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

This study describes the age of onset, symptomatology, and clinical characteristics of 25 patients with intermittent esotropia. This subgroup of esotropic patients typically has onset prior to 10 years of age and shows excellent bifoveal fixation ability, reflected by a high degree of stereopsis. In contrast to patients with other forms of esotropia, there is minimal to no hyperopia, an average esodeviation of approximately 20 prism diopters, and a low incidence of amblyopia, DVD, and oblique overaction. Symptomatic diplopia or cosmetic concern necessitated surgical intervention in 17 (68%) patients. Fifteen (88%) patients had good or excellent surgical results of either orthophoria, esophoria, or residual esotropia of 10 delta or less. One patient (6%) had residual esophoria greater than 10 delta. One patient had 4 delta of exophoria postoperatively. Intermittent esotropia should be differentiated from the various entities of microtropia, fixation disparity, and monofixation syndrome.
J Pediatr Ophthalmol Strabismus
PMID:Clinical characteristics and surgical treatment of intermittent esotropia. 189 May 70

The occlusion of one eye may trigger two types of deviation: 1) Heterophorias: the occluded eye deviates towards a horizontal, vertical or torsional abnormal position of rest. Fusion keeps the eyes straight during binocular fixation. 2) Dissociated deviations, horizontal (DHD), vertical (DVD), torsional (DTD): they are found in infantile strabismus. The deviation without fixation is always smaller than the deviation of the occluded eye. The more typical cases are the ones where the position of rest without fixation is an orthoposition. Normal binocular vision is lacking. Most of the time, an alternant neutralisation is found: the occlusion deviation is not the return of the occluded eye to an abnormal position of rest. The deviation is caused by a disequilibrium of binocular retinal stimulations. Horizontal and vertical deviations are easy to study. It is not the case in dissociated torsional deviation (DTD) where the incyclotorsion does not exist when fixation is absent. An indirect proof of extorsion is given by the study of horizontal and vertical deviations determined in the cardinal position of gaze. Extorsion of the globus leeds always to abnormal actions of the recti. This give a typical synoptometer chart which is found in any extorsion whatever its origins: paralysis, alphabetic patterns or infantile strabismus. Dissociated extorsions are always associated with a bilateral elevation in the primary position. Dissociated deviations are found in infantile strabismus with the other dissociations phenomenon such as nystagmus, optokinetic nystagmus asymmetry, fixation in adduction preference (and incyclotorsion).
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PMID:[Vertical and tortional deviations in early strabismus]. 220 93

The presence of a DVD makes the ocular motility examination complicate but it is a valuable sign for the clinician as it is noticed essentially in infantile early onset strabismus with latent nystagmus. It is fundamental not to confuse it with an hyperaction of the inferior oblique. It requires a surgical treatment: a recession of superior recti.
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PMID:[Dissociated vertical divergence. Early strabismus. Nystagmus]. 220 94

A recent survey of 25 experienced strabismus surgeons indicated that a very large superior rectus recession is the procedure of choice for DVD. We report a series of seven patients who exhibited a persistent DVD following large superior rectus recession. Furthermore, the DVD was markedly incomitant, much greater in adduction than in abduction. This residual DVD would mimic inferior oblique overaction on version testing, although proving to be purely DVD on critical observation. This "overaction" is apparently due to the marked weakening of the superior rectus and was not always predictive of the location and amount of persistent DVD. This previously unreported complication of large superior rectus recession is important to recognize so that alternative surgical approaches may be contemplated. It is hoped that more accurate observations and measurements both preoperatively and postoperatively will lead to a more orderly approach to DVD surgery.
J Pediatr Ophthalmol Strabismus
PMID:Residual incomitant DVD following large bilateral superior rectus recession. 270 80

Charts of all infantile esotropes who received their primary surgical procedure at the North Carolina Memorial Hospital, between February 1978 and June 1984 were reviewed. Neurologic problems (general and ocular) were identified in 29 of the 47 patients (61.7%) followed a minimum three months (mean = 25.0 +/- 2.9 mos). Frequent general neurologic problems were prematurity, hydrocephalus, mental retardation, cerebral palsy, meningomyelocele, intraventricular hemorrhage, and seizures (neonatal and/or postnatal). Abducens nerve palsy was the most common ocular neurologic impairment. Neurologic impaired esotropes were older (mean = 31.9 +/- 3.8 mos) than the "normal" group (mean = 17.0 +/- 3.3 mos) at the time of surgery. Recession/resection procedures were performed on 13 (44.8%) of the neurologically impaired and nine (50.0%) of the normal esotropes. Bimedial recessions were employed on 12 (41.4%) of the patients with neurologic problems and seven (38.8%) of the normal esotropes. Unilateral medial recessions and/or inferior oblique recessions were performed on six patients. At last follow-up, orthophoria (+/- 10 delta) was present in 16 (55.2%) neurologically impaired patients and 15 (83.3%) normal esotropes (p less than 0.05 by the normal deviate (z) test). Seven (24.1%) neurologically impaired patients had residual esotropia, while consecutive exotropia was present in six (20.7%) patients. Among normal esotropes, residual esotropia was found in one patient and consecutive exotropia in two (11.1%) patients. DVD's occurred in nine patients while four subjects developed a postoperative accommodative component.
J Pediatr Ophthalmol Strabismus
PMID:Infantile esotropia: results in the neurologic impaired and "normal" child at NCMH (six years). 395 Aug 44

