BACKGROUND: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. METHODS: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance. RESULTS: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively). CONCLUSION: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
Child ; Diagnosis ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Methods ; Prognosis ; Reoperation ; Strabismus

PURPOSE: To report a case of isolated abducens nerve palsy caused by the ophthalmic segment of an internal carotid artery (ICA) aneurysm which improved after endovascular coil trapping. CASE SUMMARY: A 59-year-old female visited the ophthalmology department for a sudden onset of horizontal diplopia for 10 days. The best corrected visual acuity was 20/20 in both eyes. The pupils showed normal response to light and near stimulation in both eyes. The extraocular examination showed 35 prism diopters left esotropia at primary gaze and −4 abduction limitation of the left eye. The patient suffered intermittent headaches in the left temporal area and left retrobulbar pain for 1 month. Magnetic resonance imaging with magnetic resonance angiography of the brain was performed. A focal protruding lesion of the left ICA suggested an aneurysm. The patient consulted with the neurosurgery department. The left ophthalmic segment of the ICA aneurysm was confirmed by transfemoral cerebral angiography and treated with coil placement and the patient showed gradual improvement after the procedure. Three months after the procedure there was no diplopia. The patient showed orthotropia at primary gaze without abduction limitation. CONCLUSIONS: Isolated abducens nerve palsy can be caused by the ophthalmic segment of an ICA aneurysm, which should be considered in the differential diagnosis of ocular motility disorders. The disorder improved with coil replacement treatment. Differential diagnosis as a cause of abducens nerve palsy is important for prompt and appropriate treatment. Neuroimaging should be considered in patients with isolated abducens nerve palsy with a non-ischemic origin.
Abducens Nerve Diseases ; Abducens Nerve ; Aneurysm ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Diagnosis, Differential ; Diplopia ; Esotropia ; Female ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Aged ; Neuroimaging ; Neurosurgery ; Ocular Motility Disorders ; Ophthalmology ; Pupil ; Visual Acuity

PURPOSE: To report a case of abducens nerve palsy and optic perineuritis caused by fungal sphenoidal sinusitis. CASE SUMMARY: A 48-year-old male visited emergency department for retrobulbar pain, decreased vision, and horizontal diplopia for 3 days. He reported that previous medical history was non-specific, however, blood glucose level was 328 mg/dL (70–110). He had experienced severe headache for 7 days. The best corrected visual acuity was 20/20 at right eye and 20/25 at left eye. The pupil of left eye did not have relative afferent pupillary defect. Left mild proptosis was noted. The extraocular examination showed 30 prism diopters left esotropia at primary gaze and −4 abduction limitation of left eye. The left eye showed mild optic disc swelling and inferior field defect by field test. Brain magnetic resonance imaging showed enhancement of sphenoidal sinus, ethmoidal sinus, and around optic nerve at left eye. Three days after antibiotics treatment, the vision of left eye deteriorated to 20/40 and periorbital pain developed. The drainage and biopsy of sphenoidal sinus were performed. The histopathologic examination showed hyphae consistent with aspergillosis. The ocular symptoms were improved with anti-fungal treatment. Follow-up magnetic resonance imaging performed 1 month after treatment showed improvement of lesion at left orbit. Five months after surgery, the visual acuity of left eye was improved to 20/25. The patient showed orthotropia at primary gaze without limitation. CONCLUSIONS: The abducens nerve palsy and optic perineuritis can be caused by fungal sphenoidal sinusitis. The early diagnosis and appropriate treatment can lead to favorable outcome.
Abducens Nerve Diseases ; Abducens Nerve ; Anti-Bacterial Agents ; Aspergillosis ; Biopsy ; Blood Glucose ; Brain ; Diplopia ; Drainage ; Early Diagnosis ; Emergency Service, Hospital ; Esotropia ; Ethmoid Sinus ; Exophthalmos ; Follow-Up Studies ; Fungi ; Headache ; Humans ; Hyphae ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Optic Nerve ; Orbit ; Pupil ; Pupil Disorders ; Sphenoid Sinusitis ; Visual Acuity

PURPOSE: We report a case of idiopathic orbital myositis with sudden onset of unilateral visual loss and hypertrophy of the lateral rectus muscle at the apex of the orbit that was diagnosed using orbital biopsy and treated with intravenous corticosteroids. CASE SUMMARY: We examined a 20-year-old woman who complained of decreased visual acuity and binocular diplopia for 2 weeks. She showed 40-prism diopter left esotropia at the primary position. Her visual acuity with eyeglasses was 0.7 and 0.2 in the right and left eyes, respectively. Brain magnetic resonance imaging (MRI) revealed a round mass on the left lateral rectus muscle at the apex of the orbit with optic nerve compression. We planned orbital biopsy to exclude orbital lymphoma and other biopsy-requiring diseases. After 3 weeks, the visual acuity of her left eye decreased to 0.02. Repeated MRI revealed enlargement of all extraocular muscles on the left orbit. With biopsy showing several lymphocytes infiltrating muscle fibers, we made a diagnosis of idiopathic orbital myositis. Intravenous injection of corticosteroids was administered during hospitalization. After 2 weeks of corticosteroid therapy, the visual acuity of her left eye was improved to 0.63, the esotropia disappeared, and the enlargement of the left lateral rectus muscle was improved on orbital MRI. CONCLUSIONS: For non-specific idiopathic orbital myositis located at the apex of the orbit and enlargement of the extraocular muscle in a short period with decreased visual acuity, administration of intravenous injection of corticosteroids before orbital biopsy could help restore vision.
Adrenal Cortex Hormones ; Biopsy ; Brain ; Diagnosis* ; Diplopia ; Esotropia ; Eyeglasses ; Female ; Hospitalization ; Humans ; Hypertrophy ; Injections, Intravenous ; Lymphocytes ; Lymphoma ; Magnetic Resonance Imaging ; Muscles ; Optic Nerve ; Orbit* ; Orbital Myositis* ; Telescopes ; Visual Acuity ; Young Adult

