As world-renowned strabismus specialists, Child EYE Specialist 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.
Duane’s syndrome occurs generally though not exclusively, in left eye of females, who are typically otherwise healthy. Duane’s syndrome has a number of variants that existing with various eye movement abnormalities. Most typical type, is that eye isn'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 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 in toward the nose. This is often caused by lack of ability of the superior oblique muscle, part of eye muscles, to slip through its natural pulley system along the bony wall of eye socket. This condition is usually first noted in children when there parent notes that the uninvolved eye is “floating” up when there kid looks to the side, when actually its the opposite side eye which isn't moving up normally.
Mobius syndrome is distinguish by multiple disturbances of the cranial nerves gives impulses to the muscles of the eyes and face. Most notable inability is that one or both eye move outwards. This occur wirh 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, further more as deficient closing of the eyes during sleep. The face can seem like a mask in that potential to smile or wrinkle the forehead is absent.
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 rise the eyelids. It might be congenital or acquired following head trauma, tumour , stroke or aneursysm . 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 refers to a weakness of the nerve that supplies impulses to the superior oblique muscle, a muscle of eye which has the most function of moving the eye downwards.
Sixth nerve palsy refers to a weakness of the nerve that supplies impulses to the lateral rectus muscle, the muscle of eye which is in control of moving eye outward. This often usually an acquired condition which may present with the gradual or sudden onset of eye crossing occue with blurry vision along with the incapability of the eye to move outward. An abnormal face turn may occur in order to relieve the blurry vision.
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 origin a hypotropia with limited preferment of both eyes, worse on the side of the hypotropic eye. Fibrosis of the medial rectus muscles get outcome as an esotropia.
• Perform an intensive history. Most of the data needed to manage complex strabismus is obtained by the 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, chronic sinusitis & examine extraocular muscles, MRI scan of brain, tensilon 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 for unexpected findings. After repair, use spring-back test to assure centration of 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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