Strabismus - Fundamentals of Clinical Ophthalmology.pdf

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STRABISMUS (a) (b) (c) (d) (e) Figure 7.5 Duane’s syndrome Type I in a child who had previous medial and lateral rectus muscle recession with added feature of right facial weakness. Note right convergent squint and face turn to right (a, b). Following the Carlson-Jampolsky procedure (c-e), face turn was abolished and abduction improved. Note limitation of abduction of right eye due to large medial rectus recession (e) good results from the Carlson–Jampolsky manoeuvre (Figure 7.6). Recession of the antagonist muscle greater than 6 mm will straighten the eye more than 15 dioptres. Management of “overaction” of the superior oblique or inferior oblique muscle The basis of this is thought to be a tight lateral rectus muscle slipping over the globe. A 76
THERAPY OF STRABISMUS posterior fixation along the lateral rectus muscle has been suggested, as has a recession of medial rectus with recession of the lateral rectus of the involved eye. Recession of the lateral rectus in Type I Duane syndrome does not affect the position of the eye in the primary position. Such recession of the lateral rectus seems to also reduce the pseudoptosis sometimes seen in Duane’s. Surgical techniques for Duane syndrome Most often, the best management of Duane syndrome is not to interfere if there is binocular vision and the patient does not have a marked head posture. Complications of surgery include inducing a cosmetically undesirable exotropia, and still failing to facilitate the patient’s ability to abduct the eye. There are children and adults who have enough of a head turn or enophthalmic appearance as to warrant a strabismus repair. In these cases, judicious horizontal muscle surgery may be indicated. In some cases, upshoots and downshoots of the eye occur on adduction. These upshoots and downshoots may be difficult to manage. Although the aetiology of this problem is debated, most experts would now agree that a tight lateral rectus muscle slips over the globe occasionally when stretched during adduction and slips the eye either up or down, depending on the individual patient. 3,4 When surgery is indicated, a lateral rectus recession or bifurcation of the lateral rectus with superior half transposition up and inferior transposition down may be helpful. 5 It is not due to dysfunction of the superior or inferior oblique muscles. 6 Posterior horizontal fixation procedures will also abolish the upshoots. 7 Amblyopia is rare; however, where Duane’s is associated with a marked convergent squint and amblyopia, we have had two cases where an excellent cosmetic result has been obtained with recession of the medial rectus with transposition of the lateral half of the vertical recti and suture beneath the (a) (b) Figure 7.6 The Carlson–Jampolsky procedure shown involves the separation of the temporal halves of the vertical recti muscles. Joining these two muscle segments, balancing the opposing tone to them and then suturing them together beneath the lateral rectus muscle near its insertion (a) corrected the deviation (as represented in Fig. 7.7). Note the postoperative result (b) lateral rectus balancing the tone as described in the Carlson–Jampolsky procedure. Brown syndrome This is caused by a short, tight superior oblique tendon sheath which prevents the eye from moving upwards in adduction. A forced duction test would distinguish it from an isolated inferior oblique palsy. The majority of patients are straight in primary position and on downgaze for reading. 77
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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
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STRABISMUS dim reflex whereas the m
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STRABISMUS compared to the image on
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STRABISMUS Chiasm ON LGN ON M LGN P
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STRABISMUS Table 2.1 Actions of the
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STRABISMUS Table 2.2 Types of eye m
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3 Consequences of breakdown of bino
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STRABISMUS Bifoveal fusion Normal B
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STRABISMUS • Secondly, in the bin
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Section II Strabismus in the decade
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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 and 68: ADULT STRABISMUS such as in older p
Page 69: Section III Management of strabismu
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 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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