PURPOSE: To report two cases of extraocular muscle enlargement due to malignant cancer metastasis. CASE SUMMARY: A 56-year-old woman presented with horizontal diplopia first noted 1 month earlier. She had a history of small cell lung cancer with brain and bone metastases. She had a -3 abduction deficit in the right eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Brain magnetic resonance image showed multiple nodular enlargements of the right lateral and medial rectus muscles, al so multiple metastatic nodules in the brain. A 38-year-old woman presented with horizontal diplopia first noted 3 months previously. She had undergone breast cancer surgery 6 months earlier. The patient had a -4 abduction deficit in the left eye and esotropia. The forced duction test showed no limitation in horizontal movement. Antibody tests for thyroid disease showed normal results. Orbital magnetic resonance imaging showed nodular enlargement of left lateral rectus muscle including a tendon. CONCLUSIONS: Extraocular muscle metastasis is a possible cause of extraocular enlargement and paralytic strabismus. In a patient with malignant cancer, the physician should consider the possibility of extraocular muscle metastasis and perform imaging for early diagnosis and treatment.
Adult ; Brain ; Breast Neoplasms ; Diplopia ; Early Diagnosis ; Esotropia ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Neoplasm Metastasis ; Orbit ; Small Cell Lung Carcinoma ; Strabismus ; Tendons ; Thyroid Diseases

PURPOSE: We report a case of an acute incomitant esotropia with Wernike's encephalopathy. CASE SUMMARY: A 64-year-old male visited our hospital because of diplopia lasting a week. He was a chronic alcoholic drinking two bottles of makgeolli daily and eating little for a month. He showed -2 underaction of bilateral lateral rectus muscles and 45 prism diopters of esotropia at the primary position at the first visit. He had ataxia and mild cognitive impairment. There were high signal intensities in the periaqueductal area and mammillary bodies in the brain fluid attenuated inversion recovery magnetic resonance image. He was diagnosed with Wernike's encephalopathy clinically and was immediately treated with intravenous thiamine. He showed -0.5 underaction of bilateral lateral muscles and 8 prism diopters of esotropia at the primary position 3 days after thiamine treatment. CONCLUSIONS: Wernicke's encephalopathy is a medical emergency. If diagnosis and treatment are delayed, patients may have neurological sequelae that can lead to death. Esotropia and diplopia can be the presenting manifestations in Wernike's syndrome without other symptoms. In taking patient histories, physicians should ask about alcohol consumption and low food intake because of the possibility of acute incomitant esotropia associated with Wernicke's encephalopathy.
Alcohol Drinking ; Alcoholics ; Ataxia ; Brain ; Diagnosis ; Diplopia ; Drinking ; Eating ; Emergencies ; Esotropia* ; Humans ; Male ; Mamillary Bodies ; Middle Aged ; Mild Cognitive Impairment ; Muscles ; Thiamine ; Wernicke Encephalopathy

PURPOSE: In this study we evaluated the prognostic factors by comparing the clinical manifestation of consecutive exotropia after consecutive exotropia surgery. METHODS: We performed a retrospective study of 65 patients who had surgery due to consecutive exotropia after esotropia surgery in Yeungnam University Medical Center between July 1988 and December 2013. The type of esotropia, age at diagnosis of esotropia, type of esotropia surgery, age at esotropia surgery, type of consecutive exotropia surgery, age at consecutive exotropia surgery, presence of adduction limitation, presence of amblyopia, and preoperative and postoperative angles of strabismus were analyzed. RESULTS: The mean follow-up time after consecutive exotropia surgery was 5.1 +/- 5.2 years and 50 of 65 patients showed successful surgical outcomes at the last follow-up. Cumulative success rate of consecutive exotropia remained stable postoperatively in 68.2% of patients after 7.7 years. When comparing the success group and the recurrent group, the age at consecutive exotropia surgery was significantly younger and mean follow-up time was significantly longer in the recurrent group. The mean interval between consecutive exotropia surgery and recurrence of exotropia was 16.9 months in the recurrent group. The mean angle of strabismus at postoperative 1 week was significantly different between the 2 groups; 0.5 prism diopters (PD) esodeviation in the success group and 4.5 PD exodeviation in recurrent group. CONCLUSIONS: Recurrence of consecutive exotropia frequently developed with younger age at consecutive exotropia surgery and exodeviation at postoperative 1 week. Recurrent consecutive exotropia should be observed for an extended period, thus requiring periodic long-term postoperative follow-ups.
Academic Medical Centers ; Amblyopia ; Diagnosis ; Esotropia ; Exotropia* ; Follow-Up Studies ; Humans ; Recurrence ; Retrospective Studies ; Strabismus

