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Ugeskrift For Laeger Jan 2023Strabismus is a common condition affecting both children and adults. Strabismus patients may experience double vision, abnormal head position and loss of stereovision....
Strabismus is a common condition affecting both children and adults. Strabismus patients may experience double vision, abnormal head position and loss of stereovision. The psychosocial negative impact of strabismus may be severe, affect self-esteem, social relationships, and job opportunities. Strabismus is a congenital condition or a result of an illness in later life and surgical treatment should be considered as reconstructive surgery and not downrated as just »a cosmetic procedure«. Strabismus surgery is safe, effective and addresses functional as well as psychosocial problems.
Topics: Adult; Child; Humans; Strabismus; Oculomotor Muscles; Plastic Surgery Procedures; Interpersonal Relations
PubMed: 36760141
DOI: No ID Found -
Romanian Journal of Ophthalmology 2016Age related binocular vision disorders (age related strabismus) could include all types of spontaneous strabismus appearing along the lifetime, which are directly... (Review)
Review
Age related binocular vision disorders (age related strabismus) could include all types of spontaneous strabismus appearing along the lifetime, which are directly connected with the aging process. Neurological strabismus is excluded. Functional and structural changes related to the aging process can induce phoria decompensation, convergence insufficiency decompensation and new onset strabismus as distance esotropia or vertical strabismus induced by the sagging eye syndrome. MRI studies sustain the hypothesis of age related structural changes of extraocular muscles pulleys and their influence on the eye position and motility nominated as sagging eye. Age Related Distance Esotropia, Age Related Divergence Insufficiency Esotropia are probably different names for the same type of strabismus. All types of age related binocular disorders require treatment because of the accompanying diplopia. Prisms or/ and surgery can improve the patients' life quality by eliminating diplopia in primary position and main gazes.
Topics: Aging; Humans; Magnetic Resonance Imaging; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Strabismus; Vision Disorders; Vision, Binocular
PubMed: 29450323
DOI: No ID Found -
The Turkish Journal of Pediatrics 2022Pediatricians are regularly involved in the initial examination of children presenting with strabismus, a common ocular condition occurring in 3% of children. The... (Review)
Review
BACKGROUND
Pediatricians are regularly involved in the initial examination of children presenting with strabismus, a common ocular condition occurring in 3% of children. The objective of this review was to gain insight into pediatric residents, fellows and attendings` understanding of strabismus, and to propose an etiology-based strabismus classification scheme to aid this understanding.
METHODS
A survey was conducted in a single Department of Pediatrics in a university academic institution in order to assess the degree of understanding of the classification, etiology and nomenclature of strabismus. A targeted literature review, pertinent to our classification scheme for strabismus in the pediatric age group, is provided to clarify the various underlying etiological conditions for pediatricians.
RESULTS
The surveyed cohort (n=26) consisted of 10 (38.5%) attendings and 16 (61.5%) pediatricians-in-training. Although 69% of survey participants felt comfortable performing an ocular motility evaluation, only 19% had a clear understanding of the underlying etiology of strabismus, 8% had a clear understanding of strabismus nomenclature and none of the participants had clear knowledge of a classification scheme of strabismus. We propose an etiologic-based strabismus classification scheme with streamlined nomenclature geared towards Pediatricians to facilitate the management of pediatric patients with various ocular misalignments. Eight major categories of this classification scheme include (1) physiologic, (2) comitant, (3) paralytic, (4) sensory, (5) syndromic, (6) orbital, (7) supranuclear and (8) pseudostrabismus.
CONCLUSIONS
Pediatricians at all levels of professional experience have a limited command of strabismus. An etiology-based classification scheme of strabismus may assist in understanding the underlying causes and facilitate the management of strabismus in the pediatrician`s office.
Topics: Child; Cohort Studies; Humans; Pediatricians; Strabismus; Surveys and Questionnaires
PubMed: 35611422
DOI: 10.24953/turkjped.2020.2372 -
Journal of AAPOS : the Official... Dec 2018To describe the prevalence and clinical features of a common but underrecognized disorder of adult vertical strabismus.
