Use of Video-oculography in the Diagnosis of Superior Oblique Myokymia

Sae Rom Chung; Tae Eun Lee; In Cheon You; Nam Chun Cho; Min Ahn

doi:10.3341/jkos.2016.57.8.1316

Journal List > J Korean Ophthalmol Soc > v.57(8) > 1010379

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Chung, Lee, You, Cho, and Ahn: Use of Video-oculography in the Diagnosis of Superior Oblique Myokymia

Case Report

J Korean Ophthalmol Soc 2016;57(8):1316-1319.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1316

Use of Video-oculography in the Diagnosis of Superior Oblique Myokymia

Sae Rom Chung, MD¹, Tae Eun Lee, MD, PhD¹, In Cheon You, MD, PhD^1,^2,³, Nam Chun Cho, MD, PhD^1,^2,³, Min Ahn, MD, PhD^1,^2,³

¹Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

²Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea

³Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea

Address reprint requests to Min Ahn, MD, PhD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea Tel: 82-63-250-1960, Fax: 82-63-250-1960 E-mail: ahnmin@jbnu.ac.kr

Received 28 April 2016 Revised 13 June 2016 Accepted 29 July 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

Superior oblique myokymia is intermittent spontaneous contractions of the superior oblique muscle presenting as rapid and small-amplitude intorsions and depressions of the eye. The authors report a case of superior oblique myokymia that was objectively and quantitatively diagnosed with slit lamp examination and video-oculography and completely resolved with medical treatment.

Case summary

A 44-year-old woman presented with a seven-year history of intermittent oscillopsia which continued for few seconds. She had no history of head trauma or systemic ocular disease, and the anterior segment and fundus examination were unremarkable. Right eye intorsion lasting for a few seconds as detected by slit lamp examination. Eye movements were recorded using video-oculography, which showed a torsional nystagmus of 5 to 10 degrees with 2 to 5 vertical components in the right eye. Based on these findings, the patient was diagnosed with superior oblique myokymia. The patient was prescribed topical timolol ophthalmic solution, one drop twice per day, but the symptoms persisted. Timolol ophthalmic solution was stopped and replaced with carbamazepine, 200 mg twice a day, which resolved her symptoms.

Conclusions

Slit lamp examination and video-oculography can be used as objective and quantitative diagnostic tools in order to confirmed a diagnosis and lead to proper treatment.

Keywords: Carbamazepine, Slit lamp examination, Superior oblique myokymia, Video-oculography

References

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Figure 1.

Slit lamp examination of the patient. (A) The patient's right eye before the intorsion. (B) The patient's right eye after the intorsion. The angle difference between (A) and (B) is about 7 degree, therefore about 7 degree intorsion was occurred. Iris crypts (arrowheads) movements help to detect intorsion.

Figure 2.

Video-oculography of the patient. The oculography shows superior oblique myokymia (arrows), evident in the vertical (vertical position of right eye [RV]) and torsional (torsional position of right eye [RT]) records of only the right eye. Horizontal component is time measured by second, vertical component is position measured by degree. LH = horizontal position of left eye, RH = horizontal position of left eye, LV = vertical position of left eye, LT = torsional position of left eye.

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