Divergence Insufficiency

Berscheid, Christine

doi:10.3368/aoj.55.1.106

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…Horizontal ductions and versions should be normal. Christine Berscheid [ 9 ] showed that patients with secondary DI have the tendency to present with diplopia at a younger age than those with primary DI. The average age of patients with DI in the study was 51 years, compared with 62 years in patients with primary DI.…”

Section: Discussionmentioning

confidence: 99%

Acquired distance esotropia associated with myopia in the young adult

Zheng

Han

et al. 2018

BMC Ophthalmol

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BackgroundTo describe the clinical features of acquired progressive esotropia, with a larger angle at distance than near, associated with myopia in young adults.MethodsEleven adults (ages ranging from 18 to 37 years) with constant or intermittent horizontal diplopia at distance were recruited. Subjective refraction, ocular alignment, fusional amplitudes and horizontal eye movements were measured at distance and near.ResultsDistance esotropia varied from 20 to 60 prism diopters (PD). At near, the esotropic deviation ranged from 10 to 30 PD. Spherical equivalents (SE) of the right eye ranged from − 3.50 to − 8.25 diopters (D) while SE of the left eye ranged from − 0.375 to − 7.25 D. Ten of the eleven patients presented with constant diplopia at distance. Horizontal ductions and versions were full in all patients. The pathological report of seven patients who underwent lateral rectus resection showed that there were no muscle fibres, but rather, collagenous fibres.ConclusionsThis unusual sub-type of strabismus is a benign entity with slow progression that can occur in young adults with myopia. The cause of this condition is still unknown, and may be related to long periods of near work.

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Section: Discussionmentioning

confidence: 99%

Acquired distance esotropia associated with myopia in the young adult

Zheng

Han

et al. 2018

BMC Ophthalmol

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“…5,14 In 1954, Lyle 15 described how a lesion in the lower midbrain can mimic idiopathic divergence insufficiency but eventually progress to divergence paralysis with nystagmus. They have associated neurological signs, which include nystagmus, afferent pupillary defect, posterior ischemic optic neuropathy, skew deviation, vertigo, arm numbness, papilledema, facial paralysis, tremor, ataxia, and hemifacial spasm.…”

Section: ' Presentationmentioning

confidence: 99%

“…15 A retrospective study by Berscheid 14 in 2005 found that 21 of 44 patients with secondary divergence insufficiency either had nonspecific demyelinating disease (14) or multiple sclerosis (7). The patient was orthophoric at near, there was no nystagmus, and ocular movements were full.…”

Section: Secondary Divergence Insufficiencymentioning

confidence: 99%

Update on Divergence Insufficiency

Kirkeby¹

2014

International Ophthalmology Clinics

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Divergence insufficiency is an acquired condition that is characterized by a concomitant esodeviation that is at least 10 prism diopters (PD) greater at distance than near. It was originally classified by Duane in 1896 as part of his system to categorize horizontal strabismus. 1,2 Parinaud was the first to describe divergence paralysis, which is characterized by an esotropia that is greater at distance, complete absence of divergence, and associated neuroanatomic pathology. 2,3 Previous studies have used various systems to classify divergence insufficiency-type esotropia. Some of these terms include primary divergence insufficiency, secondary divergence insufficiency, divergence weakness, divergence paresis, and divergence paralysis. Studies have suggested that divergence insufficiency, divergence paresis, and divergence paralysis are a continuum of the same condition, differing only by their clinical severity. 4,5 More recent studies have used the term ''age related distance esotropia'' to describe concomitant, idiopathic divergence insufficiency in the elderly. 6,7 This terminology is based on reports of mechanical changes to the positioning of the extraocular muscles because of degradation of the lateral rectus-superior rectus (LR-SR) band. 8 Recent magnetic resonance imaging (MRI) studies have shown similar disruption of the LR-SR band in patients with distance esotropia and high myopia, irrespective of age. 9 Because distance esotropia can occur at any age, this chapter uses the classification system defined by Jacobson, 5 wherein primary divergence insufficiency is idiopathic and secondary insufficiency is associated with neurologic pathology. Both conditions are characterized by a concomitant esodeviation that is larger at distance than near and full ocular ductions.The aim of this study was to summarize what is currently known about this condition, present new information on pathophysiological

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