Congenital esotropia represents the most common type of strabismus. Its pathogenesis, however, remains uncertain. It is typically characterized as a large angle, constant esotropia with onset during the first six months of life. Associated clinical findings include normal refractive errors for age, amblyopia, dissociated vertical deviation, inferior oblique muscle overaction and nystagmus. It must be distinguished from Duane's retraction syndrome, Moebius syndrome, nystagmus blockage syndrome, and early onset accommodative esotropia, as well as other causes of esotropia in infancy. The surgical management may involve recession of both medial recti muscles, unilateral recession of a medial rectus muscle and a resection of a lateral rectus muscle or three or four muscle surgery.

Botulinum Toxins↗

PubMedDate not supplied

Congenital fibrosis of the extraocular muscles.

Congenital fibrosis of the extraocular muscles is characterized by the replacement of normal contractile muscle tissue by fibrous tissue or fibrous bands in varying degrees. The clinical entities which result from the fibrous replacement can be classified under the following headings: general fibrosis syndrome, congenital fibrosis of the inferior rectus muscle with blepharoptosis strabismus fixus, vertical retraction syndrome and congenital unilateral fibrosis, enophthalmos, and blepharoptosis. Genetic factors may or may not be apparent. One pedigree with general fibrosis syndrome was traced through five generations. Light and electron microscopy demonstrated replacement of normal muscles by collagen and dense fibrous tissue with occasional areas of degenerated skeletal muscle. The surgical management attempts to achieve some functional readjustment of the ocular and lid position as well as the abnormal head posture. The surgical results were considered satisfactory when compared with the original position of the eyes and the backward head tilt.

Adolescent↗

PubMedDate not supplied

Ocular manifestations of child abuse.

The ocular manifestations of the "battered baby" or the physically abused child are numerous and play a prominent role in the recognition of this syndrome where the ophthalmologist is sufficiently informed concerning the characteristic features. Nonaccidental trauma must always be considered when examining a child under three years of age exhibiting intraocular hemorrhages, leukocoria, cataract or subluxated lens, retinal detachment or dialysis, Coats' disease, chorioretinal scarring, macular scarring, or periorbital ecchymosis. In addition, certain guidelines including the history, socioeconomic circumstances, general condition of the patient and disproportionate soft tissue injury compared to external signs may help stimulate the awareness of the physician toward the actual etiology. Ophthalmologists may be among the first to examine these traumatized infants so that prompt recognition is urgent since there is a known high incidence of morbidity and mortality. Reporting suspected nonaccidental injuries is required by law in every state. Any district attorney's office or child welfare agency can inform a physician about legal details. Failure to report a suspected case can be a serious misdemeanor in most states.

Adult↗