Hemifield-slide diplopia successfully managed with botulinum toxin injection in a patient with traumatic chiasmal disruption.

Abstract

PURPOSE\nThis report describes the clinical course of the traumatic chiasmal syndrome and treatment of diplopia due to the hemifield-slide phenomenon.\n\n\nCASE REPORT\nA 20-year-old male with decreased vision in both eyes following blunt head trauma was referred to the neuro-ophthalmology clinic. Neuroimaging revealed disruption of the optic chiasm and skull base fracture. After partial vision recovery, the patient noticed complete bitemporal hemianopia. Three months later, he was exotropic and complained of diplopia and difficulty in near visual tasks. His symptoms were successfully controlled by injection of botulinum toxin A in both lateral rectus muscles.\n\n\nCONCLUSIONS\nThere is some potential for improvement in vision in patients with traumatic chiasmal syndrome. Botulinum toxin could be used in patients with the hemifield-slide phenomenon to predict the sensory outcome of surgery and relieve the bothersome symptoms.