PURPOSE
To describe the prevalence and clinical features of a common but underrecognized disorder of adult vertical strabismus.
METHODS
The medical records of all adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with nonparalytic, small-angle hypertropia (NPSAH) from January 1, 1985, through December 31, 2004, were retrospectively reviewed for demographic and clinical features.
RESULTS
Of 753 patients diagnosed with adult-onset strabismus, 99 (13.1%) were found to have NPSAH, yielding an annual incidence of 7.50 per 100,000 patients >18 years of age and a cumulative incidence of 1.28%. The median age at diagnosis was 71 years (range, 27-98 years); 63 (64%) were women. Diplopia was reported at the initial diagnosis in 91 patients (93.8%), with 90 (92.8%) having the diplopia in primary or reading position. The median initial angle of hypertropia was 2 (range, 1-22) at near and 2 (range, 0-12) at distance. After a median follow-up of 10.8 years (range, 6.2 months to 23.7 years), the final median angle of vertical deviation was 4 (range, 0-20) at near and 4 (range, 0-16) at distance for all 99 patients.
CONCLUSIONS
NPSAH is a relatively common but infrequently recognized disorder among adults. More prevalent among elderly and female patients in this study cohort, the vast majority presented with diplopia and a hypertropia of ≤10 that progressed over time.
Topics: Adult; Age Distribution; Age of Onset; Aged; Aged, 80 and over; Disease Progression; Eye Movements; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Minnesota; Oculomotor Muscles; Prevalence; Retrospective Studies; Risk Factors; Sex Distribution; Strabismus; Time Factors; Visual Acuity
PubMed: 30321668
DOI: 10.1016/j.jaapos.2018.07.348 -
American Journal of Ophthalmology Oct 2022We evaluated patients with hypertropia compatible with a diagnosis of superior oblique (SO) palsy to ascertain whether the 3-step test (3ST) can distinguish SO atrophy...
PURPOSE
We evaluated patients with hypertropia compatible with a diagnosis of superior oblique (SO) palsy to ascertain whether the 3-step test (3ST) can distinguish SO atrophy characteristic of trochlear nerve pathology from masquerading conditions.
DESIGN
Prospective cross-sectional study.
METHODS
In an academic practice, we performed quasi-coronal plane, surface coil magnetic resonance imaging in 83 patients clinically diagnosed with SO palsy. We evaluated alignment, SO cross-sectional area, SO contractility, and rectus muscle pulley positions.
RESULTS
A total of 57 patients with mean age 39 years (SD = 21 years) had unilateral SO palsy manifested by SO atrophy (22 congenital and 35 acquired). There was normal SO size in 26 patients with an average age of 39 years (SD =16 years) considered masquerades (8 congenital and 18 acquired). Maximum palsied SO cross-section averaged 9.5 ± 3.8 mm, less than 18.4 ± 3.9 mm contralaterally (P < 10). In masquerades, maximum hypertropic SO cross-section was 20.7 ± 3.1 mm, which was not different from the hypotropic SO or the contralesional muscle in SO palsy. Head tilt testing in masquerades was indistinguishable from SO palsy. In SO palsy, central hypertropia averaged 13.2 ± 9.4Δ, increasing to 21.1 ± 14.0Δ in ipsilateral tilt, and decreasing to 4.3 ± 5.3Δ in contralateral tilt. In masquerades, central hypertropia averaged 13.1 ± 8.7Δ, and was 17.7 ± 11.1Δ in ipsilateral and decreasing to 4.9 ± 5.1Δ in contralateral tilt. Upright hypertropia was larger at 17.7 ± 9.9Δ in congenital than 12.0 ± 8.4Δ in acquired SO palsy (P = 0025) but was indistinguishable from congenital masquerades. Contractile change in SO cross-section was bilaterally similar in masquerades. Relevant coordinates of rectus pulleys were similar bilaterally in masquerades.
