Diagnosis of Peripheral Ocular Motor Palsies and Strabismus

This chapter reviews the physiologic basis for diplopia, including Sherington’s law of reciprocal innervation and Hering’s law of motor correspondence. Clinical testing is reviewed, including cover tests, red glass, Maddox rod, the Bielschowsky head-tilt test, and abnormal head postures. Clinical features (with illustrative video cases), etiology, and management of abducens nerve palsy, trochlear nerve palsy, oculomotor nerve palsy, and combined neuropathies are discussed, as well as Miller Fisher syndrome, amyotrophic lateral sclerosis, neuromyotonia, Brown’s syndrome and superior oblique myokymia. Disorders of the neuromuscular junction are examined, including systemic botulism, Lambert-Eaton myasthenic syndrome, and myasthenia gravis. Disorders affecting the extraocular muscles are reviewed, including chronic progressive external ophthalmoplegia, Duchenne dystrophy, myotonic dystrophy, oculopharyngeal dystrophy, congenital myopathies, Kearns-Sayre syndrome and mitochondrial myopathies. The chapter also discusses thyroid eye disease, acquired restrictive ophthalmopathies, and congenital cranial dysinnervation disorders (CCDD), Duane syndrome, horizontal gaze palsy with scloliosis, and congenital fibrosis of the extraocular muscles.

Hering’s Law Assessment Tool Revisited

Hering’s Law Assessment Tool emerged as a systematic outcome assessment tool following homeopathic intervention. The authors intend to modify it and develop a new tool—Patient Response Assessment Tool after Homeopathic Treatment (PRATHoT)—in chronic cases through Delphi technique for systematic categorization of probable outcomes following individualized homeopathic treatment in chronic cases. The PRATHoT was drafted after literature review and iterative Delphi rounds with multidisciplinary expert panel, setting Fleiss κ of 0.41 to 1.00 a priori as the desired level of multirater agreement. Following pilot testing, the tool was implemented on 37 patients suffering from knee osteoarthritis over 6 months. Logistic regression analysis confirmed that higher PRATHoT score was significantly associated with achieving pain visual analogue scale responses from the second follow-up visit onwards ( B = 0.037-0.066; SE = 0.021-0.036; P = .003-.048). The tool appeared to have acceptable psychometric properties; hence, it may be considered as a promising tool, amendable for further development.