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Chronic progressive external ophthalmoplegia (CPEO) is a descriptive term for a heterogenous group of disorders characterized by chronic, progressive, bilateral, and usually symmetric ocular motility deficit and ptosis. Significant pain, proptosis, or pupil involvement are not features of CPEO and should prompt evaluation for alternative etiologies. Mitochondrial DNA mutations are increasingly being recognized as the etiology for CPEO syndromes. Clinicians should recognize the specific syndromes associated with CPEO, characterized by variable systemic, neurologic, or other findings. Treatment is limited, but newer therapies are being investigated.

Objective To emphasize the potential complications of a retained orbital wooden foreign body (WFB) and the rationale of a surgical technique. Design Two interventional case reports. Participants Two patients sustained an orbital WFB injury. Both patients had ocular complications despite repeated attempts to remove the suspected residues. Intervention Computed tomography and magnetic resonance imaging of both patients at different intervals revealed evidence of orbital foreign body migration toward the cranium. A surgical technique combing transcranial and orbital approaches was used to remove the residues. Main outcome measures Preoperative and postoperative vision, proptosis, ocular motility, and various ocular symptoms and signs. Results In both patients, no postoperative complications were seen, and all preoperative symptoms and signs were resolved at 9- and 19-month follow-ups, respectively. Conclusions A retained orbital WFB can cause early or late complications and is known to have the potential to migrate intracranially. In selected patients, a team approach may be the best technique to ensure complete removal.

Infantile hemangiomas are the most common benign tumor of childhood. Lymphangiomas are benign hamartomatous vascular tumors. Both lesions can be problematic when located in the periocular region. Pediatricians must be familiar with the characteristics of each which would necessitate referral to an ophthalmologist or other subspecialist for evaluation, including obstruction of the visual axis which can lead to amblyopia of the affected eye. Additional potential complications include proptosis, ocular motility limitation, optic nerve injury, and poor eyelid closure with or without corneal surface disease. All children with periocular hemangiomas or lymphangiomas should be referred to an ophthalmologist for further evaluation.

Purpose: Retrospective evaluation of changes in ocular motility after surgical re-recession of the medial rectus (MR) muscles as treatment of recurrent esotropia (ET). Methods: We describe 115 patients (age, 11 months—77 years; median, 11.1 years; 83 children and 32 adults) with an average amount of non-accommodative ET before surgery of 18.7 PD (SD = 8.8 PD). Preoperative alignment, amount of re-recession, distance from insertion to the limbus, and postoperative alignment and versions were collected. Results: In most cases, MR muscles were re-recessed to a fixed distance of 12 mm from the limbus, with unilateral re-recessions in cases with relatively small ET (typically 20 PD). No clear relation was found between the amount of re-recession and the change in alignment in prism diopters. The success rate (esotropia [ET] ≤ 10 PD or exotropia [XT] ≤ 8 PD) 4 weeks to 8 months after surgery was 85%, with 4 patients still showing ET and 13 patients showing XT. Incidence of XT was higher for bilateral than for unilateral re- recessions. Significant underaction of the MR muscles was noted in 7% of the patients. None of the undercorrected patients and only 1 of the overcorrected patients were adults. Among adults, incidence of MR underaction was 4%. Long-term follow-up (8-120 months; median, 25 months) data from 59 patients indicated that good stability in alignment can be expected. Conclusion: The results support the notion that MR re-recession to 12 mm from the limbus successfully corrects recurrent ET up to 35 PD and that it is particularly effective in adults. (J AAPOS 2001;5:381-7)

The authors report one case of orbital fracture of the floor and the medial walls after trauma with an intact ocular globe displacement into the maxillary sinus. The same authors emphasize the treatment, complications and the rarity of this case. In this case the patient developed a good visual acuity and a loss of ocular motility as complication (except abduction) .

Objectives: The purpose of this paper is to report the acquired ocular motility findings in a review of a cohort of patients with idiopathic intracranial hypertension (IIH), many of which had been followed prospectively from their initial diagnosis. Methods: A total of 38 patients with a diagnosis of IIH were recruited between 1993 and 1997. There were 33 females and five males with an age range of 11 to 57 years. Each patient had a full orthoptic, ophthalmic, and neurologic evaluation. Results: Thirteen patients had an ocular motility deficit documented of which two had long-standing strabismus, one congenital paresis, and the remainder acquired defects of motility. Cranial nerve pareses other than sixth nerve paresis included partial third and fourth nerve pareses. Conclusions: Acquired ocular motility defects may be in the form of secondary strabismus, neurogenic palsies, or mechanical limitations of motility. Ocular motility signs in IIH may involve many of the cranial nerves, not just the sixth nerve...