CONCLUSIONS
The 3ST pattern characteristic of unilateral SO palsy may be mimicked in all respects by masquerades.
Topics: Adult; Atrophy; Cross-Sectional Studies; Humans; Oculomotor Muscles; Paralysis; Prospective Studies; Strabismus; Trochlear Nerve Diseases
PubMed: 35618024
DOI: 10.1016/j.ajo.2022.05.017 -
Journal of Neuro-ophthalmology : the... Mar 2022Ivanir and Trobe have claimed that hypertropia (HT) that is greater in upgaze than downgaze, or equal to it, is characteristic of decompensated congenital superior...
BACKGROUND
Ivanir and Trobe have claimed that hypertropia (HT) that is greater in upgaze than downgaze, or equal to it, is characteristic of decompensated congenital superior oblique (SO) palsy and never present in ischemic, traumatic, or tumorous SO palsy. The reliability of this claim was tested in patients with SO palsy confirmed by MRI demonstration of subnormal ipsilesional SO size.
METHODS
Quasi-coronal, surface coil MRI was performed in target-controlled central gaze to identify patients with a unilateral reduction in SO cross section indicative of palsy. Nine patients gave an unequivocal history or had markedly increased vertical fusional amplitudes indicative of congenital onset (mean age 38 ± 16 years, SD). Seven patients had unequivocal acquired onset (age 47 ± 14 years and symptom duration 5.4 ± 4.8 years), including 2 with demonstrated trochlear Schwannoma and 5 with onset after severe head trauma. Fifteen patients had gradually progressive onset unequivocally not congenital yet not associated with any identifiable precipitating event (age 52 ± 20 years and symptom duration 13 ± 14 years).
RESULTS
Maximum SO cross section averaged 8.6 ± 3.9 mm2 in congenital palsy, not significantly different from 11.3 ± 3.5 mm2 in acquired palsy (P = 0.08) either unequivocally or progressively acquired, but significantly less than about 19 mm2 contralesionally in SO palsy (P < 10-4). Although mean central gaze HT was greater at 20.6 ± 8.0Δ in 9 cases of congenital than that in 22 acquired cases at 11.4 ± 6.8Δ (P = 0.002), HT was 8.4 ± 16.3Δ less in upgaze than downgaze in congenital SO palsy and 3.7 ± 11.2Δ less in acquired SO palsy. In congenital palsy, 33% of patients had HT greater in upgaze than downgaze while in 67% HT was greater in downgaze (by up to 42Δ). In acquired SO palsy, HT was greater in upgaze than downgaze or equal to it in 8 cases (36%, P = 0.87, X2). In acquired SO palsy, HT was greater in upgaze than downgaze in 37% and greater in downgaze than upgaze in 59% of cases. The HT was equal in upgaze and centralgaze in no congenital and 3 acquired cases of SO palsy. Trends were similar in unequivocal acquired and progressive acquired (noncongenital) SO palsy (P > 0.4).
CONCLUSIONS
Hypertropia is not characteristically greater in upgaze than downgaze in congenital SO palsy proven by SO atrophy on MRI. In fact, average HT is greater in downgaze than upgaze in both acquired and congenital palsy, sometimes strikingly so in the latter. The finding of HT greater in upgaze than downgaze, or equal to it, does not reliably indicate that SO palsy is congenital, nor does maximum SO cross section.
Topics: Adult; Aged; Humans; Middle Aged; Oculomotor Muscles; Paralysis; Reproducibility of Results; Retrospective Studies; Strabismus; Trochlear Nerve Diseases; Young Adult
PubMed: 34670252
DOI: 10.1097/WNO.0000000000001301 -
Australian Family Physician Dec 2013Strabismus ('squint') is a common childhood disorder that can cause psychosocial distress and permanent functional disability. Early diagnosis is important to maximise... (Review)
Review
BACKGROUND
Strabismus ('squint') is a common childhood disorder that can cause psychosocial distress and permanent functional disability. Early diagnosis is important to maximise visual rehabilitation and reduce the risk of amblyopia. There is currently no national Australian screening program for strabismus, which makes it important for all general practitioners (GPs) to master practical skills for evaluating this condition. GPs should also be aware of red flags in a history and examination that necessitate prompt investigation and management.
