Rutstein Robert P, Cogen Martin S
School of Optometry, The University of Alabama at Birmingham, HPB 112, 1530 3rd Avenue S., Birmingham, AL 35294-0010, USA.
Binocul Vis Strabismus Q. 2004;19(1):35-8.
Paradoxical diplopia occurs when binocular visual cerebral cortex projection of diplopic images (the "subjective angle") is not commensurate and identical with angle or direction of strabismus (the "objective angle"). Its presence infers anomalous retinal correspondence and is manifest as heteronymous or crossed diplopia in esotropia and homonymous or uncrossed diplopia in exotropia. When treated, the prognosis for achieving fusion is poor, while the risk for intractable diplopia is reputedly high. We report a patient with paradoxical diplopia that resolved (and some binocular fusion developed) following botulinum toxin injections and prism therapy.
Case report.
A 25 year old man was evaluated for an exotropia. At age 4 years, he had acquired an esotropia due to a traumatic lateral rectus palsy. The esotropia resolved over 3 years. At age 14 years, he developed a consecutive exotropia. The exotropia was eventually treated surgically. There remained a residual exotropia following surgery, and he experienced paradoxical diplopia and projected it homonymously on all sensory tests as if he was esotropic. Treatment with botulinum toxin injections to both lateral rectus muscles along with a small prismatic correction in spectacles eliminated the exotropia and paradoxical diplopia, permitting some binocular fusion.
Botulinum toxin injection and prism therapy can be effective in eradicating paradoxical diplopia.
矛盾性复视是指双眼视觉皮质对复视像的投射（“主观角”）与斜视的角度或方向（“客观角”）不相称且不一致。其存在提示异常视网膜对应，表现为内斜视时的交叉性或异侧性复视以及外斜视时的同侧性或非交叉性复视。治疗时，实现融合的预后较差，而难治性复视的风险据报道较高。我们报告一例矛盾性复视患者，在接受肉毒杆菌毒素注射和棱镜治疗后复视消失（并出现了一些双眼融合）。
病例报告。
一名25岁男性因外斜视接受评估。4岁时，他因外伤性外直肌麻痹导致内斜视。内斜视在3年内消失。14岁时，他出现了连续性外斜视。外斜视最终接受了手术治疗。术后仍残留外斜视，他出现了矛盾性复视，在所有感觉测试中均表现为同侧性复视，就好像他是内斜视一样。对双侧外直肌注射肉毒杆菌毒素并在眼镜中进行小度数棱镜矫正消除了外斜视和矛盾性复视，实现了一定程度的双眼融合。
肉毒杆菌毒素注射和棱镜治疗可有效消除矛盾性复视。
