Characteristics and therapeutic effect evaluation of divergence paralysis / 眼科新进展

Objective To investigate the clinical features of divergence paralysis improve the diagnostic and therapeutic ability,and evaluate the effect of surgical and non-surgical treatment.Methods It was a retrospective case series study.11 cases with complete data,diagnosed and treated as divergence paralysis in Tianjin Eye Hospital from September 2014 to January 2016,were summarized.The observation items included general date,neurologica consultation,comprehensive eye examination,and the eye position and movement,deviation degree,binocular vision,AC / A,diplopia examination of pre-treatment and post-treatment.The patients were followed up from 3 months to 1.5 yeas,averaged 6.9 months.Results In our study,1 patient was MillerFisher syndrome,3 cases had a history of hypertension,and 1 case had the history of intaking sleeping pills for about 3 months.The rest of the patients denied the nervous system disease,cardiovascular disease and other medical history.All patients complained about uncrossed diplopia only at distance.All of the 11 patients had a sudden onset of their symptoms.Each patient was examined by same neurologist,meanwhile MRI or CT were performed.All the results showed normal.All patients had refractive error.The angle of esotropia for distance of 5 meters was from + 25 △ to + 55 △ and was from + 8 △ to + 40△ for near(33 cm)before treatment while changed into-4△ ～ + 12△ for distance (5m) and to-8△ ～ +8△ for near (33 cm) after treatment.The ratio of AC / A ranged from 1.3 to 4.0,with an average of 2.6.Conclusion The clinical characteristics of divergence paralysis are a greater angle of esotropia and ipsilateral diplopia.Lateral rectns resection and non-surgical treatment have better effects on the improvement of diplopia and esotropia.

Clinical Characteristics and Course in Divergence Paralysis

PURPOSE: To improve the understanding of divergence paralysis by identifying its clinical characteristics. METHODS: We performed a retrospective chart review analysis of patients diagnosed with divergence paralysis that were followed up for at least 6 months. Clinical features, including disease onset, course, neurological examinations, and imaging studies were evaluated. RESULTS: Fifteen patients were included in the present study and the average age was 55.6 years. Thirteen patients had an acute onset and 2 had an insidious onset. The initial distance deviation ranged from 4 to 14 prism diopters (PD) of esotropia (mean, 8 PD esotropia) and near deviation ranged from 6 PD exophoria to 10 PD esophoria (mean, 1.2 PD esophoria). None of the patients developed additional neurological disorders associated with divergence paralysis during the follow-up period. Eleven of 13 patients with primary divergence paralysis continued to depend on the prism glasses with the same diopters. In the 2 patients with secondary divergence paralysis, distant diplopia disappeared as the underlying disease improved. CONCLUSIONS: In our study, the majority of divergence paralysis was not associated with neurological diseases and the patients had an acute onset. Primary divergence paralysis lasted for an extended period. However, secondary divergence paralysis was resolved quickly as the underlying disease improved.

Clinical Characteristics and Course in Divergence Paralysis

PURPOSE: To improve the understanding of divergence paralysis by identifying its clinical characteristics. METHODS: We performed a retrospective chart review analysis of patients diagnosed with divergence paralysis that were followed up for at least 6 months. Clinical features, including disease onset, course, neurological examinations, and imaging studies were evaluated. RESULTS: Fifteen patients were included in the present study and the average age was 55.6 years. Thirteen patients had an acute onset and 2 had an insidious onset. The initial distance deviation ranged from 4 to 14 prism diopters (PD) of esotropia (mean, 8 PD esotropia) and near deviation ranged from 6 PD exophoria to 10 PD esophoria (mean, 1.2 PD esophoria). None of the patients developed additional neurological disorders associated with divergence paralysis during the follow-up period. Eleven of 13 patients with primary divergence paralysis continued to depend on the prism glasses with the same diopters. In the 2 patients with secondary divergence paralysis, distant diplopia disappeared as the underlying disease improved. CONCLUSIONS: In our study, the majority of divergence paralysis was not associated with neurological diseases and the patients had an acute onset. Primary divergence paralysis lasted for an extended period. However, secondary divergence paralysis was resolved quickly as the underlying disease improved.

Divergence Paralysis Due to a Small Hematoma in the Tegmentum of the Brainstem

There has been considerable controversy concerning divergence paralysis, an entity described as early as 1883 by Parinaud. We recently observed a patient with divergence paralysis, who on CT scan presented a small hematoma in the tegmentum of the brainstem. This case may support the theory that the center for divergence exists in the upper brainstem.