BACKGROUND: The developmental eye movement (DEM) test is a clinical test used widely to evaluate ocular motility function (accuracy and speed) in school-age children. PURPOSE: The purpose of this study was to investigate, retrospectively, the change in accuracy over time while performing the DEM horizontal reading task in children. METHODS: The charts from children who had performed the DEM test during a routine eye examination in a pediatric optometry service were reviewed. The study included 22 patients (6 to 11 years old, 12 boys, 10 girls) who had a routine eye examination that was precepted by one of the authors (R.C.) during the period of 1995 to 1999. Patients were divided into two categories: 1) those with abnormal DEM test results and 2) a control group consisting of those with normal DEM test results. Chart review was done consecutively within each category. Collected data included patient age, gender, refractive error, and DEM test results. For analysis, the horizontal task of the DEM was divided into two halves (I and II), Part I always preceded part II, and data was sorted as the number of errors per part. RESULTS: More errors in accuracy occurred in part II than in part I (Wilcoxon signed rank test, p < or = 0.01) of the horizontal DEM test in the group of subjects with an abnormal DEM test. No differences in the number of errors in parts I and II of the horizontal task of the DEM were found in the control group. CONCLUSIONS: Findings showed that when excessive errors in accuracy occurred, the number of errors increased over time. If the errors were caused by an oculomotor dysfunction found in the DEM, errors should be equally distributed throughout the text. If errors were caused by fatigue, a difference in parts I and II should have occurred in both the test and the control group. These findings suggest that attention may influence accuracy over time in those patients that do poorly on the DEM test.

This is the second of a two-part survey of current literature concerning strabismic amblyopia. The aim of this review is to bring the optometric community up to date on the status of scientific research into strabismic amblyopia. Part 1 in this series discussed research into strabismic amblyopia from the viewpoint of psychophysical experiments, which investigate both spatial and temporal behavioural deficits accompanying strabismic amblyopia. These include deficits in contrast sensitivity, spatial localisation, fixation, ocular motility, accommodation, crowding, attention, motion perception and temporal processing. Part 2 concerns neural processing in regards to strabismic amblyopia. It discusses current understanding of more fundamental aspects of central processing of visual information and in particular current theories regarding neural sites and mechanisms involved in amblyopia.

Each year brings new scientific knowledge that builds on itself in a geometric fashion. Ocular motility basic and clinical neurosciences continue to advance with this accelerating pace. The years 1997 through 1998 brought new knowledge to the motility world. This review focuses on the clinical advances within this realm, presented in supranuclear to myopathic organization. Part II of this review will appear in the September 2000 (20:3) issue.

To determine a relationship between preoperative soft tissue disruption and postoperative ocular motility in orbital blowout fractures.This retrospective cohort study reviewed 30 patients who met all criteria: retrievable coronal computed tomography (CT) scans; internal fractures of the orbital floor, with or without medial wall extension; preoperative diplopia; repair by a single surgeon; complete release of entrapped tissues; and postoperative binocular visual fields (BVFs). Motility outcomes were quantified by one group of the authors, who measured the vertical fusion within BVFs. Other authors analyzed CT scans, designating each fracture as either A or B, based on lesser or greater soft tissue distortion relative to the configuration of bone fragments. The interval between trauma and surgery was also determined.Among the 15 patients with a postoperative motility outcome poorer than the median (86 degrees or less), four (27%) had A fractures; 11 (73%) had B fractures. Among the 15 patients with an outcome better than the median (88 degrees or more), 10 (67%) had A fractures; five (33%) had B fractures. Differences were more defined away from the median. Among five patients with B fractures and better than the median result, three (60%) had surgical repair during the first week after injury. Among the 11 patients with B fractures and less than the median result, one (9%) had repair during the first week.Postoperative motility is influenced by soft tissue-bone fragment relationships. Whether the outcome can be altered by earlier surgery in selected cases will be determined by prospective studies.

Explaining Listing's Law to students or orthoptists is a time-consuming business. We have therefore developed shareware to demonstrate Listing's Law in a more direct way for teaching purposes. This realistic three-dimensional simulation helps to understand ocular motility. It shows that computer-aided simulations have advantages over printed media in explaining Listing's Law.

