Neuro-ophthalmology 0165

81071951US$ 10.50

Neuro-ophthalmology— 1995, Vol. 15,

No. 5, pp. 249-256

© AEolus Press

Buren (The Netherlands) 1995

Accepted 24 April 1995

A case report

Jeffrey Cooper1

Kenneth J. Ciuffreda~

Patricia E. Carniglia

Keith M. Zinn~

Barry Tannen~

1Departments of Clinical Science and Vision Sciences

SUNY-State College of Optometry

2Manhattan Eye, Ear, and Throat Hospital, Mount Sinai

School of Medicine;

New York, NY, USA

Abstract A 50-year-old patient with Guillain-Barré syndrome devel-

oped a symmetrical, bilateral sixth nerve palsy which resulted in constant

esotropia and diplopia. The patient was treated with both prisms and orthop-

tics, which eliminated the diplopia. This treatment also improved both fu-

sional divergence amplitudes and vergence adaptation. Objective eye move-

ment recordings revealed subtle abnormalities of fixation, pursuit and

saccades, i.e., square-wave jerks and intermittent saccadic dysmetria.

Key words Guillain-Barrd syndrome; Miller Fisher syndrome; orthop-

tics; vision therapy; fusion; diplopia; pursuit; saccades; prism adaptation;

vergence adaptation.

Introduction In 1859, Landry described a condition of rapidly ascend-

ing paralysis of unknown etiology which produced acute ataxia and are-

flexia.1 In 1916, Guillain and Barrd described a similar condition with the

added feature of albuminocytological dissociation in the cerebral spinal

fluid.2 The neurological defects in Guillain-Barré syndrome (GBS) are be-

lieved to result from lymphocyte-mediated inflammation of the peripheral

nervous system. This results in a conduction block due to segmental demye-

lination of the nerve adjacent to the area of inflammation.3’4

Cranial nerve involvement may result in partial or complete ophthalmo-

plegia with symmetrical sixth nerve palsies occurring most commonly. This

simulates a divergence paralysis in which the diplopia or image dissociation

is greater at distance than at near.3 When a third nerve palsy does occur, it

usually includes both accommodative and pupillary function. The ophthal-

moplegia tends to progress to its worst state within the first few days, with

versions often appearing to remain concomitant.3

Correspondence to: Dr. Jeffrey

Cooper, Department of Clinical

Science, State College of Optometry,

SUNY, 100 East 24th Street, New

York, NY 10010, USA

Orthoptic treatment and eye movement

recordings in Guillain-Barré syndrome

Guillain-Barré syndrome 249