Common Strabismus Entities That Require Altering One's Routine Approach

Abstract

Perhaps one reason for variable results in strabismus management is the presence of subtle characteristics which require altering one's standard treatment protocol. After studying several specific problem areas in strabismus, I offer some ideas suggested by various authors.

In the treatment of infantile esotropia, preoperative and intraoperative abduction deficits may cause surgical under-corrections; therefore, preoperative alternate occlusion and/or conjunctival recessions should be considered.

A hallmark of nystagmus compensation syndrome is variability, both preoperatively and postoperatively; recognition of this syndrome and acknowledgement of its variability to the patient/parents is important.

Since infant eyes are significantly smaller, some ophthalmologists measure axial lengths to keep their medial rectus reinsertions anterior to the equator when operating for infantile esotropia.

In the treatment of intermittent exotropia, one may approach lateral incomitance with caution to avoid overcorrections; however, small angle, comitant, intermittent exotropia seems to be easily undercorrected. A trial of base-in prism equal to or slightly exceeding the amount of deviation may be a useful diagnostic test. Undercorrections have been a problem of divergence excess type exotropia. It has been suggested that the deviation at far distance (out the window) or after a patch test may be the angle for surgical correction.

Several authors have indicated that they would perform asymmetric bilateral superior rectus recessions on patients with asymmetric DVD with fixation preference.

• strabismus
• esotropia
• exotropia
• dissociated vertical deviations
• prisms