Esotropia following botulinum toxin type A injection for facial wrinkles.

We report a rare case of eye complication following botulinum toxin type A (BTA) injection. A 36-year-old healthy woman received BTA injections on the glabella, forehead, and periocular area to improve her wrinkles. Four days after BTA injection, diplopia and esotropia developed on her right eye.

Nasolacrimal system obstruction, ptosis and esotropia due to chemotherapy in acute lymphoblastic leukemia.

Eight-year-old girl was admitted to our clinic with the complaint of constant epiphora in the right eye. It was reported that this complaint began after the start of chemotherapy with a diagnosis of Acute Lymphoblastic Leukemia (ALL) about 5 years ago. In addition, eyelid ptosis associated with esotropia also occurred during that period. We found that nasolacrimal duct obstruction did not improve with medical treatment but ptosis and esotropia improved with pyridoxine and pyridostigmine treatment during that period. Examination of the eye on admission revealed nasolacrimal duct obstruction on the right side. Other ocular findings were normal. Nasolacrimal system obstruction, ptosis and esotropia combination has not been reported previously in patients using systemic drugs or receiving chemotherapy due to ALL.

Convergence excess consecutive esotropia associated with 0.01% atropine eye drops usage in patients operated for intermittent exotropia.

To report convergence excess esotropia (CEET) following 0.01% atropine eye drops (Low dose atropine [LDA]). Children who developed CEET that resolved promptly after discontinuation of LDA are described. Three myopes aged 5.3 ± 1.2 years and mean sphere -4.5D were included. All were operated for intermittent exotropia earlier. Mean esotropia was +28.3PD for near and 10.6PD for distance. LDA induced high AC/A ratio and fusion normalized in 3 weeks after discontinuation of LDA. LDA should be used with caution in patients with esophoria or previously operated for intermittent exotropia. Any evidence of the emergence of a CEET should warrant discontinuation of LDA.

Oxybutynin-associated esotropia.

A 5-year-old girl with previously unrecognized hyperopia of approximately +3.00 D developed esotropia while being treated with oxybutynin for enuresis. The esotropia disappeared with cessation of oxybutynin and correction of her hyperopia. When the hyperopic correction was removed, she had a small esophoria. The esotropia was presumably triggered by the anticholinergic effect of oxybutynin, which reduced the ability to accommodate. The increased accommodative effort for vision generated an esotropia as a result of the accommodative convergence/accommodation ratio.

[Intracranial hypertension with ocular manifestation during the use of tetracycline: case report]. / Hipertensão intracraniana com manifestações oculares associada ao uso de tetraciclina: relato de caso.

The authors describe a young female patient with intracranial hypertension associated with ocular manifestations, during treatment with tetracycline. This is a rare adverse effect described in the medication warnings, and in a few reported cases in the scientific literature.

Pseudotumor cerebri associated with cyclosporine use.

PURPOSE: An 11-year-old boy had a one-month history of horizontal diplopia. Three years earlier, he had undergone allogeneic bone marrow transplantation complicated by graft versus host disease. METHODS: The patient had esotropia and bilateral optic disk edema. A magnetic resonance imaging scan disclosed no intracranial lesion. The opening pressure of the lumbar puncture was 500 mm of water. Pseudotumor cerebri secondary to cyclosporine was diagnosed. RESULTS: The patient improved with resolution of his esotropia and diplopia within five days of discontinuing his cyclosporine. The optic disk edema resolved within three months. CONCLUSION: Cyclosporine must be added to the list of medications with a known association with pseudotumor cerebri.

Heroin and strabismus.

QUESTIONS UNDER STUDY: We report on a series of patients with acute strabismus related to heroin and methadone intake or withdrawal, discuss possible mechanisms involved in this clinical picture and make recommendations for work-up and referral. METHODS: Retrospective study. RESULTS: Five patients presented with acute esotropia within days of heroin withdrawal, and two patients developed exotropia related to heroin or methadone intake. Neurological work-up and neuroimaging was non-contributory in all four patients who were examined. CONCLUSION: Acute esotropia with double vision is a disturbing side effect of heroin withdrawal, and, similarly, acute exotropia may be related to heroin intake. In the absence of focal neurological signs, further work-up is not mandatory. Referral to a specialised orthoptic service is beneficial in offering the patient symptomatic treatment and reassurance, thus supporting successful withdrawal therapy.

