Botulinum-toxin
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Ptosis and exotropia with secondary diplopia: case report A 17-year-old girl developed ptosis and exotropia with secondary diplopia following treatment with botulinum-toxin for oscillopsia. The girl had acquired monocular nystagmus and oscillopsia with distressing ocular discomfort. She was unsuccessfully treated with clonazepam and memantine, and experienced a pronounced and rapid visual loss. As a result, she was referred to the strabismus unit to assess the possible treatment option. She stated that, despite the decrease in visual acuity, the most limiting symptom for her quality of life was the oscillopsia. Therefore, she was scheduled for botulinum toxin treatment. She received retrobulbar injection of botulinum toxin at a dose of 7.5IU. After one week, the frequency and amplitude of the nystagmus, as well as the oscillopsia, had decreased; however, she developed ptosis and exotropia with secondary diplopia which were considered as treatment-related complications. Four to five weeks after the injection, her ptosis and exotropia with secondary diplopia resolved. The ophthalmoplegic effect of the botulinum toxin lasted for 5 months. After 5 months, her visual acuity had significantly decreased. The effect of the botulinum toxin had disappeared and the oscillopsia had returned to disabling levels. After a comprehensive anamnesis and examination, an underlying Bardet-Biedl syndrome was diagnosed. It was therefore decided to perform surgery to weaken the horizontal rectus muscles of both eyes. The girl did not have diplopia in the early postoperative period and the oscillopsia went away from the first day after surgery. Her nystagmus also resolved following the surgery. Ibanez-Garcia A, et al. Monocular nystagmus as the presenting sign of Bardet-Biedl syndrome: Diagnosis and treatment. Revista Mexicana de Oftalmologia 94: 143-147, No. 3, 2020. Available from: URL: http://doi.org/10.24875/RMO.M19000072 [Spanish; summarised from a translation] 803516543
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Reactions 21 Nov 2020 No. 1831
