Houston Kevin E, Paschalis Eleftherios I, Angueira Danielle C, Bronstad P Matthew, Barrett Anna M, Iaccarino Mary Alexis
From the Spaulding Rehabilitation Hospital, Boston, Massachusetts (KEH, DCA, MAI); Departments of Ophthalmology (KEH, EIP, PMB) and Physical Medicine and Rehabilitation (MAI), Harvard Medical School, Boston, Massachusetts; Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts (EIP); and Kessler Foundation, West Orange, New Jersey (AMB).
Am J Phys Med Rehabil. 2017 Apr;96(4):e70-e74. doi: 10.1097/PHM.0000000000000592.
Visual impairments are common after traumatic brain injury (TBI) and negatively affect quality of life. We describe a 39-year-old woman with a severe TBI who was evaluated by the inpatient optometry and vision rehabilitation service with findings of complete right homonymous hemianopia and right cranial nerve III palsy with 30-degree right exotropia (eye turn out) and complete right ptosis (eyelid will not open). The 30-degree exotropia advantageously generated 30 degrees of right visual field expansion when the right ptosis was treated with a magnetic levator prosthesis, which restores eyelid opening. Once opened, the patient used visual field expansion derived from a right exotropia to overcome functional impairments caused by right hemianopia. Field expansion improved the patient's wheelchair mobility and reaching tasks during inpatient therapy. This is the first report of visual field expansion by strabismus facilitated by correction of ptosis. Strabismus should be considered for its potential field expansion benefits when homonymous visual deficits are present, before considering patching. A multidisciplinary vision rehabilitation team is well suited to make this determination.
创伤性脑损伤(TBI)后视力障碍很常见,且会对生活质量产生负面影响。我们描述了一名39岁的重度TBI女性患者,她接受了住院验光和视力康复服务评估,结果显示完全性右侧同向性偏盲、右侧动眼神经麻痹伴30度右侧外斜视(眼球向外转动)以及完全性右侧上睑下垂(眼睑无法睁开)。当使用磁性提上睑肌假体治疗右侧上睑下垂以恢复眼睑睁开时,30度的外斜视有利地产生了30度的右侧视野扩展。一旦眼睑睁开,患者利用源自右侧外斜视的视野扩展来克服右侧偏盲引起的功能障碍。在住院治疗期间,视野扩展改善了患者的轮椅移动能力和伸手取物任务。这是首例关于通过矫正上睑下垂促进斜视实现视野扩展的报告。当存在同向性视觉缺陷时,在考虑遮盖疗法之前,应考虑斜视因其潜在的视野扩展益处。多学科视力康复团队非常适合做出这一决定。