Hipertensão intracraniana com manifestações oculares associada ao uso de tetraciclina: relato de caso

The authors describe a young female patient with intracranial hypertension associated with ocular manifestations, during treatment with tetracycline. This is a rare adverse effect described in the medication warnings, and in a few reported cases in the scientific literature.

Heroin and strabismus

QUESTIONS UNDER STUDY

We report on a series of patients with acute strabismus related to heroin and methadone intake or withdrawal, discuss possible mechanisms involved in this clinical picture and make recommendations for work-up and referral.

METHODS

Retrospective study.

RESULTS

Five patients presented with acute esotropia within days of heroin withdrawal, and two patients developed exotropia related to heroin or methadone intake. Neurological work-up and neuroimaging was non-contributory in all four patients who were examined.

CONCLUSION

Acute esotropia with double vision is a disturbing side effect of heroin withdrawal, and, similarly, acute exotropia may be related to heroin intake. In the absence of focal neurological signs, further work-up is not mandatory. Referral to a specialised orthoptic service is beneficial in offering the patient symptomatic treatment and reassurance, thus supporting successful withdrawal therapy.

Acute esotropia in heroin withdrawal: a case series

BACKGROUND

Esotropia during opiate withdrawal is a new clinical syndrome that has only recently been reported in the literature.

METHODS

Clinical case series.

RESULTS

Five patients with acute esotropia during opiate withdrawal are presented. In four there was evidence of underlying hyperopia and/or other strabismogenic features.

CONCLUSIONS

The precise cause of esotropia with heroin withdrawal is uncertain. Most (and possibly all) of these patients have one or more objective strabismogenic features, and these are probably a large factor in the causation.

Heroin withdrawal as a possible cause of acute concomitant esotropia in adults

PURPOSE

To report the possible effects of heroin withdrawal on binocular vision.

METHODS

A case series of patients is presented in whom esotropia developed on cessation of heroin use.

RESULTS

In each case the esotropia was concomitant and prismatic correction restored binocular single vision. Intermittent spontaneous control occurred in one patient, the deviation resolved in one and one patient was lost to follow-up.

CONCLUSIONS

Heroin withdrawal should be considered as a cause of acute concomitant esotropia. However, an accurate history of other medication is needed to ensure that this is not the cause of decompensation.

Effects of lorazepam on vision and oculomotor balance

BACKGROUND

Previous studies have shown an effect of the tranquilizer lorazepam on visual perception. We explored the effects of the drug on binocular vision, visual acuity and accommodation.

SUBJECTS AND METHODS

Twenty-four paid healthy volunteers (13 women, 11 men) were recruited from the University of Strasbourg (mean age: 23.6 years, mean weight: 66.8 Kg). They were randomly assigned to one of two parallel groups of 12 subjects each (a placebo group and a lorazepam 0.038 mg/kg group). Visual acuity was measured for each eye separately (Snellen chart and Parinaud scale). Binocular vision was studied using the cover tests, measurement of the fusional amplitudes (with Berens prisms), and the Duane Scale Test (near point rule) measuring convergence and/or accommodation in centimeters or diopters as a function of age.

RESULTS

Regarding vision, there was no lorazepam effect, at either 33 cm or 5 m. An esophoria was observed after the intake of lorazepam (0Delta before intake and 2.8Delta after intake, p=0.001). Both fusional convergence and fusional divergence amplitudes decreased by lorazepam, (p=0.008, and p=0.002). Lorazepam also impaired the near point of convergence but did not affect accommodation.

CONCLUSION

A single dose of lorazepam induces an esophoric oculomotor imbalance and impaired fusional convergence and divergence amplitudes without impairing visual acuity or accommodation.

Acute comitant esotropia in a boy with head trauma and convulsions receiving carbamazepine

We examined an 11-year-old boy who complained of acute onset of diplopia. The patient had head trauma and postsurgical convulsions and had been treated with carbamazepine. Diplopia developed after the dose of carbamazepine was increased to 700 mg/day. On examination, comitant esotropia and lateral gaze nystagmus were found. These disorders disappeared after carbamazepine was decreased to 400 mg/day. We believe that acute comitant esotropia and lateral gaze nystagmus may have been precipitated by head trauma and carbamazepine in our patient.

Pseudotumor cerebri associated with cyclosporine use

PURPOSE

An 11-year-old boy had a one-month history of horizontal diplopia. Three years earlier, he had undergone allogeneic bone marrow transplantation complicated by graft versus host disease.

METHODS

The patient had esotropia and bilateral optic disk edema. A magnetic resonance imaging scan disclosed no intracranial lesion. The opening pressure of the lumbar puncture was 500 mm of water. Pseudotumor cerebri secondary to cyclosporine was diagnosed.

RESULTS

The patient improved with resolution of his esotropia and diplopia within five days of discontinuing his cyclosporine. The optic disk edema resolved within three months.

CONCLUSION

Cyclosporine must be added to the list of medications with a known association with pseudotumor cerebri.