In the past year, experimental studies have analyzed instrument-induced measurement errors during strabismus surgery, investigated intraoperative variables pertinent to adjustable sutures, and investigated ways to prevent and create adhesions in animal models. Newer surgical techniques include coincident resection and recession of a rectus muscle, recession and resection without placement of scleral sutures, and modification of graded anterior transposition of the inferior obliques. Ocular motility problems related to thyroid ophthalmopathy, or lost muscles, as well as those occurring after surgery for retinal detachment remain a challenge. Patients may avoid the risks associated with the use of topical corticosteroids after strabismus surgery by using nonsteroidal anti-inflammatory drugs in their place. Recent contributions to the literature on these issues are reviewed here.

Neuro-ophthalmologic disorders affecting the afferent and efferent visual systems are frequently encountered by neurosurgeons in clinical practice. This article focuses on aspects of neuroanatomy that are most important to the diagnosis of afferent and efferent visual pathway lesions. The use of optic disc and fundus appearance, visual fields, and ocular motility and pupillary findings are emphasized in the discussions of topographic diagnosis.

Neurosurgical practice requires a solid foundation in the principles and interpretation of the neuro-ophthalmologic examination. In this article, the techniques used in the neuro-ophthalmologic examination to assess visual acuity, ocular motility, visual fields, the pupils, the eyelids, and the fundus are reviewed. An emphasis is placed on those techniques most relevant to neurosurgical practice.

Objective To show the effectiveness of endoscopic reduction surgeries for delayed cases with blowout fractures, and to determine the cause of persisting diplopia based on surgical findings. Design Retrospective study. Setting Between 1997 and 2006, 114 patients with isolated blowout fractures underwent surgery. In 6 of 114 patients, there were delayed cases in which over 3 months had elapsed since the initial trauma. For persisting diplopia, surgeries were performed using an endoscopic endonasal approach. Results Adhesion between the protruded periorbita and the paranasal sinus mucosa was remarkable in the delayed cases. Dissection of the adhesion and removal of the bone fragments were performed. The ocular motility improvement was confirmed by intraoperative eye traction tests. Postoperatively, diplopia disappeared in five patients. Conclusion Endoscopic reduction surgeries for delayed cases are available in the treatment of blowout fractures. The main cause of diplopia was determined to be the adhesion.

OBJETIVO: Avaliar a incidência, etiologia e evolução dos estrabismos paralíticos ou paréticos. MÉTODOS: Foram selecionados retrospectivamente 519 prontuários de pacientes com paresia ou paralisia isolada dos músculos inervados pelos III, IV ou VI nervos cranianos, a partir de 11.000 prontuários da Seção de Motilidade Extrínseca Ocular do Departamento de Oftalmologia da Santa Casa de São Paulo de janeiro de 1980 a outubro de 2004. Foram estudados: o nervo craniano acometido, o olho acometido, o sexo, os fatores etiológicos e a evolução desses pacientes. RESULTADOS: Dos 519 pacientes, 17,1% foram casos congênitos e 82,9% foram adquiridos. O nervo craniano mais afetado foi o VI (49,7%). Os pacientes do sexo masculino foram mais acometidos, com 58,1% dos casos. A etiologia traumática foi a mais freqüente nos casos de paresia ou paralisia de III (43,0%), IV (52,4%) e VI (48,8%) nervos cranianos. Os pacientes evoluíram mais freqüentemente para cirurgia nos três grupos: III nervo (42,9%), IV nervo (73,2%) e VI nervo (43,2%). CONCLUSÃO: O VI nervo craniano foi o mais freqüentemente acometido e o fator etiológico mais importante foi o traumatismo, dados esses que coincidem com os encontrados na literatura.

Objective: Our purpose was to develop a quantitative model of restricted ocular motility (fat adherence syndrome) in the pig orbit to facilitate research into pathogenesis and treatment. Methods: Twenty eyes of 10 pigs were used in an attempt to create a fibrous adhesion between either the inferior rectus or the medial rectus muscle and the adjacent periorbita. Quantitative forced ductions were performed preoperatively and 6 weeks postoperatively with an electronic force gauge. Results: Forced ductions displayed a linear relationship to displacement over the range tested, both preoperatively and postoperatively. Although increased resistance to forced ductions was produced in 10 of the 20 (50%) eyes, the average changes were not statistically significant. The absolute change in force (Postoperative — Preoperative) was linearly related to the amount of ocular rotation. Reproducibility of measurements was markedly improved by the use of a motorized forced duction apparatus compared with manual rotation. Conclusions: The results from this study, and those from previous work, suggest that the classic fat adherence syndrome is an uncommon event, even after significant soft tissue injury in the orbit. Further studies are needed to more completely define the risk factors and pathogenesis of the fat adherence syndrome and the suitability of the pig orbit as a model.

