Elsevier

Ophthalmology

Volume 106, Issue 7, 1 July 1999, Pages 1353-1356
Ophthalmology

Diagnosis and management of divergence weakness in adults

Presented in part at the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(99)00724-1Get rights and content

Abstract

Objective

To determine how frequently neurologic disease accompanies divergence weakness, the stability of the eye movement disorder, and the response to treatment.

Design

Prospective, interventional, noncomparative case series.

Participants and methods

Seventeen consecutive adult patients (28–96 years of age) with divergence weakness were prospectively evaluated from 1991 to 1997.

Main outcome measures

Ocular alignment was measured at distance and near and in up, down, left, and right gaze. Fusional divergence amplitudes were measured at distance. The presence or absence of associated neurologic disease was noted. The response to treatment (prisms or strabismus surgery or both) was recorded.

Results

None of the patients had concurrent neurologic disease. Thirteen patients remained stable, 3 improved, and 1 progressed. Sixteen patients were treated successfully: 12 with prisms and 4 with strabismus surgery; 1 patient was not treated.

Conclusion

Divergence weakness is usually an isolated condition that tends to remain stable and respond to treatment with either prisms or strabismus surgery.

Section snippets

Patients and methods

We prospectively evaluated all patients diagnosed with divergence weakness at a single practice site during a 7-year period (1991–1997). Divergence weakness was defined as a comitant esotropia with homonymous diplopia at distance and fusion at near. Horizontal ductions and versions were normal, and the esotropia remained the same or diminished in lateral gaze. A maximum of 2 prism diopters (PD) of incomitance was allowed between left and right gaze for those patients with greater than 20 PD

Results

The findings in 17 patients with divergence weakness are summarized in Table 1. The average age of the patients was 72 years (range, 28–96 years), and all but the youngest patient were older than 62 years of age. The patients were followed for an average of 4 years after initial evaluation by the authors. The initial distance deviation ranged from 6 to 27 PD of esotropia (mean = 14 PD esotropia). The distance deviation was constant in all but the youngest patient, whose esotropia was

Discussion

The ocular motor findings in our patients were similar to those reported in previous series and remained stable in 13 of 17 patients.4, 10 Three patients had an associated small-angle comitant vertical strabismus, a finding that has previously been reported.11 Fusional divergence amplitudes were commonly reduced (median, 2 PD) compared with “average” fusional divergence amplitudes obtained by similar means (4 PD–6 PD).10, 12

Divergence weakness has been reported in association with many

References (18)

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The authors received no financial support for the study and have no financial interest related to the article.

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