Acute-Onset Vertical Strabismus in Adults

Yun Ha Lee; Ji Eob Kim; Sang Hoon Rah

doi:10.3341/jkos.2013.54.11.1767

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Lee, Kim, and Rah: Acute-Onset Vertical Strabismus in Adults

Original Article

J Korean Ophthalmol Soc 2013;54(11):1767-1771.

Published online: 2 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.11.1767

Acute-Onset Vertical Strabismus in Adults

Yun Ha Lee, MD, Ji Eob Kim, MD, Sang Hoon Rah, MD, PhD

Department of Ophthalmology, Wonju Severance Christion Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea

Address reprint requests to Sang Hoon Rah, MD, PhD, Department of Ophthalmology, Wonju Severance Christion Hospital #20 Ilsan-ro, Wonju 220-701, Korea, Tel: 82-33-741-1391, Fax: 82-33-741-1144, E-mail: shrah@yonsei.ac.kr

Received 8 February 2013 Revised 10 July 2013 Accepted 8 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors.

Methods

We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months.

Results

Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request.

Conclusions

Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.

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Keywords: Acute diplopia, Vertical diplopia, Vertical strabismus

References

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Table 1.

Characteristics of study participants

Age (years)	Male	Female	Total
18-29	3	1	4
30-39	3	1	4
40-49	5	4	9
50-59	4	12	16
60-69	21	6	27
70-79	6	5	11
80 or more	1	0	1
Total	43	29	72

Table 2.

Etiology of acute vertical strabismus

Cause	No. of patient (%)
Unknown	41 (57)
4th nerve palsy	15 (20.8)
Myasthenia gravis	7 (9.7)
3rd nerve palsy	6 (8.3)
Brain tumor^*	2 (2.7)
Carotid- cavernous fistula	1 (1.3)
Total	72 (100)

^* Brain tumor include pituitary tumor and metastatic brain tumor.

Table 3.

Associated underlying disease

	DM	HTN	DM + HTN	CVA
Unknown	10	10	3	5
4th nerve palsy	1	2	1	0
Myasthenia gravis	1	1	0	1
3rd nerve palsy	1	3	0	0
Brain tumor	0	0	0	0
Carotid-cavernous fistula	0	1	0	0
Total	13	17	4	6

DM = diabetes mellitus; HTN = hypertension; CVA = cere- brovascular accident.

Table 4.

Angle of vertical strabismus at primary position

Angle of vertical deviation (PD)	No. of patients
0	8
1-5	24
6-10	18
11-15	14
16-20	4
20 or more	4
Total	72

PD = prism diopters.

Table 5.

Angle of vertical strabismus at secondary position if no diplopia on primary position

Angle of vertical deviation (PD)	No. of patients
1-6	2
6-10	6
Total	8

PD = prism diopters.

Table 6.

Follow up results of acute vertical strabismus^*

		Unknown (%)	4th nerve palsy (%)	3rd nerve palsy (%)	Total (%)
Recovery	Partial^†	7	6	0	13
	Complete^‡	28	7	3	38
	Total	35 (85.3)	13 (86.7)	3 (60)	51 (83.6)
Persistence		6(14.7)	2 (13.3)	2 (40)	10 (16.4)
Total		41 (100)	15 (100)	5 (100)	61 (100)

^* Patients received neurosurgery treatment due to intracranial abnormality or neurologic treatment due to myasthenia gravis were excluded;

^† Partial recovery: Decreased level of strabismus, decreased diplopia;

^‡ Complete recovery: Patients recovered to orthophoria.

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