Magnetic Resonance Imaging Findings in Divergence Paralysis

We report magnetic resonance imaging (MRI) findings in two patients with divergence paralysis that was secondary to multiple sclerosis and pontine infarction, respectively. In both patients, cranial MRI showed lesions in the unilateral tegmentum of the caudal pons. Therefore, these MRI findings suggested that involvement of the nucleus reticularis tegmenti pontis might be responsible for the divergence paralysis in our cases.     

Magnetic Resonance Imaging Finding in Divergence Paralysis

A 72-year-old woman with hyperlipidaemia was complaining of horizontal diplopia only at far viewing for 7 months. There were no neurological abnormalities other than divergence paralysis and concomitant skew deviation. Cranial magnetic resonance imaging demonstrated an old infarction in the vicinity of the periaqueductal gray matter on the left side. The precise location of the divergence centre of the eyes remains uncertain, because the responsible lesions for divergence paralysis are rarely identified by neuroimaging. This case suggests that the divergence centre may be located in the vicinity of the periaqueductal gray matter.     

Distance ESO Deviation—A Basic Deviation or Paralysis of Divergence

A Group of one hundred patients is described with the condition of distance eso deviation or convergent squint which is present for distance viewing together with an exo deviation for near viewing and in-between distance and near there is a neutral point or crossing distance where there is no deviation. The crossing distance determines the distance at which an exo deviation will be present. Accommodation increases the degree of eso deviation and shortens the crossing distance, especially in younger patients, but does not have much effect in presbyopic patients. Distance eso deviation occurs at all ages and varies in degree from a small phoria to an obvious tropia. It is a cause of diplopia in elderly patients, and may be the underlying cause of convergent squint in young patients. It is distinct from the rare condition of divergence paresis.     

Divergence insufficiency

PURPOSE: Divergence insufficiency is an unusual form of strabismus with esotropia and diplopia only at distance and single binocular vision at near. This retrospective case series describes the diagnosis and treatment of 7 patients and differentiates this clinical entity from other conditions. METHODS: Seven healthy patients aged 9 to 41 years who developed acquired esotropia only at distance were treated with unilateral or bilateral medical rectus recession. RESULTS: All patients had resolution of diplopia, although one patient initially treated with unilateral medial rectus recession required a second recession of the other medial rectus muscle. CONCLUSIONS: Divergence insufficiency is a distinct clinical entity in otherwise healthy patients, which can be successfully treated by unilateral or bilateral medial rectus recession.