Cases reported "Exotropia"

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1/23. Fresnel prism treatment of sensory exotropia with restoration of sensory and motor fusion.

    Anterior segment surgeons may treat patients with long-standing media opacities or uncorrected aphakia who have developed sensory strabismus. These patients are at risk for diplopia after surgery to clear the visual axis and restore emmetropia. This report describes 2 patients who regained comfortable single binocular vision without strabismus surgery. Sensory fusion was restored with Fresnel prisms, which were weaned and ultimately discarded as the patients' motor fusion was re-engaged after decades of disuse. Surgeons who restore vision in an eye with manifest sensory strabismus should be aware of this noninvasive, well-tolerated treatment option. Collaboration with an orthoptist or strabismologist may be helpful.
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keywords = visual
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2/23. Autogenous fascia augmentation of a partially extirpated muscle with a subperiosteal medial orbitotomy approach.

    INTRODUCTION: Endoscopic sinus surgery can result in serious extraocular muscle dysfunction. The medial rectus muscle is more frequently affected than other extraocular muscles. methods: A transconjunctival subperiosteal medial orbitotomy was successful in retrieving a partially extirpated medial rectus muscle after endoscopic sinus surgery. RESULTS: A previous attempt to localize this muscle by conventional surgery with extensive exploration was unsuccessful. A Hummelsheim procedure was also abandoned after a rupture of the nasal aspect of the inferior rectus muscle occurred. CONCLUSION: The approach we describe allowed adequate visualization of the posterior orbital content, as well as adequate space for suture placement.
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keywords = visual
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3/23. The role of vergence adaptation in recovery of binocular single vision (BSV) following sensory strabismus.

    Vergence adaptation is an important element of comfortable binocular single vision and probably contributes to the high incidence of orthophoria or small angles of heterophoria in the normal population. Where binocular single vision has been absent for a period of time, restoration of good visual acuity appears to enable the vergence adaptation mechanism to become active again. A case is presented in which a moderate to large angle of deviation rapidly 'disappeared' once good visual acuity was restored and the disparate images could be fused. Known factors concerning vergence adaptation are discussed in relation to such clinical cases.
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ranking = 6.6270465916951
keywords = visual acuity, visual, acuity
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4/23. Eye deviation in patients with one-and-a-half syndrome.

    To understand malalignments of the visual axes in one-and-a-half syndrome, we measured eye positions in 4 patients with this syndrome under two conditions: with Frenzel goggles to prevent eye fixation and without Frenzel goggles. When fixation was prevented with the Frenzel goggles, all patients showed mild outward deviation in both eyes. Removal of the Frenzel goggles elicited adduction of the eye ipsilateral to the side of the lesion for fixation, with greater outward deviation of the contralateral eye (acute stage), or adduction of both eyes to midposition for biocular fixation (convalescent stage). In 3 patients whose outward eye deviation with Frenzel goggles was greater on the ipsilateral side, a transition from one-and-a-half syndrome to ipsilateral internuclear ophthalmoplegia was noted, whereas a transition to ipsilateral gaze palsy was seen in the one patient whose deviation was greater on the contralateral side. These findings suggest that in one-and-a-half syndrome patients, the eyes tend to be in divergent positions when fixation is prevented; ipsilateral eye deviation may result from medial longitudinal fasciculus involvement, and contralateral eye deviation may result from paramedian pontine reticular formation involvement. Viewing a target may lead to a secondary deviation or adaptation of eye positions for fixation.
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keywords = visual
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5/23. diplopia as a complication of laser in situ keratomileusis surgery.

    A case is presented of a patient with high myopia who developed vertical binocular diplopia after decentred laser in situ keratomileusis (LASIK) surgery with associated decompensation of pre-existing exophoria into an exotropia. A 40-year-old man underwent LASIK surgery for high myopia in his right eye. Preoperatively, he was approximately -26.00/-2.00 x 35 degrees with visual acuity of 6/12(-2) in that eye. He also had an asymptomatic exophoria. After LASIK surgery, he achieved a refraction of -3.25/-0.50 x 80 degrees with 6/21 best-corrected visual acuity. He also developed binocular diplopia. The ablation zone had been decentred upwards and there was also an exo- and hypo-deviation of his right eye. He was able to superimpose the two images in free space with vertical and horizontal prisms.A hard contact lens also resulted in superimposition of the two images.Vertical decentration of the ablation zone can induce a vertical prism effect after LASIK surgery and result in vertical diplopia. This together with abnormal optics also caused loss of best-corrected vision and decompensation of his pre-existing exophoria into an exotropia.
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ranking = 6.6270465916951
keywords = visual acuity, visual, acuity
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6/23. Clinical and oculographic response to Dexedrine in a patient with rod-cone dystrophy, exotropia, and congenital aperiodic alternating nystagmus.

    PURPOSE: We report a child with retinal dystrophy and congenital (a)periodic alternating nystagmus (APAN) who responded immediately with improved visual function and electrooculographic parameters after taking the psychopharmacologic stimulant Dexedrine Spansule (Glaxo-Smith Kline, NC, USA) as part of treatment for his attention Deficit Disorder. DESIGN: Interventional case report. methods: General ophthalmic, ocular motor and sensorimotor examinations and ocular motility recordings were performed before and after administration of the drug Dexedrine Spansule. RESULTS: The patient's binocular visual acuity improved only at 1.5 after medicine hours from 20/63 to 20/50, his exotropic deviation decreased from 25 to 10 prism diopters, his stereopsis increased from none to 800 sec/arc and ocular motility recordings showed increased foveation periods and more and lengthened APAN transition/null zones. CONCLUSION: For unexplained reasons the stimulant Dexedrine "paradoxically" improved the nystagmus, binocular function and visual acuity in this patient with retinal dystrophy and congenital nystagmus. This observation may be the basis for investigation of a new pharmacological treatment approach to patients with congenital nystagmus or strabismus.
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ranking = 7.6270465916951
keywords = visual acuity, visual, acuity
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7/23. Exodeviation following monocular myopic regression after laser in situ keratomileusis.

