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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

15 year old girl with a droopy (R) eyelid and misaligned (R) eye since birth.

Pre-Op Exam

Pre-Op Exam




(R) superior rectus -5 Elevation OD -5, Elevation OS -3, large ET (aberrant innervation) (R) inferior oblique -5, (L) superior rectus -4 Large (R) Hypo in (R) gaze (R) Hypo 30, XT 18 (R) medial rectus normal (R) inferior rectus -2 XT 40 Relatively normal alignment

Chin-up ++, (R) ptosis +3

Diagnosis

Diagnosis

Congenital ,bilateral IIIrd nerve palsy OD>>OS, with aberrant regeneration

Surgery

Surgery

OR #1: (R) Inferior rectus recess 6 mm, (L) Inferior rectus recess 4 mm

OR #2: (R) Inferior rectus rerecess 11 to 14 mm from limbus

OR#3: Knapp procedure (superior transposition of horizontal recti) OD

OR#4: (L) Lateral rectus recess 6 mm, (L) Medial rectus resect 7 mm

Post-Op Exam

Post-Op Exam




ELEV -4, ET 10 normal (R) Hypo 15 normal DEPRESS OD -3 DEPRESS -3, XT 30

Head straight

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