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ISRN Ophthalmology
Volume 2013 (2013), Article ID 264604, 8 pages
http://dx.doi.org/10.1155/2013/264604
Research Article

Profile of Gaze Dysfunction following Cerebrovascular Accident

1Department of Health Services Research, Thompson Yates Building, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK
2Altnagelvin Hospitals HHS Trust, Altnagelvin BT47 6SB, UK
3NHS Ayrshire and Arran, Ayr KA6 6DX, UK
4Royal United Hospitals Bath NHS Trust, Bath BA1 3NG, UK
5Bury Primary Care Trust, Bury BL9 7TD, UK
6Durham and Darlington Hospitals NHS Foundation Trust, Durham DH1 5TW, UK
7Ipswich Hospital NHS Trust, Ipswich IP4 5PD, UK
8Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, UK
9St Helier General Hospital, Jersey JE2 3QS, UK
10University Hospital NHS Trust, Nottingham NG7 2UH, UK
11Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK
12Salford Primary Care Trust, Salford M6 8HD, UK
13Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2TB, UK
14Swindon and Marlborough NHS Trust, Swindon SN3 6BB, UK
15Wrightington, Wigan and Leigh NHS Trust, Wigan WN1 2NN, UK
16Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD, UK

Received 8 July 2013; Accepted 21 August 2013

Academic Editors: A. Daxer, R. Saxena, and I. J. Wang

Copyright © 2013 Fiona J. Rowe et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud’s syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.