Gill Roper-Hall

Pseudotumor cerebri associated with cyclosporine use.

PURPOSE An 11-year-old boy had a one-month history of horizontal diplopia. Three years earlier, he had undergone allogeneic bone marrow transplantation complicated by graft versus host disease. METHODS The patient had esotropia and bilateral optic disk edema. A magnetic resonance imaging scan disclosed no intracranial lesion. The opening pressure of the lumbar puncture was 500 mm of water. Pseudotumor cerebri secondary to cyclosporine was diagnosed. RESULTS The patient improved with resolution of his esotropia and diplopia within five days of discontinuing his cyclosporine. The optic disk edema resolved within three months. CONCLUSION Cyclosporine must be added to the list of medications with a known association with pseudotumor cerebri.

Ocular neuromyotonia: differential diagnosis and treatment

Abstract Ocular neuromyotonia (ONM) is a rare but distinctive clinical entity characterized by involuntary episodic contraction of one or more muscles supplied by the ocular motor nerves. A retrospective review was conducted on all patients with ONM seen by the neuroophthalmology service in the past 20 years. Ten patients were identified with ONM; six affecting vertical muscles (superior oblique; inferior rectus; superior rectus) and four affecting lateral rectus muscles. Case 1 has been reported previously. Most episodes occurred every 10–40 min, lasted a few seconds to several minutes, and were repeated throughout the day. Only two patients had previously undergone cranial radiation. Two had thyroid eye disease. One patient presented with superior oblique myokymia and subsequently developed ONM. Membrane stabilizing medications were prescribed in 7 of the 10 patients with varied success. ONM episodes ceased after extraocular muscle surgery in one patient with thyroid eye disease.

The Influence of the Vergence System on Strabismus Diagnosis and Management

The vergence system is an important element in human eye movement control. It comprises horizontal, vertical, and torsional components, the largest of which is convergence. Vergence performance is largely involuntary, although voluntary effort can influence convergence. Vergence function can be damaged by trauma or organic disease and, because convergence can be exerted voluntarily, it is susceptible to purposeful subjective disturbances. Vergence function is important in the maintenance of binocular control, being synonymous with motor fusion. The most common vergence dysfunction affects convergence and may be exhibited as an excess or weakness such as convergence spasm or paralysis. Divergence dysfunction generally presents with diminished function such as divergence weakness; vertical and cyclovergence disturbances are rare. An update is given on the neuroanatomical areas that subserve the vergence system. Clinical examples of the most common vergence disorders are presented. The influence of the vergence system on the diagnosis and management in common and less well-known clinical entities is described and discussed.

Current Concepts of Amblyopia: A Neuro-Ophthalmology Perspective

Amblyopia can be defined as a developmental disorder in which there is a deficit in visual acuity that cannot be improved by refractive correction and that has no detectable organic cause. It has been recognized as a clinical entity for over 300 years. Amblyopia can no longer be considered a single clinical entity, many subtypes having been recognized.1–9 Early detection and treatment may result in positive outcomes in some subtypes, but others, if not detected early, are not responsive to treatment.

Historical Vignette: Ernest Edmund Maddox (1860–1933): Master Surgeon, Inventor, and Investigator

Ernest Edmund Maddox, M.D., F.R.C.S.E., was renowned for his clinical and surgical expertise in strabismus. He was regarded with great esteem by his colleagues and was always to be seen at ophthalmology conferences where he presented and discussed his ideas and latest inventions (Figure 1). Maddox had a great curiosity and although he investigated and wrote about other medical and ophthalmologic conditions besides strabismus, this was his lifelong interest. Most of the instruments and devices Maddox invented were for this condition. His name will forever be associated with the Maddox rod, wing, double prism, tangent scale (Maddox cross), and cheiroscope. Maddoxs surgical skills were outstanding and he was described as a master surgeon, inventor, and investigator by his peers.

Binocular Problems in Bitemporal Hemianopsia

One of the prerequisites for comfortable binocular single vision (BSV) is the presence of normal overlapping visual fields. Any defect in the visual field of one or both eyes may interfere with BSV...

Acquired Ophthalmoplegia in Older Children and Adults

ABSTRACT Ophthalmoplegia or ophthalmoparesis are the terms given to paralysis or paresis of one or more of the extraocular muscles in one or both eyes. It may be representative of serious neurological or systemic disease. Other mechanisms may cause limitation of eye movement, including restrictive or myasthenic conditions, or combinations of several etiologies. Evaluating and differentiating the mechanisms causing ophthalmoplegia is important in determining the correct diagnosis and selecting the appropriate management in these complex cases.

Management of Vertical Ocular Deviations Secondary to Restrictive Conditions

Background and Purpose Management of vertical strabismus secondary to restrictive conditions can be challenging for both the patient and practitioner. The purpose of this paper is to identify both common and uncommon causes of vertical restrictive strabismus, to discuss the evaluation of these conditions, and to briefly review the etiology and recommendations for surgical management. Method Current literature was reviewed as well as the surgical techniques that have been found to be most useful from experience over the past twenty years of practice. Conclusion Surgical realignment and elimination of diplopia is both challenging and problematic. Surgery should be designed to relieve restriction, with attention to identifying and managing incomitance. Furthermore, it is important to establish realistic goals with patients.

Historical Vignette: Johann Friedrich Horner (1831-1886): Swiss Ophthalmologist, Scientific Contributor, and Accomplished Academician.

Johann Friedrich Horner was a Swiss ophthalmologist who was the founder of modern ophthalmology in his country and who established the first academic department of ophthalmology at the University of Zürich (Figure 1).1–3 He was widely published on a great number of medical topics, but is best known for his description of a triad of clinical findings that include unilateral ptosis, miosis, and anhydrosis, commonly referred to as Horner syndrome. Although Horner was not the first to describe these characteristics,4–7 he is recognized as the first to provide the detailed and scientifically supported description of the manifestations of this syndrome in humans and accurately interpreting the signs of sympathetic nerve damage.8,9

Franciscus Cornelis Donders (1818-1889): Dutch biologist, physiologist, and ophthalmologist.

(2012). Historical Vignette: Franciscus Cornelis Donders (1818–1889): Dutch Biologist, Physiologist, and Ophthalmologist. American Orthoptic Journal: Vol. 62, No. 1, pp. 99-106.