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Lee, Shin, and Lee: Clinical Characteristics and Course in Divergence Paralysis
Original Article

J Korean Ophthalmol Soc 2014;55(12):1878-1882.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1878

Clinical Characteristics and Course in Divergence Paralysis

Haeng Jin Lee, MD, Yong Il Shin, MD, Yeon Hee Lee, MD

Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea

Address reprint requests to Yeon Hee Lee, MD, Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea, Tel: 82-42-280-8447, Fax: 82-42-255-3745, E-mail: opticalyh@hanmail.net

Received 27 June 2014       Revised 11 September 2014       Accepted 5 November 2014

Copyright © 2014 The Korean Ophthalmological Society

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 improve the understanding of divergence paralysis by identifying its clinical characteristics.

Methods

We performed a retrospective chart review analysis of patients diagnosed with divergence paralysis that were followed up for at least 6 months. Clinical features, including disease onset, course, neurological examinations, and imaging studies were evaluated.

Results

Fifteen patients were included in the present study and the average age was 55.6 years. Thirteen patients had an acute onset and 2 had an insidious onset. The initial distance deviation ranged from 4 to 14 prism diopters (PD) of esotropia (mean, 8 PD esotropia) and near deviation ranged from 6 PD exophoria to 10 PD esophoria (mean, 1.2 PD esophoria). None of the patients developed additional neurological disorders associated with divergence paralysis during the follow-up period. Eleven of 13 patients with primary divergence paralysis continued to depend on the prism glasses with the same diopters. In the 2 patients with secondary divergence paralysis, distant diplopia disappeared as the underlying disease improved.

Conclusions

In our study, the majority of divergence paralysis was not associated with neurological diseases and the patients had an acute onset. Primary divergence paralysis lasted for an extended period. However, secondary divergence paralysis was resolved quickly as the underlying disease improved.

Keywords: Divergence insufficiency, Divergence paralysis, Divergence weakness

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Table 1.
Clinical characteristics and course in divergence paralysis patients
No. Age (years) Sex Onset Interval from onset to first visit (months) Medical history MRI Angle of deviation
 Management (prism therapy) Duration of F/U (months) Natural course (last F/U)
Distant (PD) Near (PD)
1 81 F Acute 2 HTN − 4 ET 0 B) 3 PD BO 9 No change
2 37 M Acute 0.17 − YES 10 ET 2 E B) 5 PD BO 17 No change
3 76 M Acute 7 DM − 8 ET 2 E B) 3 PD BO 24 No change
4 55 M Acute 6 − YES 6 ET 4 X L) 4 PD BO 35 No change
5 64 M Acute 0.5 − − 8 ET 3 RHT 10 X L) 6 PD BO 45 No change
6 52 M Insidious 84 − − 8 ET 2 E B) 4 PD BO 7 No change
7 70 M Acute 24 HTN/MI − 8 ET 0 B) 3 PD BO 6 No change
8 55 M Insidious 12 DM YES 6 E 0 B) 3 PD BO 13 No change
9 56 M Acute 6 − YES 4 E 6 X R) 4 PD BO 14 No change
10 35 F Acute 0.23 Hypertensive retinopathy − 10 ET 4 ET B) 5 PD BO 6 Spontaneous recovery
11 68 F Acute 6 DM/HTN YES 14 ET 6 E B) 6 PD BO 8 No change
12 22 M Acute 0.07 − YES 10 ET 0 B) 5 PD BO 6 Spontaneous recovery
13 67 F Acute 0.1 HTN YES 14 ET 0 B) 7 PD BO 6 Spontaneous recovery
14 28 M Acute 0.25 Tb meningitis YES 6 ET 2 E B) 3 PD BO 6 Spontaneous recovery
15 68 M Acute 2 − YES 4 ET 0 B) 3 PD BO 9 No change

PD = prism diopter; F/U = follow up; HTN = hypertension; DM = diabetes mellitus; MI = myocardial infarction; Tb = tuberculosis; ET = esotropia; RHT = right hypertropia; E = esophoria; X = exophoria; B = both; L = left; R = right; BO = base out.

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