Tuesday, December 14, 2010

“Bob the Builder” Goggles in Ophthalmology

Case Report: novel treatment initiated by the patient to treat her symptoms of ocular neuromyotonia, or spontaneous spasms of the extraocular muscles.

As part of the Christmas 2010 issue of BMJ, Weston et al. (2010) reported the case of a 68 yr old woman with intermittent diplopia, or double vision. A cataract on her left eye was removed, which improved her vision.
Unfortunately her symptoms continued. Her diplopia was elicited during orthoptic review, showing a left exotropia [a form of strabismus where the eyes are deviated outward], with updrift, measuring 40 prism dioptres. There was limitation of adduction and depression of the left eye. Imaging showed no structural lesion. The episodes increased in frequency to 50-100 times per day. However, she found one day, while playing with her grandson, that wearing a pair of his tight “Bob the Builder” goggles prevented the episodes from occurring (Figure 1, above).
For those who don't know, Bob the Builder is a character on a children's show in the UK. He works as a building contractor.

The patient's newly found treatment was a success, and she sported Bob the Builder goggles on a regular basis:
As a result she took to wearing the goggles daily around the house, particularly to watch the television. She also tried other types of goggles, including swimming goggles, but these were not as effective. She was diagnosed with idiopathic ocular neuromyotonia affecting left lateral rectus and left superior rectus muscles. Symptom control was achieved with carbamazepine after a trial of gabapentin failed.

In the same Christmas Cheer issue of BMJ is this callipygian coverage of a "newly discovered" reflexology of the buttocks (McLachlan, 2010). The author submitted a phony query letter to “The Jerusalem Conference on Integrative Medicine.”
I write to ask if you would be interested in a presentation on my recent work on integrative medicine. I am an embryologist by background, with an extensive publication record, in journals including Nature and the Proceedings of the Royal Society, and have written an award winning text book on medical embryology. Recently, as a result of my developmental studies on human embryos, I have discovered a new version of reflexology, which identifies a homunculus represented in the human body, over the area of the buttocks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping. In my studies, responses are stronger and of more therapeutic value than those of auricular or conventional reflexology. In some cases, the map can be used for diagnostic purposes.

This was a complete hoax, of course, but it's worth reading the rest of the article and some of the ensuing media/blog coverage (e.g., Be Honest. Does this Study Make My Butt Look Big? and Pulling reflexology out of one's nether regions).


McLachlan JC (2010). Integrative medicine and the point of credulity. BMJ 341:c6979.

Weston, K., Bush, K., Afshar, F., & Rowley, S. (2010). Can he fix it? Yes, he can! BMJ, 341 (dec08 3) DOI: 10.1136/bmj.c6645

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At January 24, 2011 1:09 AM, Anonymous rebecca m said...

Hi i am a student form EDC. can i use your image for my coursework ?

At January 24, 2011 8:18 AM, Blogger The Neurocritic said...

Sure. The BMJ articles are open access. I found 'Bob the Builder' image on the internet...


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