A light is shone on the eye. If the reflection is not on the same spot, then strabismus is present. It can be treated with eyeglasses or vision therapy. One might need strabismus surgery. Prisms can also be used. In this form of treatment, prisms change the course of light and images and this helps to cause a change in eye position. Quantum anabolic maximizer for strength and muscle, energy, stamina, fat metabolism, power and endurance. Contains key, dynamic botanical ingredients clinically tested ratios to maximize testosterone and anabolic hormones as never before. Increase your muscle tissue development at unprecedented levels. Macy's - FREE Shipping at Macys.com. Macy's has the latest fashion brands on Women's and Men's Clothing, Accessories, Jewelry, Beauty, Shoes and Home Products.
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Acute Acquired Comitant Esotropia in Adults: Is It Neurologic or Not?
1Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
2Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
Received 7 September 2016; Accepted 24 October 2016
Academic Editor: Michael Kinori
Copyright © 2016 Kadriye Erkan Turan and Tulay Kansu. Canadian foundation engineering manual 2006 pdf printer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objectives. Acute acquired comitant esotropia (AACE) can be a diagnostic challenge for ophthalmologists and neurologists because of its association with neurological pathologies. Our study describes a series of adult patients with AACE of undetermined etiology. Methods. Data on the clinical findings of patients presented with AACE of undetermined etiology with a minimum follow-up of 1 year were retrieved from the medical records and the results analyzed. Results. A series of 9 esotropia cases (age range: 20–43 years) was reviewed. All patients had full duction and versions, without an A-pattern or V-pattern. All patients had esotropia for distance and near. Neurological evaluation in all cases was normal. Among patients, 3 were treated with prisms, 4 were treated with strabismus surgery, and 1 was treated with botulinum toxin injections; 1 patient declined treatment. In treated patients posttreatment sensory testing indicated restoration of binocularity that remained stable throughout follow-up of 1–9 years. The patient that declined treatment had binocular function with base-out prisms. Conclusion. Acute onset esotropia may be seen without a neurological pathology in adults. Good motor and sensory outcomes can be achieved in these patients with AACE of undetermined etiology via surgical and nonsurgical methods.
1. Introduction
Acute acquired comitant esotropia (AACE) is an unusual presentation of esotropia that occurs in older children and adults. AACE is characterized by acute onset of a relatively large angle of esotropia, along with diplopia and minimal refractive error [1, 2]. AACE is not cyclical, although it may initially be intermittent. It is comitant at distance and near fixation [1]. AACE is categorized as 3 types, based on the clinical features and apparent etiology: type 1 (Swan type): acute onset esotropia following occlusion; type 2 (Franceschetti type): refractive error which is minimal hypermetropia without an accommodative element; type 3 (Bielschowsky type): AACE associated with myopia [3, 4]. The other causes of acute esotropia in adults include sixth nerve palsy, age-related distance esotropia, divergence palsy, accommodative esotropia, decompensated monofixation syndrome, restrictive strabismus, consecutive esotropia, sensory strabismus, ocular myasthenia gravis, and some neurological disorders (tumors of the cerebellum, brainstem, pituitary region, corpus callosum, Arnold-Chiari malformation, cerebellar disease, and idiopathic intracranial hypertension). AACE is considered rare, but no statistical data is available regarding its actual incidence or prevalence [5]. We present 9 patients with AACE of undetermined etiology and a review of the relevant literature.
2. Methods
The medical records of 9 consecutive patients older than 18 years of age presenting with acute acquired comitant esotropia of undetermined etiology between 1993 and 2014 and with a minimum follow-up of 1 year were reviewed retrospectively. The authors adhered to the tenets of the Declaration of Helsinki. All patients underwent ophthalmological, neurologic examinations and orbital-cranial MRI with contrast for inclusion. An ophthalmologist and neurologist performed the examination. Patients with incomitant esotropia were excluded. Incomitance was defined as limited abduction and larger deviation at lateral gaze.
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The following information was obtained on each patient: sex, age, presenting complaint, duration of symptoms, signs, cycloplegic refraction with cyclopentolate, best corrected visual acuity, deviation at near and distance, fusion and stereopsis, neurological examination and tests, cranial and orbital MRI findings, treatment, follow-up time, and outcomes. Snellen chart was used to test visual acuity. Sensory fusion was evaluated with Worth 4-dot test at near (1/3 m) and distance (6 m) and stereopsis was assessed with Titmus test. The angles of deviations were assessed by alternate cover (prism and cover) test in all 9 cardinal gaze positions. Both near and distance measurements were taken. Ocular motility, patterns, and nystagmus were evaluated clinically. Lees screen test was performed.
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3. Results
The 9 patients presented with acute onset of binocular horizontal diplopia that developed 10 days–18 months prior to presentation. Diplopia was constant throughout the day in all cases. Case details are given in Table 1.
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