Causes, background, and characteristics of binocular diplopia in the elderly

Kawai, Manami; Goseki, Toshiaki; Ishikawa, Hitoshi; Hoshina, Miki; Shoji, Nobuyuki

doi:10.1007/s10384-018-0617-2

Cited by 29 publications

(22 citation statements)

References 27 publications

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“…Kawai et al suggested that binocular diplopia was often caused by orbital pulley disorders in elderly patients. 13 In our study, we did not group the causes of diplopia by age, but when we evaluated the causes for all ages together, age-related esotropia was the third most common cause (8.6%).…”

Section: Discussionmentioning

confidence: 94%

“…With age, lateral rectus-superior rectus band gets thinner and lateral rectus muscle displaces inferiorly. 13 Fusional range decreases with normal aging process and this condition also causes age related esotropia. Therefore, age related pulley abnormalities and decrease in fusional range should be considered in the presence of a new onset strabismus and diplopia in elderly patients.…”

Section: Discussionmentioning

confidence: 99%

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Etiology and Treatment Outcomes in Patients with Binocular Diplopia: Experience of a Tertiary Center

Kızıltunç¹,

Atilla²

2019

Turkiye Klinikleri J Ophthalmol

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iplopia is a common symptom in ophthalmological and neurological diseases and this symptom affects the quality of life to a great extent. Once the patient is disturbed from diplopia, it must be determined whether diplopia is monocular or binocular. While monocular Etiology and Treatment Outcomes in Patients with Binocular Diplopia: Experience of a Tertiary Center A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Diplopia is a common symptom in ophthalmologic and neurological diseases. In the presence of binocular diplopia, investigation should be made for differential diagnosis. Detection of the underlying etiology provides early diagnosis of accompanying neurological diseases and facilitates the treatment of diplopia. In this study, we aimed to evaluate the causes of binocular diplopia, treatment modalities and treatment outcomes in a tertiary center. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Medical records of patients with binocular diplopia were reviewed. Demographic features and ophthalmological examination findings were noted. Etiological differential diagnoses of diplopia were elucidated according to the results of full ophthalmological examination and neuro-radiological evaluation with cranio-orbital magnetic resonance imaging. Treatment modalities and responses to these treatments were noted. R Re es su ul lt ts s: : A total of 70 patients were evaluated. Thirty-six patients (51.4%) had cranial nerve palsies. Of 36 patients, 61.1% had 6th nerve palsy, 22.2% 3th nerve palsy and 16.7% 4th nerve palsy. Patients without cranial nerve palsies were also grouped according to the type of deviations. The most common deviations were acute-decompansated esotropia (21.2%) and agerelated esotropia (18.2%). Diplopia recovered in 8 patients (11.4%) after treatment of the underlying etiology. Nineteen (27.1%) patients were not treated due to spontaneous recovery. Prism glasses were prescribed in 22 (31.4%) patients. Twelve patients (17.1%) were operated. Six (8.6%) patients received Botulinum-A toxin injections. C Co on nc cl lu us si io on n: : In the presence of binocular diplopia, cranial nerve palsies should be investigated. Diplopia can resolve spontaneously. In cases with persistant diplopia, prism glasses, Botulinum toxin-A injection and surgery can be performed.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Etiology and Treatment Outcomes in Patients with Binocular Diplopia: Experience of a Tertiary Center

Kızıltunç¹,

Atilla²

2019

Turkiye Klinikleri J Ophthalmol

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“…Double vision is an extremely disabling symptom that can affect the quality of daily life of patients. Kawai et al investigated the clinical characteristics of patients aged ≥60 years who complained of binocular diplopia and found that the most common type of strabismus was esotropia due to orbital pulley disorder (9). They classified the causes of strabismus according to the type of deviation and demonstrated that orbital pulley disorder was the main reason for esodeviation, whereas it was convergence insufficiency for exodeviation, fourth nerve palsy for vertical deviation, and orbital pulley disorder and fourth nerve palsy in an equal frequency for combined deviation (9).…”

Section: Discussionmentioning

confidence: 99%

“…Kawai et al investigated the clinical characteristics of patients aged ≥60 years who complained of binocular diplopia and found that the most common type of strabismus was esotropia due to orbital pulley disorder (9). They classified the causes of strabismus according to the type of deviation and demonstrated that orbital pulley disorder was the main reason for esodeviation, whereas it was convergence insufficiency for exodeviation, fourth nerve palsy for vertical deviation, and orbital pulley disorder and fourth nerve palsy in an equal frequency for combined deviation (9). In the present study, there was one patient with sagging eye syndrome caused by the abnormalities of the extraocular muscle bands, which are primarily induced by the aging process (10).…”

