Multiple sclerosis, euthyroid restrictive Grave's ophthalmopathy, and myasthenia gravis. A case report.

A 53-year-old physician with a 13-year history of multiple sclerosis presented with the subacute onset of an atypical, restrictive, euthyroid Grave's ophthalmopathy. The hypotropia and monocular upgaze restriction responded to a course of systemic and local steroids. Three months later, the patient developed ocular and systemic features of myasthenia gravis.

Acquired esotropia as initial manifestation of Arnold-Chiari malformation.

A 13-year-old patient originally presented with a divergence palsy and gaze-evoked nystagmus. Over a short period of time, the esotropia became increasingly comitant and was successfully treated with strabismus surgery. Three years later, she developed downbeat nystagmus.

Binocular diplopia associated with retinal wrinkling.

Four patients with retinal wrinkling and epiretinal membrane formation presented with a unique clinical syndrome consisting of comitant, small angle hyperdeviations with intractable vertical diplopia, and unstable single vision with a failure to respond to conventional prism therapy. The pathophysiology underlying this presentation appears to be the establishment of a rivalry between central and peripheral fusional mechanisms due to mechanical macular distortion.

Vertical prisms. Why avoid them?

Vertical prisms are useful in the permanent or temporary alleviation of asthenopic symptoms arising from a vertical misalignment of the visual axes. A wide variety of both comitant and noncomitant hyperdeviations may be candidates for vertical prism use. Vertical prism strength is seldom difficult to compute and when properly employed, vertical prisms do not lead to unsightly spectacles.