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Shin, Kim, and Yum: Clinical Features of Acquired Paralytic Strabismus
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(5): 572-578.

Published online: 15 May 2017

DOI: https://doi.org/10.3341/jkos.2017.58.5.572

Clinical Features of Acquired Paralytic Strabismus

Ji Soo Shin, MD, Jung Tae Kim, MD, Hae Ri Yum, MD

Myunggok Medical Research Institute, Department of Opthalmology, Konyang University College of Medicine, Daejeon, Korea.

Address reprint requests to Hae Ri Yum, MD. Department of Opthalmology, Konyang University Hospital, #158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea. Tel: 82-42-600-9258, Fax: 82-42-600-9251, Smile-ri@hanmail.net

Received 29 December 2016       Revised 9 March 2017       Accepted 18 April 2017

©2017 The Korean Ophthalmological Society

(open-access):

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

The purpose of our study was to evaluate the cause of acquired third, fourth, and sixth nerve palsy while also establishing recovery rates and important factors for recovery.

Methods

A retrospective chart review was performed for 92 patients who visited the ophthalmologic department of Konyang University Hospital with acquired third, fourth, and sixth nerve palsy from March 2015 to February 2016. Recovery rates and factors for recovery were evaluated in only 66 patients who received first ocular exam within 2 weeks of onset and who were followed up for at least 6 months. Complete recovery was defined as both complete recovery of the angle of deviation and the restoration of eye movement in all directions. For the degree of ocular motor restriction, -4 was defined as not crossing the midline and -2 was defined as 50% eye movement. The degree of ocular motor restriction was analyzed from -1/2 to 4.

Results

The fourth nerve was affected most frequently (n = 37, 40.2%), followed by the sixth cranial nerve (n = 33, 35.9%), the third cranial nerve (n = 18, 19.6%), and a combination of 2 or more cranial nerves (n = 4, 4.3%). Vasculopathy (n = 44, 47.8%) was the most common etiology, followed by trauma (n = 14, 15.2%), idiopathic (n = 13, 14.1%), inflammation(n = 10, 10.9%), neoplasm (n = 9, 9.8%), and aneurysm (n = 2, 2.2%). Complete recovery rate occurred for 66.7% (n = 44) of patients, and the overall recovery rate (i.e., at least partial recovery) was 86.3% (n = 57). Significant factors for complete recovery were the initial deviation angle and the limitation of extraocular movement (p < 0.001, p = 0.005, respectively, according to univariate analysis).

Conclusions

In this study, paralytic strabismus due to vasculopathy was the most common etiology, and a lower degree of initial deviation resulted in an improved complete recovery rate. In addition, a high overall recovery rate was possible through quick diagnosis and early treatment of cranial nerve palsy.

Keywords: Cranial nerve palsy, Paralytic strabismus, Recovery

Figures and Tables

Table 1

Demographics of 92 patients with cranial nerve palsy

jkos-58-572-i001

Values are presented as mean ± SD (range) unless otherwise indicated.

*Kruskall Wallis test; †Pearson's Chi-square test.

Table 2

Etiology of the cranial nerve palsy for total 92 patients

jkos-58-572-i002

Values are presented as mean ± SD unless otherwise indicated.

*Pearson's Chi-square test.

Table 3

Recovery rate and recovery time in recovery group

jkos-58-572-i003

mo = months.

*Overall recovery = complete recovery + partial recovery; †Pearson's Chi-square test. Mutiple nerve palsy was not included; ‡Kruskall Wallis test. Mutiple nerve palsy was not included.

Table 4

Comparison between the patients with and without complete recovery

jkos-58-572-i004

Values are presented as mean ± SD unless otherwise indicated.

PD = prism diopter; EOM = extra-ocular movement.

*Student t-test; †Pearson's Chi-square test.

Notes

This work was supported by Konyang University Myunggok Research Fund of 2015-13.

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