Section: Discussionmentioning

confidence: 99%

Strabismus in geriatric patients: etiology and clinical features

Şekeroğlu¹

2019

tjgeri

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STRABISMUS IN GERIATRIC PATIENTS: ETIOLOGY AND CLINICAL FEATURES Introduction: As life expectancy is continuously increasing, health issues, such as strabismus that has a functional and psychosocial impact on the quality of life, have gained more importance and require a solution. In the present study, we aimed to describe and determine the strabismus etiology and clinical features in patients aged ≥65 years who were examined in a strabismus clinic. Materials and Method: We retrospectively examined the data of patients aged ≥65 years who were admitted to the strabismus clinic between July 2018 and July 2019. The findings of the ophthalmological and orthoptic examination as well as the strabismus etiology, intervention required, and chief complaints were all recorded. Results: We extracted the medical records of 40 patients (16 female and 24 male) aged ≥65 years who were examined in the strabismus clinic. The chief complaint was diplopia in 30 (75%) patients, followed by ocular deviation in 10 (25%) patients. The deviation was horizontal in 26 (65%) patients. The most common etiology was thyroid eye disease (6 patients; 15%), followed by diabetes (5 patients, 12.5%), hypertension (5 patients, 12.5%), trauma (3 patients, 7.5%), cerebrovascular event (3 patients, 7.5%), intracranial mass (3 patients, 7.5%), and secondary deviation (3 patients, 7.5%). Moreover, 11 (27.5%) patients underwent surgery, whereas 17 (42.5%) patients received nonsurgical treatment; 14 (35%) patients did not re-visit the strabismus clinic. Conclusion: Strabismus can be seen in elderly individuals. The underlying etiology, such as trauma and cerebrovascular events, may be life threatening and requires prompt diagnosis and treatment.

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“…The incidence of adult-onset strabismus is reported as 54/100,000 cases, peaking in the 8th decade of life. The most frequent forms of strabismus with diplopia are paralytic forms (44.2 %), convergence insufficiency (15.7 %), small-angle hypertropia (13.1 %) and distance esotropia (10.6 %) [1,2].…”

Section: Introductionmentioning

confidence: 99%

Differential Diagnosis of Acquired Esotropia in the Elderly

Roggenkämper

Neugebauer

Hedergott

2020

Klin Monbl Augenheilkd

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Aim To provide an overview of the differential diagnoses of acquired esotropia that occur in the elderly and to facilitate their differentiation in everyday clinical practice. Methods The data of all patients who presented in our outpatient university department for strabology and neuroophthalmology from March 2014 to October 2015 due to esotropia with diplopia with onset after age 50 were evaluated retrospectively. Exclusion criteria were a known strabismus before the age of 50 and/or vertical deviations in the primary position. Anamnestic characteristics, accompanying findings and orthoptic parameters, were analysed. Results 85 patients were included in the study, 42 of them female and 43 male. The following diagnoses were made: abducens nerve palsy (n = 34, 3 of them both sides), esotropia due to myopia magna (n = 12), esotropia with accompanying neurological symptoms (n = 6) and other etiology (n = 5). In 4 cases, the diagnosis was still unclear at the end of the study. In 24 patients, none of the above diagnoses existed and the diagnosis of “sagging eye syndrome” (ETSAG) was made. The abducens nerve palsy typically showed a sudden onset of double vision, slowed abduction saccades and asymmetrical abduction ability. With unilateral abducens nerve palsy, the esotropia increased continuously from the view to the unaffected side through the primary position to the view to the affected side. Patients with ETSAG and myopia-associated esotropia, on the other hand, reported a gradual onset of double vision, showed normal abduction saccades and a slightly reduced abduction ability. The squint angle often increased slightly to both sides. Esotropia with accompanying neurological symptoms was rare and was seen in various underlying diseases. Conclusions The kind of onset of the double vision, the quality of the saccades, the incomitance pattern and the ability to abduct are important parameters for the etiological assignment of an esotropia in the elderly. The characteristics of the individual diagnoses are described and differential diagnostic aspects are discussed.

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Causes, background, and characteristics of binocular diplopia in the elderly

Abstract: About half of the elderly patients with binocular diplopia exhibited vertical deviation. In addition, binocular diplopia was often caused by orbital pulley disorders. It is the first epidemiological study focusing on orbital pulley disorders diagnosed on the basis of MRI.

Cited by 29 publications

References 27 publications

Etiology and Treatment Outcomes in Patients with Binocular Diplopia: Experience of a Tertiary Center

Etiology and Treatment Outcomes in Patients with Binocular Diplopia: Experience of a Tertiary Center

Strabismus in geriatric patients: etiology and clinical features

Differential Diagnosis of Acquired Esotropia in the Elderly

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