OPTOMETRIC MANAGEMENT OF ACQUIRED STRABISMUS SECONDARY TO VON-HIPPEL LINDAU DISEASE

Title OPTOMETRIC MANAGEMENT OF ACQUIRED STRABISMUS SECONDARY TO VON-HIPPEL LINDAU DISEASE
Author, Co-Author Janine Albanese
Topic
Year
2013
Day
Program Number
R02013004
Room
Room 6C
Affiliation
Abstract BACKGROUND: Intraoperative trauma from a craniotomy can damage oculomotor nerves, leading to acquired strabismus. This poster presents the management of a 31 y/o male with Von-Hippel Lindau disease who developed strabismus after a posterior fossa craniotomy.

CASE REPORT(S):
I. Case History Patient: 31 y/o Asian male Chief complaint: diplopia Ocular, medical history: Von-Hippel Lindau disease Medications: none Patient is s/p a posterior fossa craniotomy for a cerebellar hemangioblastoma. Due to intraoperative trauma, this patient has multiple cranial nerve deficits (V3, VII, IX, X, as well as VI). Because CN VI is affected, the pt. has constant diplopia at distance and near secondary to an acquired constant left esotropia.
II. Pertinent findings Clinical: 5 prism diopter CLET at distance and a 10 prism diopter CLET at near
III. Differential diagnosis aneurysm, tumor, grave’s disease, myasthenia gravis, multiple sclerosis, decompensated phoria, and convergence insufficiency
IV. Diagnosis and discussion This patient was diagnosed with an acquired strabismus secondary to a posterior fossa craniotomy. The craniotomy was performed to remove a posterior fossa hemangioblastoma secondary to Von-Hippel Lindau disease (VHL). VHL disease is a rare genetic condition in which patients are predisposed to benign and malignant tumors, most commonly a posterior fossa hemangioblastoma. These tumors are often removed with a posterior fossa craniotomy. Intraoperative trauma during the procedure can leave a patient with multiple cranial nerve deficits, including but not limited to the oculomotor nerves, leading to acquired strabismus.
Treatment options: - full Rx or partial Rx - full prism or partial prism (consider prism adaptation) - Other: occlusion, VT and surgery V. Treatment, management - Rxed -1.00sph OU with 7^ BO OD + OS (Pt will return for f/u 08/28/13)

CONCLUSIONS: VHL patients often require craniotomies due to the common occurrence of hemangioblastomas. Intraoperative trauma can often lead to acquired strabismus. Many treatment options are available including spectacles, prism, vision therapy, occlusion, and surgery.
Affiliation of Co-Authors
Outline