Disorders of ocular motility following head trauma.

OBJECTIVE

To determine the types and frequency of symptomatic ocular motility disturbances following head trauma and their association with severity of trauma.

DESIGN

Retrospective study of patients with (1) diplopia unless visual loss is present, (2) heterotropia for far or near targets, and (3) prior head injury.

SETTING

Office and in-hospital consulting practice of a university neuro-ophthalmologist.

SUBJECTS

Sixty patients with posttraumatic ophthalmoplegia.

MAIN OUTCOME MEASURES

Paralytic and nonparalytic heterotropias were quantitated in prism diopters or percentage limitation of ductions. Convergence insufficiency was assessed by determining the near point of convergence.

RESULTS

Fifty-one patients had nuclear or infranuclear findings, ie, trochlear palsies (n = 20), oculomotor palsies (n = 17), abducens palsies (n = 7), combined palsies (n = 5), and restrictive ophthalmopathy (n = 2). Nine patients had supranuclear dysfunction, including seven patients with convergence insufficiency. Bilateral ocular motor palsies and combined palsies were significantly (by means of chi 2 test) associated with head trauma of severity sufficient to cause corticospinal tract dysfunction. Individual or combined ocular motor palsies were not significantly (by means of chi 2 test) associated with intracranial hemorrhage and/or skull fracture or loss of consciousness.

CONCLUSIONS

Trochlear palsy was the most common nuclear or infranuclear basis for traumatic diplopia, and convergence insufficiency was the most common supranuclear cause of double vision. Head trauma distinguished by upper motor-neuron signs was correlated with specific subsets of disordered ocular motility.