1/18. Abnormal head posture associated with high hyperopia.BACKGROUND: An abnormal head posture may be adopted for ocular or nonocular reasons. The most common ocular reasons are to maintain binocularity and to obtain the best possible visual acuity. patients with undercorrected or overcorrected refractive errors have been reported to adopt a variety of head positions, thought to be an attempt to obtain the best possible visual acuity. methods: Five patients with symmetric high hyperopia (at least 5.00 D) and an abnormal head posture are presented. RESULTS: All five patients demonstrated an abnormal head posture of chin down for fixation without the spectacle correction in place. This abnormal head posture was eliminated by occlusion of either eye and also by wearing of the refractive correction. No patient demonstrated significant strabismus. CONCLUSION: An abnormal head posture when not wearing spectacle correction can occur in children who have high hyperopia and insignificant strabismus. This may be a mechanism by which the best visual acuity is obtained (indicated by the disappearance of the abnormal head posture on wearing of the glasses) and also to maintain binocularity (indicated by the disappearance of the abnormal head posture under monocular testing conditions). The presence of a chin-down abnormal head posture should alert the examiner to the possible presence of high hyperopia and therefore the necessity for a cycloplegic refraction.- - - - - - - - - - ranking = 1keywords = strabismus (Clic here for more details about this article) |
2/18. spasm of the near reflex mimicking deteriorating accommodative esotropia.PURPOSE: To describe a patient with accommodative esotropia who developed spasm of the near reflex. CASE REPORT: A 6-year-old girl with a history of successfully treated refractive, accommodative esotropia suddenly developed spasm of the near reflex after the death of a relative. The condition resolved after 2 months. CONCLUSION: spasm of the near reflex should be considered in children with accommodative esotropia who seem to deteriorate and become esotropic once again while wearing their hyperopic glasses.- - - - - - - - - - ranking = 25.779526153544keywords = esotropia (Clic here for more details about this article) |
3/18. Angle-supported refractive implantation in stable, adult accommodative esotropia.A patient with hyperopia and accommodative esotropia was implanted bilaterally with hyperopic angle-supported refractive implants. Control of the esotropia was achieved as was some improvement in fusional ability. After three years, the endothelium remains healthy, the eye is quiet and control of the esotropia is maintained.- - - - - - - - - - ranking = 25.779526153544keywords = esotropia (Clic here for more details about this article) |
4/18. Ocular components before and after acquired, nonaccommodative esotropia.BACKGROUND: Acquired nonaccommodative esotropia describes the sudden onset of a constant, comitant strabismus of idiopathic origin in children >6 months of age. CASE REPORT: We present a case of acquired nonaccommodative esotropia at 20 months of age in a subject participating in the Berkeley infant biometry Study, a longitudinal study of emmetropization and ocular component development in infants between 3 months and 3 years of age. Ocular components for this child were normal before the onset of strabismus (within 2 SD's of the mean for orthotropic study participants) for refractive error, corneal power, lens radii, lens power, and ocular axial dimensions. Refractive error postsurgically was significantly more hyperopic and crystalline lens power lower than average at 2.38 D and 37.2 D, respectively. CONCLUSIONS: The lack of abnormal ocular parameters is consistent with the idiopathic etiology of acute onset esotropia. This case suggests that ocular component values may not be useful for assessing the risk of acquired nonaccommodative esotropia.- - - - - - - - - - ranking = 30.46231560405keywords = esotropia, strabismus (Clic here for more details about this article) |
5/18. Unusual presentations of accommodative esotropia.PURPOSE: Most patients with accommodative esotropia are first examined between the ages of 6 months and 2 years. This paper discusses unusual presentations of accommodative esotropia that occur outside of this age-group and/or have a precipitating event that triggered the esotropia. In a series of patients who were from 5 to 11 years of age, trauma was the precipitating event. In some of the patients under 6 months of age, high myopia, as well as a moderate to large amount of hyperopia, was the cause. In 1 teenager, diabetic ketoacidosis precipitated accommodative esotropia. methods: We reviewed all of our records for the past 25 years involving patients with a diagnosis of esotropia, and we found 17 patients who had unusual presentations of accommodative esotropia. Of 8 who were under the age of 6 months, 2 had high myopia and 6 had moderate to large amounts of hyperopia. Nine patients were older than age 5. Eight of the 9 had suffered trauma associated with the presentation of accommodative esotropia, and 1 patient's accommodative esotropia was associated with diabetes. The patients with myopia received their full myopic correction. The children under 6 months of age with hyperopia received their full cycloplegic refraction, and the children over age 5 received the most plus that they were able to accept in a noncycloplegic state consistent with good visual acuity (at least 20/30 in each eye). RESULTS: In 17 patients, accommodative esotropia was initially controlled with glasses. In a few of the trauma cases, bifocals were required for control of near deviation. Only 2 of the patients, in whom onset was under 6 months of age, came to surgery. One had hyperopia controlled for 2 years with glasses, and the other had myopia controlled for 3 years with glasses. CONCLUSIONS: Accommodative esotropia can occur prior to 6 months of age. It can also occur in older children (5 to 14 years of age) and can be precipitated by trauma or diabetic ketoacidosis.- - - - - - - - - - ranking = 51.559052307088keywords = esotropia (Clic here for more details about this article) |
