Botulinum toxin in fourth nerve palsies

Garnham, L.; Lawson, JM; O’Neill, Damian; Jp, Lee

doi:10.1111/j.1442-9071.1997.tb01272.x

Cited by 22 publications

(15 citation statements)

References 10 publications

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“…Half of patients had improvement in their symptoms for primary and reading positions, and resolution of torticollis, but diplopia was not eliminated in lateral gaze positions (n ¼ 6). Garnham et al [25] reported that botulinum was most successful for superior oblique palsies when the inferior rectus was injected. When only the inferior oblique was injected 83% of patients ultimately did require surgery (n ¼ 20).…”

Section: Cranial Nerve Palsiesmentioning

confidence: 99%

Use of botulinum toxin in strabismus

Crouch

2006

Current Opinion in Ophthalmology

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Botulinum administration is a strabismus treatment option that may be considered for some strabismus patients; in select cases botulinum is a reasonable and preferable alternative to surgery. Current clinical recommendations regarding botulinum should be considered in the context of the existing comparative studies that are summarized in this review. Since there are very limited data directly comparing the success rates of botulinum with standard strabismus surgery, additional, well designed prospective studies are needed. Data from such studies would enable recommendations for strabismus management to be formulated using an evidence-based approach.

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Section: Cranial Nerve Palsiesmentioning

confidence: 99%

Use of botulinum toxin in strabismus

Crouch

2006

Current Opinion in Ophthalmology

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“…1 Treatment for SOP commonly consists of surgical intervention since lateral incomitance often limits prism use, and botulinum toxin studies have not been encouraging for long-term improvement. 2 Vertical diplopia, torsional diplopia, or significant torticollis are all indications for surgery. A number of operative techniques have been recommended for the treatment of SOP including weakening the ipsilateral inferior oblique, 3–7 contralateral inferior rectus recession, 8 ipsilateral superior rectus recession, 9 and superior oblique tuck, isolated or in combination.…”

Section: Introductionmentioning

confidence: 99%

Surgical Results of Patients With Unilateral Superior Oblique Palsy Presenting With Large Hypertropias

Nejad

Thacker²,

Velez³

et al. 2013

J Pediatr Ophthalmol Strabismus

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Purpose Surgical management of superior oblique palsy (SOP) is challenging because of combined vertical, horizontal, and torsional misalignment. Our purpose is to report the surgical results of subjects with large primary position hypertropias (≥20 PD) due to unilateral SOP. Methods Retrospective review of the records of patients with large hypertropias (>20 PD) secondary to clinically diagnosed SOP. Criteria for success included (1) correction of the anomalous head posture, (2) primary position alignment between orthotropic and 6 PD of undercorrection, and (3) no reoperation required for residual deviations in any direction of gaze. Results Forty-five subjects met inclusion criteria. Mean preoperative alignment in primary gaze was 26.5 +/− 6.5 PD compared to 3.0 +/− 4.4 PD postoperatively (p value = <0.001). Twenty-three (51%) cases met our criteria for success with one operation. Of the subjects who had single muscle surgery, 14% had a successful outcome, with a mean 67% (17.3 PD) reduction in hypertropia. Of subjects who underwent simultaneous multiple muscle surgery, 58% met the criteria for a successful result, with a mean 92% (24.6 PD) reduction in primary gaze hypertropia. Success was the highest in subjects who underwent ipsilateral inferior oblique combined with contralateral inferior rectus recessions with (60% success) or without (65% success) a Harada-Ito procedure. Conclusions Undercorrections are frequent following surgery for unilateral SOP with preoperative deviations ≥20 PD in primary position, especially after single muscle surgery. Simultaneous multiple muscle surgery rarely results in overcorrection and is recommended in SOP patients with >20 PD of hypertropia in primary position.

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“…1,4,[10][11][12] The magnitude of visual disturbance can also be evaluated more objectively using prisms. In one study 13 the mean vertical deviation of 20 patients (aged 19-70 years) with congenital or traumatic fourth CN palsy was 11 prism diopters. In this patient, the diplopia was both vertical and torsional, with left gaze being off by 20 prism diopters at 5 weeks postinjury.…”

Section: Discussionmentioning

confidence: 96%

Fourth Cranial Nerve Palsy in a Collegiate Lacrosse Player: A Case Report

Stiller-Ostrowski

2010

Journal of Athletic Training

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Objective: To present the case of a National Collegiate Athletic Association Division I men's lacrosse athlete with fourth cranial nerve injury as the result of a minor traumatic blow.Background: The athlete was struck on the right side of his head during a lacrosse game. On-field evaluation revealed no cervical spine involvement or loss of consciousness. He complained of headache and dizziness, with delayed reports of visual disturbance. Sideline visual acuity and cranial nerve screenings appeared within normal limits. Consultation with the team physician indicated that immediate referral to the emergency department was unnecessary.Differential Diagnosis: Concussion, third cranial nerve palsy, fourth cranial nerve palsy.Treatment: The certified athletic trainer safely removed the athlete from the playing field and monitored him on the sideline. After being seen by the team physician, the patient was referred to a neurologist, ophthalmologist, and finally a neuro-ophthalmologist before a definitive diagnosis was made. The palsy did not necessitate surgical intervention, resolving with conservative treatment. The athlete was able to return to full athletic ability at his preinjury level by 8 months postinjury.Uniqueness: Superior oblique palsy as the result of fourth cranial nerve injury is the most frequent isolated cranial nerve palsy; however, these palsies are often underdiagnosed by health professionals. Such palsies are uncommon within the athletic realm, making timely diagnosis even less likely.Conclusions: Cranial nerve palsy may present very subtly in patients. Therefore, on-field health care providers should be aware of the descriptions and types of compensations that signal nerve injury.

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Botulinum toxin in fourth nerve palsies

Abstract: BTXA is of greatest benefit in patients with residual deviations particularly when the inferior rectus is injected, but is of limited value as a primary therapy in chronic IV N palsy.

Cited by 22 publications

References 10 publications

Use of botulinum toxin in strabismus

Use of botulinum toxin in strabismus

Surgical Results of Patients With Unilateral Superior Oblique Palsy Presenting With Large Hypertropias

Fourth Cranial Nerve Palsy in a Collegiate Lacrosse Player: A Case Report

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