ABSTRACT
We treated five patients with vestibular neuritis who had strabismus. Three of them spontaneously noted vertical diplopia. During the following weeks and months, strabismus progressively resolved, indicating the recently acquired nature of the oculomotor condition. In three of these individuals, a change in visual vertical and cyclo-torsion of the globes suggested that strabismus was a form of skew deviation that occurred as a part of an ocular tilt reaction resulting from the peripheral vestibular lesion. Strabismus appears to occur frequently in this common vestibular condition.
Subject(s)
Neuritis/complications , Strabismus/etiology , Vestibular Nerve , Adult , Aged , Diplopia/etiology , Female , Fundus Oculi , Humans , Male , Middle Aged , Strabismus/diagnosis , Vestibulocochlear Nerve Diseases/complicationsABSTRACT
BACKGROUND: Candida endophthalmitis may occur either during systemic Candida infection (candidemia), particularly in immunocompromised hosts or as a single manifestation in drug abusers. PATIENT AND METHODS: One case of endogenous candida endophthalmitis (ECE) in a patient with systemic candidiasis and four cases of drug abusers are presented. Well confined inflammatory lesions in retina and choroid were adequately treated with systemic Amphotericin B administration, whereas lesion extension beyond the internal limiting membrane towards the vitreous required surgical management, to remove epiretinal fibrovascular tissue, and intravitreal Amphotericin B injection. CONCLUSION: In all cases, treatment resulted to regression of the lesions, however visual function recovery depends on location of chorioretinal lesions.
Subject(s)
Amphotericin B/administration & dosage , Candidiasis/drug therapy , Endophthalmitis/drug therapy , Opportunistic Infections/drug therapy , Adult , Chorioretinitis/drug therapy , Combined Modality Therapy , Dose-Response Relationship, Drug , Female , Humans , Injections, Intravenous , Male , Middle Aged , VitrectomyABSTRACT
Little attention has been paid in the ophthalmological literature to strabismus resulting from lesions located in the peripheral vestibular system. However, this phenomenon is commonly encountered in clinical practice. As a rule, this kind of strabismus shows a prominent vertical component. It is generally combined with a change in perception of verticality, conjugate cyclotorsion of the eyes, and head tilt. This association is known as "ocular tilt reaction". It occurs in a number of clinical settings which are believed to be related with alteration in the otolithical and/or vertical semicircular canal pathways. Strabismus occurring as a feature of ocular tilt reaction might result from different mechanisms according to the location of the lesion, e.g. in the utricles, in the midbrain tegmentum, and in the dorso-lateral medulla oblongata. This phenomenon is illustrated here with the report of a patient suffering from Ménière disease, who underwent selective vestibular neurectomy. Methods of ophthalmological evaluation in such cases is described.
