A-pattern and V-pattern strabismus

Discussion in 'Optometry Archives' started by Peter, Nov 6, 2004.

  1. Peter

    Peter Guest

    Hi all,

    I can see a single perfectly perpendicular line as two tilted lines,
    joined at the top, resembling the letter "A". I was wondering is this
    an "A" pattern syndrom, or a "V"-pattern syndrom? I actually got
    doagnosed with an "A" pattern, but thinking logically I think that it
    is a "V" pattern. In the "V" pattern, eyeballs follow the lines of the
    letter "V", and therefore, what the patient really sees should be a
    mirror image, i.e. the letter "A". Is my thinking correct?

    I believe the letter syndroms are associated with cyclotropia. By the
    way, is there a commonly accepted criterion about the extent of
    cyclotropia that is operable? For instance, is a 15 degree angle
    excyclotropia operable? A 5-degree incyclotropia?

    Thanx,
    Peter
     
    Peter, Nov 6, 2004
    #1
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  2. Peter

    Peter Guest

    Dr/Mr. Tyner,

    Thanx for the reply.

    If I see a vertical line as 2 lines, the top of the left one (seen by
    left eye) tilted toward the nose, and the top of the right line (seen
    by right eye) tilted toward the nose, thus forming an "A"-pattern,
    does that mean I have 2 excyclotropias? I was diagnosed with having an
    excyclotropia and incyclotropia, but it seems to me I have 2
    excylcotropias.

    Best,
    P.
     
    Peter, Nov 7, 2004
    #2
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  3. Since both lines tilt inwards at the top, that means the eyes are rotated
    outwards at the top, that is, excyclotorsion of each each. HOWEVER, most
    people, even if they have it each eye, generally on notice it in the
    nondominant eye. The torsion in the dominant eye is generally "zeroed out"
    by you system; it perceives it as the "normal".

    In any case, torsions less than about 10 degrees total tend not to be a
    problem - your system often can fuse such an angle. Larger angles can be
    operated. The surgery is a Harada-Ito procedure, to rotate the eye inwards
    (incyclotort it) by advancing the anterior portion of the superior oblique
    tendon.
     
    David Robins, MD, Nov 9, 2004
    #3
  4. Peter

    Peter Guest

    Dr. Robins,

    Thank you for your reply.

    Can, iinstead of the Harada-Ito operation, a recession of the inferior
    oblque be performed? The inferior oblique is an excyclorotator, so if
    it is relaxed by a recession, is it going to relieve the
    excyclotropia?

    P.S. I have read that there is a risk of Brown Syndrome if the
    superior oblique is operated. And how about Botox, my impression is
    that it's not used for cyclotropia?

    Peter
     
    Peter, Nov 10, 2004
    #4
  5. The inferior oblique cannot be operated in a way to affect torsion without
    influencing elevation. The Harada-Ito does just that. Weakening (recessing)
    the iferior oblique it can increase intorsion, but it will reduce elevation
    of the eye, especially in upgaze and up-and-in gaze on that eye, cauing
    diplopia.

    Browns can result from tucking the posterior part or all of the superior
    oblique. Advancing the anterior 1/4 of the muscle, as in the Harada-Ito,
    does not (normally).
     
    David Robins, MD, Nov 11, 2004
    #5
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