
Animals ; Blindness ; Cicatrix ; Dogs ; Exotropia ; Humans ; Larva ; Larva Migrans, Visceral ; Ovum ; Parasites ; Retinaldehyde ; Retinopathy of Prematurity ; Soil ; Toxocara canis ; Toxocariasis*

Lymphangiomas are congenital, benign, slowly progressive tumors of the lymphovascular system. Those located in the ocular adnexa are uncommon and may appear clinically as isolated orbital, eyelid, or conjunctival lesions, or some combination of these. The authors have experienced a case of lymphangiomas of the eyelid and conjunctiva in 8 years old male. This patient was seen with a history of a lump on the superonasal aspect of the left upper eyelid present since birth and intermittent hemorrhagic edematous swelling of the left bulbar conjunctiva beginning at the age of 4 year. The lid mass was partially excised and a biopsy of the conjunctival lesion was also undertaken. Microscopic examination of the excised tissues revealed cavernous lymphangiomas with a moderate lymphocytic infiltration. So, the authors report this case with a brief review of the literature.
Biopsy ; Child ; Conjunctiva* ; Eyelids* ; Humans ; Lymphangioma* ; Male ; Orbit ; Parturition

PURPOSE: Stereoacuity test is commonly used to determine the status of sensory function in patients with strabismus. We performed Titmus test and Mentor B-VAT II videoacuity tester in patients with basic or simulated divergence excess type intermittent exotropia {X(T)}, before and after surgery, to determine the effectiveness of near stereoacuity and the correlation between near stereoacuity and distance stereoacuity. METHODS: Near stereoacuity was measured using Titmus test and distance stereoacuity was measured using a Mentor B-VAT II videoacuity tester, before and after surgery, in 41 patients with X(T). RESULTS: The stereoacuity according to Titmus test was improved from a preoperative average of 70 seconds of arc to postoperative average of 60 seconds; however, this improvement was not statistically significant (P=0.38). Distance stereoacuity was significantly improved from a preoperative average of 221 seconds to a postoperative average of 60 seconds (P=0.001). No significant correlation was present between preoperative near stereoacuity and distance stereoacuity (P=0.99). CONCLUSIONS: Titmus test was not effective in determining the status of sensory function before and after surgery in patients with basic or simulated divergence excess type X(T). We believe that distance stereoacuity is effective in determining the status of sensory function.
Exotropia ; Humans ; Mentors ; Sensation ; Strabismus