Citation

Houston KE, Pachalis EI, Angueira DC, Bronstad PM, Barrett AM, Iaccarino MA. Am. J. Phys. Med. Rehabil. 2016; 96(4): e70-e74.

Affiliation

From the Spaulding Rehabilitation Hospital, Boston, Massachusetts (KEH, DCA, MAI); Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts (KEH, EIP, PMB); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (MAI); Keratoprosthesis Laboratory, Massachusetts Eye and Ear, Boston, Massachusetts (EIP); and Kessler Foundation, West Orange, New Jersey (AMB).

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/PHM.0000000000000592

PMID

27552350

Abstract

Visual impairments are common after traumatic brain injury (TBI) and negatively affect quality of life. We describe a 39-year-old woman with a severe TBI who was evaluated by the inpatient optometry and vision rehabilitation service with findings of complete right homonymous hemianopia and right cranial nerve III palsy with 30-degree right exotropia (eye turn out) and complete right ptosis (eyelid will not open). The 30-degree exotropia advantageously generated 30 degrees of right visual field expansion when the right ptosis was treated with a magnetic levator prosthesis, which restores eyelid opening. Once opened, the patient used visual field expansion derived from a right exotropia to overcome functional impairments caused by right hemianopia. Field expansion improved the patient's wheelchair mobility and reaching tasks during inpatient therapy. This is the first report of visual field expansion by strabismus facilitated by correction of ptosis. Strabismus should be considered for its potential field expansion benefits when homonymous visual deficits are present, before considering patching. A multidisciplinary vision rehabilitation team is well suited to make this determination.

Language: en