A Case of Horizontal Gaze Palsy with Ipsilateral Esotropia due to Pontine Hemorrhage

ABSTRACT

PURPOSE: We describe a patient with a horizontal pontine gaze palsy and a concurrent esotropia and discuss the etiology and surgical management of this condition. METHODS: A 42-years-old male visited the hospital with dipopia and left ocular pain. He had a history of pontine hemorrhage a year ago. Because of left ficial palsy, lagophthalmos was noted on the left eye and slit-lamp examination showed filament keraititis and superficial punctate keratitis. Left face turn was noted and a left horizontal gaze palsy with inability to abduct the left eye and to adduct the right eye past the midline was also noted. By Krimsky estimation, 40 prism diopter (PD) left esotropia was present in the primary position. Brain magnetic resonance imaging carried a yeas ago showed a large lobulated hyperdense lesion and the central lesion is on the left dorsal portion of pons. RESULTS: The patient underwent a right lateral rectus muscle recession of 5 mm, a left medial rectus muscle recession of 6 mm and a parial tendon transfer of the left superior and inferior rectus muscles th the left lateral rectus muscle insertion (modified Hummelsheim operation with augmentation). A lateral tarsorrhaphy was also performed. 3 months after operation, he didn't complain diplopia and orthotropia was noted in the primary position by Hirshberg test. His head posture was also right. The lagophthalmos and keratitis was markely improved and ocular pain was not complained. CONCLUSIONS: The lesion in this patient caused by potine hemorrhage may be involve the left PPRF, the left sixth nerve nucleus and the left facial nerve fascicles. Strabismus surgery on the patient improved diplopia and face turn.