Synkinesis of the extraocular muscles forms a subset of congenital ocular motility abnormalities termed congenital cranial dysinnervation disorders. Synkinesis most frequently involves the abducens or oculomotor nerves and rarely the trochlear nerve. Only 3 such patients have been described in the literature. We report an isolated case of trochlear-oculomotor synkinesis in a healthy 6-year-old boy and discuss the proposed pathophysiology of this disorder.

To report a case of a 4 months old girl presenting with massive spontaneous proptosis, due to a large hematoma resulting from systemic vitamin K deficiency. Systemic features resolved with appropriate medical management, but proptosis was persistent and needed surgical intervention to prevent visual loss. Such a presentation of vitamin K deficiency has not been previously reported in the literature.

Silent sinus syndrome is an acquired condition in which there is a gradual collapse of the orbital floor and inward retraction of the maxillary sinus (atelectasis of the maxillary sinus). This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. This is a report of an 8 year-old boy with silent sinus syndrome and associated ocular motility disorders. The association between silent sinus syndrome and ocular motility disturbance has been recently described in the literature. However, this is an infrequent association, mainly in childhood.

Our goal was to improve existing MR methods used in the assessment of ocular motility in the horizontal gaze direction, by using high resolution 20 s images and an experimental setup that prevents physiologically induced head motion in patients and eye convergence to the fixation point, thus improving the analysis of the relationships between the eyeball and the right muscle bellies in horizontal gaze exploration. The method has potential clinical applications for the diagnosis and/or follow-up of complex strabismus.

Myotonic dystrophy is a disorder with frequent ophthalmologic features. A 44-year-old black male with myotonic dystrophy is described. The patient displays a previously unreported type of motility disturbance in myotonic dystrophy in which there is an apparent limitation of motility that simulates a bilateral internuclear ophthalmoplegia. Myotonic dystrophy may be considered as another possible cause of pseudo-internu-clear ophthalmoplegia.

We examined the characteristics of the presaccadic spike potential (SP) in normal human subjects to clarify some of the discrepancies between previously reported studies. Measurement of SP was performed in 14 normal human volunteer subjects performing saccades to visual stimuli. These were compared left versus right, centripetal versus centrifugal, and in increments of 5, 10, 20, and 40 degrees. SP amplitudes for saccades to center were greater than from saccades away from center at higher degrees. SP amplitudes to abducting saccades were of larger amplitude than those of adducting saccades. This study clarifies some discrepancies in previous reports on SP which did not distinguish saccades to center versus from center. SP data of normal individuals, for multiple saccade angles and directions, provides a basis for studying patients with disorders of ocular motility.

Opsoclonus is a striking disorder of ocular motility. It is generally associated with myoclonus. Although there are many reported cases of opsoclonus in children in association with neuroblastoma, only a few adult cases have been described. Preceding viral infections and underlying malignant tumors are known to be the most frequent causes in adults. We report on four adult cases with opsoclonus. Preceding gastrointestinal and urinary tract infections were present in two of them, while a lung tumor was detected in the third patient. Despite extensive evaluation, the underlying process could not be identified in the fourth patient.

Fixation-linked hypotropia, or hypotropic dissociated vertical deviation, is a rare but well-defined ocular motility disorder characterized by a slow downward drift of a poor-seeing eye when the other eye is fixating on a distant target. It can be successfully treated with a large recession or recession-resection of the inferior rectus muscle. We report 3 cases of fixation-linked nondissociated hypotropia with unilateral high myopia and amblyopia presenting with intermittent hypotropia of the worse-seeing eye when the dominant eye was fixating on a distant target and a hypertropia of the dominant eye when the poorer-seeing eye was made to fix. We discuss the surgical management of one of these patients.

