A Case of Exotropia with Convergence Insufficiency due to Right Parieto-occipital Lobe Hemorrhage

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  • Gamo Mari
    Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College
  • Hara Naoto
    Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College International University of Health and Welfare Department of Orthoptics and Visual Sciences
  • Kimijima Masumi
    Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College
  • Suzuki Hiromi
    Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College
  • Mukuno Kazuo
    Department of Ophthalmology, Yokohama Dental and Medical Clinic, Kanagawa Dental College

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  • 右頭頂後頭葉出血により輻湊不全型外斜視を発症した1例

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Abstract

A 22-year-old man complained of double vision after receiving a craniotomy procedure due to hemorrhage caused by cerebral arteriovenous malformation in the right parieto-occipital area. The patient was referred to us from the hospital for strabismus surgery 2 years after the onset of double vision. He manifested right exotropia with convergence insufficiency. Visual field testing showed a left inferior quadrantanopia. Version eye movement was unrestricted in all directions. Furthermore, accommodative function showed a reduction in the amplitude of accommodation of the right eye, and convergence reaction in the right eye was slightly decreased. However, using an electronic pupillometer, the pupillary light reaction was normal with no difference between the right and the left eye. After undergoing an 8-mm right external rectus muscle recession, convergence became possible and an orthophoric eye position was maintained. The right parieto-occipital area plays an important role in eliciting near reflexes which led us to hypothesize that this area might be responsible for exotropia with convergence insufficiency.

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