A Review of Ocular Movement Abnormalities in Hereditary Cerebellar Ataxias.

Cerebellar ataxias are a wide heterogeneous group of disorders that may present with fine motor deficits as well as gait and balance disturbances that have a significant influence on everyday activities. To review the ocular movements in cerebellar ataxias in order to improve the clinical knowledge of cerebellar ataxias and related subtypes. English papers published from January 1990 to May 2022 were selected by searching PubMed services. The main search keywords were ocular motor, oculomotor, eye movement, eye motility, and ocular motility, along with each ataxia subtype. The eligible papers were analyzed for clinical presentation, involved mutations, the underlying pathology, and ocular movement alterations. Forty-three subtypes of spinocerebellar ataxias and a number of autosomal dominant and autosomal recessive ataxias were discussed in terms of pathology, clinical manifestations, involved mutations, and with a focus on the ocular abnormalities. A flowchart has been made using ocular movement manifestations to differentiate different ataxia subtypes. And underlying pathology of each subtype is reviewed in form of illustrated models to reach a better understanding of each disorder.

Oculomotor impairments in de novo Parkinson's disease.

Objective: Reliable electrophysiological indicators are urgently needed in the precise evaluation of Parkinson's disease (PD). It is still elusive whether oculomotor performance is impaired or has clinical value in early PD. This study aims to explore oculomotor performance in newly diagnosed, drug-naïve PD and its correlation with clinical phenotype. Methods: Seventy-five patients with de novo PD, 75 patients with essential tremor (ET), and 46 gender-and age-matched healthy controls (HCs) were included in this cross-sectional study. All subjects underwent oculomotor test via videonystagmography. Visually guided saccade latency, saccadic accuracy and gain in smooth pursuit eye movement (SPEM) at three frequencies of the horizontal axis were compared among the three groups. Patients with PD also received detailed motor and non-motor evaluation by serial scales. The association between key oculomotor parameters and clinical phenotypes were explored in PD patients. Results: Both de novo PD and ET patients showed prolonged saccadic latency and decreased saccadic accuracy relative to HCs. SPEM gain in PD was uniformly reduced at each frequency. SPEM gain at 0.4 Hz was also decreased in ET compared with HCs. However, there was no significant difference of oculomotor parameters between de novo PD and ET patients. Furthermore, prolonged saccadic latency was correlated with long disease duration, whereas decreased SPEM gain was associated with severe motor symptoms in de novo PD patients. Conclusion: Ocular movements are impaired in de novo, drug naïve PD patients; these changes could be indicators for disease progression in PD.

ABC of Gaze and Ocular Oscillations.

The chief goal of all eye movements is to maintain the image of an object steady on the retina especially the macula to preserve visual acuity. Gaze palsy refers to lack of the conjugate movements due to a failure of supranuclear control mechanisms. Supranuclear control is maintained by not one, but multiple eye movement systems and gaze mechanisms. Supranuclear gaze palsies can be associated with a myriad of aetiologies- from trauma or metabolic abnormalities to stroke, demyelinating disorders and space occupying lesions like tumours. Culprit lesions may be in frontal motor centres, brainstem gaze centres gaze or interconnecting segments. While the brainstem network for horizontal gaze lies in pons, that for vertical gaze is situated in midbrain. Further, ocular oscillations and nystagmus are abnormal eye movements that disrupt a steady fixation of gaze. It is prudent to be aware of various gaze pathways and their anatomical corelates in order to establish a topographic relationship of clinical findings. A systematic clinical examination may provide deep insights on the patho-physiological mechanisms along with aiding in localizing the lesion accurately. This review deals with systematic clinical approach to various gaze control systems.

Normal Range of Ocular Ductions in Various Age Brackets by Prism Shifting Light-Reflex Test.

