-: Hi everyone, and welcome.
I'm Pavlina Kemp, and I'm here on behalf of the
American Academy of Ophthalmology ONE Network
Here with Dr. Gena Heidary, who will tell us more about
warning signs in
adults with acute onset strabismus.
Welcome, Dr. Heidary.
-: Thanks so much. It's great to be here.
-: I'm going to start out with a question about
what are the signs that we should look for in patients
who are presenting to our clinics
with adult onset acute strabismus?
-: Well, I think in general we have to have a high index
of suspicion that new onset adult strabismus can be the
harbinger of something neurologic
that needs to be evaluated.
So the things that we are trying to exclude include tumor
aneurysm, infarction, mimickers such
as myasthenia gravis or thyroid eye disease.
So I really feel that
unless we know at the outset
what is the underlying etiology,
so for example, if a patient came in with known trauma
or they had surgery for a tumor
and then developed strabismus,
unless we really know etiology, I typically pursue a workup.
-: Generally. What workup do you recommend?
-: I think it's safe to go forward with neuroimaging,
including MRI of the brain and orbits.
I usually ask for thin cuts of the brain stem so
that we can really carefully delineate the cranial nerves.
I send a panel for myasthenia gravis
and thyroid eye disease.
I think it's really important to still have in the back
of our minds that giant cell arteritis may also present
with acute onset diplopia,
and so in the right patient we have
to send laboratory studies to rule out
or exclude giant cell arteritis.
-: That's very helpful. Thank you.
What conditions do you not pursue a further workup for?
-: I think there's a growing literature that our adults
in a a certain population may develop sagging eye syndrome
or a divergence insufficiency-type esotropia.
They may be a little bit enophthalmic
and have certain external features that we
don't really need to pursue
neuroimaging for this. I think convergence insufficiency
that's age-related.
So we see this, for example, in our patients
with Parkinson's, doesn't need to be evaluated.
And again, in those patients in whom we have known etiology,
so it's iatrogenic because of either ocular surgery
or a neurosurgical procedure with subsequent diplopia.
I think those patients don't require a workup.
-: That's very helpful.
Dr. Heidary, thank you so much for sharing those pearls of wisdom
with us and we appreciate your time.
-: Thank you so much.