OBJECTIVE
This article reviews practical screening tests to identify childhood strabismus, and discusses a framework for timely intervention.
DISCUSSION
A comprehensive history is used to distinguish between primary and acquired strabismus. The four tests used to screen for stra-bismus are the light reflex test, the red reflex test, the cover test and the uncover test. Any child diagnosed with strabismus should be referred to an ophthalmologist for further assessment.
Topics: Australia; Child; Diagnosis, Differential; General Practice; Humans; Medical History Taking; Physical Examination; Strabismus; Vision Tests
PubMed: 24324989
DOI: No ID Found -
Journal of Binocular Vision and Ocular... 2022Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of... (Review)
Review
Heavy eye syndrome is a condition that results in an acquired, progressive strabismus that is due to extreme myopia and long axial length. The underlying pathogenesis of the condition is due to prolapse of the supero-temporal aspect of the myopic globe causing displacement of the lateral and superior rectus muscles inferiorly and nasally, respectively. Treatments for heavy eye syndrome often target this anatomical defect and seek to re-place the globe within the extraocular muscle cone. This review will discuss current theories of pathogenesis and treatment of heavy eye syndrome.
Topics: Adult; Humans; Esotropia; Diplopia; Magnetic Resonance Imaging; Oculomotor Muscles; Strabismus; Ocular Motility Disorders; Syndrome
PubMed: 36279483
DOI: No ID Found -
The Cochrane Database of Systematic... Nov 2017Superior oblique palsy is a common cause of vertical strabismus in adults and children. Patients may be symptomatic from binocular vertical diplopia or compensatory head... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Superior oblique palsy is a common cause of vertical strabismus in adults and children. Patients may be symptomatic from binocular vertical diplopia or compensatory head tilt required to maintain single vision. Most patients who are symptomatic elect to undergo strabismus surgery, but the optimal surgical treatment for vertical strabismus in people with superior oblique palsy is unknown.
OBJECTIVES
To assess the relative effects of surgical treatments compared with another surgical intervention, non-surgical intervention, or observation for vertical strabismus in people with superior oblique palsy.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), MEDLINE Ovid (1946 to 13 December 2016), Embase Ovid (1947 to 13 December 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 13 December 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 13 December 2016, ClinicalTrials.gov (www.clinicaltrials.gov); searched 13 December 2016, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 13 December 2016. We did not use any date or language restrictions in the electronic searches for trials.
SELECTION CRITERIA
We included randomized trials that compared at least one type of surgical intervention to another surgical or non-surgical intervention or observation.
DATA COLLECTION AND ANALYSIS
Two review authors independently completed eligibility screening, data abstraction, 'Risk of bias' assessment, and grading of the evidence.
