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Query: UMLS:C0038379 (strabismus)
 9,317 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertropia following trauma to the trochlea is rare. The more widely recognized response of the trochlea to trauma is hypotropia or acquired Brown syndrome. We observed three cases of hypertropia following penetrating trauma to the trochlea. Each had computerized tomography and/or magnetic resonance imaging to assist in the understanding of the mechanism of the observed superior oblique dysfunction. The clinical course of these cases was variable. Awareness of the damaged trochlea's capacity to respond as a hypertropic as well as a hypotropic syndrome will allow for improved management of these unusual patients.
J Pediatr Ophthalmol Strabismus
PMID:Hypertropia following trochlear trauma. 143

Surgical treatment for Brown superior oblique tendon sheath syndrome, now called Brown syndrome, has been advocated for patients with abnormal head posture or manifest hypotropia in primary gaze. Several surgical procedures with variable results and complications have been reported without consensus. Techniques and results of treatment for Brown syndrome at two institutions were reviewed. Charts of all patients who had undergone surgical treatment at Texas Children's Hospital, Houston, Tex, and Riley Hospital for Children, Indianapolis, Ind, between 1965 and 1989 were reviewed. The review yielded 38 patients. Superior oblique tenectomy was the most efficacious initial procedure. Surgery was successful in the treatment of anomalous head posture associated with Brown syndrome. There was no loss of sensory function as a result of surgery, but surgery did not inevitably lead to improved sensory function. We do not advocate superior oblique weakening combined with simultaneous surgery for iatrogenic superior oblique palsy as an initial procedure for Brown syndrome, since nearly one-half of our patients did not develop superior oblique palsy when followed for more than 1 year.
J Pediatr Ophthalmol Strabismus
PMID:Surgical results in Brown syndrome. 189 May 75

Ipsilateral hypotropia with restricted elevation is an increasingly recognized strabismic entity resulting from injury to the inferior rectus muscle after local retrobulbar anesthesia. Eight patients with this disorder are described. Computed tomography of the orbit in three patients demonstrated isolated segmental enlargement of the retrobulbar portion of the inferior rectus muscle; the findings of magnetic resonance imaging in one patient was most compatible with fibrosis. Four patients underwent strabismus surgery consisting of adjustable recession of the affected inferior rectus muscle; all recovered single binocular vision in the functional fields of gaze postoperatively. Surgical exploration of the ipsilateral inferior rectus muscle demonstrated normal anatomy in the peribulbar portion of the muscle.
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PMID:Inferior rectus muscle contracture syndrome after retrobulbar anesthesia. 196 35

The adjustable Harada-Ito procedure, as described by Metz, was performed on four patients. A hypotropia of 10 to 12 prism diopters (PD), in addition to incyclotorsion, was induced in two patients in whom the superior oblique tendon was split 8 mm, only enough to permit mobilization to its new location. Splitting the tendon for 15 mm eliminated the induced hypotropia while preserving incyclotorsion.
J Pediatr Ophthalmol Strabismus
PMID:Vertical effect of the adjustable Harada-Ito procedure. 304 88

A transfer procedure is very useful in the treatment of strabismus. The most common use of this procedure is to augment an already planned resection or recession procedure so that it can be performed monocularly to reduce an accompanying hypertropia or hypotropia or to collapse the A or V pattern when horizontal surgery is being performed for estropia or exotropia. In transfer procedures, the resultant change of deviation and cosmetic improvement is good or excellent in almost all cases. Some special transfer procedures, such as the Harada-Ito or the Jensen operation, can have dramatic effects on both comfort and change of symptoms for the patient.
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PMID:Transposition procedures in strabismus. 350 17

Thirteen patients with oculomotor nerve palsy had their strabismus managed with a recess/resect procedure on the horizontal recti of the affected eye. A simultaneous graded supraplacement of both horizontal recti in the affected eye was used to manage the hypotropia in 9 of 11 patients with unilateral palsies. If some medial rectus function exists, correction of III nerve palsy is best achieved with a recess/resect procedure with supraplacement of the horizontal recti, 1 mm for each 2 prism diopters of hypotropia in primary position. Eight of 13 patients required additional procedures. Four of 13 patients did achieve high levels of binocular function.
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PMID:Results following surgical management of oculomotor nerve palsy with a modified Knapp procedure. 408 2

