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Core Messages Recognition and diagnosis of the individual forms of childhood strabismus are important for the best preservation of visual function. Esotropia is the most common form of pediatric ocular deviation in the West, whereas exotropia predominates in the East. Accommodative esotropia is the most prevalent form of strabismus in the West, comprising half...
Core Messages Patients with long-standing unilateral strabismus, such as “sensory” exotropia in the absence of fusion or esotropia with unilateral amblyopia, typically show bilateral deviations under anesthesia, often symmetric. Forced ductions usually show symmetric muscle tightness. Changes in extraocular muscle lengths thus appear to occur primarily bilaterally, whether...
Core Messages Binocular movements that result from unequal visual input to the two eyes are defined as dissociated. Dissociated esotonus, an unrecognized form of binocular dissociation, underlies dissociated horizontal deviation. Because dissociated eye movements arise in the setting of infantile strabismus, they have traditionally been considered to be the result...
Core Messages Parks' monofixation syndrome (MFS) is an abnormality of binocular vision consisting of a foveal suppression scotoma, peripheral sensory fusion, fusional vergence, and stereopsis. A majority of cases also demonstrate small angle strabismus or amblyopia, but these are secondary to the monofixation and not characteristics of the syndrome. Animal studies have begun...
Core Messages Proper alignment of the eyes requires information sharing (fusion) between monocular visual input channels in the CNS; the first locus for fusion in the CNS of primates is the striate cerebral cortex (area V1). Fusion behaviors and V1 binocular connections are immature at birth, maturing during a critical period in the first months of life; maturation of fusion...
Core Messages Strabismus may arise from identifiable structural abnormalities of the extraocular muscles (EOMs) or their innervation. Congenital or acquired myopathies affect EOM function or structure to impair normal relaxation and force generation. Abnormalities of EOM paths may produce strabismus by altering EOM pulling directions. Path abnormalities arise from abnormalities of the...
Core Messages Congenital cranial dysinnervation disorders (CCDDs) are a group of neurodevelopmental diseases of the brainstem and the cranial nerves. Endogenic or exogenic disturbances lead to a primary dysinnervation of structures supplied by cranial nerves. Motility disturbances and potentially structural changes occur. Secondary dysinnervation occurs if fibers...
Core Messages Vision screening for children may be considered in terms of detection of amblyopia, strabismus, and/or refractive error. Variations exist within and between countries regarding vision screening for children in terms of program content, referral criteria, and personnel. Recommendations state pre-school vision screening programs be conducted by orthoptists or by professionals...
Core Messages The Brückner test is useful to detect various amblyogenic disorders. After a short training, every physician can perform the test. The test as originally described consists of four elements to observe: (1) the position of the first Purkinje images (corneal light reflexes), (2) the fundus red reflex in the pupil, (3) pupillary light reflexes, and (4) any movement...
Core Messages Wearing optimum refractive correction before initiation of patching or other amblyopia therapy is associated with improvement in amblyopia in about three quarters of children and a cure in about one fourth. This improvement may facilitate subsequent treatment. For initial therapy of moderate anisometropic and strabismic amblyopia among children 3–7 years of age,...
Core Messages The result of surgery for infantile esotropia (IE) can be described by the following outcome parameters: (1) the binocular vision conserved or regained by early surgery, (2) the postoperative angle of strabismus and the long-term stability of alignment, and (3) the number of operations needed to reach these goals or the chance of spontaneous reduction of the strabismus into...
Core Messages Congenital nystagmus consists of involuntary periodic to-and-fro oscillations of the eye, which are usually horizontal and present within the first 3 months of life. Congenital nystagmus can be idiopathic or occur in association with defects in the afferent visual system such as albinism, congenital retinal dystrophies or congenital retinal dysfunction disorders...
Core Messages Dissociated deviation (DD) manifests as a slow, intermittent, and variable vertical (DVD), horizontal (DHD), and torsional (DTD) movement. It is usually found in patients with early onset strabismus and profound sensorial anomalies. The treatment for patients with DD requires a specific surgical approach to improve the vertical, horizontal, and torsional misalignment...
Core Messages The superior oblique (SO) tendon is attached to the undersurface of the superior rectus muscle by an areolar frenulum. The frenulum, if left intact, causes the SO tendon to move posteriorly with the superior rectus muscle when it is recessed. This can prevent the SO from becoming scarred into the superior rectus insertion when the latter is recessed. It can,...
Core Messages Careful preoperative assessment and a correct diagnosis of the problem are the essential factors for a successful outcome of surgical treatment. The pearl to go through the correct route in surgical management of paralytic strabismus is to know the questions that need to be answered during the preoperative assessment. The correct answers for these questions clarify...
Core Messages Graves orbitopathy (GO) is part of an autoimmune systemic disease, which is composed of hyperthyroidism, orbitopathy, dermopathy, and acropachy Stimulating antibodies against the TSH receptor are directly involved in the pathogenesis of hyperthyroidism; their role is less clear with regard to the other manifestations. However, high TSH receptor antibody concentrations...
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