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First report of abducens ocular neuromyotonia: case report A 47-year-old woman developed abducens ocular neuromyotonia after receiving cisplatin and fluorouracil for nasopharyngeal carcinoma. Six years prior to presentation, the woman received four courses of concurrent chemoradiotherapy with cisplatin and fluorouracil [routes and dosages not stated]. On referral, she presented with a 3-year history of intermittent diplopia. Examinations in the primary position revealed a left esotropia of 14 prism diopters (PD), decreasing in right gaze and increasing in left gaze. She also had reduced sensation on the left side of her chin. Examinations conducted 3 months later showed a left esotropia of 6 PD in the primary position that increased to 10 PD in left gaze. She had disconjugated leftward saccades with a slower velocity in her left eye. Following sustained leftward gaze for more than 1 minute, she experienced a pulling sensation in her left eye. On moving her eyes back towards the primary position, she exhibited a large left exotropia, greater than 50 PD. On rightward gaze, her left eye displayed globe retraction, down-shoot movement and palpebral fissure narrowing. Due to her carbamazepine intolerance, the woman started phenytoin resulting in fewer diplopia episodes. Author comment: "Our patient was treated with cisplatin and fluorouracil while receiving radiation . . . The concurrent use of these drugs during radiotherapy might increase tissue sensitivity to radiation and increase the likelihood of developing [ocular neuromyotonia]." Kau H-C, et al. Abducens ocular neuromyotonia in a patient with nasopharyngeal carcinoma following concurrent chemoradiotherapy. Journal of NeuroOphthalmology 30: 266-267, Sep 2010. Available from: URL: http:// 803043359 dx.doi.org/10.1097/wno.0b013e3181e08ee7 - Taiwan

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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of ocular neuromyotonia associated with fluorouracil or cisplatin. The WHO ADR database contained one and three reports of eye movement disorder associated with cisplatin and fluorouracil, respectively.

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Reactions 13 Nov 2010 No. 1327