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Query: UMLS:C0038379 (strabismus)
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Superior oblique muscle palsy is not only the most frequent cause of acquired vertical strabismus, anomalous head posturing and torsional diplopia, but also the most common isolated oculomotor paralysis seen in everyday ophthalmic practice. Adults typically present to the ophthalmologist with asthenopic symptoms of long duration, while children present with objective clinical signs. An understanding of the available subjective and objective examination techniques will enable the clinician to diagnose the presence of this cyclovertical muscle paralysis. There are clues from the examination that suggest a superior oblique palsy of long duration, which may save the patient a needless neurological workup and a 6-month wait before surgical options can be considered. There are also clues from the examination that suggest the presence of a "masked" bilateral superior oblique palsy. Most cases of previously diagnosed skew deviation, if examined closely, will actually turn out to be mild trochlear nerve pareses.
J Clin Neuroophthalmol 1981 Sep
PMID:Diagnosis of superior oblique palsy. 621 62

A patient with acquired esotropia underwent apparently successful strabismus surgery. Subsequent recurrence of esotropia, associated with square-wave jerks and downbeat nystagmus led to further investigation. Although standard CT scan was normal, rescanning after instillation of metrizamide demonstrated a Chiari I malformation. Posterior fossa decompression alleviated the esotropia. Acquired esotropia has not been recognized as a manifestation of Chiari I malformation. Our case illustrates that a high degree of suspicion is required to make the diagnosis of Chiari I malformation. Specialized techniques, such as metrizamide cisternography, or magnetic resonance imaging may be necessary if routine diagnostic measures are unrevealing.
J Clin Neuroophthalmol 1984 Sep
PMID:Acquired esotropia. A manifestation of Chiari I malformation. 623 49

Fifty-five patients with amblyopia in unilateral high myopia without strabismus were treated. Thirty-two (58%) had a visual improvement by two lines or more on the Snellen chart and 17 (31%) attained a final visual acuity of 6/12 or better. In patients with pretreatment corrected vision of 6/60 or better in the amblyopic eye treatment consisted of full-time occlusion of the good eye, in some cases supplemented by the after-image method of pleoptic exercises in the amblyopic eye. Overall improvement of vision in this group was 72.7%. Occlusion of the good eye combined with pleoptic exercises in the amblyopic eye had no advantage over simple occlusion of the good eye. In patients with pretreatment corrected vision worse than 6/60 in the amblyopic eye occlusion of the amblyopic eye was done and the after-image method of pleoptic exercises was instituted. Improvement of vision in this group was 36.3%. The study showed that it is worth the trouble to treat this disorder even after the age of 14 years and stresses the utility of pleoptic therapy in older patients with severe amblyopia.
Br J Ophthalmol 1984 Sep
PMID:Results of treatment in amblyopia associated with unilateral high myopia without strabismus. 646 95

Forty-nine patients, ranging in age from 12 to 77 years, underwent strabismus surgery under local anesthesia. With standard preoperative medication and a retrobulbar injection of 2% mepivacaine hydrochloride (hyaluronidase added in 12 patients), effective anesthesia was obtained. Twenty-four patients were observed during the immediate postoperative period, and return of extraocular muscle function and visual acuity was found to be complete an average of 3.8 hours after the injection. The addition of hyaluronidase significantly altered the duration of the anesthetic. Local anesthesia may be a preferable technique in terms of decreased morbidity, especially in the older patient. The short duration of anesthesia and lack of side effects also enable the surgeon to use adjustable sutures and make the final adjustment relatively early in the postoperative period.
Arch Ophthalmol 1984 Sep
PMID:Retrobulbar anesthesia in strabismus surgery. 647 50

Recordings were made from striate cortex in five groups of cats that had been raised with strabismus produced by sectioning the extraocular muscles. These groups included animals reared with exotropia, unilateral or bilateral esotropia, and esotropia combined with lid suture of the unoperated eye. In addition, a group of esotropes was studied in which the unoperated eye was removed a few hours prior to recording. For comparison, five normal adult cats were also studied. In each of the above groups, cells were sampled in the representations of the central and peripheral visual fields in area 17 ipsilateral and contralateral to the deviated eye. We mapped the receptive field of each responsive cell, determined its ocularity, and tested it for selectivity. Confirming previous work, we found a marked loss of cortical binocularity in cats raised with strabismus. On average only 7% of the neurons that we recorded could be driven by both eyes. This percentage was relatively constant at all cortical locations that were studied and was not influenced by whether cats had been reared with exotropia, unilateral esotropia, or bilateral esotropia. The percentage of selective cells driven by the deviated eye in exotropes or esotropes did not appear to be different from normal at most cortical locations (but see 5, below). In addition, we did not observe any bias in the axial preference of selective cells in strabismic cats when compared with normal adult cats. In both exotropes and esotropes the deviated eye drove fewer cells when compared with the proportion that are driven by one eye in normal cats. In exotropes this deficit did not vary at different cortical representations of the visual field. In esotropes, however, this deficit was graded, being least in the representation of the peripheral visual field in area 17 contralateral to the deviated eye, intermediate in the representations of the central visual field in the contralateral and ipsilateral hemispheres, and greatest in the representation of the peripheral visual field in ipsilateral area 17. Furthermore, only when recording from the peripheral field representation in the ipsilateral hemisphere did we encounter significant numbers of cells driven by the deviated eye that lacked normal selectivity. Since it is possible that deprivation of the converged eye during development might account for the deficits noted above, we attempted to evaluate this factor using several independent lines of evidence. First, we could find no correlation between the angle of esotropia and the ability of the deviated eye to drive ipsilateral cortical cells representing the peripheral visual field.(ABSTRACT TRUNCATED AT 400 WORDS)
J Neurophysiol 1984 Sep
PMID:Response properties of striate cortex neurons in cats raised with divergent or convergent strabismus. 648 42

