Session: Poster session B

Heimann-Bielschowsky phenomenon and Hypotropic Dissociated Vertical Deviation: Case series

Introduction: The Heimann-Bielschowsky phenomenon (HBP) describes unilateral vertical, slow, coarse, pendular variable amplitude movements in an eye with profound visual loss. Dissociated Vertical Deviation (DVD), wich almost always shows a hypertropia of the affected eye, ocasionally can manifest as hypotropia, also associated with an asimetric visual input. Three patients are presented who had this rare variant of DVD and/or HBP, describing the clinical features of this rare disorders and treatment.



Methods: A retrospective study of three cases of acquired Hypotropic DVD associated with visual deficit. Data regarding demographic characteristics, clinical features, image studies and surgical treatment were analyzed.



Results: Case 1: A 36-year-old woman with right frontal and optic foramen meningioma, best-corrected visual acuity (BCVA) in the right eye: light perception, left eye: 6/7,5; who presented an intermitent downward drift of his right eye. Case 2: A 29-year-old woman with left optic nerve Glioma, BCVA in the right eye: 6/6, left eye: amaurosis; who presented a variable hypotropia 0-25PD of the left eye and vertical pendular movements of the same eye. Case 3: A 59-year-old woman with supraselar meningoma and previous divergent strabismus surgery, BCVA in the right eye: amaurosis, left eye: 6/12; who presented vertical, slow, pendular right eye movement.

In case 2 we performed a combined recession-resection of the inferior rectus muscle of the left eye. The result at two months was an improvement with no vertical deviation in primary position at near and distance fixation, and without pendular movement.



Conclusions: The HBP and the Hypotropic DVD are both underrecognized conditions induced by asymmetric visual input. There are few references, especially in terms of the association of both entities and their surgical treatment.