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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three patients with various manifestations of the amniotic band syndrome associated with strabismus are presented and discussed. All three cases demonstrate a paralytic strabismus due to a unilateral paresis-paralysis of the medial rectus in one case and of the superior rectus in another. The third case showed a bilateral lateral rectus paralysis. In two cases, the strabismus was accompanied by other ocular manifestations, while in one patient strabismus and amblyopia were the sole ophthalmological findings. In two of the cases, a direct association between the mesodermal bands and the strabismus could be established, while in one case this association might have been incidental. Careful ophthalmological followup and treatment of these cases prevented needless loss of vision while appropriate muscle surgery restored acceptable cosmetic appearance in one case.
J Pediatr Ophthalmol Strabismus
PMID:Amniotic band syndrome and strabismus. 720 45

Masked bilateral superior oblique paresis which was unsuspected occurred in 9 out of 57 cases. In every case of superior oblique paresis, bilaterality should be presumed until proven otherwise. Maximum attention on multiple examinations should be utilized to elicit the slightest contralateral inferior oblique overaction.
J Pediatr Ophthalmol Strabismus
PMID:Masked bilateral superior oblique paresis. 724 6

Interventions in cases of vertical squint are done in most cases on the oblique muscles. Vertical squint occurs most frequently as a vertical component in horizontal deviations in children with early concomitant strabismus. Without horizontal deviation but with binocular vision, it is rare in symmetric, but rather frequent in asymmetric forms: the sursoadductory form occurs as "congenital trochlear paresis", the deorsoadductory form as "Brown's syndrome". Acquired paresis can cause oblique vertical forms of squint. Operative indications to be observed: 1. Size and nature of vertical deviation, changes of field of gaze. In horizontal and vertical changes of gaze, different patterns of incomitance have to be observed. 2. Horizontal components of squint: Their correction does not abolish VD (vertical deviation), this should be performed by intervention on the obliqui. In A- and V- incomitance with dysfunction of the vertical motors, these have to be operated on. 3. Method of fixation: If forms of upper squint are asymmetric, both eyes should be operated on.
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PMID:[Indications for interventions on oblique muscles of the eye (author's transl)]. 724 35

Twelve patients with clinical findings of divergence paralysis underwent horizontal saccadic velocity testing. Peak velocities were measured using digitally sampled electro-oculography during 10 degrees, 20 degrees, and 30 degrees saccades. Results were compared with those of 12 age-matched controls. The peak saccadic velocities of each eye in adduction and 10 degrees abduction did not differ from those of age-matched controls (P > .05). The 20 degrees and 30 degrees abducting saccades showed mildly reduced saccadic velocities when compared with controls (P < .05). The finding of only mildly reduced abduction saccadic velocities bilaterally is not consistent with bilateral lateral rectus palsy. The data support the hypothesis that divergence paralysis represents a distinct clinical entity unrelated to abducens nerve paresis and argues for the existence of an active divergence center. We further report the surgical results of five patients who were treated with strabismus surgery. A 4.0 to 6.0 mm bilateral lateral rectus muscle resection corrected 16 to 30 delta of esotropia at distance without resulting in an overcorrection at near. Bilateral lateral rectus muscle resection is an effective therapy for divergence paralysis.
J Pediatr Ophthalmol Strabismus
PMID:Saccadic velocity analysis in patients with divergence paralysis. 762 73

This study evaluated the ophthalmological outcome following sixth nerve palsy or paresis in 64 children 7 years of age and younger. The outcomes considered were vision, residual strabismus and the need for strabismus surgery. Etiologies included tumor, hydrocephalus, trauma, infection, malformation, and idiopathic and miscellaneous causes. Strabismus surgery was performed on 24% of the patients, with residual strabismus present in 66% of the patients. Neurologists and ophthalmologists should monitor visual acuity in these young children at frequent intervals be prepared to institute amblyopia therapy early in the course of the ocular misalignment if permanent visual disability is to be avoided.
J Pediatr Ophthalmol Strabismus
PMID:Outcome of sixth nerve palsy or paresis in young children. 763 94

To help determine whether ocular torticollis causes facial asymmetry, we analyzed photographs of patients with long-standing head tilts for amounts of tilt and facial asymmetry. Significant facial asymmetry that correlated with the side of the head tilt was found in patients with congenital superior oblique muscle paresis, but not in patients with traumatic superior oblique muscle paresis nor in patients with dissociated vertical deviation. The mechanism explaining the development of facial asymmetry in these patients may be deformational molding of the face and skull from the infant's sleeping with its head turned predominantly to one side during the first 6 to 12 months of life. Early strabismus surgery to correct the head tilt may help prevent facial asymmetry, but ensuring that the infant sleeps with alternating head positions may be more important.
J Pediatr Ophthalmol Strabismus
PMID:Should early strabismus surgery be performed for ocular torticollis to prevent facial asymmetry? 763 96

