ABSTRACT
The first case of Lyme disease was described more than 25 years ago in the city of Lyme, Connecticut (USA) and although the responsible pathogenic organism is known (Borrelia Burgdorferi) as well as its vector (a tick from the Ixode genus), it is still underdiagnosed and often poorly known by practitioners. The symptomatology is classically divided into three phases depending on the time between the tick bite and the first symptoms. However, in a number of cases this clinical division of the disease is not easily applied. We describe three cases of atypical ocular manifestations to illustrate this problem. Recently developed laboratory tests help confirm the diagnosis but should not be used without a good knowledge of the disease. This study aims to emphasize the difficulty of diagnosis and the importance of appropriate treatment and to avoid potentially permanent complications.
Subject(s)
Lyme Disease , Aged , Biomarkers/blood , Child , Female , Humans , Lyme Disease/blood , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Male , Middle Aged , OphthalmologyABSTRACT
PURPOSE: To study these changes in patients and their relation to manifestation of accommodative esotropia and response to surgery. METHODS: Patient-subjects: 21 patients who had difficulty adjusting to spectacle correction and underwent bilateral medial rectus loop suspension-recession surgery to alleviate their accommodative esotropia. Measurements of AC/A, uncorrected distance phoria, and related parameters were taken before and after surgical intervention was performed and were analyzed using analysis of variance (ANOVA). RESULTS: Both AC/A ratios and the distance phorias are "statistically significantly" (p< or =0.05), and independently, reduced by this surgical procedure. The manifestation of accommodative esotropia and response to surgery can be fairly accurately predicted from the values of AC/A ratio and distance phoria. CONCLUSION: Surgical treatment of accommodative esotropia creates well defined, long-lasting reductions in the AC/A ratio and the distance phoria.
Subject(s)
Accommodation, Ocular , Esotropia/surgery , Oculomotor Muscles/surgery , Vision, Binocular/physiology , Adolescent , Adult , Child , Child, Preschool , Convergence, Ocular , Depth Perception/physiology , Esotropia/physiopathology , Eye Movements/physiology , Humans , Oculomotor Muscles/physiopathology , Treatment Outcome , Visual AcuityABSTRACT
The authors present a case of Tolosa-Hunt syndrome with the particularity of a simultaneous palsy of both oculomotor nerves. The evolution is followed during 16 years. The clinical description, the criteria of the syndrome and the differential diagnosis are discussed. The diagnosis is based on the clinical evolution, the transitory palsy of the oculomotor nerves and the involvement of the optic nerve. The response on steroid treatment was spectacular. Bilateral and fluctuant oculomotor palsy is possible in the TolosaHunt syndrome. General investigations are mandatory to exclude other pathologies.
Subject(s)
Oculomotor Nerve Diseases/complications , Ophthalmoplegia/complications , Pain/complications , Diplopia/complications , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/drug therapy , Ophthalmoplegia/diagnosis , Ophthalmoplegia/drug therapy , Visual AcuityABSTRACT
The most important causes of surgical failure of accommodative strabismus are discussed and treatment is proposed. Limitations of duction are the most frequent causes and are to be carefully searched for. Postoperative diplopia is most often transitory and will be treated if it causes an obstacle to fusion. The prevention of surgical complications results in the long experience in motility examination and the system of combined horizontal and cyclovertical surgery.
Subject(s)
Esotropia/surgery , Postoperative Complications/physiopathology , Accommodation, Ocular , Amblyopia/physiopathology , Child, Preschool , Convergence, Ocular , Diplopia/physiopathology , Esotropia/physiopathology , Exotropia/physiopathology , Fixation, Ocular , Humans , ReoperationABSTRACT
Whether surgery should be used to correct for accommodative esotropia is still largely debated among strabologists. Fincham's theory (Fincham and Walton, 1957), describing the interaction between accommodation and vergence control systems (accommodative vergence and vergence accommodation), has been extensively studied. Models suggest that weakening of the accommodative vergence should correct esotropia. To test the model proposed by Semmlow (1981), we compared AC/A ratios in esotropic children and age-related normals (orthophoric) and monitored AC/A ratios for immediate (first week) and long term (1-2 months) changes in esotropic children following surgical correction. The AC/A ratio was determined at near and far. The accommodation stimulus was modified using lenses. The slope of the regression line between accommodation stimulus and disparity provided a measurement of AC/A ratio. Preliminary results show a normalisation of AC/A ratio occurring during the first month after surgery, supporting Semmlow's model and validating surgery as a means to correct for accommodative esotropia.
Subject(s)
Accommodation, Ocular , Convergence, Ocular , Esotropia/physiopathology , Esotropia/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Male , Postoperative Period , Vision TestsABSTRACT
A near target generates two different, though related stimuli: image disparity and image blur. Fixation of that near target evokes three motor responses: the so-called oculomotor "near triad". It has long been known that both disparity and blur stimuli are each capable of independently generating all three responses, and a recent theory of near triad control (the Dual Interactive Theory) describes how these stimulus components normally work together in the aid of near vision. However, this theory also indicates that when the system becomes unbalanced, as in high AC/A ratios of some accommodative esotropes, the two components will become antagonistic. In this situation, the interaction between the blur and disparity driven components exaggerates the imbalance created in the vergence motor output. Conversely, there is enhanced restoration when the AC/A ratio is effectively reduced surgically.
Subject(s)
Accommodation, Ocular , Convergence, Ocular , Vision, Ocular/physiology , Child , Esotropia/physiopathology , Fixation, Ocular , Humans , Models, BiologicalABSTRACT
The cause of amblyopia by ametropia is evaluated, hypoaccommodation plays an important role and also astigmatism. The treatment of hypermetropia by full spectacle correction is contested and the tests used to detect amblyopia and hypoaccommodation are described. The use of videorefraction and photoscreening is important in the follow-up of our patients.
Subject(s)
Accommodation, Ocular , Amblyopia/etiology , Refractive Errors/complications , Child , Humans , Hyperopia/physiopathology , Refraction, Ocular , Refractive Errors/physiopathology , Vision Tests , Visual AcuitySubject(s)
Astigmatism/physiopathology , Strabismus/surgery , Adolescent , Adult , Child , Child, Preschool , Humans , Middle Aged , Oculomotor Muscles/surgery , Prospective Studies , Refraction, OcularABSTRACT
Detailed description of the technique of adjustable sutures on the medial rectus muscle. Discussion of the indications and complications.
