ISSN: 1300-0365
Dil: Türkçe
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Convergence Insufficiency In Thyroid Ophthalmopathy
Deniz Can*, Seyhan B. Özkan**, Meltem F.Söylev***, Remzi KasIm****, Sunay Duman*****
* Uz.Dr.,SB Ankara Hastanesi Göz Kliniği, ANKARA** Yrd.Doç.Dr.,Adnan Menderes Üniversitesi Göz Hastalıkları AD, AYDIN*** Uz.Dr.,Dokuz Eylül Üniversitesi Göz Hastalıkları AD, İZMİR**** Dr.,SB Ankara Hastanesi Göz Kliniği Şef Yardımcısı,***** Dr.,SB Ankara Hastanesi Göz Kliniği Şefi, ANKARA
If there is an asymmetrical involvement of the agonist and antagonist muscle groups by the ophthalmopathy, this may lead to convergence insufficiency symptoms. The incidence of convergence insufficiency in patients with thyroid eye disease and the relation between convergence insufficiency and the clinical and tomographic involvement of the extraocular muscles have been investigated.
The patients were divided into the following two groups: Group I consisted of 15 patients who had a diagnosis of thyroid eye disease for less than a year. Out of 134 patients who had a diagnosis of thyroid eye disease for more than 2 years 35 were invited for further clinical assessment. Group II consisted of 14 patients who applied after the invitation. In addition to a full orthoptic assessment, near point of convergence ,fusional convergence amplitudes, recovery points, accomodation amplitudes and AC/A ratios (using gradient method at 5 meters) were assessed in all patients. All assessments were repeated twice and the mean was taken. Axial and coronal CT scans were investigated to detect extraocular muscle involvement. 15 prism diopters (PD) and lower fusional reserves were defined as convergence insufficiency (CI).
CI was detected in 2 out of 15 patients in group I. Three patients out of the remaining 13 patients in this group presented with lower than normal fusional amplitudes. Four patients in group II had CI. All patients with CI in group I and II had clinical class IV thyroid eye disease. Inferior rectus was the most frequently involved muscle, medial rectus being the second.Convergence near points were within normal limits in 3 out of 6 patients. All 6 had amplitudes of accomodation that were normal for their respective ages. Three cases with CI and 3 cases in group I with lower than normal fusional reserves had normal recovery points.
Patients with thyroid eye disease are more succeptible to CI as asymmetric involvement of the agonist and antagonist muscles by the ophthalmopathy may reduce patients binocular capabilities. Fusional convergence amplitudes must not be overlooked in thyroid eye disease patients; as is usual in otherforms of CI, convergence exercises can improve patients' symptoms.Keywords: Convergence insufficiency,
thyroid eye disease, convergence,
extraocular musclesTurkiye Klinikleri J Ophthalmol 1998, 7:237-240
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