Management of Vertical Diplopia Secondary to Inferior Rectus Paresis Following Traumatic Brain Injury Using Prism Correction: A Case Report
Keywords:
Traumatic brain injury, prism glasses, vertical diplopiaAbstract
Abstract
Traumatic brain injury (TBI) is an acquired brain insult caused by external mechanical forces and may result in a wide range of neurological and ophthalmic sequelae. Diplopia is a common but often under-recognized complication that can significantly impair functional ability and quality of life. We report the case of a previously healthy 21-year-old male who developed persistent binocular vertical diplopia following severe TBI sustained in a motor vehicle accident. Ophthalmic evaluation revealed right hypertropia measuring 10 prism diopters (Δ) base down with a small 2Δ base-in exotropia, consistent with right inferior rectus paresis. Prism adaptation testing demonstrated optimal symptomatic relief with 4Δ base-down prisms in both eyes. The patient was managed conservatively with ground-in prism glasses and followed up over a two-month period. At follow-up, best-aided visual acuity improved to 6/7.5 in the right eye and 6/9 in the left eye, with complete resolution of diplopia in primary gaze and daily activities. Surgical intervention was offered but declined due to satisfactory symptom control with prism correction. This case highlights the effectiveness of prism glasses as a safe, non-invasive treatment option for post-traumatic vertical diplopia and underscores the importance of early ophthalmic assessment in patients with TBI to optimize functional recovery and quality of life.
Keywords - Traumatic brain injury, prism glasses, vertical diplopia
References
Maas AIR, Menon DK, Adelson PD, Andelic, N, Bell MJ, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987–1048. doi: 10.1016/S1474-4422(17)30371-X
Sen N. An insight into the vision impairment following traumatic brain injury. Neurochem Int. 2017;111:103–107. doi: 10.1016/j.neuint.2017.01.019
Konrad C, Geburek AJ, Rist F, Blumenroth H, Fischer B, et al. Long-term cognitive and emotional consequences of mild traumatic brain injury. Psychol Med. 2011; 41:1197–1211. doi: 10.1017/S0033291710001728
Johnson VE, Stewart W, & Smith DH. Traumatic brain injury and amyloid-β pathology: a link to Alzheimer’s disease? Nat Rev Neurosci. 2010;11:361–370. doi: 10.1038/nrn2808
Kapoor N, & Ciuffreda KJ. Vision disturbances following traumatic brain injury. Curr Treat Options Neurol. 2002;4:271–280. doi: 10.1007/s11940-002-0027-z
Capó-Aponte JE, Urosevich TG, Temme LA, Tarbett AK, & Sanghera NK. Visual dysfunctions and symptoms during the subacute stage of blast-induced mild traumatic brain injury. Mil Med. 2012;177:804–813. doi: 10.7205/milmed-d-12-00061
Rauchman SH, Zubair A, Jacob B, Rauchman D, & Pinkhasov A. Traumatic brain injury: Mechanisms, manifestations, and visual sequelae. Front Neurosci. 2023;17:1090672. doi: 10.3389/fnins.2023.1090672
Anilkumar SE & Narendran K. Prisms in the treatment of diplopia with strabismus of various etiologies. Indian J Ophthalmol. 2022;70:609–612. doi: 10.4103/ijo.IJO_939_21
Barton JJS & Ranalli PJ. Vision therapy: Occlusion, prisms, filters, and vestibular exercises for mild traumatic brain injury. Surv Ophthalmol. 2021;66:346–353. doi:
1016/j.survophthal.2020.08.001
Fox SM, Koons P, & Dang SH. Vision rehabilitation after traumatic brain injury. Phys Med Rehabil Clin N Am 2019;30:171–188. doi: 10.1016/j.pmr.2018.09.001
Ciuffreda KJ, Ludlam DP, Yadav NK, & Thiagarajan P. Traumatic brain injury. Adv Ophthalmol Optom. 2016;1:307–333. doi:10.4172/2155-9562.1000401
Doble JE, Feinberg DL, Rosner MS, & Rosner AJ. Identification of binocular vision dysfunction (vertical heterophoria) in traumatic brain injury patients and effects of individualized prismatic spectacle lenses in the treatment of postconcussive symptoms: a retrospective analysis. PM&R. 2010;2:244–253. doi: 10.1016/j.pmrj.2010.01.011
Jain S. Diplopia: Diagnosis and management. Clin Med (Northfield Il). 2022;22:104–106. doi: 10.7861/clinmed.2022-0045
Portela-Camino JA, Sanchez I, Gutierrez C, & MartÃn-González S. Successful treatment of diplopia using prism correction combined with vision therapy/orthoptics improves health-related quality of life. PeerJ. 2024;12:e17315. doi: 10.7717/peerj.17315
Kapoor N, Ciuffreda KJ, & Han Y. Oculomotor rehabilitation in acquired brain injury: A case series. Arch Phys Med Rehabil. 2004;85(10):1667-1678. doi: 10.1016/j.apmr.2003.12.044
Ponsford, J., Sloan, S., & Snow, P. Traumatic brain injury: rehabilitation for everyday adaptive living, 2nd edition. 1st ed. Psychology Press 2012.
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