Two Cases of External Ophthalmoplegia after Vincristine Treatment in Childhood

Dong Hyun Lee; Jae Ho Jung

doi:10.3341/jkos.2016.57.7.1176

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Lee and Jung: Two Cases of External Ophthalmoplegia after Vincristine Treatment in Childhood

Case Report

J Korean Ophthalmol Soc 2016;57(7):1176-1179.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1176

Two Cases of External Ophthalmoplegia after Vincristine Treatment in Childhood

Dong Hyun Lee, MD, Jae Ho Jung, MD, PhD

Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Address reprint requests to Jae Ho Jung, MD, PhD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2131, Fax: 82-55-360-2161 E-mail: jungjaeho@pusan.ac.kr

Received 11 February 2016 Accepted 27 May 2016

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 report 2 cases of extraocular muscle paresis with ptosis after vincristine treatment in childhood with acute leukemia.

Case summary: A 4-year-old girl with acute lymphoblastic leukemia experienced diplopia, esotropia and bilateral ptosis after intravenous vincristine treatment. Ptosis improved after two weeks of pyridoxine treatment with vincristine reduction. After 2 months, left abduction defect and ptosis completely disappeared with pyridoxine treatment. A 23-month-old boy with acute lymphoblastic leukemia had bilateral ptosis with worsening preexisting infantile esotropia after intravenous vincristine treatment. Bilateral ptosis resolved and esotropia improved after vincristine reduction with pyridoxine treatment for 2 months.

Conclusions

We observed extraocular muscle paresis and ptosis after vincristine treatment for acute leukemia in pediatric patients. Physicians should be suspicious of toxic neuropathy related to vincristine treatment when patients have extraocular ophthalmoplegia, and physicians should know that vincristine reduction with pyridoxine supplement may be helpful.

Keywords: Ophthalmoplegia, Ptosis, Vincristine

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Figure 1.

Example of patient before and after vincristine reduction and pyridoxine treatment. (A) Bilateral ptosis and esotropia at initial visit. (B) Ptosis and eso-drift were resolved after vincristine reduction and pyridoxine treatment at two months.

Figure 2.

Example of patient before and after vincristine reduction and pyridoxine treatment. (A) Bilateral ptosis with esotropia at initial visit. (B) Ptosis was resolved and esotropia was improved after vincristine reduction and pyridoxine treatment at one month.

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