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PubMedDate not supplied

Varying esotropia-exotropia.

A 20-year old female was found to have an alternating pattern of right esotropia and right exotropia following surgery for a clivus chordoma three years previously. When esotropic, abduction was markedly limited while adduction was full in the right eye. When exotropic, mild limitation of both abduction and adduction was noted. Horizontal saccadic velocity studies were consistent with the diagnosis of sixth nerve palsy when esotropia was manifest and a Duane's syndrome, type II when exotropia was present. The etiology of these unusual findings is not well understood.

Adult↗
PubMedDate not supplied

The surgical overcorrection of intermittent exotropia.

Many strabismus surgeons recommend an initial surgical overcorrection for intermittent exotropia. Others caution against overcorrection because of possible nasal suppression and amblyopia in children, or because of possible diplopia in adults. We reviewed the records of 69 patients who were initially overcorrected following surgery for an intermittent exotropia. The mean postoperative follow-up was 3.1 years. Eight patients (11.6%) had a persistent overcorrection of 3 prism diopters or more and three patients (4.3%) had persistent diplopia. Patients with a persistent overcorrection had a greater mean age (P less than .02) and a greater mean initial overcorrection (P less than .005) compared with the patients who were not overcorrected 3 delta or more. No child lost stereoacuity or developed amblyopia due to the overcorrection.

Adolescent↗
PubMedDate not supplied

Excessive single lateral rectus muscle recession in the treatment of intermittent exotropia.

Ten patients with small angle intermittent exotropia of 14 to 16 prism diopters were treated by unilateral lateral rectus muscle recession of 11.5 to 12 mm on the nondominant eye. In the immediate postoperative phase, overcorrection of 4 to 6 delta gave a very good functional result. Abduction deficiency was minimal for recession up to 12 mm. This procedure should be considered as an alternative approach in the treatment of small angle intermittent exotropia showing a "basic" pattern.

Child↗
PubMedDate not supplied

Lateral incomitance in exotropia: fact or artifact?

The prevalence of significant lateral incomitance in patients with nonparetic exotropia is reported to be 22%. We speculated that measurement artifact may be the cause for some cases of apparent lateral incomitance. We measured the effective power of plastic ophthalmic prisms using a helium-neon laser in the frontal plane position and at 10 degrees, 20 degrees, and 30 degrees of rotation from the frontal plane. The rotated prisms represented the situation in which a neutralizing prism rotates with the head during measurement of lateral gaze positions. For prisms of 35 prism diopters or more, even 10 degrees of rotation produced significant artifactual incomitance. For smaller prisms, 20 degrees or more of rotation was necessary to induce significant lateral incomitance. We prospectively measured 40 consecutive patients with exotropia. Only three patients (9%) had true incomitance greater than 5 delta, and only one had incomitance in both directions of gaze. Significant lateral incomitance could be induced in every patient examined by improperly positioning the neutralizing prism. Because the detection of lateral incomitance causes most strabismus surgeons to reduce the amount of surgery they perform, special care is necessary when measuring deviations in lateral gazes.

Diagnostic Errors↗
PubMedDate not supplied

An alternative approach to the surgical management of exotropia--the unilateral lateral rectus recession.

Fifty-five patients with moderate angle exotropia of 15 to 20 prism diopters were surgically treated with a unilateral lateral rectus recession of 7.0, 7.5, or 8.0 mm. The mean age at surgery was 14.5 years. The mean preoperative deviation was 18.0 delta. The mean lateral rectus recession was 7.6 mm. At the initial postoperative follow up, all patients were either a small-angle exotropia or esotropia, or orthophoric. Twenty-eight of the 55 patients (51%) were orthophoric at their most recent follow up. Twenty-four patients (44%) were undercorrected, with 22 of these having residual exodeviations less than 8 delta. Three patients (5%) were overcorrected.

Adolescent↗
PubMed1999

[Consecutive exotropia as a result of esotropia surgery].

