MyMedR

Fulltext Understanding and preventing computer vision syndrome

Loh KY, Reddy SC

Malays Fam Physician, 2008;3(3):128-30.

The invention of computer and advancement in information technology has revolutionized and benefited the society but at the same time has caused symptoms related to its usage such as ocular sprain, irritation, redness, dryness, blurred vision and double vision. This cluster of symptoms is known as computer vision syndrome which is characterized by the visual symptoms which result from interaction with computer display or its environment. Three major mechanisms that lead to computer vision syndrome are extraocular mechanism, accommodative mechanism and ocular surface mechanism. The visual effects of the computer such as brightness, resolution, glare and quality all are known factors that contribute to computer vision syndrome. Prevention is the most important strategy in managing computer vision syndrome. Modification in the ergonomics of the working environment, patient education and proper eye care are crucial in managing computer vision syndrome.

Matched MeSH terms: Diplopia

Surgical Timing and Fracture Type on the Outcome of Diplopia After Orbital Fracture Repair

Yu DY, Chen CH, Tsay PK, Leow AM, Pan CH, Chen CT

Ann Plast Surg, 2016 Mar;76 Suppl 1:S91-5.

PMID: 26808744 DOI: 10.1097/SAP.0000000000000726

Orbital fractures and the concomitant soft tissue injuries within the bony orbit result in well-recognized complications such as diplopia and enophthalmos. Guidelines for timing and indications for surgery for achieving an optimal outcome remain elusive. This study examined the effects of timing and fracture type on the outcome of orbital fracture repair.

Matched MeSH terms: Diplopia

White-eyed blowout fracture: Diagnostic pitfalls and review of literature

Yew CC, Shaari R, Rahman SA, Alam MK

Injury, 2015 Sep;46(9):1856-9.

PMID: 25986667 DOI: 10.1016/j.injury.2015.04.025

White-eyed blowout fracture was first termed by Jordan et al. in individuals sustaining a blow to the periocular area and presenting with ocular symptoms, although with minimal soft tissue signs of trauma. It is often found in pure orbital floor blowout fractures among paediatric patients, and it could manifest as a linear or hinge-like trapdoor deformity. Unlike the more common open orbital blowout fractures with distinct diagnostic clinical signs, white-eyed blowout fractures are rarer and their diagnoses can be easily missed, subsequently costing an optimal time window for surgical intervention. This is critical as better outcomes are found with earlier release of entrapments. This report describes a case of a white-eyed blowout fracture in a 10-year-old child faced with its diagnostic challenges. The current literature review discusses the types of fracture pattern, signs and symptoms, mechanism of action, as well as timing of surgery. In view of the common complication of persistent diplopia, clinical pitfalls in achieving this diagnosis are emphasized to prevent any delay of treatment. Current literature evidences are weighted towards urgent surgical intervention, as positive outcomes are found to correlate with earlier release of entrapments.

Matched MeSH terms: Diplopia

Fulltext The two-minute approach to monocular diplopia

Tan AK, Faridah Hanom A

Malays Fam Physician, 2010;5(3):115-118.

PMID: 25606202 MyJurnal

To describe a quick and simple diagnostic approach to monocular diplopia. Diplopia is a common visual complain in casualty departments, general practice clinics, neurologic clinics as well as ophthalmic clinics. Monocular diplopia, however, is uncommon. Many well established clinical examination methods are available to address diplopia. Some require special equipments which are not easily available or unfamiliar outside of ophthalmic clinic. We describe a simple two-minute diagnostic approach to monocular diplopia. Basic knowledge and understanding of simple clinical examination techniques enhances diagnostic skill and allow proper localization of underlying disorders.

Matched MeSH terms: Diplopia

Silent sinus syndrome due to a maxillary mucocele

Tan TY, Shashinder S, Subrayan V, Krishnan G

Auris Nasus Larynx, 2008 Jun;35(2):285-7.

PMID: 18024042

Silent sinus syndrome is a rare clinical condition in which patients present with spontaneous enophthalmos and hypoglobus secondary to collapse of orbital floor due to chronic subclinical maxillary sinusitis. It is postulated that obstruction of the osteomeatal complex lead to negative antrum pressure which causes the maxillary sinus atelectasis.

