J Korean Ophthalmol Soc.  2015 Oct;56(10):1604-1609. 10.3341/jkos.2015.56.10.1604.

Clinical Manifestations and Prognosis of Convergence Insufficiency after Craniofacial Trauma

• Shin MH
• Kim DH

• KMID: 2214422
• DOI: http://doi.org/10.3341/jkos.2015.56.10.1604

Abstract

PURPOSE
To evaluate the clinical manifestation and prognosis of convergence insufficiency after craniofacial trauma.
METHODS
Twelve patients injured by craniofacial trauma were analyzed for the cause of trauma, ocular and accompanied non-ocular symptoms, presence of loss of consciousness, presence of craniofacial fracture and intracranial hemorrhage, treatment modality for ocular symptoms, change in strabismic angle and near point of convergence (NPC) after treatment and prognosis using clinical records from April 2008 to December 2014.
RESULTS
Traffic accidents (8 patients) were the leading cause of trauma. Near diplopia (11 patients) was the leading type of ocular symptom and other following symptoms included headache, asthenopia and reading difficulty. Ten patients experienced loss of consciousness and craniofacial fracture and intracranial hemorrhage were observed in 7 patients. Intracranial hemorrhage and craniofacial fracture occurred in 3 patients and only 1 patient had neither intracranial hemorrhage nor craniofacial fracture. All 12 patients performed orthoptic exercises, but no improvement of near strabismic angle, NPC and ocular symptoms was observed. However, 4 patients who received surgery demonstrated improvement in near strabismic angle, NPC and ocular symptoms.
CONCLUSIONS
Convergence insufficiency after craniofacial trauma occurred by relatively strong traumatic force and had a poor outcome in non-surgical methods such as orthoptic exercise. Surgery was an effective treatment method rather than orthoptic exercise.

Keyword

Convergence insufficiency; Craniofacial trauma; Near point of convergence; Orthoptic exercise; Surgery

MeSH Terms

Accidents, Traffic
Asthenopia
Diplopia
Exercise
Headache
Humans
Intracranial Hemorrhages
Ocular Motility Disorders*
Orthoptics
Prognosis*
Unconsciousness

Reference

References

1. Kulkarni AR, Aggarwal SP, Kulkarni RR. . Ocular manifes-tations of head injury: a clinical study. Eye (Lond). 2005; 19:1257–63.

2. Faith M, Githinji KJ, Sheila M, Margaret N. Ocular findings in pa-tients with head injury. International Journal of Medical and Clinical Sciences. 2014; 1:9–17.

3. Van Stavern GP, Biousse V, Lynn MJ. . Neuro-ophthalmic manifestations of head trauma. J Neuroophthalmol. 2001; 21:112–7.

4. Arnoldi K, Reynolds JD. A review of convergence insufficiency: what are we really accomplishing with exercises? Am Orthopt J. 2007; 57:123–30.

5. Duke-Elder S. System of Ophthalmology: Ocular Motility and Strabismus. Vol. 6. St. Louis: CV Mosby. 1973; 570.

6. Duane A. Anomalies of the accommodation clinically considered. Trans Am Ophthalmol Soc. 1915; 14:(Pt 1). 386–402.

7. Brown HW. Strabismus in the adult. In: Haik GM, ed. Strabismus Symposium of the New Orleans Academy of Ophthalmology. St. Louis: Mosby. 1950; 351.

8. Paik HJ, Lim HT. Accommodation and convergence, anomalies of convergence. J Korean Ophthalmol Soc. 2012; 53:1719–26.

9. Doden W, Bunge H. Fusion disturbances following cerebrocranial injury. Klin Monbl Augenheilkd. 1965; 146:548–53.

10. Cross AG. Neuromuscular aspects in ocular sequelae of head injuries. Trans Ophthalmol Soc U K. 1945; 65:20–34.

11. Cohen M, Groswasser Z, Barchadski R, Appel A. Convergence in-sufficiency in brain-injured patients. Brain Inj. 1989; 3:187–91.

12. Ciuffreda KJ, Kapoor N, Rutner D. . Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2007; 78:155–61.

13. Duke-Elder S, Macfaul P. System of Ophthalmology. Vol. 14. London: Henry Kimpton;1972. p. 710.

14. al-Qurainy IA. Convergence insufficiency and failure of accom-modation following midfacial trauma. Br J Oral Maxillofac Surg. 1995; 33:71–5.

15. Annegers JF, Grabow JD, Kurland LT, Laws ER Jr. The incidence, causes, and secular trends of head trauma in Olmsted County, Minnesota, 1935-1974. Neurology. 1980; 30:912–9.

16. Lapore FE. Disorders of ocular motility following head trauma. Arch Neurol. 1995; 52:924–6.

17. Daum KM. Convergence insufficiency. Am J Optom Physiol Opt. 1984; 61:16–22.

18. Sabates NR, Gonce MA, Farris BK. Neuro-ophthalmological find-ings in closed head trauma. J Clin Neuroophthalmol. 1991; 11:273–7.

19. Jeong JS, Kim DH. Associated injuries and prognosis in traumatic isolated 3rd, 4th, and 6th cranial nerve palsies. J Korean Ophthalmol Soc. 2014; 55:596–601.

20. Dhaliwal A, West AL, Trobe JD, Musch DC. Third, fourth, and sixth cranial nerve palsies following closed head injury. J Neuroophthalmol. 2006; 26:4–10.

21. Elston JS. Traumatic third nerve palsy. Br J Ophthalmol. 1984; 68:538–43.

22. Memon MY, Paine KW. Direct injury of the oculomotor nerve in craniocerebral trauma. J Neurosurg. 1971; 35:461–4.

23. Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol. 2008; 126:1336–49.

24. Scheiman M, Rouse M, Kulp MT. . Treatment of convergence insufficiency in childhood: a current perspective. Optom Vis Sci. 2009; 86:420–8.

25. Convergence Insufficiency Treatment Trial (CITT) Study Group The convergence insufficiency treatment trial: design, methods, and baseline data. Ophthalmic Epidemiol. 2008; 15:24–36.

26. Kim KM, Chun BY. Effectiveness of home-based pencil push-ups (HBPP) for patients with symptomatic convergence insufficiency. Korean J Ophthalmol. 2011; 25:185–8.

27. Candler RG. Ocular sequelae of head injuries: the response of per-sonnel affected by head injury to orthoptic treatment. Trans Ophthalmol Soc U K. 1945; 65:57–67.

28. Scheiman M, Mitchell GL, Cotter S. . A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. Optom Vis Sci. 2005; 82:583–95.

29. Krohel GB, Kristan RW, Simon JW, Barrows NA. Posttraumatic convergence insufficiency. Ann Ophthalmol. 1986; 18:101–2. 104.

30. Grisham JD. Visual therapy results for convergence insufficiency: a literature review. Am J Optom Physiol Opt. 1988; 65:448–54.

31. von Noorden GK. Resection of both medial rectus muscles in or-ganic convergence insufficiency. Am J Ophthalmol. 1976; 81:223–6.