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Convergence palsy secondary to amoxicillin
Parálisis de la convergencia secundaria a amoxicilina
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Only choroidal vessels can be observed, but papilla or central retinal vessels cannot be clearly seen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Martín-Begué, M. Saint-Gerons" "autores" => array:2 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Martín-Begué" ] 1 => array:2 [ "nombre" => "M." 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Pérez-Roca, A. Alfaro Juárez, C. Sánchez Merino, A. Navarro Mingorance" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Pérez-Roca" "email" => array:1 [ 0 => "oftalmofer@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Alfaro Juárez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Sánchez Merino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Navarro Mingorance" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Área de Oftalmología, Hospital General Básico de Baza, Baza, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Óptica y Optometría, Hospital General Básico de Baza, Baza, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parálisis de la convergencia secundaria a amoxicilina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 490 "Ancho" => 950 "Tamanyo" => 74729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Impossibility of converging eyes when fixing gaze on an object at a short distance.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ocular convergence is the movement of eyes toward the nose, that takes place when fixing the gaze on an object at a short distance. Convergence palsy is an infrequent alteration which makes it impossible to converge when focusing on said object. The disorder expresses with diplopia, difficulty in reading, blurred vision and headaches. It has been related to traumatism, infections or toxic agents. In the present case, the authors suspected association with amoxicillin.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male, 11, without relevant personal history, who visited the emergency department due to blurred vision and binocular diplopia in near gaze with 48<span class="elsevierStyleHsp" style=""></span>h evolution. Ophthalmological examination produced monocular visual acuity (VA) in both eyes of one, both in near and far gaze. Intrinsic and extrinsic motility was normal, free of limitations or restrictions but with totally inability in convergence. The cover test revealed near micro-exophoria and far ortophoria. Anterior and posterior segments were absolutely normal, and refraction with and without cycloplegia was insignificant. The diagnostic was acute convergence insufficiency under study and the patient was referred to pediatrice emergencies, where neurological or systemic disorders were discarded.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Five days later, the patient was assessed again in outpatient practice, maintaining VA of one in both eyes, with persistence of diplopia and convergence alteration (video 1). Cerebral and orbital magnetic resonance study was requested, prescribing convergence exercises for the patient to do several times a day on an outpatient basis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fifteen days later, the patient visits for a checkup, referring some subjective improvement. Examination produced similar results. Neuroimaging study was normal. Anamnesis in depth was performed, emphasizing intake of toxics or medicaments. The mother referred that a few days prior to onset of the condition, the patient had been treated with amoxicillin (50<span class="elsevierStyleHsp" style=""></span>mg/kg/day) due to pharyngeal amigdalitis and that, when he was younger, he expressed temporary gait ataxia after taking amoxicillin. In addition, she referred that the child had never shown reading problems and had always been a good student. On the other hand, the study carried out by hospital pediatricians did not find any type of neurological, systemic or infectious disorder that could explain the clinic.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One month later, the patient visited for a checkup, free of symptoms, VA of one in both eyes, without diplopia and normal motility and convergence (video 2). The condition remained stable 6 months later and the patient was released.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Ocular convergence disorders include convergence palsy, characterized by the impossibility of converging the eyes in near gaze with normal ductions and versions. Clinically, said palsy expresses with diplopia in near gaze.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> It is an infrequent entity with very few cases described in medical literature, mostly secondary to lesions in the upper midbrain, above all related to head injuries. Other described causes include infections caused by flu or diphtheria.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Amoxicillin is a broad range antibiotic derived from penicillin that is extensively used for treating a range of infections. It is a safe drug and its most common side effects are associated to variable types of hyper-sensitivity reactions, ranging from skin rash to severe anaphylactic reactions. Less frequently, expressions in the central nervous system (CNS) have also been described, above all in large dosages or in patients with kidney insufficiency, giving rise to headaches, insomnia, agitation, confusion and ataxia in animals. When amoxicillin is administered orally, it does not easily penetrate the blood–brain barrier although it can reach the CNS and produce neurological alterations.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The first step was to discard traumatic and neurological causes. This did not exclude infectious causes although it seemed unlikely because the infection was smaller, self-limited, prior to the palsy, with benign course and without lab studies. However, the antecedent of ataxia after taking amoxicillin a few years ago reinforced suspicions about the etiology of the condition. Ataxia is lack of gait coordination which in this particular case expressed as palsy, as well as lack of coordination of ocular convergence. Although infrequent, it is possible that some parts of the drug penetrated the blood-brain barrier, altering ocular coordination centers (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The prognostic was positive, with full improvement of convergence within a few weeks. To date, this is the first documented event of said condition, increasing awareness about similar cases that could occur in the future, taking into account the consumption of toxic agents or drugs when studying binocular function despite alterations being an infrequent occurrence.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres764837" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec766267" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres764838" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec766266" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-06" "fechaAceptado" => "2016-02-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec766267" "palabras" => array:5 [ 0 => "Convergence palsy" 1 => "Amoxicillin" 2 => "Diplopia" 3 => "Pharyngitis" 4 => "Convergence disorders" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec766266" "palabras" => array:5 [ 0 => "Parálisis de la convergencia" 1 => "Amoxicilina" 2 => "Diplopía" 3 => "Faringitis" 4 => "Trastornos de la convergencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present the case of an 11-year-old boy with acute diplopia in near vision secondary to transient convergence palsy, possibly in relation to amoxicillin.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Convergence palsy is an uncommon eye disorder. The causes are reviewed, and amoxicilin is identified as presumptive etiologic agent. This is the first case reported.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un varón de 11 años, con diplopía aguda en la visión cercana, secundario a una parálisis de la convergencia transitoria, posiblemente relacionada con la toma de amoxicilina.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La parálisis de la convergencia es un trastorno poco frecuente. Repasamos las causas que la pueden producir, e identificamos a la amoxicilina como agente etiológico. Es el primer caso comunicado.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Roca F, Alfaro Juárez A, Sánchez Merino C, Navarro Mingorance A. Parálisis de la convergencia secundaria a amoxicilina. Arch Soc Esp Oftalmol. 2016;91:601–603.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0060" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 490 "Ancho" => 950 "Tamanyo" => 74729 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Impossibility of converging eyes when fixing gaze on an object at a short distance.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 489 "Ancho" => 950 "Tamanyo" => 81610 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Improvement of convergence several weeks after onset of the condition.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 6749360 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 3 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 4436542 "Video" => array:2 [ "mp4" => array:2 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" ] "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parálisis oculomotoras: diagnóstico y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. 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