J Korean Ophthalmol Soc.  2013 Nov;54(11):1767-1771. 10.3341/jkos.2013.54.11.1767.

Acute-Onset Vertical Strabismus in Adults

• Lee YH
• Kim JE
• Rah SH

• KMID: 2217925
• DOI: http://doi.org/10.3341/jkos.2013.54.11.1767

Abstract

PURPOSE
To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors.
METHODS
We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months.
RESULTS
Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request.
CONCLUSIONS
Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.

Keyword

Acute diplopia; Vertical diplopia; Vertical strabismus

MeSH Terms

Adult*
Brain Neoplasms
Diplopia
Fistula
General Surgery
Humans
Myasthenia Gravis
Oculomotor Nerve
Paralysis
Retrospective Studies
Strabismus*
Trochlear Nerve Diseases
Wounds and Injuries

Reference

References

1. Tollefson MM, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood hypertropia: a population-based study. Op- hthalmology. 2006; 113:1142–5.

2. Von Noorden GK, Murray E, Wong SY. Superior oblique paralysis. A review of 270 cases. Arch Ophthalmol. 1986; 104:1771–6.

3. Tamhankar MA, Kim JH, Ying GS, Volpe NJ. Adult hypertropia: a guide to diagnostic evaluation based on review of300 patients. Eye (Lond). 2011; 25:91–6.

4. Magramm I, Schlossman A. Strabismus in patients over the age of 60 years. J Pediatr Ophthalmol Strabismus. 1991; 28:28–31.

5. Brazis PW, Lee AG. Binocular vertical diplopia. Mayo Clin Proc. 1998; 73:55–66.

6. Palla A, Straumann D. Neurological evaluation of acute vertical diplopia. Schweiz Arch Neurol Psychiatr. 2002; 153:180–4.

7. Tiffin PA, MacEwen CJ, Craig EA, Clayton G. Acquired palsy of the oculomotor, trochlear and abducens nerves. Eye. 1996; 10:377–84.

8. Park UC, Kim SJ, Yu YS. Clinical features and natural history of acquired third, fourth, and sixth cranial nerve palsy. J Korean Ophthalmol Soc. 2005; 46:1555–62.

9. Rucker CW. The causes of paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol. 1966; 61(5 Pt 2):1293–8.

10. Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1000 cases. Arch Ophthalmol. 1981; 99:76–9.

11. Berlit P. Isolated and combined pareses of cranial nerves Π, W, and Y. A retrospective study of 412 patients. J Neurol Sci. 1991; 103:10–5.