PURPOSE: To find out the probable reasons of the postoperative consecutive exotropy. MATERIAL AND METHODS: We studied 22 patients aged more than 14 years, operated due to esotropia during the first 7 years of life. Two categories were formed: the first contained the patients in the age between 14 and 18, and the second one the patients 19 years old and older. The period between the first and the second procedure was not shorter than seven years. The reoperations were performed due to exotropia in 15 cases. The following examinations were performed before the surgery: visual acuity, squint angle, eye movements, convergention, binocularity by Sobański, Bagolini, TNO, Worth, Titmus tests and with synoptofor. RESULTS: We found out the probable reasons of the postoperative exotropia: incorrect, unconservative surgery, high hypermetropia, primary vertical deviation, amblyopia, absence of binocularity, simultaneous surgery for 3 or 4 muscles, too extensive surgery and irregular treatment.

Adolescent↗
PubMed2000

Intermittent exotropia: stimulus characteristics affect tests for retinal correspondence and suppression.

BACKGROUND AND PURPOSE: Prior studies have reported various sensory responses in subjects with intermittent exotropia [X(T)]. These varying responses have been proposed due to differences in stimulus targets, backgrounds, or even a lack of control of binocular alignment. This study investigated the effects of varying target and background stimuli while controlling binocular alignment. METHODS: Eight X(T)s of the divergence excess or basic type were presented dichoptic computer generated visual stimuli while an infra red eye movement monitoring system determined horizontal eye position of each eye. Target and background were varied to assess their effect on sensory responses during latent and manifest exotropia. RESULTS: Most of our X(T)s demonstrated, while tropic, a consistent, i.e., dominant, type of retinal correspondence, i.e. a response that occurred on most tests, independent of the stimulus or background used for testing. Four subjects demonstrated harmonious anomalous retinal correspondence (HARC) while three subjects demonstrated normal retinal correspondence (NRC) with three out of four of the tests. In two out of four stimuli used for testing, one subject demonstrated NRC and another HARC. CONCLUSIONS: Complex backgrounds resulted in the largest number of suppressions, whereas blank backgrounds decreased the number of reported suppressions.

Adaptation, Ocular↗
PubMed2002

[A case of non-paralytic pontine exotropia with vertical dissociated nystagmus in the contralateral eye].

We report a 74-year-old woman presenting non-paralytic pontine exotropia (NPPE) with vertical monocular nystagmus in her contralateral eye, due to a small infarction in the upper pons. On forward gaze, the ocular position of the right eye was fixed at the midline, while the left eye was abducted. On the leftward gaze, the left eye was abducted and monocular nystagmus was noted, but the right eye was not able to pass midline, which indicated NPPE. Neither a skew deviation nor an alternating exotropia was observed. In the acute phase of this case, disturbances in the vertical eye movement of her right eye and the monocular upper gaze-evoked nystagmus of her left eye were observed. On the 7th hospital day, the monocular nystagmus disappeared simultaneously with an improvement of vertical eye movement. This finding suggests that the patient's vertical monocular nystagmus occurred due to an adaptive increase in the innervation to the left eye according to Hering's law of equal innervation, which indicates either horizontal dissociated nystagmus in MLF syndrome or NPPE.

Aged↗
PubMed1992

[Pontine infarction presenting non-paralytic pontine exotropia--evaluation of its clinical course and its MRI findings].

We report two patients with brainstem infarction who presented non-paralytic pontine exotropia (NPPE) in acute phase. Case 1 was a 76-year-old woman. NPPE observed 3 hours after the onset disappeared two days later. Case 2 was a 60-year-old man. Paralytic pontine exotropia was observed 4 hours after the onset of his stroke. NPPE was noted on the next day and left medial longitudinal fasciculus (MLF) syndrome was still present on the third day. Seven days later, the disturbances of ocular movement was disappeared. T2-weighted cranial MRI showed high signal intensity lesions in the paramedian portion of the mid-pontine tegmentum beneath the fourth ventricle in both cases. Although it has been thought that NPPE is a rare clinical symptom, we think that NPPE is by no means a rare symptom in the acute stage of brainstem infarction.