PURPOSE: To introduce a new direct measurement method for ocular ductions by shifting light reflex with plastic prism [Prism Shifting Light-Reflex Test (PLR test)]. We used it to establish normative values of ocular ductions in each age bracket defined by decade and to investigate the change of ocular ductions with aging. METHODS: Participants aged 21-80 years old without paralytic or restrictive eye disease were examined. The ocular ductions were measured by PLR test. Normal range of ocular ductions and rate of change with aging were evaluated. RESULTS: Of 123 participants, the mean ± standard deviation of ocular ductions in all age groups were 60 ± 12, 86 ± 9, 102 ± 9, and 123 ± 9 prism diopters for supraduction, adduction, abduction, and infraduction. From regression analysis, the ocular supraduction, adduction, abduction, and infraduction significantly decreased with aging (P < .0001) by the rate of -0.66, -0.33, -0.27, and -0.25% per year. CONCLUSION: PLR test is a new technique for ocular duction measurement. Supraduction had the smallest range of ductions followed by adduction, abduction, and infraduction. Aging has the largest decremental effect on supraduction and the smallest decremental effect on infraduction. The normative values of ocular ductions by age in each decade were established.

Novel method of intraoperative ocular movement monitoring using a piezoelectric device: experimental study of ocular motor nerve activating piezoelectric potentials (OMNAPP) and clinical application for skull base surgeries.

Intraoperative monitoring systems that utilize various evoked potentials for the detection and/or preservation of cranial nerves have become increasingly common due to recent technical and commercial developments, particularly during skull base surgeries. We established a novel system for the intraoperative monitoring of the extraocular motor nerves (eOMNs) using a piezoelectric device capable of detecting imperceptible vibrations induced by ocular movement, with sensors placed on the eyelids alone. We first evaluated the efficacy and reliability of this device for the intraoperative monitoring of eOMNs in two Beagle dogs. Based on the results, we then determined the appropriate stimulation parameters for use in human surgical cases involving removal of various skull base tumors. Animal experiments revealed that a 0.4 mA monopolar electrical stimulation was required to elicit significant responses and that these responses were not inferior to those obtained via the electrooculogram/electromyogram. Significant responses were also detected in preliminary clinical investigations in human patients, following both direct and indirect monopolar electrical stimulation of the oculomotor and abducens nerves, although obtaining responses from the trochlear nerve was difficult. Intraoperative monitoring using a piezoelectric device provides a simple and reliable method for detecting eOMNs, especially the oculomotor and abducens nerves. This monitoring system can be adapted to various surgeries for skull base tumor.

Complete horizontal gaze palsy due to bilateral paramedian pontine reticular formation involvement as a presentation of multiple sclerosis: a case report.

BACKGROUND: Demyelinating central nervous system diseases include several disorders that multiple sclerosis (MS) is identified as the most common among them. Ocular movement disturbances are a typical presentation in MS patients where lesions affect the complex and interconnected pathways involved in eye motion. Centers for gaze control are located in the pons primarily; therefore, lesions involving these centers can be presented with abnormalities in gaze. However, bilateral lesions in pontine gaze centers are exceptionally rare. CASE PRESENTATION: A 16-year-old girl with bilateral horizontal gaze palsy was referred to the neurology clinic. Magnetic resonance imaging of the patient indicated bilateral hyperintensities in the pons at the level of the paramedian pontine reticular formation. The patient was diagnosed with multiple sclerosis with respect to clinical and imaging findings and managed. CONCLUSION: Ocular movement abnormalities are a commonly encountered manifestation in patients with multiple sclerosis, however, bilateral gaze palsy is an exceptionally rare sign and should guide the physician to contemplate for anticipated lesions in the pons, and suspect MS, especially in childbearing-aged women. Although an extensive workup should also be done to rule out possible mimickers.

Ocular movement disorders following scleral buckling surgery: A case series study.

