ABSTRACT
Superior oblique myokymia (SOM) is a rare disorder characterized by unilateral paroxysmal oscillopsia or diplopia. Recent studies revealed that SOM can be associated with neuro-vascular cross compression (NVCC) of the trunk of the trochlear nerve. Although it frequently occurs without any underlying systemic disease or concurrent neurologic sign, we need to consider this NVCC especially in cases with persistent disturbing symptoms. Hereby, we present two cases of SOM whose neuroimaging studies suggest NVCCs and, discuss recent update of the pathomechanism of SOM.
Subject(s)
Diplopia , Nerve Compression Syndromes , Neuroimaging , Neurologic Manifestations , Trochlear Nerve , Trochlear Nerve DiseasesABSTRACT
PURPOSE: Superior oblique myokymia is intermittent spontaneous contractions of the superior oblique muscle presenting as rapid and small-amplitude intorsions and depressions of the eye. The authors report a case of superior oblique myokymia that was objectively and quantitatively diagnosed with slit lamp examination and video-oculography and completely resolved with medical treatment. CASE SUMMARY: A 44-year-old woman presented with a seven-year history of intermittent oscillopsia which continued for few seconds. She had no history of head trauma or systemic ocular disease, and the anterior segment and fundus examination were unremarkable. Right eye intorsion lasting for a few seconds as detected by slit lamp examination. Eye movements were recorded using video-oculography, which showed a torsional nystagmus of 5 to 10 degrees with 2 to 5 vertical components in the right eye. Based on these findings, the patient was diagnosed with superior oblique myokymia. The patient was prescribed topical timolol ophthalmic solution, one drop twice per day, but the symptoms persisted. Timolol ophthalmic solution was stopped and replaced with carbamazepine, 200 mg twice a day, which resolved her symptoms. CONCLUSIONS: Slit lamp examination and video-oculography can be used as objective and quantitative diagnostic tools in order to confirmed a diagnosis and lead to proper treatment.
Subject(s)
Adult , Female , Humans , Carbamazepine , Craniocerebral Trauma , Depression , Diagnosis , Eye Movements , Slit Lamp , Timolol , Trochlear Nerve DiseasesABSTRACT
Superior oblique myokymia is an unusual disorder of ocular motility characterized by rapid, small ampulitude and rotary oscillations limited to one eye. Symptoms of monocular oscillopsia and torsional diplopia are experienced by the patient, and the cause remains obscure. We experienced a case of superior oblique myokymia that developed in a 53-year-old male. We report this unusual case with literature review.