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Abstract. Intractable diplopia secondary to paralytic strabismus may be treated with the occlusion of the affected eye. Established treatments include occlusion with a patch, opaque spectacles or contact lenses, and perfoming upper lid lowering procedures or tarsorrhaphies. Two cases are presented in which intractable diplopia was resolved by performing clear lens phacoemulsification and the insertion of an opaque intraocular lens. Both patients reported a resolution of their diplopia having been dissatisfied with other forms of treatment. Although opaque intraocular lens insertion is not recommended as the initial treatment of choice in such cases, it offers a valuable treatment option for those patients in whom other forms of therapy have failed. [Ophthalmic Surg Lasers 2000;31:429-431]
CASE1
A 61-year-old female was referred to the strabismus department at Moorfields Eye Hospital in April 1997 because she was suffering from intractable diplopia as a result of a third nerve palsy.
In 1988 at age 52, she had been diagnosed as having an intracavernous meningioma causing a complete third nerve palsy. The tumor was surgically removed at another hospital. Postoperatively, her ptosis improved but she was left with a 30 diopter exotropia in the primary position with a small right hypotropia (Figure 1). She had limitation of adduction, elevation, and depression of the right eye resulting in a small field of binocular single vision. Oculomotor synkinesis was manifested by miosis in downgaze and by elevation of the right upper eyelid on adduction of the right eye.
In an attempt to alleviate symptoms of diplopia, occlusive spectacles were tried, but these were unsatisfactory to the patient. An occlusive contact lens was then fitted but the eye developed severe contact lens related keratopathy. She was subsequently offered a tarsorrhaphy or an iatrogenic ptosis, but both of these were refused. Her diplopia became so debilitating that she had asked her ophthalmologist to remove her right eye. This request was refused and she was referred to our strabismus department for further management.
It was suggested that in light of her failure...