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Year : 2018  |  Volume : 111  |  Issue : 2  |  Page : 43-48

Ocular motility disorders: unusual presentation of pituitary adenoma

1 Oththalmology Department, Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Neurosurgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 ENT Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Correspondence Address:
Manal A Kasem
Dakahlyia, Gomhoria Street, Mansoura City 35511
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejos.ejos_16_18

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Background The aim of this study was to describe ocular palsies as a rare presentation of pituitary adenomas and their relation to the size, type, and extension of tumor. Patients and methods Patients who presented with acquired onset of diplopia or ptosis during the period from February 2014 to January 2017 were included. Patients were referred to the neurology unit for transphenoidal removal of the gland. Full ophthalmologic and neurologic examinations were performed preoperatively and postoperatively. Results This study included 15 (12 men and three women) patients. Nine (60%) patients had isolated third nerve palsy; four (26.6%) patients had isolated sixth nerve affection; and two (13.3%) patients had total external ophthalmoplegia. Ocular motor disorders occurred more in nonfunctioning macroadenomas (73.3%) with grade 3 paraseller extension (60%). Apoplexy occurred in 46.7% of the cases. After surgical removal of the tumor, ocular motor improvement started within 3 weeks postoperatively. Full recovery occurred in seven (46.6%) patients within 6 months; five (33.3%) patients showed partial recovery; and three (20%) patients showed no improvement. Conclusions Acquired ocular motility disorders should raise the possibility of pituitary adenoma. The third nerve is the most affected, followed by the sixth nerve. The majority of the cases occurred in nonfunctioning macroadenoma. Transphenoidal tumor excision has a favorable outcome regarding the improvement of ocular motility.

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