Disorders of ocular motility following head trauma
F. E. Lepore
Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA.
OBJECTIVE: To determine the types and frequency of symptomatic ocular
motility disturbances following head trauma and their association with
severity of trauma. DESIGN: Retrospective study of patients with (1)
diplopia unless visual loss is present, (2) heterotropia for far or near
targets, and (3) prior head injury. SETTING: Office and in-hospital
consulting practice of a university neuro-ophthalmologist. SUBJECTS: Sixty
patients with posttraumatic ophthalmoplegia. MAIN OUTCOME MEASURES:
Paralytic and nonparalytic heterotropias were quantitated in prism diopters
or percentage limitation of ductions. Convergence insufficiency was
assessed by determining the near point of convergence. RESULTS: Fifty-one
patients had nuclear or infranuclear findings, ie, trochlear palsies (n =
20), oculomotor palsies (n = 17), abducens palsies (n = 7), combined
palsies (n = 5), and restrictive ophthalmopathy (n = 2). Nine patients had
supranuclear dysfunction, including seven patients with convergence
insufficiency. Bilateral ocular motor palsies and combined palsies were
significantly (by means of chi 2 test) associated with head trauma of
severity sufficient to cause corticospinal tract dysfunction. Individual or
combined ocular motor palsies were not significantly (by means of chi 2
test) associated with intracranial hemorrhage and/or skull fracture or loss
of consciousness. CONCLUSIONS: Trochlear palsy was the most common nuclear
or infranuclear basis for traumatic diplopia, and convergence insufficiency
was the most common supranuclear cause of double vision. Head trauma
distinguished by upper motor-neuron signs was correlated with specific
subsets of disordered ocular motility.