Complex Strabismus Treatment in Delhi

As world-renowned strabismus specialists, Child EYE Specialists are experienced in treating patients with even complicated cases of complex strabismus. These cases may occur due to a pre-existing condition like thyroid disease, or due to a stroke, brain tumor, or perhaps head trauma.

Complex strabismus conditions that Child Eye Specialist specialize in:

• Duane's syndrome

Duane’s syndrome occurs generally though not exclusively, in the left eye of females, who are typically otherwise healthy. Duane’s syndrome has several variants that exist with various eye movement abnormalities. The most typical type is that the eye doesn't move outwards from the usual straight-ahead position. When the involved eye moves inverse direction towards the nose the eye is pulled slightly into the eye socket causing a narrowing of the opening of the eyelids.

• Brown’s syndrome

Brown’s syndrome is a condition typically present from birth but later in life, the eye not be able to move upward direction, especially when it's turned toward the nose. This is often caused by a lack of ability of the superior oblique muscle, part of the eye muscles, to slip through its natural pulley system along the bony wall of the eye socket. This condition is usually first noted in children when their parent notes that the uninvolved eye is “floating” up when their kid looks to the side when it's the opposite side eye that isn't moving up normally.

• Mobius syndrome

Mobius syndrome is distinguished by multiple disturbances of the cranial nerves that give impulses to the muscles of the eyes and face. The most notable inability is that one or both eyes move outwards. This occurs with eye crossing at birth which generally must be corrected with eye muscle surgery. The involvement of the nerves that provide the muscles of the face is noted by early difficulty with sucking and feeding, furthermore as deficient closing of the eyes during sleep. The face can seem like a mask in that the potential to smile or wrinkle the forehead is absent.

• Third nerve palsy

Third nerve palsy refers to a delicateness of the nerve that supplies impulses to four of the six extraocular muscles and to the muscle that raises the eyelids. It might be congenital or acquired following head trauma, tumor, stroke, or aneurysm. The affected eye is mostly misaligned outward (exotropia) and downward (hypertropia). At that time an associated drooping eyelid (ptosis) or enlarged pupil.

• Fourth nerve palsy

Fourth nerve palsy refers to a weakness of the nerve that supplies impulses to the superior oblique muscle, a muscle of the eye that has the most function of moving the eye downwards.

• Sixth nerve palsy

Sixth nerve palsy refers to a weakness of the nerve that supplies impulses to the lateral rectus muscle, the muscle of the eye that is in control of moving the eye outward. This is often usually an acquired condition that may present with the gradual or sudden onset of eye crossing with blurry vision along with the incapability of the eye to move outward. An abnormal face turn may occur to relieve the blurry vision.

• Thyroid eye disease

Strabismus related to thyroid diseases occurs as inflamed muscles change to become fibrotic and stiff. All the extraocular muscles are affected, but the inferior rectus (IR) and rectus medialis muscles are most severely involved. Asymmetric IR fibrosis will originate a hypotropia with limited preferment of both eyes, worse on the side of the hypotropic eye. Fibrosis of the medial rectus muscles results in an esotropia.

Principles and Management of Complex Strabismus

• Perform an intensive history. Most of the data needed to manage complex strabismus is obtained from history.
• Keep an open mind until the diagnosis is definite. Don't ever try to fit the patient into your first diagnostic impression.
• Allow time for in-depth examination, and measure ocular motility itself. Schedule a return appointment, if necessary.
• Additional diagnostic tests are selectively chosen as needed; orbital CT scan to rule out fracture, and chronic sinusitis & examine extraocular muscles, MRI scan of the brain, tension test, laboratory tests for thyroid function, and rheumatologic disease.
• Final diagnosis may await the preoperative assessment, including forced removal to rule out fibrosis, restrictions, or weakness, and direct imaging of the extraocular muscles to rule out trauma, malposition, or healing abnormality following prior strabismus surgery.
• During surgery, be flexible in approach to permit unexpected findings. After repair, use a spring-back test to ensure centration of the eye, and reposition muscle(s) if necessary. 
• Postoperatively tailor steroid use to the condition, and use adjunctive procedures like motility exercise and in-office forced duction to expand range of motion.
 

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