PURPOSE: To evaluate ocular movement disorders after scleral buckling surgery (SBS) for retinal detachment. METHODS: In this prospective, observational, case series, 206 patients (206 eyes) with rhegmatogenous retinal detachment who underwent SBS and investigated at the strabismus ward of Farabi Eye Hospital in Iran between November 2011 and November 2014 were assessed. Patients were followed from 6 to 36 months after SBS to evaluate for strabismus. Logistic regression analysis test and SPSS software version 20 were used for statistical analysis. RESULTS: From 206 patients, 56.8% were male, and 33.2% were female. For scleral buckle in 44.7% of patients, silicone band and tire (SBT) was used, and in 55.3%, a sponge. Among all patients, seven (3.39%) exhibited ocular movement disorder. There was no significant relation between type of buckle (P = 0.65) or the location of buckle (P = 0.56) and movement disorder. CONCLUSION: Ocular movement disorder is one of the main complications after SBS without specific association between the type and location of exoplanet.

Changes in lateral ocular movement after two muscle exotropia surgery / 中华实验眼科杂志

Objective This study was to identify the surgical procedures associated with changes of lateral eye movement to help inform surgical planning for patients with concomitant exotropia.Methods The medical records of 87 concomitant exotropia surgical procedures that were performed at Henan Eye Hospital from June 2014 to August 2015 were retrospectively reviewed.The deviation angle was measured by prism and alternate cover test.Photographs and arc campimeter was used to obtain changes of abduction and lateral monocular fixation field respectively.Data were compared preoperatively and postoperatively among five groups based on the surgical procedures.The surgical procedures were 0 mm for control group (61 eyes),8 mm unilateral rectus recession for lateral rectus recession (LR) group (27 eyes),5-6 mm recession/4-5 mm resection for small amount recess-resect (R-R) group (24 eyes),7-8 mm recession/5-6 mm resection for medium amount R-R group (29 eyes) and 8-10 mm recession/7-8 mm resection for large amount R-R group (33 eyes).The minimum follow-up period was 6 months.Informed consent was signed from each patient or the guardian.Results The success,overcorrection and undercorrection rate was 81.61％,5.56％ and 12.64％,respectively.Mean preoperative abduction of each group was (11.86± 1.11)mm in the control group,(12.04±0.68)mm in the LR group,(11.58 ± 1.06)mm in the small amount R-R group,(11.86±0.93)mm in the medium amount R-R group and (12.22±0.60)mm in the large amount R-R group.The postoperative mean abduction of each group was (11.81±1.03),(11.81 ±0.70),(10.78±1.05),(10.54±1.07) and (9.90±0.82)mm,respectively.Mean abduction among the five groups was not significantly different preoperatively (F =1.85,P =0.12),while it was significantly different postoperatively (F =28.04,P =0.00).The abduction between control group and small amount R-R group was not significantly different postoperatively (P =0.99),but the abduction of control group was significantly greater than that of all the R-R groups (all at P=0.00).Mean lateral monocular fixation field of each group preoperatively was (50.82 ± 3.30) ° in control group,(51.48 ±2.39)° in LR group,(50.13±3.51)° in small amount R-R group,(51.06±2.90)° in medium amount R-R group and (52.09±2.61)° in large amount R-R group.The postoperative mean lateral monocular fixation field of each group was (50.52 ± 3.51)°,(50.11 ± 2.36)°,(46.38 ± 3.67)°,(44.00 ± 3.00)°,(41.84 ±2.46)°,respectively.Preoperative lateral monocular fixation field among the five groups was not significantly different (F =1.75,P =0.14),while postoperative difference was significant (F =55.75,P =0.00).Lateral monocular fixation field between control group and LR group was not significantly different postoperatively (P=0.57),but the mean lateral monocular fixation field of control group was significantly greater than that of all the R-R groups (all at P =0.00).Conclusions The successful alignment rate of unilateral recess/resect procedure is satisfying,but it can also create abduction deficit especially in large surgical amounts eye.Patients with binocular vision will be sensitive to diplopia in side gaze;in such cases,the consequences of recess/resect procedure should be considered particularly to avoid decrease of the binocular single vision field.