Matched MeSH terms: Diplopia/etiology*

Nystagmus and diplopia in a patient with positive aquaporin-4 antibody

Koh KL, Sonny Teo KS, Halim SA, Wan Hitam WH

Can J Ophthalmol, 2019 04;54(2):e66-e69.

PMID: 30975364 DOI: 10.1016/j.jcjo.2018.06.022

Matched MeSH terms: Diplopia/diagnosis*; Diplopia/etiology; Diplopia/immunology

Fulltext An adult patient with double vision

Koh KC

Malays Fam Physician, 2013;8(1):50-52.

PMID: 25606271 MyJurnal

A 27-year old Nepali man presented with a four-day history of fever, vomiting and horizontal diplopia. There was no history of trauma. The patient has esotropia of the left eye or what is commonly known as a squint or strabismus. The squint is an inward squint (synonyms include convergent squint or esodeviation of the eye). Esotropia is a condition where either one or both eyes are turned inward. Congenital esotropia, often seen in infants below six years old, may give rise to amblyopia. Accommodative esotropia is common among patients with moderate amounts of
hypermetropia or hyperopia. Esotropias can be concomitant, where the degree of deviation is independent of the direction of the gaze, or incomitant, where the degree of deviation is influenced by the direction of the gaze. This patient had incomitant esotropia as the squint was revealed when he was asked to look to the left. A comprehensive step-bystep approach to a patient presenting with a squint has been described extensively in literature.

Matched MeSH terms: Diplopia

Recurrent bilateral orbital myositis: case report and review of the literature

Abd-Rashid R, Hussein A, Yunus R, Naik VR, Shatriah I

Ann Trop Paediatr, 2011;31(2):173-80.

PMID: 21575325 DOI: 10.1179/1465328111Y.0000000004

Orbital myositis in children is uncommon. Recurrence is a major challenge in management. An 11-year-old Malay girl who presented with bilateral orbital myositis with recurrent attacks of diplopia is reported.

Matched MeSH terms: Diplopia/diagnosis; Diplopia/etiology

Lateral rectus myositis mimicking an abducens nerve palsy in a pregnant woman

Haslinda AR, Shatriah I, Azhany Y, Nik-Ahmad-Zuky NL, Yunus R

Ophthalmic Plast Reconstr Surg, 2013 3 28;30(1):e13-5.

PMID: 23531952 DOI: 10.1097/IOP.0b013e31828957ae

Myositis is a rare unknown inflammatory disorder of the skeletal muscle tissue. Generalized inflammatory myopathies, polymyositis, and dermatomyositis have been reported during pregnancy. Isolated orbital myositis in pregnancy has not been previously described in the literature. The authors report a case of left isolated orbital myositis in a primigravida at 38 weeks gestation affecting the patient's left lateral rectus muscle. MRI of the orbit was consistent with the diagnosis. She showed remarkable clinical improvement with oral corticosteroids therapy.

Matched MeSH terms: Diplopia/diagnosis; Diplopia/drug therapy

Fulltext Epiphora as the primary initial presentation for a huge sino-nasal osteoma: a rare presentation

Nadia Yaacob, Adil Hussein

Journal of Biomedical and Clinical Sciences, 2018;3(2):26-28.

MyJurnal

Sino-nasal osteoma is a common benign tumour of paranasal
sinuses and usually asymptomatic. Here, we presented a case of a huge sinonasal osteoma. Despite the large size of the tumour, the only presentation
was epiphora. There were no headache, facial pain or diplopia. Nasal
obstruction only occurred after involvement of the nasal cavity. In diagnosing
aetiology of the epiphora, sino-nasal pathology needed to be ruled out after
excluding ocular causes. Multidisciplinary approach between otolaryngology
(ORL) team and ophthalmology team was essential in managing the case.
The tumour was successfully removed surgically via endoscopic approach;
and dacryocystorhinostomy (DCR) was performed to alleviate the epiphora.

