Binocular Diplopia due to Oculomotor Paresis or Palsies: Outcomes of Treatment Options

Abstract

Objective: To determine outcomes of treatment options for binocular diplopia in patients with oculomotor paresis or paralysis.

Method: A descriptive, longitudinal and prospective study was carried out of a series of cases that were assisted at the consultation of the Pediatric

Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The variables evaluated were age, sex, etiology, treatment options, limitation of ocular movements, elimination of diplopia, fusion and stereopsis.

Results: The microvascular etiology was the most frequent. 66.7 % of the studied sample was resolved only with medical treatment, 100.0 % of them had a diagnosis of paresis or paralysis of the third cranial nerve, followed by the sixth and fourth with 63.6 % and 33.3 %, respectively. Six patients required medical and surgical treatment and application of botulinum toxin, 33.3 % of the fourth and 22.7 % of the sixth cranial nerve. The rest of the treatment options with only one patient. No significant association was found between treatment options and affected cranial nerve. 86.6 % finished without limitation of eye movements. 86.7 % of cases eliminated diplopia in all diagnostic gaze positions. 76.7 % achieved fusion and 56.7 % stereopsis.

Conclusions: Medical treatment and combined medical treatment plus botulinum toxin injection and extraocular muscle surgery were the most used options and allowed ocular alignment and elimination of binocular diplopia.