PURPOSE: To investigate horizontal image disparity in three-dimensional (3-D) perception using 3-D animations in normal control patients and patients with intermittent exotropia, anisometropic amblyopia, and partially accommodative esotropia. MATERIALS AND METHODS: A total of 133 subjects were included. Stereopsis was measured using the Titmus Stereo test (Stereo Optical Inc., Chicago, IL, USA) and a 3-D stereopsis test with a 15 inch 3-D display laptop, adjusting 3-D parameters of 0 mm horizontal disparity to 15 mm horizontal disparity. RESULTS: When compared with normal controls, the average threshold of the 3-D stereopsis test was significantly reduced for esotropia patients (p<0.001) and for anisometric amblyopia patients (p<0.001), compared to normal controls. No significant difference was observed between normal controls and intermittent exotropia patients (p=0.082). The 3-D stereopsis test was correlated with the Titmus Stereo test (Spearman's rho=0.690, p<0.001). Mean difference in stereoacuity was 1.323 log seconds of arc (95% limits of agreement: 0.486 to 2.112), and 125 (92.5%) patients were within the limits of agreement. CONCLUSION: This study demonstrated that a 3-D stereopsis test with animation is highly correlated with the Titmus Stereo test; nevertheless, 3-D stereopsis with animations generates more image disparities than the conventional Titmus Stereo test. The 3-D stereopsis test is highly predictive for estimating real stereopsis in a 3-D movie theater.
Adult ; Aged ; Amblyopia/diagnosis ; Anisometropia/diagnosis ; *Depth Perception ; Esotropia/diagnosis ; Female ; Humans ; Imaging, Three-Dimensional/*instrumentation ; Male ; Middle Aged ; *Perceptual Disorders ; Software ; *Vision Disparity ; Vision, Binocular ; Visual Acuity/*physiology

PURPOSE: To evaluate ocular abnormalities in children with developmental disability and to find out whether any correlation exists between developmental disability and surgical outcome. METHODS: Totally 43 patients with the diagnosis of developmental disability were enrolled in this retrospective study. RESULTS: Mean follow-up was 4.54 +/- 2.35 year. 20 patients had exodeviation, 15 patients had esodeviation, 10 patients had dissociated vertical deviation and 4 patients had dyskinetic strabismus. 21 patients had surgery and the mean deviation angle was decreased from 36.67 +/- 15.70 PD to 5.33 +/- 5.93 PD in exotropia and 56.25 +/- 8.54 PD to 5.75 +/- 4.65 PD in esotropia. Refractive error was found in 33 patients (88.4%). 26 patients (60.5%) had monocular amblyopia and 17 patients (65.38%) showed improvement of visual acuity after treatment. CONCLUSIONS: Exotropia is the most common type strabismus in patients with developmental disability and dyskinetic strabismus is found in cerebral palsy. Strabismus Surgery for patients with stable angle deviation and amblyopia treatment is effective in children with developmental disability. However decision for surgery should be made after a long follow up period.
Amblyopia ; Cerebral Palsy ; Child ; Developmental Disabilities* ; Diagnosis ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Refractive Errors ; Retrospective Studies ; Strabismus ; Visual Acuity

PURPOSE: To investigate the ophthalmologic manifestations of Korean patients with Gaucher disease. METHODS: Clinical records of 5 patients who were referred to the pediatric ophthalmology clinic of Seoul National University Bundang Hospital after diagnosis of Gaucher disease at the genetics clinic of Ajou University Hospital between 2007 and 2008 were retrospectively reviewed. RESULTS: Five patients with type 3 Gaucher disease had hepatosplenomegaly and oculomotor apraxia, and 4 patients had growth and developmental delay. The most commonly detected genetic mutation was L444P. In addition, P201H, F2131, R257Q, and D315E+Rec 1b were identified. Five patients had oculomotor apraxia and limitation of abduction, and 4 patients had esotropia. One of the 4 patients who showed combined limitation of abduction, oculomotor apraxia, and esotropia, yet did not have growth and developmental delay. CONCLUSIONS: Most of the patients who were referred for ocular motor abnormalities with Gaucher disease showed a limitation of abduction, oculomotor apraxia, and esotropia. In patients with a limitation of abduction, oculomotor apraxia, and esotropia, Gaucher disease should be considered. Ophthalmologic examination is essential for subtyping and prognosing Gaucher disease.
Apraxias ; Diagnosis ; Esotropia ; Gaucher Disease* ; Genetics ; Growth and Development ; Humans ; Lysosomal Storage Diseases ; Ophthalmology ; Retrospective Studies ; Seoul