Matched MeSH terms: Diplopia

Fulltext Managing Subacute Subperiosteal Hematoma with High Intraocular Pressure: A case report

Hashim SE, Fatisha A, Nazri MN

International Medical Journal Malaysia, 2017;16(1):135-138.

MyJurnal

Subperiosteal haematoma of the orbit is an uncommon complication of maxillofacial trauma, hence easily missed. It usually presents subacutely with proptosis and diplopia. In our case, the subperiosteal haematoma is complicated with high intraocular pressure, necessisating measures to reduce the intraocular pressure. Unresponsive to only medical treatment, surgical evacuation was carried out in this patient. Removal of the clot finally relieved the intraocular pressure and simultaneously improved the proptosis and the cumbersome diplopia.

Matched MeSH terms: Diplopia

Biomaterials for repair of orbital floor blowout fractures: a systematic review

Gunarajah DR, Samman N

J Oral Maxillofac Surg, 2013 Mar;71(3):550-70.

PMID: 23422151 DOI: 10.1016/j.joms.2012.10.029

To evaluate the reported use and outcomes of implant materials used for the restoration of post-traumatic orbital floor defects in adults.

Matched MeSH terms: Diplopia/etiology

Fulltext "Why do I always see double?" A misdiagnosed case of ocular myasthenia gravis for 10 years

Yousuf UA, Yashodhara BM, Thanigasalam T, Ting HS

BMJ Case Rep, 2014 May 02;2014.

PMID: 24792021 DOI: 10.1136/bcr-2013-203488

A 58-year-old man presented with diplopia and partial ptosis for 10 years. It was non-progressive in nature, despite inadequate medical attention the patient received from non-specialists/general practitioners. He did not have fatigability or diurnal variation in weakness and was clinically stable without exacerbations of disease for a decade. He did not have features of Graves's disease, oculopharyngeal dystrophy, cranial nerve paralysis, polymyositis and stroke. The possibility of an atypical presentation of myasthenia gravis (MG) was considered and the patient was evaluated. Ice pack test was negative, Cogan's lid twitch (CLT) test was positive and high titres of acetylcholine receptor antibodies (AChR Ab) suggestive of MG were found. He was treated accordingly with a very good response.

Matched MeSH terms: Diplopia/drug therapy; Diplopia/etiology

Fulltext Diagnostic dilemma of dural carotid cavernous fistula

Noorlaila B., Zunaina E., Raja Norliza R.O., Nor Fadzillah A.J., Alice, G.K.C.

Journal of Biomedical and Clinical Sciences, 2017;2(1):38-41.

MyJurnal

We report a case of dural carotid cavernous fistula (CCF) pose a diagnostic dilemma with initial symptoms of the arteriovenous shunt. A 56 year-old man presented with right eye diplopia, thensubsequently developed ptosis, congestion of conjunctiva, dilated episcleral vessels, and gradual rise in intraocular pressure. Initial diagnosis of pseudotumour was made based on negative finding of CCF by computed tomography angiography (CTA). In view of persistent clinical manifestations in spite of steroid therapy, and with the presence of new ocular signs; cock-screw conjunctival vessels, dilated retinal veins, and proptosis, digital subtraction angiography (DSA) was performed and confirmed the diagnosis of dural CCF.The ocular symptoms resolved completely post embolization of the fistula.

Matched MeSH terms: Diplopia

Case Report: Ocular Tilt Reaction with Internuclear Ophthalmoplegia and Multiple Cranial Nerve Palsies

Teo SK, Mohd Khialdin S, Yong MH, Othman O, Ami M

Optom Vis Sci, 2020 Dec;97(12):1018-1022.

PMID: 33252541 DOI: 10.1097/OPX.0000000000001607

SIGNIFICANCE: Ocular tilt reaction (OTR) is an abnormal eye-head postural reaction that consists of skew deviation, head tilt, and bilateral ocular torsion. Understanding of the pathway of the vestibulo-ocular reflex (VOR) is essential because this will help to localize the pathology.

PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies.

CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons.

CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.

Matched MeSH terms: Diplopia/diagnosis; Diplopia/etiology; Diplopia/physiopathology

Fulltext Compensatory renal hypertrophy in reflux nephropathy presenting as hypertensive emergency

Othman Tan SES, Mohamad SD, Ahmad MZ

Oxf Med Case Reports, 2021 Feb;2021(2):omaa132.