Acute esotropia in heroin withdrawal: a case series.

BACKGROUND: Esotropia during opiate withdrawal is a new clinical syndrome that has only recently been reported in the literature. METHODS: Clinical case series. RESULTS: Five patients with acute esotropia during opiate withdrawal are presented. In four there was evidence of underlying hyperopia and/or other strabismogenic features. CONCLUSIONS: The precise cause of esotropia with heroin withdrawal is uncertain. Most (and possibly all) of these patients have one or more objective strabismogenic features, and these are probably a large factor in the causation.

Effects of lorazepam on vision and oculomotor balance.

BACKGROUND: Previous studies have shown an effect of the tranquilizer lorazepam on visual perception. We explored the effects of the drug on binocular vision, visual acuity and accommodation. SUBJECTS AND METHODS: Twenty-four paid healthy volunteers (13 women, 11 men) were recruited from the University of Strasbourg (mean age: 23.6 years, mean weight: 66.8 Kg). They were randomly assigned to one of two parallel groups of 12 subjects each (a placebo group and a lorazepam 0.038 mg/kg group). Visual acuity was measured for each eye separately (Snellen chart and Parinaud scale). Binocular vision was studied using the cover tests, measurement of the fusional amplitudes (with Berens prisms), and the Duane Scale Test (near point rule) measuring convergence and/or accommodation in centimeters or diopters as a function of age. RESULTS: Regarding vision, there was no lorazepam effect, at either 33 cm or 5 m. An esophoria was observed after the intake of lorazepam (0Delta before intake and 2.8Delta after intake, p=0.001). Both fusional convergence and fusional divergence amplitudes decreased by lorazepam, (p=0.008, and p=0.002). Lorazepam also impaired the near point of convergence but did not affect accommodation. CONCLUSION: A single dose of lorazepam induces an esophoric oculomotor imbalance and impaired fusional convergence and divergence amplitudes without impairing visual acuity or accommodation.

Vincristine-induced polyneuropathy in a child with stage I Wilms' tumour presenting with unilateral abducens nerve palsy.

A 4-year-old boy presented with right esotropia while receiving vincristine and dactinomycin for stage I Wilms' tumour according to the National Wilms Tumour Study-5 protocol. On examination, he had isolated limitation of his right lateral gaze. CT of the brain and cerebrospinal fluid examination were normal. A nerve conduction velocity study which was performed on the peripheral nerves revealed predominant motor polyneuropathy compatible with axonal loss involving the upper limbs. The patient had received a cumulative vincristine dose of 17 mg/m(2) before developing esotropia. Vincristine-induced abducens nerve mononeuropathy and subclinical motor polyneuropathy was suspected. Unilateral esotropia markedly improved after the discontinuation of vincristine and a short course of oral pyridoxine treatment.

Diplopia with dextropropoxyphene withdrawal.

As an infrequent symptom diplopia has been reported with opiate withdrawal, especially heroin, but not dextropropoxyphene. We report incomitant esotropia and diplopia in a case with dextropropoxyphene withdrawal that resolved completely with the resolution of the opiate withdrawal syndrome.

Isolated sixth nerve palsy after intravitreal bevacizumab injection.

PURPOSE: To report a case of sixth nerve palsy after intravitreal bevacuzimab injection. METHODS: After intravitreal bevacizumab injection in a 64-year-old man, the patient admitted to our clinic with the complaint of diplopia. A complete ophthalmologic examination was done to clear the symptomatology of patient. RESULTS: Examination of ductions revealed marked limitation of abduction of the right eye and full ductions of the left eye, consistent with right lateral rectus paralysis. CONCLUSIONS: Although intravitreal bevacizumab injections are generally well tolerated, it is possible that some serious systemic adverse events may occur. For this reason, patients must be closely monitored following these injections.

Heroin withdrawal as a possible cause of acute concomitant esotropia in adults.

PURPOSE: To report the possible effects of heroin withdrawal on binocular vision. METHODS: A case series of patients is presented in whom esotropia developed on cessation of heroin use. RESULTS: In each case the esotropia was concomitant and prismatic correction restored binocular single vision. Intermittent spontaneous control occurred in one patient, the deviation resolved in one and one patient was lost to follow-up. CONCLUSIONS: Heroin withdrawal should be considered as a cause of acute concomitant esotropia. However, an accurate history of other medication is needed to ensure that this is not the cause of decompensation.