An Approach to Oculomotor Anomalies in a Child
Vivek Lal in A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Infantile esotropia is a comitant, constant, non-accommodative esotropia that typically begins before the age of 6 months (Figure 21B.1). The angle of esotropia is generally large and amblyopia is not common. In cases of suspected infantile esotropia, it is important to evaluate for frequently associated signs such as dissociated vertical deviation, over-elevation in adduction, latent nystagmus, and optokinetic asymmetry. In addition, one must be sure that abduction is full in each eye, and this may require testing monocularly to avoid cross-fixation. A complete eye examination is essential to rule out other etiologies of infantile-onset esotropia such as Duane syndrome, Mobius syndrome, myasthenia gravis, early-onset accommodative esotropia, nystagmus blockage syndrome, or other neurological diseases. In addition, early-onset sensory strabismus due to poor vision in one or both eyes may present with an esotropic deviation (although sensory exotropia is more common). In cases of typical infantile esotropia, no neuroimaging is required.
Screening Programs
Ching-Yu Cheng, Tien Yin Wong in Ophthalmic Epidemiology, 2022
Strabismus or squint can be tested by lightning reflex test, where a light source is aimed at the nose of the child and the reflex on the cornea is assessed. The reflex should fall mirrored on the same place in both eyes. If not, non-parallel eyes should be suspected. Another test for strabismus is the cover test, in which the movement of one eye in the covering of the other eye reveals a pretest squint. This movement can sometimes be more easily seen compared to the light reflex in younger, restless children. Furthermore, stereopsis can be measured by Lang stereopsis test in older pre-school children. If it is not possible to measure visual acuity or to fully examine children, great attention must be paid to the parents’ suspicions and observations and the child should be referred for expert evaluation by an ophthalmologist.
What can eye muscle studies tell us about strabismus?
Jan-Tjeerd de Faber in 28th European Strabismological Association Meeting, 2020
It is not generally believed that concomitant strabismus is due to a primary abnormality of the eye muscles or the ocular motor system. The gross anatomy of EOM including the shape and position of the eye muscle pulleys was not changed in strabismus. The histology of the EOM fibers was also basically the same, but changes have been observed in the cellular and biochemical machinery of the fibers, most notably in the singly innervated orbital fibers. Functionally this was seen as slower contractions and reduced fatigue resistance of EOM in animals with strabismus and defects of binocular vision. Most likely the changes represented an adaptation to modified visual demands on the ocular motor control, due to the defects of binocular vision in strabismus from an early age. Adaptation of EOM function to visual demands could be seen also in the adult human ocular motor system, but here the effects can be reversed with treatment in some conditions. However, it is not known if the developmental modifications of EOM function seen in animals are reversible or represent an insurmountable obstacle to treatment of strabismus.
A pilot randomized clinical trial comparing muscle transplant versus hang back recession in extra-large angle exotropia
Published in Strabismus, 2023
Amar Pujari, Sujeeth Modaboyina, Rajeswari Thangavel, Deeksha Rani, Sudarshan K. Khokhar
Strabismus is the misalignment of the visual axis of one eye with respect to the other. Based on the direction of deviation, strabismus can broadly be classified as esotropia, exotropia, hypertropia, or hypotropia. Among these, exotropia is a unique type. Here, one eye’s visual axis deviates outward with respect to other eye or the sagittal plane. It begins as intermittent deviation and then progresses to become a fixed deviation, which happens due to many complex reasons.1 As of now, to gain better results, early diagnosis and treatment remains a preferred approach.2 When it is not addressed early, it progresses further with increasing deviation and decreasing binocularity. In early stages, when patient is still able to fuse or in intermittent stage, the treatment must be initiated. If allowed to worsen further, they lose the fusional ability and manifest as constant or alternate divergent squint (right/left eye divergent squint depending on the fixation behavior).
Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits
Published in Disability and Rehabilitation, 2022
Fiona J. Rowe, Lauren R. Hepworth, Claire Howard, Kerry L. Hanna, Jim Currie
The profile of visual impairment following stroke has received little attention. Monocular or binocular vision loss can be an isolated presentation of stroke [9]. Reduced central vision has largely been attributed to spectacle need or eye disease but with less consideration to new onset low vision after stroke [3,10]. Homonymous hemianopia is the most common form of visual field loss due to stroke but less is reported on other types of visual field loss [11,12]. Strabismus is an ocular misalignment in which both eyes no longer coordinate as a pair and usually causes the symptoms of blurred/jumbled or double vision (diplopia). The misaligned eye may turn inwards, outwards, up, down or a combination [13]. Ocular motility abnormalities are varied following stroke and include ocular cranial nerve palsies, horizontal and vertical gaze palsies, nystagmus and deficits in saccadic, smooth pursuit and vergence eye movements. Resultant symptoms are often diplopia, oscillopsia, reading difficulty and altered vision [14].
Vision Abnormalities in Children and Young Adults With Cerebral Palsy; A Systematic Review
Published in Seminars in Ophthalmology, 2022
Samira Heydarian, Marziye Moradi Abbasabadi, Mehdi Khabazkhoob, Hosein Hoseini-Yazdi, Masoud Gharib
Esotropia was the most prevalent type of strabismus, followed by exotropia, with vertical deviations being the least common. Amongst the total of 1404 individuals with CP examined across 15 studies,17,18,26,27,29–31,33–40 420 cases (30%) were esotropic and 292 (21%) were exotropic. Even though the total number of esotropic cases was higher than exotropic ones across the entire CP population studied, however, a higher prevalence of exotropia compared to esotropia was reported in 3 out of the 17 selected studies.18,35,36 The cover test was employed in most studies to diagnose strabismus; however, the angle of ocular deviation was reported in only one study. Although strabismus is reportedly the most common oculomotor disorder among the CP patients (overall affecting approximately 48% of the evaluated population), CP is also associated with other oculomotor impairments including nystagmus, and deficits in the saccadic, pursuit and fixational eye movements. Among the oculomotor abnormalities, the second most common reported problem was nystagmus, ranging from 2% to 22% in the evaluated studies. However, the type of nystagmus and its frequency and amplitude were not reported in the studies.17,26,28–40
Related Knowledge Centers
- Amblyopia
- Diplopia
- Esotropia
- Exotropia
- Depth Perception
- Preterm Birth
- Cerebral Palsy
- Vision Disorder
- Far-Sightedness
- Hypertropia