    We report a 44-year-old woman with intermittent left exotropia of 35 prism diopters at distance who initially exhibited alignment of both eyes after bilateral laser in situ keratomileusis (LASIK). The exophoria was not preserved due to myopic regression in the dominant eye. An uneventful LASIK treatment was performed to correct -11.00 -0.50 x 130 in the right eye and -13.50 -1.50 x 145 in the left eye. The aim was to achieve emmetropia in both eyes. Although an examination revealed exophoria at near and distance during the 6 months following refractive surgery, the tropic aspect of the divergent deviation appeared in the right eye following the myopic regression. Laser in situ keratomileusis is an effective option to achieve binocular visual quality in myopic anisometropic patients. However, myopic regression after LASIK may disrupt the binocular visual quality.
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ranking = 2
keywords = visual
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8/23. Elimination of paradoxical diplopia following treatment with botulinum toxin and prism.

    BACKGROUND: Paradoxical diplopia occurs when binocular visual cerebral cortex projection of diplopic images (the "subjective angle") is not commensurate and identical with angle or direction of strabismus (the "objective angle"). Its presence infers anomalous retinal correspondence and is manifest as heteronymous or crossed diplopia in esotropia and homonymous or uncrossed diplopia in exotropia. When treated, the prognosis for achieving fusion is poor, while the risk for intractable diplopia is reputedly high. We report a patient with paradoxical diplopia that resolved (and some binocular fusion developed) following botulinum toxin injections and prism therapy. research design: Case report. CASE REPORT: A 25 year old man was evaluated for an exotropia. At age 4 years, he had acquired an esotropia due to a traumatic lateral rectus palsy. The esotropia resolved over 3 years. At age 14 years, he developed a consecutive exotropia. The exotropia was eventually treated surgically. There remained a residual exotropia following surgery, and he experienced paradoxical diplopia and projected it homonymously on all sensory tests as if he was esotropic. Treatment with botulinum toxin injections to both lateral rectus muscles along with a small prismatic correction in spectacles eliminated the exotropia and paradoxical diplopia, permitting some binocular fusion. CONCLUSION: Botulinum toxin injection and prism therapy can be effective in eradicating paradoxical diplopia.
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ranking = 1
keywords = visual
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9/23. Temporal influences on retinal correspondence: ocular motor findings in paradoxical spatial projection.

    BACKGROUND: Paradoxical diplopia is a condition in which objective eye position contradicts subjective localization in visual space. The term "paradoxical" is usually reserved for instances when known sensory adaptations cannot explain the contradiction. The development of this condition begins with infantile or childhood strabismus, followed by the development of a common sensory adaptation, anomalous retinal correspondence (ARC). ARC causes a reduction in the subjective angle of strabismus compared with the objective angle, and in its completed form the subjective angle decreases to zero. There is no "adaptive" mechanism that would increase the subjective angle such that it would be greater than the objective. In cases of treatment by corrective surgery, the anatomically based motor correction leads to a contradiction between eye position and binocular perception. In this event, the objective angle is less than the subjective, and the result is a paradoxical perception. We encountered a 25-year-old woman who experiences paradoxical localization on cover testing in the absence of a manifest strabismus and with no previous surgical intervention. methods: Using a magnetic search coil technique, we evaluated eye movements during fixation, smooth pursuit, saccades, and during cover test conditions to determine how these eye movements correlated to the subjective perception in space. RESULTS: Although smooth pursuit and saccades were normal, there were two elements during cover test that could explain the paradoxical projection. One was the phenomenon that during the cover test the paradoxical projection appeared only when the eye was covered for >4 s. The second was that there was a regression from the full exophoria position toward the midline while the eye was under cover that correlated with a possible paradoxical projection situation. DISCUSSION: ARC, usually associated with a beneficial sensorimotor adaptation, can express itself as a detrimental sensorimotor manifestation. Paradoxical perception also can exist without previous surgical intervention and without the influence of prisms and instrumentation such as the synoptophore. Further studies are indicated to explore the sensorimotor feedback mechanism between eye position and spatial perception.
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ranking = 1
keywords = visual
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10/23. Visual evoked potentials during suppression in exotropic and esotropic strabismics: strabismic suppression objectified.

    BACKGROUND: We performed an electrophysiological study in order to objectify suppression in strabismus. The extent of cortical involvement in the process of interocular suppression was also explored. Possible differences in the suppressive process of esotropic and exotropic strabismics were also studied. methods: An electroencephalographic recorder with eight leads was applied to the posterior one-third of the skull; three occipital, three parietal, and two temporal leads. We measured the activity of these visual cortical areas during stimulation of each eye under monocular as well as binocular viewing conditions with hemisinusoidal light pulses in a nature-like complex visual background. Recordings were made from six primary esotropic strabismic subjects and four primary exotropic and one consecutive exotropic strabismic subject. Also, five normal controls were studied. RESULTS: A characteristic, triphasic response complex was found at approximately 80 ms following the start of each light pulse under monocular viewing conditions in the dominant and the nondominant eye. However, under dichoptic viewing conditions in the nondominant eye of all esotropic cases as well as in the nondominant eye of three of five exotropic cases, this response complex was completely absent. They showed approximately 100% reduction of their cortical response activity. CONCLUSIONS: These results show the vast extent of the cortex that is involved in the suppressive process, giving a good insight in the power of suppression.
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ranking = 2
keywords = visual
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Last update: September 2014