Highly myopic strabismus is a rare acquired ocular motility disorder that affects highly myopic adults. The axial length of the eye frequently exceeds 30 mm. The eye movement is mechanically restricted in both abduction and supraduction, resulting in esotropia and hypotropia. In the most advanced form, strabismus fixus, the affected eye is so tightly fixed in an esotropic and hypotropic position that no movement in any other direction is possible even passively. MRI reveals that the globe is dislocated out from the muscle cone through the space between the superior and lateral rectus muscles. A surgical procedure to unite the muscle bellies of the superior and lateral rectus muscles is effective on improving both abnormal ocular motility and eye position.

(2013). Surgical Solutions for Supranuclear and Internuclear Ocular Motility Problems. American Orthoptic Journal: Vol. 63, No. 1, pp. 69-72.

Lacrimal gland tumors are common in middle age group individuals. Proptosis is one of theircommon presentations. Sometimes the tumors may undergo malignant changes which if neglectedcan be life threatening. Here we present a case of 49 years male with gradual painless protrusion anddiminution of vision in his right eye for eight years and more since last 2 months, with restrictionof ocular motility in right lateral gaze. Expecting a benign mass, superolateral orbitotomy withexcisional biopsy was done which astonishingly revealed carcinoma ex pleomorphic adenomawith components of adenocarcinoma and squamous cell carcinoma without any lymphovascularinvasion. Proptosis and vision of the patient in right eye improved post excisional biopsy withoutany residual mass in respective follow ups._______________________________________________________________________________________Keywords: adenocarcinoma; lacrimal gland; malignant transformation; proptosis._______________________________________________________________________________________

Pediatric orbital trauma with fracture involving the junction of roof and medial wall leading to superior oblique entrapment is rare. Here the authors report a case of orbital fracture at the junction of roof and medial wall with entrapment of the superior oblique muscle presenting clinically as canine tooth syndrome which was surgically released. Postoperatively, the ocular motility improved, and the patient was relieved of diplopia. They recommend early surgical exploration in such cases, which lead to successful resolution of diplopia.

Background: Eye movements in essential tremor (ET) are poorly described and may present useful information on the underlying pathophysiology of the disorder. Methods: Sixty patients with ET, including 15 de novo untreated patients, and 60 age-matched controls constitute the study population. A video-based eye tracker was used to assess binocular eye position. Oculomotor function was assessed while subjects followed random horizontally and vertically step-displaced targets. Results: For all reflexive saccades, latencies were increased in ET subjects by a mean of 16.3% (p, Tremor and Other Hyperkinetic Movements, Tremor and Other Hyperkinetic Movements

The anophthalmia is an eye disease identified by the absence of this, and its solution requires not only a coupled prosthetic eye but also a surgery to generate motility. Pre, post-operative and rehabilitation results of eye motility are required by health specialists. However, the motility analysis techniques currently used, provide only a qualitative evaluation. This paper presents a systematic tool to quantify ocular motility in lateral, nasal, upper and lower eye movements, with the help of image acquisition and digital processing techniques. An interface that also allows relating pre and postoperative patient data, as well as, relevant data to the process of rehabilitation, was developed by the authors. This diagnostic tool created as part of this research is noninvasive, the test time is shorter and more comfortable in comparison to currently used techniques and tools, and provides a measurable value of improved prosthetic motility patient's eyeball. This tool development was verified on patients with unilateral anophthalmia with age between 7 and 15 years old at Clinica de Oftalmologia in Cali, Colombia.

The impetus to pursue the study of ocular motility in sleeping adults was derived from a previous study conducted by the author on infants. He noted through visual observation alone that there was an approximate twenty minute interlude of complete ocular quiescence during each hour of sleep. This period of quiescence was termed ‘No Eye Movement Period’ or ‘N.E.M. Period’, and it was the intent of the author to ascertain what effect age would have on the distribution of N.E.M. periods during sleep. In the latter part of 1951, the first continuous all‐night recording of ocular motility in sleep using a combined EEG and EOG technique was conducted on the author's eight year old son. Instead of N.E.M. Periods, what he found were approximately twenty minute periods of vigorous ocular activity including saccadic‐like eye movements. Although he ultimately termed these epochs as ‘REM Periods’, his initial intent was to name them ‘Jerky Eye Movement Periods’ or ‘JEM Periods’. Ironically, some three decade...

We compared the ocular motor alignment of patients with exodeviations after surgery or botulinum A toxin injection. Ocular motility measurements were compared at time intervals of 3, 6, 12, and 24 ...