Downbeat nystagmus due to ranitidine in a pediatric patient.

BACKGROUND: Ranitidine has not been considered as a potential cause of ocular movement conditions. However, it is known that the vestibular nucleus complex, that has a key role in gaze control and vestibule-ocular reflexes, receives hypothalamic histaminergic innervations. Some studies reported the effect of ranitidine blocking the excitatory responses of vestibular nuclei neurons to histamine. CASE REPORT: We report the first case of a downbeat nystagmus secondary to ranitidine in an infant. A 3-month-old female developed a downbeat gaze after starting treatment with ranitidine for a pediatric gastroesophageal reflux disease. Microbiological test were negative and neuroblastoma evaluation was normal. CONCLUSION: As ranitidine is widely prescribed in the pediatric population, clinicians should be aware of its potential to cause ocular movements disorders.

Range of Eye Movement in a Normal Population and Its Relationship to Age

PURPOSE: The purpose of this study is to measure the range of normal eye movement and to evaluate the effect of age on the range of ocular movement in a normal population. METHODS: We conducted a prospective observational study of 85 subjects aged between 5 and 91 years. Photographs were taken of the cardinal position, and these images were analyzed using an image analysis software (Adobe Photoshop 6.0, Adobe, San Jose, CA, USA). To measure the range of eye movement, the preprocessed images were analyzed using the Image J program. The range of movement of the eyeball was quantitatively measured using corneal limbal analysis. Specifically, the ranges of ocular movement according to adduction, abduction, elevation, and depression were measured. RESULTS: The normal movement ranges were 44.4 ± 6.9° in adduction, 44.8 ± 5.5° in abduction, 27.7 ± 7.6° in elevation, and 46.7 ± 8.4° in depression. Adduction, abduction, and elevation were negatively correlated with age (R² = 0.220, R² = 0.126, and R² = 0.304, respectively, all p < 0.001). However, there was no significant correlation between age and depression (R² = 0.030, p = 0.113). CONCLUSIONS: For all ages, the range of normal ocular movement in the horizontal direction was symmetric, while the range of ocular movement in elevation was smaller than that of depression. As age increased, the range of ocular movement decreased in all directions except depression, but depression did not decrease with age. When assessing eye movement, it is necessary to consider the range of ocular movements relative to both the movement direction and changes in the ocular movement range according to age.

Clinical Observation on Acupuncture Combined with Western Medicine in Treating Acquired Paralytic Strabismus / 中医杂志

Objective To observe clinical curative effect of acupuncture combined with western medicine in treating acquired paralytic strabismus.Methods Randomly divided 60 patients with acquired paralytic strabismus into a treatment group and a control group,with 30 cases in each group.The control group accepted compound anisodine injection for subcutaneous injection beside superficial temporal artery and oral administration of neurotrophic drugs.The treatment group accepted acupuncture treatment in addition to the treatment of the control group.Both groups were treated for 4 weeks.Before and after treatment,measured the ocular symptom scores,including eye position deviation,eyeball movement obstacle,diplopia,the first squint angle being greater than the second,compensatory head posture and evaluated the clinical curative effect.Results The clinical curative rate in the treatment group was 40.0％ and the total effective rate was 93.4％,which in the control group were 10.0％ and 66.7％ respectively.The total effective rate and curative rate in the treatment group were significantly higher than those in the control group (P＜ 0.05).After treatment,the improvement in the total ocular symptom score and diplopia,deviation of eye position,eyeball movement disorder scores were superior to those in the control group (P ＜ 0.05).Conclusion Acupuncture combined with western medicine was superior to simple western medicine in treating acquired paralytic strabismus,and could significantly improve the eye symptom.

Ocular Movement Nerve Palsy After Mild Head Trauma.

