Strabismus - Fundamentals of Clinical Ophthalmology.pdf

Section II
Strabismus in the decades of life
Overview of Section II
Consideration of strabismus in the decades of
life is important for two reasons.
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It draws attention to the fact that earlier in
life, the causes are likely to be developmental
in origin, whereas in adult years tumours,
thyroid eye disease, trauma, and myasthenia
gravis are more common, culminating in the
older adult where vascular disease is more
dominant.
It highlights in the child the consequences of
strabismus in an immature visual system as
distinct from the adolescent and adult where
breakdown of binocular single vision occurs
in a mature visual system.
Nevertheless, it is important for the clinician
to realise that because strabismus is common
in childhood, a significant part of adult eye
movement disorders may present with residua of
childhood onset strabismus.
In the first decade (0–10 years)
of infancy and childhood
In the first decade of life the majority of cases
of strabismus have non-progressive underlying
pathology or a static neurological abnormality.
However, strabismus in the first decade also
has added complexity because of the secondary
consequence of amblyopia. The earlier the
onset, the more likely the strabismus will be
manifest without any obvious underaction of
ocular muscle movements, although vertical
muscle imbalance may present later with
disturbance of action of the oblique muscles or
vertical rectus muscles. Craniofacial anomalies
or inappropriate milestones should alert the
clinician to the possibility of associated
pathology as the basis of strabismus.
In the second decade (10–20 years)
In the second and succeeding decades of life
the strabismus is increasingly likely to affect
specific third, fourth or sixth cranial nerve
dysfunction. In adolescence and early adult life
refractive changes in the eye are occurring and it
is also important to be alert to clinical conditions
that may underlie strabismus, including trauma
and benign intracranial hypertension.
In the third, fourth, and fifth
decades (20–50 years)
Trauma, thyroid eye disease, multiple sclerosis,
myasthenia gravis, developmental vascular
anomalies including berry aneurysms and neoplasms
need to be considered. Other inflammatory
conditions including sarcoidosis, infectious
polyneuritis, myositis, orbital pseudo tumour and
otitis media are important causes of strabismus
within this age group.
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