Use of Video-oculography in the Diagnosis of Superior Oblique Myokymia

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.

A Case of Kawasaki Disease Diagnosed with the Assistance of Ophthalmologic Examination

Kawasaki disease is a systemic vasculitis in which bilateral nonexudative conjunctivitis and anterior uveitis are common early findings in the course of illness. We report an eleven-year-old boy with atypical Kawasaki disease who was diagnosed with the help of an ophthalmologic examination. The patient presented with fever, epigastric pain with vomiting, erythematous rash, and severe bilateral conjunctival injection, a red throat without strawberry tongue and scarletiniform rash on the chest and back. Cervical lymphadenopathy and changes in the extremities were not shown. Slit lamp biomicroscopic examination three days after admission revealed bilateral bulbar conjuctival injection, superficial punctate erosions, and aquous humor inflammatory reaction(3+/4+ cells and 2+/4+ flare), a manifestation of anterior uveitis. After receiving two consecutive doses of intravenous immunoglobulin(IVIG, total 2.4g/kg) the boy showed no response. He was subsequently treated with high dose methylprednisolone(14mg/kg) intravenously. Two-dimensional echocardiography 2 weeks after admission showed aneurysmal changes on the proximal parts of the left main coronary artery(4.5mm) and right coronary artery(4.0mm). Slit lamp examination early in the course of the illness can help in the diagnosis of Kawasaki disease.