A retrospective study was performed on 18 consecutive patients with A-pattern esotropia and no apparent oblique muscle dysfunction, mechanical restriction, paresis, or previous muscle surgery. All patients underwent graded bilateral medial rectus recession for their esotropia with simultaneous vertical upshift to treat the A-pattern. The quantitative relationship between amount of upshift, amount of A-pattern correction, preoperative A-pattern, and preoperative esotropia was examined. We found that the amount of A-pattern correction was closely correlated with the size of the A-pattern preoperatively (r = 0.83), independent of amount of upshift. While the change in A-pattern did correlate with the amount of the upshift (r = 0.60), it was not a significant independent predictor of the surgical response. The amount of recession had little influence on the effectiveness of the procedure in correcting the vertical incomitance, and the transposition did not seem to affect the correction of the basic esotropia, adversely. We conclude that medial rectus recession with vertical upshift of the muscle insertions is an effective procedure for correcting the vertical incomitance in A-pattern esotropia, and that the amount of A-pattern correction achieved is determined primarily by the size of the preoperative A-pattern and not the amount of upshift.
J Pediatr Ophthalmol Strabismus
PMID:Vertical shift of the medial rectus muscles in the treatment of A-pattern esotropia: analysis of outcome. 763 97

Diplopia in the reading position developed in two patients with unilateral Brown syndrome after a 7-millimeter section of #240 silicone retinal band was sewn between the cut ends of the superior oblique tendon at tenotomy. In both cases, forced ductions were positive, indicating a restrictive downgaze deficit. Surgical exploration revealed adhesions that prevented the normal sliding of the superior oblique tendon beneath the superior rectus muscle. Forced ductions became normal and downgaze improved after removal of the silicone band. Secondary superior oblique muscle paresis was also evident at the time of reoperation, requiring recession of the contralateral inferior rectus muscle (cases 1 and 2) and recession of the ipsilateral inferior oblique muscle (case 1). A restrictive downgaze deficit and a paretic overcorrection must be recognized as possible complications of the superior oblique tendon silicone "expander" operation.
J Pediatr Ophthalmol Strabismus
PMID:Downgaze restriction after placement of superior oblique tendon spacer for Brown syndrome. 775 31

The patients with strabismus, including 8 with superior oblique paresis, 1 with inferior rectus paresis, and 1 with congenital constant exotropia, were examined with MR imaging at 1.5 tesla (T) or 0.5T with a surface coil. Abnormal findings of extraocular muscles were identified in 8 of the 10 patients and most of them were consistent with the clinical findings. Deviation of the optic nerves was noted in 5 patients. Coronal short repetition time (RT) and echo time (ET) images were used to measure the concerned extraocular muscles and the optic nerves. The differences in diameters between the concerned extraocular muscles of both the diseased and normal eyes were calculated. MR imaging is considered to be advantageous and can be favorably used to observe and measure the extraocular muscles and other intraorbital structures in patients with strabismus.
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PMID:MR imaging in patients with strabismus. 780 51

Esotropia from chronic sixth nerve palsy or paresis usually requires surgery. Chemodenervation of the antagonist medial rectus muscle, while popular for the treatment of acute sixth nerve palsies and pareses, has not been used extensively for chronic cases. In this study, 22 patients with sixth nerve palsies or partially recovered palsies of greater than 5 months duration were treated with chemodenervation. The etiologies of the sixth nerve palsies were trauma (n = 7), tumor (n = 4), infection/inflammation (n = 3), nerve compression from aneurysm or increased intracranial pressure (n = 4), congenital (n = 1), ischemia (n = 2), and idiopathic (n = 1). The mean preinjection deviation was 41 prism diopters. A total of 38 injections were administered (mean, 1.7 per patient). Each patient received an injection of 2.5 to 7.5 units (mean, 4.1) of botulinum neurotoxin A to the ipsilateral medial rectus muscle. Treatment success was assessed 6 months after the last injection. A course of chemodenervation significantly improved the alignment of 9 of the 22 patients (41%). The mean postinjection deviation was 8 delta. Seven patients (32%) had single binocular vision in primary position restored. These patients had a mean horizontal binocular field of 70 degrees (range, 40 degrees to 100 degrees). Thirteen patients (59%) had only modest improvement and required surgery. The data suggest that injection of botulinum neurotoxin A is a useful treatment for some patients with chronic sixth nerve weakness. A course of chemodenervation therapy compares less favorably with transposition surgery with concomitant neurotoxin injection for the treatment of these difficult problems.
J Pediatr Ophthalmol Strabismus
PMID:The efficacy of botulinum neurotoxin A for the treatment of complete and partially recovered chronic sixth nerve palsy. 771 9


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