Ocular neuromyotonia (ONM) is a rare but distinctive clinical entity characterized by involuntary episodic contraction of one or more muscles supplied by the ocular motor nerves. A retrospective review was conducted on all patients with ONM seen by the neuroophthalmology service in the past 20 years. Ten patients were identified with ONM; six affecting vertical muscles (superior oblique; inferior rectus; superior rectus) and four affecting lateral rectus muscles. Case 1 has been reported previously. Most episodes occurred every 10-40 min, lasted a few seconds to several minutes, and were repeated throughout the day. Only two patients had previously undergone cranial radiation. Two had thyroid eye disease. One patient presented with superior oblique myokymia and subsequently developed ONM. Membrane stabilizing medications were prescribed in 7 of the 10 patients with varied success. ONM episodes ceased after extraocular muscle surgery in one patient with thyroid eye disease.

No abstract

AEO occurring only on awakening from sleep is a rare entity. Neuroimaging and extensive laboratory testing are not indicated without associated neurologic or ocular findings. There may be a Caucasian female preponderance and autoimmune link in patients with AEO, but further studies are required.

The human promyelocytic leukemia cell line HL60 can be induced to differentiate into mature granulocytes by exposure to Me2SO. [1-14C]Arachidonic acid incubated overnight with these cells was incorporated mainly into membrane phospholipids. Stimulation of these cells with the calcium ionophore, A23187, resulted in a rapid release of esterified arachidonic acid from phosphatidylethanolamine and phosphatidylcholine. The released arachidonic acid was metabolized via both the cyclooxygenase and lipoxygenase pathways into three major hydroxylated products, 12-L-hydroxy-5,8,10-heptadecatrienoic acid (HHT), 5(S)-hydroxy-6,8,11,14-icosatetraenoic acid (5-HETE), and 5-(S),12(R)-dihydroxy-6,8,10,14-icosatetraenoic acid (leukotriene B). Arachidonic acid was also incorporated into triacylglycerols and phosphatidylinositol. The lipoxygenase product, 5-HETE, was rapidly esterified into cellular lipids. Thirty minutes after ionophore stimulation, 55% of the total 5-HETE synthesized was esterified into phospholipids and 35% incorporated into acylglycerols. In contrast, the other hydroxylated derivatives of arachidonic acid (HHT and leukotriene B) were not incorporated into acylglycerols or phospholipids. Esterification of hydroxylated metabolites of arachidonic acid into membrane phospholipids may serve to regulate a number of granulocyte functions.