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. CarnicJiia~

Keith M. Zinn~ Barry Tannen~

1Departments of Clinical Science and Vision Sciences SUNY-State College of Optometry

School of Medicine;

New York, NY, USA

Abstract A 50-year-old patient with Guillain-Barré syndrome developed a symmetrical, bilateral sixth nerve palsy which resulted in constant esotropia and diplopia. The patient was treated with both prisms and orthoptics, which eliminated the diplopia. This treatment also improved both fusional divergence amplitudes and vergence adaptation. Objective eye movement 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; orthoptics; vision therapy; fusion; diplopia; pursuit; saccades; prism adaptation; vergence adaptation.

Introduction In 1859, Landry described a condition of rapidly ascending paralysis of unknown etiology which produced acute ataxia and areflexia.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 believed to result from lymphocyte-mediated inflammation of the peripheral nervous system. This results in a conduction block due to segmental demyelination of the nerve adjacent to the area of inflammation.3’4

Cranial nerve involvement may result in partial or complete ophthalmoplegia 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 ophthalmoplegia 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, ioo East 24th Street, New

York, NY 10010, USA

Orthoptic treatment and eye movement recordings in Guillain-Barré syndrome

Guillain-Barré syndrome 249