Diagnosis and management of divergence weakness in adults

Objective: To determine how frequently neurologic disease accompanies divergence weakness, the stability of the eye movement disorder, and the response to treatment. Design: Prospective, interventional, noncomparative case series. Participants and Methods: Seventeen consecutive adult patients (28-96 years of age) with divergence weakness were prospectively evaluated from 1991 to 1997. Main Outcome Measures: Ocular alignment was measured at distance and near and in up, down, left, and right gaze. Fusional divergence amplitudes were measured at distance. The presence or absence of associated neurologic disease was noted. The response to treatment (prisms or strabismus surgery or both) was recorded. Results: None of the patients had concurrent neurologic disease. Thirteen patients remained stable, 3 improved, and 1 progressed. Sixteen patients were treated successfully: 12 with prisms and 4 with strabismus surgery; 1 patient was not treated. Conclusion: Divergence weakness is usually an isolated condition that tends to remain stable and respond to treatment with either prisms or strabismus surgery.