Aged↗
PubMed1992

[Paralytic pontine exotropia disclosing endocarditis].

A case of bacterial endocarditis complicated by paralytic pontine exotropia is reported. Magnetic resonance imaging clearly showed a rostral lesion of the paramedial pontine reticular formation and the medial longitudinal fasciculus. The occurrence of paralytic pontine exotropia is suggestive of ischaemia, and patients with this so-called "one-and-a-half syndrome" associated with signs of infection should be investigated for endocarditis.

Brain Ischemia↗
PubMed2003

Intermittent exotropia with high AC/A ratio: is it a bane to surgical cure? Some facts and fictions of the two clinical tests: occlusion of one eye and the use of +3.00 spherical lenses.

BACKGROUND AND PURPOSE: To review the multiple factors in intermittent exotropia (X(T)) responsible for the discrepancy between the distance and near deviations; to challenge the classification of X(T) into types according to the two standard clinical tests of occlusion of one eye and the use of +3.00 D spherical lenses at near by demonstrating the pitfalls of these two tests, as in X(T), masquerading as high AC/A ratio at times or as strong proximal fusional convergence at other times. METHODS OF STUDY: Fifteen patients demonstrating findings characteristic of X(T) with so-called high AC/A ratio are reported. Fourteen patients had an exodeviation initially. The fifteenth had become exotropic following medial rectus recessions for infantile esotropia. Fourteen patients had bilateral lateral rectus recession and one had unilateral lateral rectus recession. RESULTS: The only patient who did develop a long term postoperative overcorrected high AC/A ratio esotropia was the patient who had initially an infantile esotropia. Of the other 14 patients initially X(T) none developed a long term postoperative overcorrected high AC/A ratio esotropia. Fifty % of these were "cured" (OT +/- 8 delta) and 50% had a "significant (> or = 8 delta) recurrence" of their exodeviation. CONCLUSION: Patients with intermittent exotropia and significantly more exodeviation at distance than at near, and classified to have high AC/A ratio by occlusion of one eye and the use of +3.00 spheres at near, do not necessarily have a high accommodation-convergence relationship but rather, other factors mimicking this high AC/A relationship. They do not necessarily develop a postoperative overcorrected high AC/A ratio esotropia.

Accommodation, Ocular↗
PubMed1992

[Short-term and long-term prognosis of recession-resection surgery for exotropia].

The short- and long-term results of recession-resection surgery on 141 exotropic patients were analyzed. The corrected angle of exodeviation one week after surgery was not affected by age at surgery, state of binocular vision or the type of intermittent exotropia. The corrected exodeviation was larger when the pre-operative exodeviation exceeded 30 prism diopters or when previous surgery had been performed. Since there was no difference between the angle of deviation at 4 and 8 years postoperatively, the period of four years was considered to be appropriate for long-term assessment. Post-operative exophoria of less than 15 prism diopters were obtained in patients whose short-term results were overcorrected or were under 5 prism diopters of exodeviation. The surgical guideline for exotropia should be determined considering the short-term and the long-term prognosis. It was concluded that the optimal time for surgery was between 5 and 10 years of age.

Adolescent↗
PubMed2004

Some clinical characteristics of V-pattern exotropia and surgical outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 22 consecutive patients and a comparison with V-pattern esotropia.

