Strabismus - Fundamentals of Clinical Ophthalmology.pdf

STRABISMUS
microscope. Inflammation of the conjunctiva
can occur if Tenon’s layer is breached and fat
prolapses forward. Prophylaxis is preferred.
Redundant conjunctiva
Redundant conjunctiva may require excision.
Care when suturing the conjunctiva to the
limbus is important. If it disturbs the tear film,
discomfort and thinning of the cornea (dellen)
may occur.
Conjunctival scarring and
displacement of plica
This usually occurs after multiple procedures.
It is probably best dealt with by excision of the
plica and a simple conjunctival graft beneath the
upper anterior to the superior rectus.
Anterior segment ischaemia syndrome
Patients may present within 24 hours of
surgery with corneal oedema and a mild anterior
uveitis and may respond to topical or systemic
corticosteroids. The anterior ciliary vessels
supplying anterior segment structures run
superficial within the four recti muscle sheaths.
Removal of recti may predispose the anterior
segment to ischaemia, especially in older patients
over the age of 60 with a past history of systemic
vascular disease. Surgery involving three or more
recti at the same time or within 6 months has a
higher risk of ischaemia. It is also possible to
perform surgery preserving the anterior ciliary
vessels. 18 Anterior ischaemia is uncommon in
children.
3. Cassidy L, Taylor D, Harris C. Abnormal supranuclear
eye movements in the child: a practical guide to
examination and interpretation. Surv Ophthalmol 2000;
44:479–506.
4. Kraft SP. A surgical approach for Duane’s syndrome.
J Paediatr Ophthalmol Strabismus 1988;25:119–30.
5. Carlson MR, Jampolsky A. An adjustable transposition
procedure for abduction deficiencies. Am J Ophthalmol
1979;87:382–7.
6. Magoon E, Cruciger M, Scott AB. Diagnostic injection
of xylocaine into extra-ocular muscles. Ophthalmology
1982;89:489–91.
7. von Noorden GK, Murray E. Up and downshoot in
Duane’s retraction syndrome. J Paediatr Ophthalmol
Strabismus 1986;23:212–15.
8. Knapp P. A and V patterns. In: Burian HM, ed.
Symposium on Strabismus. St Louis: Mosby, 1971.
9. Fierson WM, Boger WP, Diorio PC. The effect of
bilateral superior oblique tenotomy on horizontal
deviation in A-pattern strabismus. J Paediatr
Ophthalmol Strabismus 1980;17:364–71.
10. Stager DR, Parks MM. Inferior oblique weakening
procedures. Effect on primary position horizontal
alignment. Arch Ophthalmol 1973;90:15–16.
11. Harada M, Ito Y. Surgical correction of cyclotropia. Jpn
J Ophthalmol 1964:88–96.
12. Helveston EM. Surgery of the superior oblique muscle.
In: Helveston EM, ed. Symposium on Strabismus.
St Louis: Mosby, 1978.
13. Wright KW. Adjustable suture technique. In: Wright
KW, ed. Colour Atlas of Ophthalmic Surgery.
Philadelphia: Lippincott, 1992.
14. Biglan AW, Burnstine RA, Rogers GL. Management of
strabismus with botulinum A toxin. Ophthalmology
1989;96:935–43.
15. Parks MM. The weakening surgical procedures for
eliminating overaction of the inferior oblique muscle.
Am J Ophthalmol 1972;73:107–22.
16. Apt L, Isenberg S, Yoshimori R, Spierer A. Outpatient
topical use of povidone-iodine in preparing the eye for
surgery. Ophthalmology 1989;96:289.
17. Apt L, Isenberg S, Yoshimori R, Paez JH. Chemical
perforation of the eye in ophthalmic surgery: effect of
povidone-iodine on the eye. Arch Ophthalmol 1984;
102:728.
18. McKeown CA, Lambert M, Shore JW. Preservation of
anterior ciliary vessels during extraocular muscle
surgery. Ophthalmology 1989;96:498.
19. Brodsky MC. Dissociated vertical divergence: a
righting reflex gone wrong. Arch Ophthalmol 1999;117:
1216–22.
References
1. Kutschke PJ. Use of prisms: are they really helpful? Am
Orthoptics J 1996;46:61–4.
2. Sinelli JM, Repka MX. Prism treatment of incomitant
horizontal deviations. Am Orthoptics J 1996;41:123–6.
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