Background & Aims

INTRODUCTION: The literature shows anatomical and physiological evidence between the oculomotor and stomatognathic systems, in addition to significant associations between ocular convergence insufficiency and signs and symptoms of TMD. OBJECTIVE: To verify the effect of oculomotor therapy added to the treatment of TMD of myogenic etiology in reducing muscle pain, increasing range of mandibular movement, TMD severity and improving ocular convergence.

Methods

MATERIALS AND METHODS: The study was approved by the Uninove Research Ethics Committee (CAAE: 56799322.9.0000.5511). The design is a case report, in which the patient was part of a pilot study for a randomized clinical trial. HNE patient, male, 19 years old, with mixed TMD, presenting pain in the masticatory muscles and convergence insufficiency. The study was divided into two moments: assessment and intervention. Assessments were carried out using the Fonseca Anamnestic Index (IAF), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), Numerical Pain Scale (END) and the Convergence Insufficiency Symptom Survey (CISS). After the evaluation, 12 physiotherapy sessions were carried out at weekly intervals, for 50 minutes each, containing manual techniques for TMD and oculomotor exercises. The patient was reassessed immediately after treatment, using the same outcome instruments.

Results

RESULTS: After 12 treatment sessions, it was observed that pain intensity 7 decreased to zero in END, that is, a clinically important decrease of 100%; In the initial DC/TMD assessment, the patient was diagnosed with mixed TMD and after treatment he was diagnosed without TMD. The pain-free mouth opening increased from 42mm to 45mm after treatment, a clinically important increase of 3mm. The IAF had scored 55 (moderate severity) and after treatment it dropped to zero and the CISS of 17 points went to 9 after treatment, that is, normal binocular vision.

Conclusions

CONCLUSION: The patient no longer has pain, has gained mandibular range and normal ocular convergence. Oculomotor therapy can improve the clinical picture of TMD, convergence insufficiency and its symptoms and thus improve the quality of life of these individuals.

References

REFERENCES: 1. Monaco A, Streni O, Marci MC, Sabetti L, Giannoni M. Convergence defects in patients with temporomandibular disorders. E. Skull. 2003 Jul;21(3):190-5. doi: 10.1080/08869634.2003.11746250. PMID: 12889675.; 2. Scheiman M, Mitchell GL, Cotter S, Kulp MT, Cooper J, Rouse M. A randomized clinical trial of vision therapy/orthoptics versus pencil pushups for the treatment of convergence insufficiency in young adults. Optom Vis Sci. 2005 Jul;82(7):583-95. doi: 10.1097/01.opx.0000171331.36871.2f. PMID: 16044063.; 3. Convergence Insufficiency Treatment Trial (CITT) Study Group. The convergence insufficiency treatment trial: design, methods, and baseline data. Ophthalmic Epidemiol. 2008 Jan-Feb;15(1):24-36. doi: 10.1080/09286580701772037. PMID: 18300086; PMCID: PMC2782898.; 4. Dos Santos DM, Politti F, de Azevedo LMA, de Cassia das Neves Martins R, Ricci FC, Masuda KSY, et al. Association between convergence insufficiency and temporomandibular disorder cross-sectional study. Clin Oral Investig. 2021 Mar;25(3):851-858. doi: 10.1007/s00784-020-03372-8. Epub 2020 Jun 4. PMID: 32500402.
Key Words: Temporomandibular joint disorders, Convergence insufficiency, Eye movement disorders, Exercise Therapy.

Presenting Author

Leticia Neves Modé

Poster Authors

Leticia Neves Mode

Mestre

UNIVERSIDADE NOVE DE JULHO

Lead Author

Alcylene Carla de Jesus dos Santos

Universidade Nove de Julho

Lead Author

Taisi Antunes da Cunha

UNIVERSIDADE NOVE DE JULHO

Lead Author

Fernanda Cardoso Nakamoto

UNIVERSIDADE NOVE DE JULHO

Lead Author

Lais Silva Ferreira

UNIVERSIDADE NOVE DE JULHO

Lead Author

Cindy Nakamura

MSc

Universidade Nove de Julho

Lead Author

Fabiana Xavier

BSc

Universidade Nove de Julho

Lead Author

Daniela Aparecida Biasotto-Gonzalez

UNIVERSIDADE NOVE DE JULHO

Lead Author

Topics

  • Assessment and Diagnosis