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

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

Elaine Wong

Lionel Kowal


Yh 37 yo f
YH 37 yo F injection for protective ptosis

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 f1
YH 37 yo F injection for protective ptosis

12/2005

  • VAR 6/8 VAL 6/18

  • R hypertropia

    32 24

    40 40 28

    40 14

  • XT 15

  • LIO ---

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

  • L fundus extorted


Yh 37 yo f2
YH 37 yo F injection for protective ptosis

03/2006

  • Had Acupuncture treatment

  • Feels diplopia has improved

  • R hypertropia

    20 10

    37 29 15

    33 20

  • Exotropia 4Δ

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

  • L SO ++,L IO --


Yh 37 yo f3
YH 37 yo F injection for protective ptosis

Diagnosis

  • ? Permanent Botox induced vertical misalignment

  • ? Skew deviation following acoustic neuroma surgery


Discussion
Discussion injection for protective ptosis

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


Discussion1
Discussion injection for protective ptosis

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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