Strabismus - Fundamentals of Clinical Ophthalmology.pdf

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STRABISMUS Fourth nerve palsy is common and the majority of cases are congenital or traumatic. The patient may not be aware of compensatory head postures, but old photos will confirm. If the superior oblique palsy is not congenital or traumatic, a neurological consultation to exclude intracranial neoplasm is mandatory. Horizontal diplopia is usually related to sixth nerve paresis and is obvious clinically. Trauma, vascular disease and raised intracranial pressure are the commonest causes. Diplopia in the older person is sometimes ascribed to divergence insufficiency. There may be associated symptoms of nystagmus, vertigo or dizziness on head turn, suggesting vertebrobasilar insufficiency. The diplopia is often readily corrected with prisms and may reflect underlying bilateral mild sixth nerve palsy. It is important to consider whether or not to investigate carotid and vertebral circulations and the associated circle of Willis depending on the patient’s age and possibility of therapeutic intervention. Horizontal diplopia may occur as a result of a lesion in the medial longitudinal fasciculus due to multiple sclerosis in a young adult or microvascular disease in the older patient. An important cause to consider is internuclear ophthalmoplegia. The leading eye will reveal abducting nystagmus, whilst the following eye will show inability to adduct in horizontal gaze in the presence of diplopia, and convergence is usually preserved. A diverse range of disease processes can damage the sixth nerve causing horizontal diplopia, reflecting its long course from the brainstem to the lateral rectus. References 1. Calcutt C, Murray AD. Untreated essential infantile esotropia: factors affecting the development of amblyopia. Eye 1998;12:167–72. 2. Calcutt C. The natural history of infantile esotropia. A study of the untreated condition in the visual adult. Advances in Amblyopia and Strabismus. Transactions of the VIIth International Orthoptic Congress, Nurnberg, 1991. 3. Pratt-Johnson JA. 18th Annual Frank Costenbader Lecture. Fusion and suppression: development and loss. J Pediatr Ophthalmol Strabismus 1992;29:4–11. 4. Pratt-Johnson JA, Tillson G. Suppression in strabismus – an update. Br J Ophthalmol 1984;68:174–8. 5. Pratt-Johnson JA, Tillson G, Pop A. Suppression in strabismus and the hemiretinal trigger mechanism. Arch Ophthalmol 1983;101:218–24. 6. Parks MM. Isolated cyclovertical muscle palsy. Arch Ophthalmol 1958;60:1027–35. 7. Guyton DL. Exaggerated traction test for the oblique muscles. Ophthalmology 1981;88:1035–40. 8. Rootman J. Diseases of the Orbit. Philadelphia: J.B. Lippincott, 1988. 54
Section III Management of strabismus
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Fundamentals of Clinical Ophthalmol
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Fundamentals of Clinical Ophthalmol
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© BMJ Books 2003 BMJ Books is an i
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CONTENTS Sequelae of strabismus in
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Preface This book has been written
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Foreword We should welcome the fine
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Section I Neurophysiological substr
Page 18 and 19: STRABISMUS dim reflex whereas the m
Page 20 and 21: STRABISMUS compared to the image on
Page 22 and 23: STRABISMUS Chiasm ON LGN ON M LGN P
Page 24 and 25: STRABISMUS Table 2.1 Actions of the
Page 26 and 27: STRABISMUS Table 2.2 Types of eye m
Page 28 and 29: 3 Consequences of breakdown of bino
Page 30 and 31: STRABISMUS Bifoveal fusion Normal B
Page 32 and 33: STRABISMUS • Secondly, in the bin
Page 35 and 36: Section II Strabismus in the decade
Page 37 and 38: 4 Childhood onset of strabismus Chi
Page 39 and 40: CHILDHOOD ONSET OF STRABISMUS indic
Page 41 and 42: CHILDHOOD ONSET OF STRABISMUS (a) (
Page 43 and 44: CHILDHOOD ONSET OF STRABISMUS In ad
Page 45 and 46: CHILDHOOD ONSET OF STRABISMUS may b
Page 47 and 48: CHILDHOOD ONSET OF STRABISMUS retin
Page 51 and 52: CHILDHOOD ONSET OF STRABISMUS Figur
Page 55 and 56: Transient skew deviation CHILDHOOD
Page 57 and 58: CHILDHOOD ONSET OF STRABISMUS add w
Page 59 and 60: CHILDHOOD ONSET OF STRABISMUS Spasm
Page 61 and 62: 5 Adult strabismus Introduction The
Page 63 and 64: ADULT STRABISMUS Case example An ad
Page 65 and 66: ADULT STRABISMUS patient presenting
Page 67: ADULT STRABISMUS such as in older p
Page 72 and 73: STRABISMUS ● the pattern of the a
Page 74 and 75: STRABISMUS Figure 6.5 An example of
Page 76 and 77: STRABISMUS Sensory evaluation - bin
Page 78 and 79: STRABISMUS Normal R L Normal binocu
Page 80 and 81: STRABISMUS torsional deviations can
Page 82 and 83: STRABISMUS (a) (b) (c) (d) Figure 6
Page 84 and 85: 7 Therapy of strabismus Non-surgica
Page 86 and 87: STRABISMUS of the eye with good vis
Page 88 and 89: STRABISMUS other forms of non-surgi
Page 90 and 91: STRABISMUS (a) (b) (c) (d) (e) Figu
Page 92 and 93: STRABISMUS In attempting to elevate
Page 94 and 95: STRABISMUS drawn underneath the lat
Page 96 and 97: STRABISMUS Figure 7.7 Recession wit
Page 98 and 99: STRABISMUS MR MR LR LR LR LR MR MR
Page 100 and 101: STRABISMUS overacting in a V patter
Page 102 and 103: STRABISMUS more persistent diplopia
Page 104 and 105: STRABISMUS microscope. Inflammation
Page 106 and 107: STRABISMUS Strabismus Malalignment
Page 108 and 109: INDEX surgical correction 83-6 see
Page 110 and 111: INDEX horizontal 54 “horror fusio
Page 112 and 113: INDEX esotropia 31, 31 monofixation
Page 114 and 115: INDEX oculocutaneous albinism 43 oc
Page 116: INDEX vertical muscle surgery 83-6,
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