Clinical features of isolated inferior rectus paralysis

The aim of this study was to evaluate the incidence, clinical features, and risk factors of sustaining inferior rectus (IR) palsy in a group of pediatric patients with orbital floor blowout fractures. We performed a retrospective case review of sequential cases of pediatric orbital floor blowout fractures (<18 years old) from 2000 to 2013 in a tertiary ophthalmic center in Singapore. A total of 48 patients were included in our study, of whom 5 had IR palsy (10.4%). Patients with IR palsy had a higher mean age (16.4 ± 1.5 years) compared with patients without IR palsy (12.4 ± 3.3 years), had significantly ( p < 0.05) worse preoperative motility, and had significantly greater proportion developing postoperative hypertropia (100%) compared with patients without IR palsy (4.7%). Our series of pediatric blowout fractures demonstrated IR palsy prevalence and clinical features for IR palsy which may be distinct to the pediatric group.

Download Full-text

Vertical restrictive strabismus associated with proptosis: Similar clinical signs, different etiopathogenetic causes. A report of three patients

European Journal of Ophthalmology ◽

10.1177/1120672120946929 ◽

2020 ◽

pp. 112067212094692

Author(s):

Gustavo Savino ◽

Gianluigi Petrone ◽

Giulio Volpe ◽

Giulia Midena ◽

Gabriela Grimaldi ◽

...

Keyword(s):

Clinical Features ◽

Outpatient Service ◽

Clinical Signs ◽

Case Series ◽

Inferior Rectus ◽

Superior Rectus ◽

Pleomorphic Sarcoma ◽

Contrast Enhanced ◽

Unilateral Proptosis ◽

Restrictive Strabismus

Purpose: To report the different uncommon pathogenesis of three cases of severe vertical restrictive strabismus associated with progressive unilateral proptosis with similar clinical features. Methods: Case series of three patients who presented to the Orbit Outpatient Service of Policlinico Gemelli with a history of left progressive unilateral proptosis, slowly worsening vertical strabismus and the left eye fixed in downward position. A thorough hematologic work up was performed. All patients underwent complete abdomen ultrasonography, orbital contrast enhanced magnetic resonance imaging, forced duction test under general anesthesia, and orbital biopsy. Results: Patients were 30, 60, and 46 years old respectively. MRI showed left inferior rectus enlargement in two cases and superior rectus enlargement in one case, with contrast enhanced combined muscle belly and tendon enlargement in all cases. Patients underwent forced duction test, muscle weakening (in two cases), and muscle biopsy with histopathologic examination. The superior rectus appeared infiltrated by an undifferentiated high-grade pleomorphic sarcoma, whereas the two inferior recti were positive for idiopathic orbital inflammatory disease with fibrosis areas and neuromuscular choristoma, respectively. Conclusion: Although proptosis and acquired vertical restrictive strabismus are most commonly associated with thyroid associated orbitopathy (TAO), they can also be a manifestation of many other conditions and the differential diagnosis can be particularly challenging. The three reported cases presented indeed with similar clinical features but had three distinct underlying orbital etiologies, two of which were extremely uncommon.

Download Full-text

Absent Bell’s phenomenon in patients with thyroid eye disease

BMC Ophthalmology ◽

10.1186/s12886-021-02107-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hyun Woo Chung ◽

Hwa Lee ◽

Sehyun Baek

Keyword(s):

Clinical Features ◽

Thyroid Function ◽

Muscle Hypertrophy ◽

Rectus Muscle ◽

Thyroid Function Test ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Inferior Rectus ◽

Function Test ◽

Inferior Rectus Muscle

Abstract Background To investigate the incidence of absent Bell’s phenomenon (BP) and the relationship between absent BP and inferior rectus muscle hypertrophy and other clinical features in patients with thyroid eye disease (TED). Methods A total of 104 patients who were first diagnosed with TED between January and December 2014 were included. Inferior rectus muscle area and associations with clinical features of TED and thyroid function test including thyroid specific antibodies were compared between patients with TED with and without BP. The volume of the inferior rectus muscle was calculated by adding up all the cross-sectional areas measured on sagittal CT images. Results Among the 104 patients, 14 had absent BP (13.5%), 12 with bilateral and two with unilateral. There was no significant difference in thyroid function test, presence of TSIs, exophthalmos, or volume of inferior rectus muscle measured in CT scans (P > 0.05). Incidence of diplopia, elevation limitation, and upper eyelid retraction were risk factors of absent BP in TED patients (by logistic regression analysis, P < 0.05). Conclusions Inferior rectus muscle hypertrophy was not the cause of absent BP in TED patients. Fibrosis and tightening of the inferior rectus muscle, lower eyelid, and surrounding orbital tissues, rather than inferior rectus muscle hypertrophy, might be related to absent BP in TED patients.

Download Full-text

Clinical Features Of Ocular Myasthenia Gravis In Adult Patients: Diplopia and Ophthalmoplegia

10.21203/rs.2.23102/v1 ◽

2020 ◽

Author(s):

Junjie Tang ◽

Fangyuan Chen ◽

Xiaoyong Liu ◽

Jian Chen ◽

Qing Zhou

Keyword(s):

Myasthenia Gravis ◽

Clinical Features ◽

Case Series ◽

Adult Patients ◽

Lateral Rectus ◽

Initial Symptom ◽

Inferior Rectus ◽

Ocular Myasthenia ◽

Case Series Study ◽

Ocular Myasthenia Gravis

Abstract Background: The diagnosis of ocular myasthenia gravis (OMG) in adult patients remained challenged and the characteristics of diplopia and ophthalmoplegia in OMG is unclear. Methods: Retrospective case series study of medical records of 40 adult patients diagnosed with OMG at The First Affiliated Hospital of Jinan University from June, 2016 to December, 2019, was performed to analyze the clinical features, diagnostic tests and preferential affected extraocular muscles of OMG. Results: 40 adult patients with OMG were involved and men represented 20 (50%) of cases. Mean age (±SD) among men was 49 ± 21 years (range: 19-81 years) and 40 ± 15 years (range: 21-65 years) among women. 18 patients (45.0%) were 18 to 39 years old, 12 patients (30.0%) were 40 to 59 years old, 9 patients (22.5%) were 60 to 79 years old, 1 patients (2.5%) over 80 years old. The median course of the disease among all the patients was 6 months (ranged: 1 month to 10 years). Neostigmine test was positive in 32 of 40 patients (80.0%), acetycholine receptors antibodies assay was positive in 4 of 40 patients (10.0%), Thymus CT showed abnormal findings in 5 of 40 patients (12.5%). At the first visit, 27 patients (67.5%) showed diplopia only, 9 patients (22.5%) showed ptosis only, 4 patients (10.0%) showed diplopia with ptosis. The most paralytic EOM, determined through light reflection, cover-uncover test and red glass test for patients presented with diplopia only (n=27) and diplopia with ptosis (n=9), was lateral rectus (51.6%), superior rectus (19.4%), medial rectus (12.9%), inferior rectus (9.8%), superior oblique (3.2%), inferior oblique (3.2%) in order. Conclusions: OMG mainly affected adults at the working ages. Diplopia serves as initial symptom in most adult patients with OMG and lateral rectus is most susceptible.

Download Full-text