Vertical diplopia after acoustic neuroma surgery and botox injection for protective ptosis
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Vertical diplopia after acoustic neuroma surgery and Botox injection for protective ptosis. Elaine Wong Lionel Kowal. YH 37 yo F. PMHx Left acoustic neuroma Excision of acoustic neuroma 05/2005 Left facial nerve palsy with exposure keratopathy

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Vertical diplopia after acoustic neuroma surgery and Botox injection for protective ptosis

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Vertical diplopia after acoustic neuroma surgery and Botox injection for protective ptosis

Elaine Wong

Lionel Kowal


YH 37 yo F

PMHx

  • Left acoustic neuroma

    • Excision of acoustic neuroma 05/2005

    • Left facial nerve palsy with exposure keratopathy

    • Left upper lid botox (10U) to induce protective ptosis

    • Once botox worn off - noticed vertical diplopia


YH 37 yo F

12/2005

  • VAR 6/8VAL 6/18

  • R hypertropia

    3224

    404028

    4014

  • XT 15

  • LIO ---

  • LIR tight [thru- the- lid - forced- duction - test]

  • L fundus extorted


YH 37 yo F

03/2006

  • Had Acupuncture treatment

  • Feels diplopia has improved

  • R hypertropia

    2010

    372915

    3320

  • Exotropia 4Δ

  • Single vision in primary and for 15˚ on upgaze and right gaze

  • L SO ++,L IO --


YH 37 yo F

Diagnosis

  • ? Permanent Botox induced vertical misalignment

  • ? Skew deviation following acoustic neuroma surgery


Discussion

Persisting hypotropias following protective ptosis induced by botulinum neurotoxin

PL Heyworth, JP Lee

Eye 1994; 8 (pt 5): 511-5

  • 3 case reports of permanent superior rectus weakness and vertical deviation

  • Require surgical correction

  • ? Prolonged occlusion led to breakdown of fusion

  • ? Contracture of ipsilateral IR


Discussion

Skew deviation following vestibular nerve surgery

P Riordan-Eva, JP Harcourt, M Faldon, GB Brookes, MA Gresty

Annual of Neurology 1997 Jan; 41(1); 94-9

  • 5/18 patients develop vertical deviation following surgery

  • 3 with manifest vertical deviation

  • 1 with unilateral Meniere’s, 1 with bilateral Meniere’s and 1 with acoustic neuroma

  • Diplopia lasted from 1 day to 6 months

  • Surgical vestibular deafferentation


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