James O'Brien, MD, R. Michael Siatkowski, MD, Bradley K. Farris, MD
Subject
See saw nystagmus; MRI; Optic chiasm; Afferent visual pathways
Presenting Symptom
A four-year old male presented for evaluation of abnormal eye movements and strabismus which had been present since approximately 6 weeks of age. He was previously diagnosed with nystagmus, ocular torticollis, and esotropia by another provider. An MRI of the brain was performed at approximately 4 weeks of age. The study was reportedly normal, but it was unavailable for our direct review. He underwent right medial rectus recession and right lateral rectus resection for esotropia at age 3. His parents reported exotropia following this strabismus surgery. His medical history otherwise included valve-sparing repair of Tetralogy of Fallot, repair of esophageal atresia, and tracheoesophageal fistula repair. Examination revealed uncorrected visual acuity of 20/200 OD and 20/100 OS. This was not improved by cycloplegic refraction: +2.00 +1.00 x70 OD and +2.00 +1.00 x105 OS. His pupillary exam and gross visual fields by confrontation were normal. His ocular motility revealed pendular nystagmus with predominantly horizontal waveforms but occasional super-imposed see-saw waveforms as well. He had A-pattern exotropia of 8, 15, and 25 prism diopters in up-, primary-, and down-gaze, respectively, with chin-down head posture. There was bilateral overdepression in adduction on motility testing. Anterior segment and dilated fundus examinations were normal bilaterally. A diagnostic test was ordered. (A video demonstrating his ocular motility will be shown)
Date
2018-03
Language
eng
Format
video/mp4
Source
2018 North American Neuro-Ophthalmology Society Annual Meeting
Relation is Part of
NANOS Annual Meeting 2018: Frank B. Walsh Session 1