Kang Hae Min, Kim Hye Young
Department of Ophthalmology, Yonsei University Medical Center, Seoul, Korea.
Korean J Ophthalmol. 2011 Aug;25(4):289-93. doi: 10.3341/kjo.2011.25.4.289. Epub 2011 Jul 22.
An 11-year-old female presenting diplopia only at distance was found to have comitant esotropia of 20 prism diopters (PD) at distance and normal alignment at nearer proximity. Other ocular movement, including abduction, was normal and a thorough neurologic examination was also normal. The deviation angle of esotropia was increased to 35 PD in 6 months, and a brain magnetic resonance imaging with venogram at that time demonstrated no intracranial lesion. A lumbar puncture showed increased opening pressure but the cerebrospinal fluid composition was normal. The patient was diagnosed as having idiopathic intracranial hypertension and treated with oral acetazolamide. Three months after treatment, the deviation angle decreased to 10 PD. This is a case report of divergence insufficiency in pediatric idiopathic intracranial hypertension, with an increasing deviation angle of esotropia. Although sixth cranial nerve palsy is a common neurologic manifestation in intracranial hypertension, clinicians should be aware of the possibility of divergence insufficiency. Also, ophthalmoparesis may not be apparent and typical at first presentation, as seen in this case, and therefore ophthalmologists should be aware of this fact, while conducting careful and proper evaluation, follow-up, and intervention.
一名11岁女性仅在远距离时出现复视，检查发现其远距离时有20棱镜度（PD）的共同性内斜视，近距离时眼位正常。包括外展在内的其他眼球运动正常，全面的神经系统检查也正常。6个月内，内斜视的偏斜角度增加到35 PD，当时的脑部磁共振成像及静脉造影未显示颅内病变。腰椎穿刺显示初压升高，但脑脊液成分正常。该患者被诊断为特发性颅内高压，并接受口服乙酰唑胺治疗。治疗3个月后，偏斜角度降至10 PD。这是一例小儿特发性颅内高压伴内斜视偏斜角度增加的散开功能不全病例报告。虽然第六脑神经麻痹是颅内高压常见的神经表现，但临床医生应意识到散开功能不全的可能性。此外，如本病例所示，眼肌麻痹在首次就诊时可能并不明显和典型，因此眼科医生在进行仔细、恰当的评估、随访和干预时应注意这一情况。