PMID: 33614043 DOI: 10.1093/omcr/omaa132

Hypertensive emergency in the paediatric population is not uncommon. However, due to its numerous etiologies, care should be taken in determining the approach of management. We report a case of a child who presented with double vision, giddiness and elevated blood pressure. Blood investigations were normal. Renal ultrasound and magnetic resonance imaging of the abdomen were performed which both showed findings suspicious of a large heterogeneous mass at the lower pole of the left kidney with dysplastic right kidney. A final diagnosis of bilateral vesicoureteric reflux with left compensatory hypertrophy was made based upon micturating cystourethrography findings and was later confirmed by 99mTc-dimercaptosuccinic acid (DMSA) study. The objective of this case is to share the importance of the appropriate choice of radiological examinations, not only in achieving an accurate diagnosis but to ensure that unnecessary investigations are avoided.

Matched MeSH terms: Diplopia

Fulltext Thyroid associated ophthalmopathy - a review

Mallika PS, Tan AK, Aziz S, Syed Alwi SAR, Chong MS, Vanitha R, et al.

Malays Fam Physician, 2009;4(1):8-14.

PMID: 25606151 MyJurnal

Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Smoking has been identified as the strongest risk factor for the development of the disorder. The pathogenesis involves activation of both humoral and cell mediated immunity with subsequent production of gycoaminoglycans, hyaluronic acid resulting in oedema formation, increase extraocular mass and adipogenesis in the orbit. The natural history of the disease progresses from active to inactive fibrotic stage over a period of years. Diagnosis is mainly clinical and almost all patients with ophthalmopathy exhibit some form of thyroid abnormality on further testing. Treatment is based on the clinical severity of the disease. Non-severe cases are managed by supportive measures to reduce the symptomatology and severe cases are treated by either medical or surgical decompression. Rehabilitative surgery is done for quiescent disease to reduce diplopia and improve cosmesis.

Matched MeSH terms: Diplopia

Fulltext The blue man who presented with a stroke

Koh KC, Wong MH

Malays Fam Physician, 2011;6(1):29-31.

PMID: 25606217 MyJurnal

A 19-year-old man presented with sudden onset of right eye ptosis, diplopia and giddiness. He had no previous medical illnesses with negative history of exertional dyspnoea, epistaxis, haemoptysis, palpitations, chest pain and chronic cough. Examination revealed central cyanosis, digital clubbing, polycythaemia, partial ptosis of right eye, diplopia on right gaze and dilated right pupil. Examination of the chest revealed pectus excavatum but no cardiac murmurs were heard. Investigations revealed a solitary right pulmonary arteriovenous malformation with two feeder vessels which were successfully embolized surgically.

Matched MeSH terms: Diplopia

Spontaneous retrobulbar haemorrhage secondary to orbital varices of inferior ophthalmic vein-a case report

Haizul, I.M., Umi Kalthum, M.N., Mae-Lynn, C.B., Faridah, H.A.

Journal of Surgical Academia, 2012;2(2):49-51.

MyJurnal

A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.

Matched MeSH terms: Diplopia

Fulltext Dangerous diplopia: A case of pansinusitis

Haizul I, Umi Kalthum M

Malays Fam Physician, 2013;8(1):38-41.

PMID: 25606267 MyJurnal

PURPOSE: To report a case of pansinusitis after swimming in a common pool.

CASE REPORT: Acute sinusitis is ranked the fifth-most common indication for antibiotic prescriptions.2 Although sinusitis is often diagnosed clinically, cases that are resistant to conventional antibiotic therapy or recurrent cases may require diagnostic imaging in order to confirm the diagnosis. The complications of sinusitis, though rare, may lead to serious consequences if not diagnosed and treated early. We report a 33-year old man with pansinusitis presenting with a sudden onset of peripheral gaze diplopia associated with progressive frontal headache. His symptom resolved completely after he was given intravenous antibiotics and a nasal decongestant.

Matched MeSH terms: Diplopia

Displaying publications 1 - 20 of 35 in total