Phenotypic, karyotypic, and developmental homology between affected children of carriers of an inverted insertion (9) (q22.1q34.3q34.1) led to recognition of a new chromosome syndrome: dup 9q34. Individuals with dup 9q34 have slight psychomotor retardation, understand simple directions, and acquire a limited vocabulary. In childhood, many are hyperactive. Clinical features include low birth weight, normal birth length, and initial poor feeding and thriving. Musculo-skeletal systems are affected: there are joint contractures, long thin limbs, and striking arachnodactyly. There is abnormal implantation of the thumb, increased space between the first and second fingers, and excess digital creases. Marfan syndrome was a provisional diagnosis for several cases prior to cytogenetic analysis. Cardiovascular and ocular systems are minimally affected, erythema and heart murmurs occur, and ptosis and strabismus are frequent, but lens dislocation is not observed. Features at birth include: dolichocephaly, facial asymmetry, narrow horizontal palpebral fissures, microphthalmia, prominent nasal bridge, small mouth, thin upper lip with down-turned corners, and slight retrognathia. In older children, retrognathia is diminished and the nose becomes long and narrow. The new culture and chromosome banding techniques enable sorting of cases with the distal dup 9q phenotype into two groups. The cases with a longer dup 9q are more likely to develop with life-threatening congenital anomalies. The cases with the shorter dup 9q34 have a less severe long-term prognosis and will benefit, together with their parents, from special education. Female carriers of the inv ins(9) (q22.1q34.3q34.1) have about a 31% risk in each pregnancy to conceive a fetus affected by the dup 9q34 syndrome. A comparable figure is not yet available for male carriers.
Am J Hum Genet 1983 Sep
PMID:Duplication 9q34 syndrome. 661 95

We implanted nine intraocular lenses for the aphakic correction of congenital monocular cataracts in eight children (eight eyes). During follow-up periods ranging from 18 to 50 months in six children, there were no major complications connected to the surgery. Parental cooperation with treatment for amblyopia was satisfactory in all cases. The degree of strabismus, the fixation pattern, and the optokinetic nystagmus responses improved postoperatively in all six. Three children old enough to cooperate during visual testing had visual acuities better than 20/200 and two of these had visual acuities of 20/40. In all six children the sound eye is still patched for three to six hours a day. All six attend regular kindergartens and participate in their normal activities without difficulty.
Am J Ophthalmol 1983 Sep
PMID:Congenital cataract and intraocular lenses. 661 10

In examination and treatment of patients with strabismus one often encounters abnormal sensory adaptations such as eccentric fixation and anomalous retinal correspondence. Prognosis and treatment of strabismus are dependent on the presence or absence of these conditions. When eccentric fixation is present it becomes difficult to interpret the results of many tests used to determine retinal correspondence. This determination is further complicated when the patient is unable to give accurate responses. A technique utilizing visuoscopy and an afterimage has been performed on somewhat less cooperative patients. The results compare favorably to amblyoscopic measurements of the angle of anomaly.
J Am Optom Assoc 1983 Sep
PMID:A three step method of the determination of fixation status and retinal correspondence. 661 83

The connectivity of the corpus callosum in visual cortical areas 17 and 18 was studied in normal cats, in cats reared with unilateral convergent or divergent surgically-induced strabismus, and in a Siamese cat. The extents of the callosal cell and terminal zones were determined following multiple injections of horseradish peroxidase and tritiated amino-acids into one hemisphere. Following surgically-induced strabismus, abnormally wide callosal cell zones were seen in both the left and the right hemisphere irrespective of the direction of eye misalignment. Abnormally wide callosal terminal zones were seen in the hemisphere ipsilateral to the deviating eye in cats reared with unilateral convergent and divergent strabismus. Abnormally wide callosal zones were seen in cats which had strabismus induced as late as postnatal day 36. In a Siamese cat with a naturally-occurring convergent strabismus, callosal cells had a different distribution and were fewer in number compared to normal cats or cats with surgically induced strabismus. This implies that the abnormal callosal connectivity of Siamese cats is not a simple result of strabismus.
Brain Res 1983 Sep 12
PMID:Alterations in connections of the corpus callosum following convergent and divergent strabismus. 662 49

Campos (1982a) reported on his psychophysical studies on the binocularity of patients with comitant strabismus. With binocular visual field techniques, it was possible to show that patients with small-angle eso- and exotropia exhibit a binocular vision, without suppression of the deviated eye. In the present paper visual electrophysiology is used objectively these findings and to provide more insight in the problem. First, the studies on binocularity in normals and strabismics, done by using visual evoked responses (VER) are reviewed. This type of investigation is relatively new and the results of the literature are still conflicting. Then personal results of the authors are reported. It is shown that with VER it is possible to objectively assess the presence of anomalous binocular vision (ABV) sustained by anomalous retinal correspondence (ARC) in small-angle strabismus. In patients with large angle deviations this type of binocularity is absent. A correlation between psychophysical and electrophysiological data is provided. Lastly a simple method is described for differentiating the binocularity of normals from that of Strabismics with ARC. This method is based on the recording of binocular VER with the anteposition in front of the fixing eye of neutral filters of increasing density.
Doc Ophthalmol 1983 Sep 30
PMID:Binocularity in comitant strabismus: II. Objective evaluation with visual evoked responses. 664 76


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