BACKGROUND: Ocular movement nerve (cranial nerve III, IV and VI) palsy (OMNP) is rarely encountered after mild head trauma. As a result of the inconsistent definition of this specific entity in published studies, it is difficult to offer an accurate management strategy and prognosis assessment to affected patients. METHODS: A retrospective review of the medical records of the patients at the First Hospital of Jilin University combined with a systematic review of published studies was conducted. RESULTS: Thirty-one patients (17 females, 55%), including 6 cases in our institution, were identified in this systematic review. Cranial nerves III, IV, and VI were involved in 54.8%, 3.2%, and 45.2% of the patients, respectively. Although all the patients in our case series experienced complete resolution, only 54.6% experienced complete resolution in a time course of 10 days to 13 months. Additional intracranial findings other than traumatic brain injury on imaging modalities that might predispose to OMNP after mild head trauma were identified in 25.8% of the patients. CONCLUSIONS: OMNP after mild head trauma is a rare entity in neurosurgical practice. In patients with no positive intracranial finding, observation and follow-up are the mainstay of management. If any underlying intracranial lesions are identified, the management should be focused on the underlying lesions. From the data available, mild trauma does not mean mild injury or favorable recovery in OMNP after mild head trauma.

Possible rare congenital dysinnervation disorder: congenital ptosis associated with adduction.

Ptosis is defined as an abnormally low position of the upper eyelid margin. It can be congenital or acquired, uni or bilateral, and isolated or associated with other ocular and nonocular defects. We report a case of a female child, aged 8 years, with congenital right ptosis increased on right adduction and with left ptosis on left adduction. There was no horizontal ocular movement limitation. Apparent underaction of the right inferior oblique muscle was also present. We believe that within the possible mechanisms it is more likely that it is a congenital innervation dysgenesis syndrome (CID)/congenital cranial dysinnervation disorder (CCDD).

Caracterización de colaboradores cubanos con dengue en el municipio venezolano de Bolívar / Clinical and epidemiological characterization of Cuban collaborators with dengue in the Venezuelan municipality of Bolívar

Se realizó un estudio descriptivo y retrospectivo de 18 colaboradores cubanos diagnosticados con dengue en el municipio venezolano de Bolívar, desde mayo del 2008 hasta igual periodo del 2011, con vistas a caracterizarles según variables clinicoepidemiológicas de interés, entre las cuales figuraron: edad, sexo y síntomas clínicos. Para el procesamiento y análisis de los resultados se utilizó el paquete estadístico Epi Info (versión 6.04). En la serie predominaron el grupo etario de 42-52 años (38,9 %), el sexo masculino (66,7 %); en tanto, la fiebre (100,0 %), el dolor retroorbitario, los movimientos oculares (83,3 %), y las artralgias con mialgias (77,8 %) fueron los síntomas clínicos más frecuentes. La evolución favorable en la mayoría de los pacientes puso de manifiesto la necesidad de un control epidemiológico de esta afección para disminuir su incidencia entre los colaboradores cubanos en el exterior.

A descriptive and retrospective study of 18 Cuban collaborators diagnosed with dengue in the Venezuelan municipality of Bolívar was carried out from May, 2008 to the same period of 2011, with the aim of characterizing them according to clinical and epidemiological variables of interest, among which there were: age, sex and clinical symptoms. For the prosessing and analysis of the results, the statistical package Epi Info was used (version 6.04). In the series the age group 42-52 years (38.9%), the male sex (66.7%) prevailed; while fever (100,0%), the retroorbitary pain, the ocular movements (83.3%) and the artralgias with myalgia (77.8%) were the most frequent clinical symptoms. The favorable clinical course in most of the patients showed the necessity of an epidemiological control of this disorder to decrease its incidence among the Cuban collaborators abroad.

