Tejedor Jaime, Díez Laura
Department of Ophthalmology, Hospital Ramón y Cajal, Madrid - Spain.
Eur J Ophthalmol. 2012 Nov-Dec;22(6):1042-4. doi: 10.5301/ejo.5000202. Epub 2012 Sep 26.
To report management of diplopia with botulinum toxin injection in traumatic multiple ocular motor cranial neuropathies.
Alternate prism and cover measurement of deviation in different positions of gaze, examination of ductions, field of binocular single vision, and complete ocular anterior and posterior segment evaluation were carried out. CT and MRI of the orbit were available.
We describe a case of traumatic VI, IV, and mainly superior III cranial nerve palsies, with left hypotropia of 35 prism diopters and esotropia of 45 prism diopters and incapacitating diplopia, due to fracture of the roof and lateral wall of the orbit, extending to the superior orbital fissure, as demonstrated by CT and MRI of the orbit. Severe limitation of abduction, elevation, and depression of the left eye was found. A single botulinum toxin injection in the medial rectus with diffusion to the inferior rectus was effective as a temporary measure for the treatment of diplopia and attainment of a small field of binocular single vision. The patient remained symptom-free for 5 months after injection.
Botulinum toxin injection may be useful for the temporary management of diplopia in multiple ocular motor cranial neuropathies.
报告肉毒杆菌毒素注射治疗外伤性多发性动眼神经麻痹所致复视的情况。
采用交替棱镜遮盖法测量不同注视位的斜视度，检查眼球运动、双眼单视视野，并对眼前节和后节进行全面评估。眼眶CT和MRI检查可用。
我们描述了1例因眼眶顶壁和侧壁骨折并延伸至眶上裂导致的外伤性Ⅵ、Ⅳ及主要为Ⅲ脑神经麻痹病例，患者左眼有35棱镜度的下斜视和45棱镜度的内斜视，复视严重影响生活。眼眶CT和MRI显示左眼外展、上抬和下转严重受限。在内直肌注射肉毒杆菌毒素并扩散至下直肌，作为治疗复视和获得小范围双眼单视的临时措施有效。注射后患者5个月无症状。
肉毒杆菌毒素注射可能有助于临时治疗多发性动眼神经麻痹所致的复视。
