OBJECTIVE: To observe the effect of the direct stimulation of acupuncture at extraocular muscle attachment point on acquired extraocular muscle palsy. METHODS: Thirteen patients with acquired extraocular muscle palsy were treated with acupuncture directly at extraocular muscle (paralytic muscle) attachment point. Firstly, the intraocular conjunctival sac drops of topical anesthetic (procaine hydrochloride eye drops) were administered, 0.2 mL each time, once every 10 minutes, for a total of 3 times. Acupuncture was delivered immediately after the third drop. The sterile acupuncture needle for single use, 0.25 mm×25 mm, was inserted at the anatomical location of the corneal limbal attachment of paralytic extraocular muscle, with an angle of 10° to 15° formed between the needle tip and extraocular muscle, and a depth of 0.3 mm to 0.5 mm. Pivoted by the needle tip, the eyeball was moved passively towards the direction of normal action of orbital muscle, 30 to 50 times until the patient felt soreness of the eyeball; afterwards, the needle was removed. After acupuncture, levofloxacin eye drops were administered once (0.2 mL) at the affected eye. The treatment was given twice a week, and completed when diplopia disappeared. Before and after treatment, the diplopia and the synoptophore circumference were observed respectively. RESULTS: After 7 to 24 (15.46±5.56) times of direct stimulation with acupuncture at extraocular muscle attachment point, the symptoms of diplopia disappeared in 13 patients, the eye position restored to orthophoria, and the circumference of synoptophore was reduced to be (4.04±0.82)° from (19.38±3.98)° detected before treatment (P<0.05). CONCLUSION Acupuncture directly at extraocular muscle attachment can attenuate diplopia and improve ocular muscle function in patients with acquired extraocular muscle palsy.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Adult ; Oculomotor Muscles/physiopathology* ; Aged ; Acupuncture Points ; Ophthalmoplegia/physiopathology*

PURPOSE: To evaluate the correlation between hypertropia and excyclotorsion in acquired superior oblique palsy (SOP). METHODS: Thirty-one patients with acquired unilateral SOP were recruited for this study. The torsional angle of each patient was assessed via one objective method (fundus photography) and two subjective methods (double Maddox rod test and major amblyoscope). The patient population was divided into two groups (concordance group, n = 19 and discordance group, n = 12) according to the correspondence between the hypertropic eye (paralytic eye) and the more extorted eye (non-fixating eye), which was evaluated by fundus photography. RESULTS: The mean value of objective torsion was 5.09degrees +/- 3.84degrees. The subjective excyclotorsion degrees were 5.18degrees +/- 4.11degrees and 3.65degrees +/- 1.93degrees as measured by double Maddox rod test and major amblyoscope, respectively. Hypertropia and the excyclotorsional angle did not differ significantly between the groups (p = 0.257). Although no correlation was found in the discordance group, the concordance group showed a significant and positive correlation between hypertropia and excyclotorsion (p = 0.011). CONCLUSIONS: Torsional deviation was not related to hypertropia. However, in the concordance patients in whom the hypertropic eye showed excyclotorsion, a significant positive correlation was found between hypertropia and excyclotorsion.
Adolescent ; Adult ; Aged ; Child ; Diagnostic Techniques, Ophthalmological ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/*physiopathology ; Ophthalmologic Surgical Procedures/*methods ; Ophthalmoplegia/*etiology/physiopathology/surgery ; Retrospective Studies ; Strabismus/*etiology/physiopathology/surgery ; Treatment Outcome ; Trochlear Nerve Diseases/*complications/physiopathology/surgery ; Young Adult

Aged, 80 and over ; Brain ; Breast Neoplasms ; complications ; drug therapy ; physiopathology ; radiotherapy ; Cranial Fossa, Posterior ; diagnostic imaging ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; diagnosis ; radiotherapy ; Ophthalmoplegia ; complications ; diagnosis ; physiopathology ; radiotherapy ; Radiography

To the best of our knowledge, isolated bilateral oculomotor nuclear palsy has not yet been reported in the literature, while bilateral oculomotor nuclear palsy with more widespread rostral brainstem infarction has often been reported. We present a patient having top of the basilar syndrome with midbrain infarction selectively involving the bilateral oculomotor nucleus. A 61-year-old woman with two episodes of vertebrobasilar infarction presented with sudden onset of bilateral ptosis. Examination revealed pronounced bilateral ptosis. In the primary position, fixation of either eye produced an approximately 50 prism diopter exotropia. Adduction of the right eye was restricted to the midline. There was moderately decreased adduction of the left eye, severe limitation of depression, and moderately decreased elevation of both eyes. Abduction of both eyes was normal. The pupils were equal, round, and reactive to light. Bilateral ptosis is suggestive of oculomotor nuclear palsy. On the basis of clinical findings alone, we could not establish whether the precise location of the lesion was all the subdivisions of the oculomotor nucleus except the Edinger-Westphal nucleus or the central caudal nucleus and bilateral fascicles. However, because axial MRI showed a small midbrain infarct in the oculomotor nucleus region, we concluded that she had an isolated, pupil-sparing, bilateral oculomotor nuclear palsy caused by midbrain infarct.
Cerebral Infarction/*complications/diagnosis ; Female ; Human ; Magnetic Resonance Imaging ; *Mesencephalon ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/physiopathology

The authors present the clinical findings of a 30-year-old female and a 29-year-old male who both had isolated unilateral lateral rectus muscle palsy in neuro-Behcet's disease. The clinical feature related to isolated abduscens nerve palsy was identified by CT, systemic assessment and extraocular examination. These patients' constellation of findings appear to be unique: it does not follow any previously reported pattern of ocular manifestations of neuro-Behcet's disease.
Abducens Nerve/physiopathology ; Adult ; Behcet's Syndrome/complications* ; Case Report ; Eye Movements/physiology ; Female ; Human ; Male ; Ophthalmoplegia/physiopathology ; Ophthalmoplegia/etiology* ; Paralysis/physiopathology ; Paralysis/etiology*