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Ocular Motor Cranial Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Zane Foster, Ashwini Kini, Bayan Al-Othman, Andrew G. Lee
The best test to diagnose a fourth neve palsy is the three-step method (Figure 15A.4). First, the hypertropic or hypotropic eye in primary gaze is identified, and its deviation should be measured. Since hypertropia of one eye is equivalent to a contralateral hypotropia, at this stage, deficiency of four muscles could be the cause: the elevators of one eye (inferior oblique and superior rectus) or the contralateral depressors (superior oblique and inferior rectus). Next, deviation is measured in both horizontal gazes. This isolates the elevator muscles from each other – in medial gaze, only the obliques are active; in lateral gaze, only the rectus muscles are active. Finally, the head is tilted to either side, and the deviation is again measured. This isolates the muscles based on cyclotorsion.
Clinical features of isolated inferior rectus paralysis
Published in Jan-Tjeerd de Faber, 28th European Strabismological Association Meeting, 2020
The mean age of patients was 30.2 years (min: 6 max: 64 years) the aetiology was congenital in 3 patients and myastenia gravis in one patient. Three of 4 patients were female. The ophthalmologic examination and motility analysis were performed. Hypertropia was presenting symptom. Mean deviation of hypertropia was 18 prism diopters (range 8–25 prism diopters).Severe limitation in down-ward gaze, head posture, secondary deviation was revealed in examination. No other manifestation of partial third nerve involvement such as pupillary anomalies, ptosis were present. An associated exotropia (range 4–90 prism diopters) was present in all patients. Forced duction test was positive in three congenital patients who underwent surgical procedure. One patient required one operation, 2 had two. As an surgical approach, superior rectus recession and inferior rectus resection was performed in two eyes, but in one of them, combined lateral rectus recession was also performed for associated exotropia. In one patient, lateral rectus recession-medial rectus resection with infraplasman and superior rectus recession and contralateral inferior rectus recession was performed. The mean postoperative deviation of hypertropia was 5 prism diopters (0 to 12). Postoperatively, ductions of affected eye were improved in three patients The patient who developed sudden onset of vertical diplopia especially in downward gaze had diabetes mellitus and myastenia gravis. The ocular finding of patients was shown in table 1.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Pseudoptosis is the appearance of ptosis rather than true ptosis (i.e. droopy upper lid); for example, Globe displacement, e.g. with enophthalmos.Mechanical lid displacement, e.g. inflammation, oedema.Dermatochalasis (excess redundant skin).Contralateral lid retraction, e.g. thyroid eye/Grave’s disease.Hypertropia; visual axis is higher than the fixating eye; dissociated vertical deviation.Blepharochalasis – rare condition in young, with recurrent lid oedema and subsequent stretching.Duane syndrome – absent/hypoplastic abducens nerve, and the lateral rectus is innervated by the oculomotor nerve, which leads to limitation of abduction and sometimes adduction. There may also be fibrosis of the attachments of the extraocular muscles. The globe tends to retract into the orbit.Blepharospasm.
Congenital anomalies of inferior rectus and its surgical outcomes
Published in Strabismus, 2022
Jenil Sheth, Aparajita Shinde, Ramesh Kekunnaya
We reviewed the English literature of case report/short case series of IR hypoplasia/aplasia from 1997 to 2017 (Table 1).1–4,14–23 A total of 20 cases of IR hypoplasia/aplasia in 15 publications were identified. There was a female preponderance with a male:female ratio of 8:12. Bilateral involvement was more common (n = 10) followed by right eye (n = 6) and left eye (n = 4). Hypertropia of the involved eye was the initial presentation in all but two patients who had a large A pattern strabismus. Coexisting horizontal deviation (exotropia > esotropia) was present in 14 (70%) cases. Five cases were of familial IR aplasia, whereas the rest were isolated and sporadic. Seven (35%) cases had other coexisting ocular anomalies. Surgeries performed were—only inverse Knapp’s—inferior transposition of horizontal rectus (n = 6), only SR recession (n = 5), IOANT (n = 4), and combined inverse Knapp’s with SR recession (n = 3). Five patients (27%) required resurgery to achieve a satisfactory outcome.
Atypical Noninfectious Surgically Induced Necrotizing Scleritis in a Child
Published in Ocular Immunology and Inflammation, 2022
Darakhshanda Khurram Butt, Muhammad Irfan Khan, Basil M Fathalla, Syed Asad Ali, Igor Kozak
A 6-year-old female presented to the clinic with a marked left hypertropia of the left eye1–3 she had undergone surgery for a horizontal squint 2 weeks prior to attending. Her past medical history was significant for chronic interstitial lung disease, epilepsy, and hypothyroidism. She had been diagnosed with an autistic spectrum disorder as part of a neurological disease of unknown etiology presenting with epilepsy, developmental delay, developmental regression, and severe speech regression.4 She was also known to have interstitial lung disease with clubbing, asthma, pulmonary disease secondary to recurrent aspiration, and swallowing disorder. Additionally, she had flexion contractures of her joints and limited range of motion of lower extremities joints from spasticity.5,6
The Role of Hypertropia in the Surgical Management of Bilateral Inferior Oblique Muscle Overaction
Published in Journal of Binocular Vision and Ocular Motility, 2022
Matteo Scaramuzzi, Massimiliano Serafino, Aldo Vagge, Alessia Nuzzi, Giuseppe Rao, Paolo Nucci
We have retrospectively analyzed a group of patients with bilateral IOOA with and without a hypertropia in primary position, who underwent bilateral IO weakening surgery between 2017 and 2019 and had at least 6 months of follow-up. Surgeries were performed by MS together with PN. Patients were excluded if previous ocular surgery was performed or if another cause of hypertropia was present such as ipsilateral superior oblique palsy, dissociated vertical deviation or limitation in elevation in the contralateral eye. We only considered the presence or absence of a hypertropia in the primary position when deciding between symmetric versus asymmetric surgery, as opposed to a hypertropia in eccentric gazes. Consequently, when we use the term “hypertropia,” we are specifically referring to a hypertropia in the primary position.