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Case Atlas

Esodeviations
- Pseudoesotropia
- Infantile esotropia
  - 058 - Infantile esotropia
  - 065 - Infantile esotropia, “V” pattern, inferior oblique overactions, dissociated vertical deviations
- Moebius syndrome
  - 077 - Moebius Syndrome
- Esotropia with nystagmus
- Non-accomodative esotropia
- Partially accommodative esotropia
  - 037 - Esotropia, partially accommodative
- Sensory esotropia
  - 078 - Sensory esotropia; Cataract
- Consecutive esotropia
- “A” pattern esotropia
  - 072 - Esotropia, “A” pattern
  - 039 - "A" pattern esotropia c oblique dysfunction
- “V” pattern esotropia
  - 073 - Esotropia, “V” pattern, inferior oblique overactions
  - 067 - Esotropia, “V” pattern
- Esotropia with myopia
  - 047 - Esotropia; High myopia
Exodeviations
- Pseudoexotropia
- Congenital exotropia
  - 068 - Congenital exotropia; Dissociated vertical deviation
- Intermittent exotropia
  - 030 - Intermittent exotropia
  - 050 - Intermittent exotropia, “A” pattern, bilateral superior oblique overactions
- Sensory exotropia
- Consecutive exotropia
  - 044 - Exotropia, consecutive, superior and inferior oblique overactions, “X” pattern
  - 060 - Exotropia, consecutive; Dissociated horizontal deviation, bilateral
- “Tight lateral rectus” syndrome
  - 035 - Exotropia; Tight lateral rectus syndrome
- “A” pattern exotropia
- “V” pattern exotropia
  - 033 - Exotropia; “V” pattern; Inferior oblique overaction, bilateral
  - 056 - Exotropia, “V” pattern, bilateral inferior oblique overactions
- DHD (Dissociated horizontal strabismus)
A + V Patterns
- "A" pattern esotropia
  - 039 - "A" pattern esotropia c oblique dysfunction
  - 072 - Esotropia, “A” pattern
- "V" pattern esotropia
- "A" pattern exotropia
- "V" pattern exotropia
  - 033 - Exotropia; "V" pattern; Inferior oblique overaction, bilateral
  - 056 - Exotropia, “V” pattern, bilateral inferior oblique overactions
- Duane syndrome with up/down shoots
  - 019 - Duane syndrome (Type III), downshoot
- Brown syndrome
  - 024 - Brown syndrome
- Congenital fibrosis syndrome
  - 048 - Congenital inferior rectus fibrosis
- Bilateral superior oblique palsy
  - 018 - Superior oblique palsy, bilateral
Paralytic Strabismus
- Superior oblique palsy (unilateral)
- Superior oblique palsy (bilateral)
- IIIrd nerve palsy – complete
- IIIrd nerve palsy – partial
  - 102 - VIth nerve palsy, partial, unilateral
- IIIrd nerve palsy – bilateral
- VIth nerve palsy – complete
- VIth nerve palsy – partial
- VIth nerve palsy – bilateral
- MED (monocular elevation defect)
- Inferior oblique palsy
  - 040 - Inferior oblique palsy
  - 092 - Inferior oblique palsy
- Inferior rectus palsy
- Moebius syndrome
  - 077 - Moebius Syndrome
- Botox
- Medial rectus palsy
  - 085 - Medial rectus palsy, unilateral
Restrictive Strabismus
- Congenital fibrosis syndrome
  - 057 - Congenital inferior rectus fibrosis, Bilateral; Exotropia
  - 098 - Congenital fibrosis of the extraocular muscles
- Brown syndrome
- Blowout fracture
  - 096 - Blow-out fracture, posterior fixation suture
- Thyroid-related strabismus
- “Dogbite” syndrome
  - 036 - Dogbite syndrome
- Post retinal detachment surgery
- EsoHypotropia with high myopia
- Post functional endoscopic sinus surgery (FESS)
  - 110 - Restrictive exohypertropia
Vertical Deviations
- DVD (dissociated vertical deviation)
Miswiring Syndromes
- Duane syndrome I, II, III
- IIIrd nerve palsy with aberrant regeneration
  - 008 - IIIrd nerve palsy, aberrant regeneration
  - 029 - IIIrd nerve palsy, aberrant regeneration
- Congenital fibrosis syndrome
- Marcus-Gunn jaw-winking
  - 087 - Marcus-Gunn jaw-winking + MED
Strabismus Surgery-Related Problems
- “Tight lateral rectus” syndrome
  - 035 - Exotropia; Tight lateral rectus syndrome
- Slipped medial rectus
  - 015 - Slipped medial rectus muscle; Exotropia
  - 074 - Lost medial rectus; Exotropia
- Lost medial rectus
  - 038 - Exotropia; Lost medial rectus
- Silicone-spacer fibrosis
  - 097 - Bilateral restrictive hypotropia post-silicone-spacer insertion
- Post-op Brown syndrome
- Antielevation syndrome
  - 091 - Antielevation syndrome
Myopathies With Strabismus
- CPEO (chronic progressive external ophthalmoplegia)
- MD (myotonic dystrophy)
- OPS (oculopharyngeal syndrome)
- MG (myasthenia gravis)
  - 023 - Myasthenia Gravis
Neuropathies With Strabismus
- Nuclear IIIrd nerve palsy
  - 042 - IIIrd nerve palsy, nuclear
  - 055 - IIIrd nerve palsy, bilateral, nuclear
- Nuclear VIth nerve palsy
  - 076 - VIth nerve and VIIth nerve palsy, bilateral
- “1-1/2” syndrome
- Skew deviation
- Parinaud’s syndrome (DMS)
- INO (internuclear ophthalmoplegia)
  - 069 - Internuclear ophthalmoplegia
- WEBINO (wall-eyed bilateral INO)
  - 033 - Exotropia; "V" pattern; Inferior oblique overaction, bilateral
- Vertical gaze palsy
Post Traumatic-Strabismus
- Blowout fracture
- Ruptured IR
  - 084 - Ruptured inferior rectus
  - 101 - Ruptured inferior rectus
- Ruptured MR
- FESS (Functional endoscopic sinus surgery) related
  - 110 - FESS related restrictive exohypertropia
Nystagmus
- Congenital
  - 103 - Congenital motor nystagmus - Kestenbaum
- Acquired
  - 099 - Superior oblique myokymia