BACKGROUND AND PURPOSE: A V-pattern exotropia (XT) with bilateral overaction of the inferior obliques (IO) and/or underaction of the superior obliques (SO) is a common finding. The clinical characteristics of this condition in a large series are not available in the scientific literature. Also, data is lacking about the surgical outcome of graded bilateral IO recession. Lastly, a comparison of the pre- and postoperative findings of a V-pattern exotropia population with those of a V-pattern esotropia population is also lacking in the literature. SUBJECTS AND METHODS: Twenty-two consecutive patients without complicating factors were fully evaluated and submitted to bilateral graded recessions of the IO; 19 were also operated for a horizontal binocular alignment imbalance. RESULTS: Preoperative findings: The distribution of V patterns showed 77.2% in the range of 15 to 25 prism diopters (PD) and 22.8% in the range 26 to 35 PD. An overaction of the IO was present bilaterally in 86.4% of the patients and unilaterally in 4.5%. Bilateral underaction of the SO was observed in 4.5% and unilateral in 13.6%. Bilateral overaction of the SO was seen in 18.2% and unilateral in 31.8%. Elevation in adduction was observed bilaterally in 13.6% and unilaterally in 31.8%. A vertical deviation was seen in 50.0% and a marked tendency of it to vanish or diminish in the up- and down positions, as well as at near, was observed. After surgery, 72.7% had less than 15 PD of V pattern or less than 10 PD of A pattern; 36.4% had the V pattern fully corrected. Surgery eliminated a vertical imbalance in 72.7% of the patients, reduced in 9.1%, left unchanged in 9.1% and increased in 9.1% Of the 11 patients devoid of vertical deviation, 72.7% remained so and in 27.3% a vertical deviation was created. Binocularity: There was an improvement of the fusional status with surgery, (ascertained with the Worth Four Dot Test and the major amblyoscope measurement). CONCLUSION: All cases were in the range of 15-35 PD preop'. Overaction of the IO was a prominent finding. Underaction of the SO was less prevalent as compared with a V-ET population. Overaction of the SO was observed bilaterally in 18.2% and unilaterally in 31.8%, a finding never detected in a V-ET population. A vertical imbalance was observed in one-half of the cases. A good outcome (collapse of the V pattern) was obtained with bilateral graded recession of the IO, This procedure is relatively safe concerning the vertical alignment.

Adolescent↗
PubMed1991

[Reversion of eye position after surgical correction of exotropia].

The authors analysed the reversion of eye position in 62 postoperative patients of concomitant exotropia. The results indicated the presence of a correlation with the preoperative condition of binocular vision, the type of strabismus, and the age of patient. The authors opened that the amplitude of surgical correction should depend on these factors, and prudence should be exercised in recommending surgical intervention for mild intermittent exotropia in children.

Adolescent↗
PubMed1989

[The surgical treatment of intermittent exotropia].

77 cases of surgically treated intermittent exotropia were followed up for analysis with regard to the relation between the age of operation and curative effect, the age and post-operative restoration of homologous retinal correspondence, and the effect of over-correction on final orthophoria. The authors were of the opinion that the earliest surgical intervention was conducive to recovery of Grade III visual function and restoration of homologous retinal correspondence, and slight over-correction was significant for final orthophoria. They recommended that the earliest surgical intervention be accorded patients with intermittent exotropia of 20 delta and over, instead of purposeless waiting and observation.

Adolescent↗
PubMed1989

Management of intermittent exotropia using a combination of vision therapy and surgery.

Vision therapy has been shown to provide higher success rates than surgery in the treatment of intermittent exotropia, but vision therapy is not successful in all cases. A case of intermittent exotropia is presented that illustrates the use of vision therapy in combination with surgery. Issues that should be considered when selecting this treatment option are discussed.

Adult↗
PubMed1987

Divergence excess exotropia.

This paper presents a summary of information regarding divergence excess exotropia. The first portion of the paper deals with the description (i.e., definition, onset, natural history, prevalence, sexual distribution, symptomatology, and the differential diagnosis of the two subtypes) of this entity. The second portion of the paper reviews the various treatment options (surgery, lens therapy, prism therapy, and vision training) currently available with emphasis on vision training/orthoptics. We conclude that divergence excess exotropia is effectively managed at least as well by vision training/orthoptics as it is by surgery. We propose that future research examine in greater detail the characteristics of the subtypes of this entity to potentially derive improved training techniques for this population.

Exotropia↗
PubMedDate not supplied

[Internuclear ophthalmoplegia and non-paralytic pontine exotropia].

The authors discuss internuclear ophthalmoplegia associated with non-paralytic pontine exotropia of the contralateral eye. Impairment of the posterior oculogyric tract in its protuberantial segment, resulting in oculographic signs of alteration in the contralateral continuation. Seems to be responsible for the exotropia.

Aged↗