The term “vestibulocerebellar ataxia” has been applied to a rare, autosomal dominant, late-onset disease with unusual ocular motility findings. We examined the ocular motility of 18 family members from two different kindreds and found 11 affected individuals. Both families in the present study, one

Objective The purpose of the study was to analyze the association between dento-skeletal malocclusions, ocular motility, and convergence disorders in growing subjects. Materials and methods 84 subjects (49 males, 35 females) with a mean age of 7.3±1.7 years were enrolled in a screening procedure for celiac disease at the Department of Gastroenterology of the University of Rome "Tor Vergata". Each child underwent an orthodontic, orthoptic, and ophtalmological examination. Pearson's Chi-Square test with Yates' correction and Fisher's exact test were conducted to assess the association between orthoptic defects and malocclusions (p Results Ocular motility disorders were present in 44.9% of males and in 57.1% of females, while convergence defects were present in 10.2% of males and in 2.9% of females. Ocular motility disorders were more frequent in subjects with Angle Class III malocclusion (66.7%) than in subjects with Angle Class II (59.1%) and Class I (45.8%) malocclusion. Convergence defects were equally frequent in Angle Class I and Class II malocclusion (5.1%), while none subject presenting with Angle Class III malocclusion exhibited convergence defects. A statistically significant correlations was found between ocular motility disorders and unilateral cross-bite with midline deviation. Conclusion Ocular motility defects had a significant greater prevalence in subjects presenting with unilateral cross-bite and midline deviation. The importance of role of orthodontic diagnosis among interdisciplinary treatment in growing children should be recognized.

Duane's retraction syndrome (DRS) is a well-known congenital ocular motility disorder. It has been described as the consequence of a congenital anomaly of the 6th cranial nerve nuclei with aberrant innervations by supply from the 3rd cranial nerve. The syndrome includes abduction deficiency, adduction deficiency, or a combination of the two. Compensatory head adaptation helps maintain binocular vision. The purpose of this study is to report a rare case of DRS with a probable inverse DRS (occurrence of both the forms together is a rare phenomenon) presenting to a secondary care institute in this hilly terrain and highlight the ocular findings.

Objective—Diplopia after endoscopic sinus surgery (ESS) is rare but very serious. In this study, we investigated the characteristics, prognosis and treatment of diplopia occurring after ESS.Material and Methods—A retrospective analysis was carried out to investigate three patients with diplopia after ESS referred to us from other hospitals.Results—In one case, an improvement in ocular motility was seen after surgical treatment. In the other cases, no improvement was observed, despite surgical treatment.Conclusion—In order to prevent diplopia after ESS, the surgeon must possess a complete anatomical knowledge obtained by means of cadaveric dissection, the ability to carefully read preoperative CT scans and the necessary surgical experience.

Two articles in this issue discuss strabismus associated with vincristine. Chemotherapeutic toxicity is an uncommon cause of ocular motility disturbance and one that could easily be overlooked by oncologists, strabismus surgeons, and primary care providers alike. In addition, ophthalmologists use chemotherapeutic agents infrequently, and drug-induced ocular side effects related to their use are uncommon. Still, it is important to be aware of potential ocular side effects from this class of medication. Reported here is a summary of reports of ocular motility disorders caused by chemotherapeutic agents. It is hoped that clinicians will recognize this association in select patients and diagnose the condition and treat their patients accordingly. We reviewed information from the National Registry of Drug-Induced Ocular Side Effects (NR) at Casey Eye Institute (Portland, Oregon), as well as the World Health Organization’s (WHO; Uppsala, Sweden) database of adverse drug reactions. We also performed a literature search for articles describing ocular motility dysfunction in this setting. 1-5 We included reports of diplopia, strabismus, ptosis, and myasthenia-like effects, but we specifically excluded nystagmus because this condition is both frequently reported and poorly characterized throughout the literature. Most reports of strabismus or diplopia were associated with extraocular muscle paresis, although several drugs are known specifically to be myotoxic. Similarly, strabismus and diplopia normally occurred together but are sometimes reported independently. Our findings are presented in Tables 1 and 2. In this review, we distinguish between drug effects reported to the NRor the WHO and those reported in the scientific literature. Furthermore, the adverse drug reactions contained in these databases have been reviewed to determine the strength of the association. It is often unclear whether an observed side effect can be attributed to a specific agent or whether it could have been caused by