All Cases

History

A 37 year-old woman presents with a wandering eye and left head tilt since childhood.

Pre-Op Exam

Pre-Op Exam




(L) inferior oblique normal RHT 6 (R) hypertropia in upgaze RHT 20 (R) inferior oblique +3 RHT 25 (R) hypertropia in (R) gaze RHT 15 (R) hypertropia in primary position RHT 22 (R) hypertropia in (L) gaze RHT 25 (R) inferior rectus -1 RHT 22 (R) hypertropia in downgaze RHT 15 (R) superior oblique underaction -2 RHT 22

Note:
BiMaddox test: excyclotorsion 4 degrees

Pre-Op Exam 2

Pre-Op Exam 2




(R) Hypertropia increases on tilt to the right habitual head position: tilt to the left (R) hypertropia decreases on tilt to the left

Head tilts

Diagnosis

Diagnosis

Right superior oblique palsy (Knapp type IV)

Surgery

Surgery

Right inferior oblique disinsertion myectomy
Left inferior rectus recess 4 mm

Post-Op Exam

Post-Op Exam




(R) inferior oblique normal head posture normal eyes straight in primary position

Website Authors:
Daniel Flanders MD, FRCPC
Norman Mainville MD, FRCSC
Pascale Dubé MD, FRCSC
Michael Flanders MD, FRCSC

Contact Information:
For any comments or questions, please contact:
Michael Flanders
michael.flanders@mcgill.ca