The diagnosis and management of patients having had superior rectus suspension procedures for the correction of blepharoptosis can be quite difficult. Patients who have had these procedures frequently present with a syndrome which included 1) history of an unknown type of ptosis surgery performed at least ten years ago, 2) good eyelid excursion, 3) minimal lid lag associated with marked lagophthalmos, 4) hypotropia, and 5) corneal scarring. One must evert the upper eyelid to demonstrate the pathognomonic adhesion between tarsus and the superior rectus muscle. The correct management of this condition is virtually impossible until the diagnosis is made. To correct the corneal and motility problems that result from superior rectus suspension procedures, the adhesion between the superior rectus muscle and the upper eyelid must be released. It is very easy to overlook this syndrome if one is unaware of its presentation. We present five patients who illustrate the superior rectus suspension syndrome.
J Pediatr Ophthalmol Strabismus
PMID:The diagnosis and management of the superior rectus suspension syndrome. 726 56

The primary goal in mismanaged as well as untreated cases of combined double elevator muscle palsy and ptosis is alleviation of the paretic ocular motor imbalance to correct pseudoptosis, followed, if necessary, by levator resection to correct any residual true ptosis component. The great hypotropia often found in double elevator muscle palsy should be corrected, preferably by a muscle transposition procedure combined, in certain cases, with inferior rectus muscle recession if the inferior rectus muscle has contracted. Only in young patients can these two surgical procedures be safely combined, particularly if it is desirable to decrease the number of general anesthetics that the patient must take. Only after proper management of the paretic strabismus should the levator be resected, because, in certain cases, extraocular muscle surgery will completely abolish the upper lid ptosis.
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PMID:Surgically mismanaged ptosis associated with double elevator palsy. 745 35

Dissociated strabismus includes movements in the vertical, horizontal, and torsional axes. Dissociated vertical deviation (DVD) is an oversimplified label because it implies a purely vertical deviation. When the abducting component of the dissociated strabismus complex is prominent, the term dissociated horizontal deviation (DHD) is used. We present six patients with accommodative esotropia who developed prominent DHD. Only two patients have a prior history of congenital esotropia. Latent nystagmus was observed in five of the patients. With the combination of DHD and esotropia, an esodeviation during active fixation may become an exodeviation when the patient is visually inattentive. Five patients required surgery for DHD. Four options are used and discussed. DHD can be treated alone with lateral rectus muscle recession. DHD can be treated as above, but combined with medial rectus muscle recessions or posterior fixation sutures to simultaneously treat the esotropia. The esotropia can be treated alone, possibly with a reduced surgical dosage. If the patient varies from an esodeviation to an exodeviation, but is straight much of the day, observation without surgical therapy may be advisable. Just as a hypotropia can have an overlying DVD, an esotropia can have an overlying DHD. This combination may masquerade as variable angle esotropia or may present as an esodeviation when the patient is visually attentive and an exodeviation when the patient is visually inattentive.
J Pediatr Ophthalmol Strabismus
PMID:Dissociated horizontal deviation and accommodative esotropia: treatment options when an eso- and an exodeviation co-exist. 749 58

Anterior transposition of the inferior oblique (ATIO), is an accepted surgical procedure for the treatment of primary inferior oblique overaction and dissociated vertical deviation. Our study was undertaken to see if ATIO could be useful in the treatment of preselected unilateral superior oblique palsy (SOP) patients. Three consecutive patients with unilateral SOP with preoperative primary-position hypertropia averaging 27 delta, Knapp class V, underwent ATIO. The results were excellent and none of these patients developed primary-position hypotropia. Complications of ATIO in our patients consisted of some elevation deficiency, elevation of the lower lid in upgaze, and reduced inferior "scleral show" in the surgically treated eye. We are proposing that ATIO be considered as a beneficial operation in unilateral SOP patients with at least 25 delta of preoperative primary-position hypertropia.
J Pediatr Ophthalmol Strabismus
PMID:Anterior transposition of the inferior oblique in the treatment of unilateral superior oblique palsy. 762 64


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