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March 1997

Ocular Neuromyotonia in Graves Dysthyroid Orbitopathy

Author Affiliations

From the Anheuser Busch Eye Institute and the Department of Ophthalmology (Drs Chung, Holds, and Cruz and Ms Roper-Hall), and the Departments of Neurology (Dr Chung), Otolaryngology (Dr Holds), and Pediatrics (Dr Cruz), St Louis University School of Medicine, St Louis, Mo; and the Cullen Eye Institute and the Departments of Ophthalmology, Neurology, and Neurosurgery, Baylor College of Medicine, Houston, Tex (Dr Lee).

Arch Ophthalmol. 1997;115(3):365-370. doi:10.1001/archopht.1997.01100150367009

Objectives:  To describe 2 patients with ocular neuromyotonia in association with Graves orbitopathy and to consider the possible underlying mechanisms.

Design:  Description of the clinical findings in 2 patients with these conditions.

Setting:  Neuro-ophthalmology referral centers.

Patients:  Two patients, aged 55 and 52 years, had episodic, involuntary periods of vertical diplopia and dysthyroid orbitopathy.

Intervention:  Treatment with carbamazepine in one patient and external beam radiation therapy in the second patient.

Main Outcome Measures:  Frequency and duration of episodic spasms of the extraocular muscles.

Results:  Although radiation therapy is the most common association with ocular neuromyotonia, it cannot explain the involuntary contractions of extraocular muscles in all affected patients. Other mechanisms must be involved, such as those discussed in this article.

Conclusion:  Ocular neuromyotonia is described in 2 patients with dysthyroid orbitopathy, confirming previous findings. Possible mechanisms are given.

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