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| + | ====== Superior Oblique Myokymia ====== | ||
| + | ===== Definition ===== | ||
| + | Uniocular paroxysms of small-amplitude, | ||
| + | |||
| + | ===== Etiology ===== | ||
| + | * Unknown. | ||
| + | * May be regeneration of damage to trochlear nerve as it has been described in two patients who had superior oblique palsy. [[http:// | ||
| + | * If there are other neurological symptoms there could be a tumor compressing the midbrain. | ||
| + | |||
| + | ===== Clinical Features ===== | ||
| + | === Patient History === | ||
| + | |||
| + | * Intermittent bursts of torsional and/or vertical diplopia or " | ||
| + | * Episodes last several seconds to several minutes | ||
| + | * Fatigue and stress may exacerbate | ||
| + | === Exam === | ||
| + | |||
| + | * Rapid small-amplitude torsional eye movement, may only be seen at the slit lamp | ||
| + | * Normal eye movements in absence of symptoms | ||
| + | ===== Work Up ===== | ||
| + | None unless other neurologic signs then consider neuroimaging | ||
| + | ===== Treatment ===== | ||
| + | None if the patient is not bothered | ||
| + | === Medical Treatment === | ||
| + | * topical betaxolol (Betoptic 0.5%, Betoptic S 0.25%) BID- one report of success | ||
| + | * [[carbamazepine|carbamazepine]] (tegretol) 100 mg BID or TID to start and move to up to 200 mg TID as needed | ||
| + | * potential side effects including leucopenia, acute renal failure, thromboembolism, | ||
| + | * blood counts (CBC, including platelets and reticulocytes), | ||
| + | * [[gabapentin|gabapentin]] 100mg QD or BID can titrate up to 300mg PO BID | ||
| + | * [[propranolol|propranolol]] 80 mg long acting | ||
| + | * phenytoin (dilantin) 100mg PO TID | ||
| + | * propranolol plus valproic acid | ||
| + | * Medical treatment is often disappointing and fraught with side effects | ||
| + | |||
| + | === Surgical Treatment === | ||
| + | * Tenectomy of Superior Oblique- a large portion needs to be removed | ||
| + | * Combine above with prophylactic inferior oblique weakening | ||
| + | * Some require a second surgery to treat residual diplopia with recession of contralateral inferior rectus with a nasal shift and possibly a nasal shift of both inferior rectus muscles if there is excyclotorsion | ||
| + | |||
| + | {{tag> | ||