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An Approach to Oculomotor Anomalies in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Intermittent exotropia is characterized by occasional outward drifting of the eyes combined with periods of binocular fusion. Intermittent exotropia may present as an intermittent unilateral eye deviation or alternating strabismus. Since intermittent exotropia is the most common form of divergent strabismus,5 a high index of suspicion should be held for it in all cases of exotropia. The underlying cause of intermittent exotropia is not well-defined, but the characteristics are so typical that further workup is rarely indicated. Patients typically present with exotropia occurring within the first decade of life, monocular squinting in sunlight or photophobia, and normal stereopsis when in periods of fusion. In children with exotropic deviations, it is important to assess for the control of their deviation which is typically better in cases of intermittent exotropia than in other more ominous neurologic etiologies of exotropia.
Complications of Fillers and Their Management
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
The incidence of eye complications is the most dreaded complication of injectable fillers. Beleznay et al. presented data showing that cases of eye complications most commonly occurred from injections to the glabella (69). The incidence of blindness in order of frequency was: glabella, followed by nasal, NLF, forehead, periocular, temple, cheek, eyelids, lips, and chin. The most common fillers responsible in descending order were: fat, HA, collagen, paraffin, PMMA, silicone, PLLA, CaHA, polyacrylamide, and micronized dermal matrix. The signs and symptoms included unilateral vision loss, ocular headache or pain, ophthalmoplegia, ptosis, exotropia, or significant skin changes. In one case, the patient died. Treatment for eye complications includes hyaluronidase retrobulbar location, digital massage, ocular pressure-lowering agent, systemic steroids, oxygen, and thrombolytics. In the case of HA, the emphasis should be on very prompt injection of hyaluronidase into the offending vessel and into the retrobulbar region.
What can eye muscle studies tell us about strabismus?
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
In vibration of the inferior rectus muscles, the direction of eye movements and past pointing was mainly upwards in both normal and exotropic subjects. During lateral rectus vibration in normal subjects and in patients with intermittent exotropia the covered, non-dominant eye deviated in the temporal, abducting direction. However, in the patients with basic exotropia the covered, strabismic eye deviated in the nasal, adducting direction. The directions of the eye deviations, summarized in Table 2, were the same as the pointing directions during eye muscle vibration. The results indicate that proprioceptive information plays a part in the gaze directing mechanisms, but that the information is used differently for horizontal gaze in normal and strabismic subjects, and probably related to the state of binocular vision.
Correlation of saccade amplitude during refusion with the fusional convergence amplitude in patients with intermittent exotropia
Published in Strabismus, 2022
Ken Kakeue, Miharu Mihara, Ryoi Tamura, Atsushi Hayashi
ntermittent exotropia (IXT) can present as exotropia and exophoria in various situations. When exotropia appears, it presents as diplopia or visual suppression in the exodeviated eye with strabismus whereas exophoria presents as normal stereopsis. It is believed that IXT causes abnormal sensory and motor fusion.1–3 Evaluation of the fusion in IXT is thus very important. There are a variety of methods to evaluate sensory and/or motor fusion, including the assessment of the fusion amplitude (range) and the maintenance of phoria, and the determination of the phoria control score. For diagnosis of IXT, the cover-uncover test and the alternate cover test are essential. In patients undergoing the cover-uncover test, recovery speed and the presence or absence of spontaneous exotropia and fusion instability have been examined.4–6
Nasal insertion of the superior oblique tendon presenting as Brown syndrome
Published in Strabismus, 2022
Ahmed Awadein, Ahmed Adel Youssef, Jylan Gouda
Bilateral superior oblique lengthening with 5–0 polyester suture spacers was performed, 7 mm on the right side and 6 mm on the left side. The tendons were cut approximately midway between the trochlea and the scleral insertion of the tendon. One month after surgery, there was an improvement in the elevation in adduction in both eyes, with no superior oblique deficits, inferior oblique deficits or overaction on either side. The hypertropia in the primary position and the chin up position disappeared. However, the patient developed a large, poorly controlled, intermittent exotropia that measured 35Δ in the primary position (Figure 3). Fundus examination showed no abnormal torsion. Alternate eye patching was advocated in an attempt to improve the control of intermittent exotropia. However, 4 months after surgery, there was no improvement. Bilateral lateral rectus recession was performed with improvement of alignment in primary position. Postoperatively, the girl was able to fuse in Worth-4 dot test without adopting a head posture.
Clinical and genetic study on two Chinese families with Wagner vitreoretinopathy
Published in Ophthalmic Genetics, 2020
Huajin Li, Hui Li, Lizhu Yang, Zixi Sun, Shijing Wu, Ruifang Sui
The proband (F2-II1) was a 29-year-old female (Figure 1(B)). She experienced night blindness from childhood. Retinal detachment occurred in the left eye at the age of 20 and she underwent scleral buckling surgery. On examination, her BCVA was 20/33 (OD) and light perception (OS). Exotropia in the left eye was present. She had a normal color vision in the right eye. The anterior segment of the right eye was normal, while pupil synechia and cataract were detected in the left eye under slit-lamp examination. Her right eye fundus showed an optically empty vitreous with vitreous veils in the periphery retina. Chorioretinal atrophy with numerous greyish RPE mottling scattered in the mid-periphery region (Figure 2(C)). The left eye fundus was difficult to observe due to a small synechia pupil. OCT revealed loss of ellipsoid zone and discontinuation of interdigitation zone OD (Figure 2(F)). Visual field testing showed tunnel vision around 12-degree OD (Figure 3(I)). FAF displayed foveal circular hyperfluorescence with arched hyperfluorescence in the posterior pole, hypofluorescence around optic disc, and scattered in the mid-periphery region OD (Figure 3(H)). Ultrasonography revealed vitreous veils and vitreoretinal membrane OD (Figure 2(I)) and retinal detachment OS (Figure 2(J)). Both rod and cone responses were remarkably reduced in ERG (Figure 4). The patient denied family history of visual dysfunctions.