MAIN RESULTS
We identified two randomized trials comparing four different surgical treatments for this condition, two methods in each trial. The studies included a total of 45 children and adults. The surgical treatments were all procedures to weaken the ipsilateral inferior oblique muscle. One study compared inferior oblique myectomy to recession of 10 mm; the other study compared inferior oblique disinsertion to anterior transposition (2 mm anterior to the temporal border of the inferior rectus insertion).We judged both studies to be at unclear risk of bias due to incomplete reporting of methods and other methodological deficiencies.Neither study reported data on the primary outcome of this review, which was the proportion of participants with postoperative surgical success, defined as hypertropia less than 3 prism diopters (PD) in primary gaze. However, both studies reported the average reduction in hypertropia in primary gaze. One study found that at 12 months' postoperatively the average decrease in hypertropia was higher in participants who underwent inferior oblique myectomy than in those who underwent recession, however data were not available for statistical comparison. The other trial found that after at least six months of follow-up, the mean decrease in primary position hypertropia was lower in participants who underwent inferior oblique disinsertion than in those who underwent anterior transposition (mean difference (MD) -5.20 PD, 95% confidence interval (CI) -7.76 to -2.64; moderate-quality evidence).Both trials also reported the average postoperative reduction in vertical deviation in adduction. One study reported that the average reduction in hypertropia in adduction was greater in participants who underwent inferior oblique myectomy than in those who underwent recession, but data were not available for statistical comparison. The other study found a lower decrease in hypertropia in contralateral gaze in participants who underwent inferior oblique disinsertion than in those who underwent anterior transposition (MD -7.10 PD, 95% CI -13.85 to -0.35; moderate-quality evidence).Secondary outcomes with sufficient data for analysis included proportion of participants with preoperative head tilt that resolved postoperatively and proportion of participants who underwent a second surgery. These outcomes were assessed in the trial comparing inferior oblique anterior transposition to disinsertion; both outcomes favored anterior transposition (risk ratio 7.00, 95% CI 0.40 to 121.39 for both outcomes; very low-quality evidence). None of the participants who underwent inferior oblique anterior transposition or disinsertion developed postoperative hypotropia or reversal of the vertical deviation. All participants who underwent inferior oblique anterior transposition developed elevation deficiency, which the authors deemed to be clinically insignificant in all cases, whereas no participants who underwent inferior oblique disinsertion experienced this complication. Additionally, the trial comparing inferior oblique myectomy to recession reported that no participant in either group required another strabismus surgery during the postoperative period.
AUTHORS' CONCLUSIONS
The two trials included in this review evaluated four inferior oblique weakening procedures for surgical treatment of superior oblique palsy. We found no trials comparing other types of surgical procedures for this disorder. Both studies had enrolled a small number of participants and provided low-quality evidence due to limitations in completeness and applicability. We therefore found no high-quality evidence to support recommendations for optimal surgical treatment of superior oblique palsy. Rigorously designed, conducted, and reported randomized trials are needed to identify the optimal surgical treatment for vertical strabismus in this disorder.
Topics: Adult; Child; Humans; Oculomotor Muscles; Ophthalmoplegia; Postoperative Complications; Randomized Controlled Trials as Topic; Strabismus
PubMed: 29178265
DOI: 10.1002/14651858.CD012447.pub2 -
Indian Journal of Ophthalmology Jul 2023The optimal method of treatment for a child depends on the patient's age at the time of diagnosis, the onset and type of amblyopia, and the degree of compliance... (Review)
Review
The optimal method of treatment for a child depends on the patient's age at the time of diagnosis, the onset and type of amblyopia, and the degree of compliance attainable. In deprivation amblyopia, the cause of visual impairment (e.g., cataract, ptosis) needs to be treated first, and then the disorder can be treated such as other types of amblyopia. Anisometropic amblyopia needs glasses first. In strabismic amblyopia, conventionally amblyopia should be treated first, and then strabismus corrected. Correction of strabismus will have little if any effect on the amblyopia, although the timing of surgery is controversial. Best outcomes are achieved if amblyopia is treated before the age of 7 years. The earlier the treatment, the more efficacious it is. In selected cases of bilateral amblyopia, the more defective eye must be given a competitive advantage over the comparatively good eye. Glasses alone can work when a refractive component is present, but occlusion might make the glasses work faster. The gold standard therapy for amblyopia remains occlusion of the better eye although penalization is also evidenced to achieve equal results. Pharmacotherapy has been shown to achieve suboptimal outcomes. Newer monocular and binocular therapies based on neural tasks and games are adjuncts to patching and can also be used in adults.
Topics: Child; Adult; Humans; Amblyopia; Visual Acuity; Sensory Deprivation; Strabismus; Refraction, Ocular; Treatment Outcome
PubMed: 37417105
DOI: 10.4103/IJO.IJO_338_23