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Maria D Garcia, Jose Pulido, John Jing-Wei Chen; Ophthalmic Features of Multiple System Atrophy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5986.
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© ARVO (1962-2015); The Authors (2016-present)
Few studies have analyzed the ocular features of Multiple System Atrophy (MSA), a rapidly progressive neurodegenerative disorder characterized by parkinsonism, autonomic dysfunction, and/or ataxia. Therefore, we conducted a retrospective, case series to gain a better understanding of the ocular manifestations of MSA.
A search for patients seen at Mayo Clinic Rochester who had a mention of MSA in the chart and had an eye examination between January 1, 2005 and December 31, 2014 yielded 285 cases. Of the 285 cases, we identified 43 cases of true MSA (35 with a diagnosis of MSA and 8 with features of MSA overlapping with another neurodegenerative disorder). Each of these 43 patients was further reviewed for ocular abnormalities related to MSA.
Binocular diplopia from MSA was observed in 8 out of 43 patients (18.6%). There were 3 cases due to skew deviation, 1 of possible skew deviation, 2 of divergence insufficiency, 1 of both skew deviation and divergence insufficiency, and 1 of an unspecified esotropia. In addition, monocular diplopia was reported in 6 patients (14%), predominantly due to dry eyes. One patient had monocular diplopia from trichiasis due to ocular cicatricial pemphigoid. 10 out of 43 (23.3%) reported oculomotor abnormalities other than misalignment of the eyes, which included hypometric saccades (N=4), poor smooth pursuit (N=6), downbeat nystagmus (N=2), upgaze palsy (N=1) and dysfunctional vestibulo-ocular reflex (N=1). One of the patients with poor saccades also had concordant bilateral optic atrophy.
Our study confirms that oculomotor abnormalities and diplopia are the most common ocular findings in patients with MSA. Diplopia was most commonly caused by skew deviation and divergence insufficiency. Interestingly, there was a single case of bilateral optic atrophy, which has rarely been reported in MSA. There was also a case of ocular cicatricial pemphigoid among our MSA cohort, which is interesting because pemphigoid has been associated with other neurologic conditions, including Parkinson’s disease, but has not been reported in MSA in the past.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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