Early clinical characteristics and follow-up treatment of alternating hemiplegia in children / 中华神经医学杂志

Objective To discuss the clinical features and prognosis of patients with childhood alternating hemiplegia (AHC).Methods The clinical presentation and follow up data of 9 patients diagnosed as AHC in our hospital from January 2010 and June 2014.Results Onset appeared within 18 months of born in these 9 patients;no migraine family history, repeated and alternated limbs dyskinesia, varying degrees of delayed psychomotor development, and with/without abnormal eye movements were noted in these patients.No specific auxiliary examination results were noted.All the patients were treated in our hospital with flunarizine (2.5-5 mg per time for one time every night), and among them, one also treated with topiramate.Two patients were lost to follow-up.One patient had fluctuated condition after taking drugs: the frequency of attack declined one month after drug taking, but then, rebounded gradually.One had frequency of attack declining to three times a month from four times a month.Two added the dose offlunarizine to 10 mg, leading to the obvious decline of both frequency and duration.Three had no release.Conclusion It is hoped to improve patients' life quality and prognosis by recognizing AHC early, insistting long-term pharmacotherapy and avoiding the inducing factors.

Vertiginous headache and its management.

Vertiginous headache encompasses patients with dizziness or vertigo as well as headache, even though the symptoms may not occur in an obvious temporal relationship. The type of dizziness experienced by patients is different from the heavy-headedness experienced during rhinogenic headache. Patients may have a personal or family history of typical or atypical migraine. They should be evaluated for possible Meniere syndrome, migraine headaches, and/or eye movement disorders. Management is directed to treatment of the underlying abnormality. Long-term follow-up of these patients is necessary, because further otologic abnormalities may present later.

Analysis of the structure and function of the extraocular muscle connective tissue in rabbit / 中华实验眼科杂志

Background The extraocular muscles (EOMs) Pulley in primate is related to the function of EOMs,but there are arguments about that.The location of rabbit's eyes is different from the primate.Study on the structure of the extraocular muscle connective tissue in rabbit may play a role to analyze the function of the EOMs Pulley.Objective The structure of the connective tissue around EOMs in rabbit was studied,the difference between this structure in rabbit and homan' s EOMs Pulley in past reports was analyzed,and then,the role of EOMs Pulley to ocular movement was investigated.Methods Five adult rabbits were involved.The gross anatomy of an orbit in each rabbit was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin(α-SMA) was used to show the smooth muscle,while Weigert stain was used to show muscle and collagen,and Masson trichrome stain to show the elastin.Results An encircling ring of collagen circled every EOM.The collagen ring was thin and connected to the orbital layer muscle fiber loosely.Collagen tissues coupled to adjacent EOMs.Less elastin fibers and scanty the smooth muscle cells were embedded in the collagen.Conclusions The connective tissue around rectus in rabbit is different from that in human with developed binocular ocular movements.It shows that connective tissue around EOMs may be related to the function of ocular movements.

Study on the connective tissue around extraocular muscle in cat / 中华实验眼科杂志

Background The extraocular muscles (EOMs) Pulley is considered as the functional origins of the recti EOMs,it is determinants of ocular motility.Objective The structure of the connective tissue around EOMs in cat was studied,and the role of EOMs Pulley to ocular movement was investigated.Methods Five adult cats were involved.The gross anatomy of an orbit in each cat was observed.The other orbit was processed with paraffin imbedding and coronal serial sections.A murine monocolonal antibody to α-smooth muscle actin (α-SMA) was used to show smooth muscle,while Masson trichrome stain was used to show muscle and collagen,and Weigert stain to show elastin.Results An encircling ring of collagen circled EOM was thin and connected to the orbital layer of muscle fiber loosely.Less elastin fibers and little smooth muscle cells were embedded in the collagen ring and connective band.Collagen ring around medial rectus and the connective band between medial rectus and inferior rectus was not more significantly developed than other bands.Conclusions The connective tissue around EOMs in cat may be related to its function of ocular movement,which is not developed.