The risk of diplopia following orbital floor and medial wall decompression in subtypes of ophthalmic Graves' disease.

We preoperatively divided 58 ophthalmic Graves' disease patients into types I and II categories before two-wall orbital decompression. Type I classification was given to patients who had no diplopia and essentially normal versions. Type II classification was assigned to patients with restrictive motility loss and diplopia within 20 degrees of the primary position.

Long-term fluctuation of relative afferent pupillary defect in subjects with normal visual function.

Purpose: To determine whether the relative afferent pupillary defect (RAPD) remains constant over time in normal subjects.

Methods: Seventeen normal subjects were tested with infrared pupillography and automated perimetry in four sessions over 3 years. The changes in RAPD and visual field asymmetry between testing sessions were compared.

Management of experimental globe perforation during strabismus surgery.

Background: The incidence of potentially vision-threatening globe perforation during strabismus surgery is reportedly between less than 1% and 12% of cases. Optimal treatment of globe perforation is not known; however, traditionally it has been treated with cryotherapy at the time of surgery or observation without treatment. The indirect-ophthalmoscope-directed diode laser may provide a safe and effective alternative treatment.

Neuro-Ophthalmologic Rehabilitation after Stroke.

Cerebrovascular disease may affect vision in a variety of ways. Stroke involving the afferent visual pathways typically causes visual field loss with or without defects in higher cortical processing. Damage to the efferent visual system may result in gaze palsy, diplopia, or fixational instability.

Persistent palinopsia following ingestion of lysergic acid diethylamide (LSD).

Objective: To identify a distinctive chronic visual complication of lysergic acid diethylamide (LSD) use.

Design: Description of the clinical findings in three patients with this disorder.

Setting: A neuro-ophthalmology referral center.

Variability of the relative afferent pupillary defect.

Purpose: Afferent asymmetry of visual function is detectable in both normal and pathologic conditions. With a computerized test, we assessed the variability in measuring afferent asymmetry of the pupillary light reflex, that is, the relative afferent pupillary defect.

Methods: In ten normal subjects, pupillary responses to an alternating light stimulus were recorded with computerized infrared pupillography.

Neuro-ophthalmic features of cerebral venous obstruction.

Objective: To characterize the neuro-ophthalmologic manifestations of impaired cranial venous outflow.

Design: A retrospective study of 20 patients who developed increased intracranial pressure as the result of impaired cerebral drainage.

Setting: Three neuro-ophthalmologic referral centers.

Anterior ischemic optic neuropathy secondary to interferon alfa.

Objective: To report the occurrence of anterior ischemic optic neuropathy as a complication of treatment with interferon alfa and to consider the possible underlying mechanisms for this association.

Design: Description of the clinical findings in two patients with this condition.

Setting: A neuro-ophthalmology referral center.

Raeder's paratrigeminal syndrome due to spontaneous dissection of the cervical and petrous internal carotid artery.

The combination of pain, ipsilateral oculosympathetic defect (ptosis and miosis), and ipsilateral trigeminal dysfunction constitutes Raeder's syndrome. We describe a patient with an acute presentation of Raeder's syndrome due to spontaneous internal carotid artery dissection. True trigeminal dysfunction due to carotid dissection is rare, and the potential mechanisms for its involvement are reviewed in this paper.

Visual disturbance secondary to clomiphene citrate.

Objective: To identify a distinctive constellation of persistent visual abnormalities secondary to treatment with clomiphene citrate.

Design: Description of the clinical findings in three patients with visual disturbance secondary to clomiphene treatment.

Setting: A neuro-ophthalmology referral center.

Adie's tonic pupil secondary to migraine.

A 46-year-old woman observed transient unilateral mydriasis during a classic migraine attack. One week later she experienced a similar episode after which anisocoria was persistent. Subsequent examination showed the clinical and pharmacologic features of a postganglionic parasympathetic paresis (Adie's tonic pupil).

Hemifacial spasm. An unusual manifestation of idiopathic intracranial hypertension.

Increased intracranial pressure may produce a variety of clinical manifestations, some common and others rare. We present a patient with idiopathic intracranial hypertension whose initial symptom was hemifacial spasm. All signs and symptoms of intracranial hypertension resolved with acetazolamide.

Recurrent neuroretinitis.

Objective: To characterize a distinct disorder of the optic nerve that manifests as recurrent episodes of acute, monocular disc edema and macular star formation.

Design: Description of the clinical features and laboratory findings in a group of patients with this disorder.

Setting: Referral center.

Isolated trochlear nerve palsy secondary to dural carotid-cavernous sinus fistula.

Ophthalmoplegia associated with dural carotid-cavernous sinus fistula typically involves the third, fourth, and sixth cranial nerves. Occasionally, isolated palsy of the oculomotor or abducens nerve is noted. We report a patient with bilateral dural carotid-cavernous sinus fistulas who presented with an isolated trochlear nerve palsy.