6/18. presbyopia complicating pre-existing strabismus.BACKGROUND: presbyopia may affect pre-existing sensory adaptations or aggravate previously asymptomatic heterophoria. We describe the presentation, underlying problem and management of 11 patients with pre-existing strabismus or heterophoria who presented with new symptoms of double vision attributable to presbyopic change, an association not previously reported. methods: patients with new strabismic symptoms attributable to presbyopia were recruited prospectively over a 1-year period. RESULTS: The 11 patients had had a recent decrease of accommodative amplitude that resulted in blurred vision at near with a breakdown of pre-existing heterophoria (2 patients), alteration of fixation pattern (6 patients), symptomatic alternating fixation (2 patients) or intolerance to correction owing to restrictive strabismus (1 patient). INTERPRETATION: At the onset of presbyopia, symptoms may be varied and subtle. Ophthalmologists and orthoptists should carefully determine the exact nature of the symptoms. Any pre-existing fixation pattern should then be established from the history, old photographs or suppression characteristics. Refractive or surgical management should be aimed at returning the patient to his or her long-standing sensory adaptation. Other important issues, such as incomplete correction of hypermetropia by refractive surgery and problems using bifocals with vertical restrictive strabismus, should be noted.- - - - - - - - - - ranking = 3.5keywords = strabismus (Clic here for more details about this article) |
7/18. Optometric management of optically induced consecutive exotropia.A 5-1/2 year old black female initially presenting with a moderate angle esotropia and latent hyperopia developed a large angle constant exotropia 2 years after final correction of her refractive error. The occurrence of consecutive exotropia as a result of optical correction of hyperopia has been documented infrequently in the ophthalmologic literature and has rarely been mentioned in the optometric literature. While the overall risk for occurrence of this complication from correction of hyperopia may be small, it is a problem which may occur and can be avoided. Unfortunately, there is only limited information about the various risk factors that should be monitored to avoid the occurrence of an optically induced consecutive exotropia. What is available with regard to evaluation and management is scant, and there are no case reports emphasizing optometric management which includes the use of lenses, occlusion and vision therapy. The purpose of this paper is to present a case report of optically induced consecutive exotropia followed by a summary of the available information from the optometric and ophthalmologic literature. This combined information will aid optometrists managing these patients to avoid the occurrence of this problem and better understand the various management aspects when it does occur.- - - - - - - - - - ranking = 3.6827894505063keywords = esotropia (Clic here for more details about this article) |
8/18. Form vision deprivation amblyopia: further observations.Nine cases of esotropia occurring in deprivation amblyopia, where exotropia rather than esotropia is usually found, showed a refractive error of hypermetropia. This fact suggested that an accommodative factor is largely responsible for the development of esotropia. A- or V-pattern strabismus was encountered in a higher incidence in deprivation amblyopia than in ordinary strabismus. Pattern-reversal VEP showed more prominent abnormality than flash VEP did. Studies of the sensitive period of the visual system revealed that the sensitivity is likely to be low for a month or two after birth and increases with a peak around the 18th month of age, decreasing thereafter with a waning slope to the end of the 8th year of life.- - - - - - - - - - ranking = 12.048368351519keywords = esotropia, strabismus (Clic here for more details about this article) |
9/18. Retinal correspondence in typical accommodative esotropia.Typical (refractive) accommodative esotropia is a form of acquired esotropia caused primarily by hypermetropia; correction of the hypermetropic refractive error with convex lenses generally leads to rehabilitation. A significant number of cases clinically diagnosed as typical accommodative esotropia do not, however, respond satisfactorily to this form of treatment, suggesting the presence of nonrefractive etiological factors. Fifty cases diagnosed by conventional methods as typical accommodative esotropia were examined with the fundus haploscope; abnormal or subnormal retinal correspondence was discovered in nearly 50% of the total. Congenital elements are thought to play a contributory role in these cases.- - - - - - - - - - ranking = 29.46231560405keywords = esotropia (Clic here for more details about this article) |
10/18. Bilateral hypermetropic amblyopia.A retrospective analysis was performed on the records of 184 children who had hyperopia of at least 4.0 diopters in each eye to see if bilateral amblyopia was more than just a rare occurrence and to evaluate how well it responded to treatment. Twelve patients were found to have bilateral amblyopia of 20/50 or worse. The mean age at diagnosis was four and a half years (two and a half to six and a half) and mean follow-up was 22 months (five months to seven years, four months). Ten of 12 patients showed improvement of vision to 20/40 or better in both eyes. Treatment consisted of full cycloplegic correction in all cases. Six patients had accommodative esotropia but this did not account for the bilateral nature of the amblyopia. Bilateral amblyopia should be considered in patients with large amounts of hyperopia. It responds well to treatment with standard amblyopia therapy.- - - - - - - - - - ranking = 3.6827894505063keywords = esotropia (Clic here for more details about this article) |
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