The previously reported nomenclature and clinical characteristics of dissociated vertical deviation have been recorded. The incidence and characteristics of DVD have been determined by evaluation of 1,000 consecutive strabismus or nystagmus patients, and with selected chart study carried out on the 111 DVD patients found in this series. Electro-oculographic studies of selected patients with DVD provided objective evidence of the speed and amplitude of the ocular movements in DVD. Bell phenomenon, strabismus sursoadductorius and the Bielschowsky phenomenon were recorded and compared to clinical findings of strabismus patients with DVD. The technique for the results of surgery for DVD were described. Dissociated vertical deviation was characterized as a component of the overall strabismus picture.
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PMID:Dissociated vertical deviation-a clinical and laboratory study. 702 Feb 16

Cyclovertical deviations represent a major diagnostic and therapeutic problem in strabology. In this paper 4 topics are discussed. Long term evolution of strabismus after surgery shows that the patient's residual threshold for a residual vertical factor is very weak; its correction is of the utmost importance. Indeed, if some degree of binocular vision is to be recovered, the residual vertical factor should not be greater than 4 D in esotropia. There are many different varieties of vertical deviation but 3 are particularly common: oblique muscles overactions, DVD and alphabetical syndromes. There are several arguments against sagittalization during oblique muscles development. The author then presents an epidemiological survey of vertical factors based on a randomized study of 1500 consecutive cases of strabismus. In the last section, the problem of vertical factors in accommodative strabismus is discussed; there are many arguments against Gobin and Berard's ideas on the role and management of optical correction in accommodative squint.
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PMID:[Vertical deviation in strabismus in children]. 763 33

Congenital esotropia develops in the first 4 months of life in an infant who lacks the inborn mechanism for motor fusion. It manifests as an esotropia which is not eliminated by correction of hyperopia and occurs in an otherwise neurologically normal infant. The earliest practical time for surgery is 4 months of age. The eye is anatomically suited for surgery at this age and also, this is the earliest age that congenital esotropia can be diagnosed with confidence. The best attainable result of treatment of congenital esotropia is subnormal binocular vision. This result is more likely to be attained if infants are aligned by 18 months of age. Satisfactory alignment is produced in 80% to 85% of infants in one procedure with an appropriate bimedial rectus recession. An array of motor defects including DVD, latent nystagmus, oblique dysfunction, and A- and V-pattern appear at varying times after successful alignment. These associated findings are commonly found with, but are not unique to, congenital esotropia. The onset and clinical picture of congenital esotropia is satisfactorily explained by a theory first suggested by Worth that the strabismus is caused by an inborn defect in the motor fusion mechanism and aggravated by esotropital factors as suggested by Chavasse. In contrast to congenital esotropia, all other strabismus can be thought of as occurring on a secondary basis in a person with the inborn capacity for motor fusion, but who failed to maintain it because of conatal insurmountable strabismus (congenital third nerve palsy), who lost it because of acquired (postnatal) strabismus, who uses a strategy such as head posture alteration to retain fusion under favorable circumstances (Duane syndrome), who has intermittent strabismus with part-time suppression (X(T)), or who is maintaining alignment with nonsurgical means (refractive esotropia). For the future, I believe that advances in the management of congenital esotropia will depend on a better understanding of etiology leading to design and use of innovative nonsurgical techniques to discourage convergence and stimulate bifoveal fusion.
J Pediatr Ophthalmol Strabismus
PMID:19th annual Frank Costenbader Lecture--the origins of congenital esotropia. 771 8

We present a retrospective study of 28 consecutive patients who where operated three times or more with a total amount of operations of 99 (mean: 3.7). The main factors leading to a reoperation rate were analysed and discussed. Most of the patients were presenting a congenital pathology (96.5%) associated with early onset strabismus (85.7%) or superior oblique palsy (14.2%). The main factors for reoperations were DVD (78.5%), recurrence of esotropia (42%) and consecutive exotropia (32%).
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PMID:[Study and analysis of a population of multi-operated strabismus]. 981 Jan 1

We have operated 79 children with vertical strabismus. We have treated 52 children with primary overaction of the inferior oblique muscles and 27 of them with DVD and primary overaction of the inferior oblique muscles. In all of them, we have done recession of the inferior oblique muscles (for 4, 6, 8 or 10 mm). In only seven of them, from the second group, we did recession of the superior recti (for 7, 8 or 9 mm) simultaneously. This surgery very significantly and adequately ameliorate vertical strabismus (p = 0.004). Mentioned surgery on vertical extraocular muscles theoretically may product more esodeviation. In our practice with 79 operated children we didn't prove that (p = 0.148).
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PMID:[Changes in the horizontal angle in strabismus after surgery of the vertical ocular muscles]. 1460 76


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