American Orthoptic Journal Anissas Fun Patches
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Amer. Orthoptic Jrnl. 58(1):79-87 (2008); doi:10.3368/aoj.58.1.79
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Roper-Hall, G.
Right arrow Search for Related Content

Neurological Significance of Small Esodeviations

Gill Roper-Hall, D.B.O.T., C.O., C.O.M.T.

From the Saint Louis University Eye Institute, St. Louis, Missouri

Correspondence: Requests for reprints should be addressed to: Gill Roper-Hall, D.B.O.T., C.O., C.O.M.T., Saint Louis University Eye Institute, 1755 S. Grand Blvd., St. Louis, MO 63104; e-mail:grh{at}slu.edu


   Abstract
TOP
 Abstract
REFERENCES
 
A small esodeviation detected in an adult may represent an acquired event caused by a number of different mechanisms. These deviations may be comitant or incomitant, occur with or without diplopia and appear in association with other ocular or neurological findings or in isolation.

The mechanisms include lateral rectus dysfunction, supranuclear gaze disturbances, anomalies in the vergence system, the influence of the near synkinesis and certain restrictive components. The presence of a small, acquired esodeviation may have neurological significance that may influence diagnosis and management decisions.1,2 Conditions such as divergence paralysis and convergence spasm are described in the classic literature with large esodeviations and obvious clinical features.3–7 They are not a common occurrence in most strabismus practices but are recognized readily when they occur.

More subtle presentations of these entities are seen far more frequently and may be so small, or co-exist with other ocular findings, as to be overlooked. It is likely that with many clinical disorders like divergence paresis and convergence spasm that they present as a spectrum of dysfunction; it is the small end of that spectrum that will be discussed.

Key words: esotropia, divergence paresis, divergence insufficiency, convergence spasm, spasm of the near reflex, abduction deficits, binocular blurring


   REFERENCES
TOP
 Abstract
 REFERENCES
 

  1. MacPherson H, De Becker I, MacNeill JR: Beware: Armed and dangerous—acquired nonaccommodative esotropia. Am Orthopt J 1996; 46: 44–56.
  2. Roper-Hall G: The influence of the vergence system on strabismus diagnosis and management (Burian Lecture). In: Transactions of the XI International Orthoptic Congress. Belgium, May 2008. In press.
  3. Bielschowsky A. Lectures on Motor Anomalies. Hanover, N.H.: Dartmouth College Publications; 1943. p. 152.
  4. Roper-Hall G: Clinical dysfunction of the vergence system. In: Schor CM Ciuffreda K, eds. Vergence Eye Movements: Basic and Clinical Aspects . Woburn, Mass.: Butterworths, London; 1983. pp. 671–698.
  5. von Noorden GK, Campos EC. Binocular Vision and Ocular Motility; Theory and Management of Strabismus, sixth edition. St. Louis: CV Mosby Co.; 2002. pp. 502–506, 572–573.
  6. Miller NR, Newman NJ, Biousse V, Kerrison JB. Walsh and Hoyt’s Clinical Neuro-Ophthalmology , sixth ed. Philadelphia: Lippincott Williams and Wilkins; 2005. pp. 910–915, 1328–1330.
  7. Leigh JR, Zee DS: Vergence eye movements. In: The Neurology of Eye Movements, fourth ed. New York: Oxford University Press; 2006. pp. 367–371.
  8. Roper-Hall G, Burde RM: A-pattern exotropia as a complication of thyroid ophthalmopathy. In: Lenk-Schafer M, ed. Transactions 6th International Orthoptic Congress, Harrogate, U.K., 1987. pp. 361–364.
  9. Berschied C: Divergence insufficiency. Am Orthopt J 2005; 55: 106–111.[CrossRef]
  10. Jacobson DM: Divergence insufficiency revisited. Arch Ophthalmol 2000; 118: 1237–1241.[Abstract/Free Full Text]
  11. Roper-Hall G, Burde RM: Diagnosis and management of divergence paresis. Am Orthopt J 1987; 37: 113–121.
  12. Roper-Hall G, Chung SM: Interpretation and management of symptoms in supranuclear gaze disorders. In: Transactions of IX International Orthoptic Congress, Stockholm, Sweden, 1999 .
  13. Bothun ED, Archer SM: Bilateral medial rectus recession for divergence insufficiency pattern esotropia. J AAPOS 2005; 9: 3–6.[CrossRef][Medline]
  14. Clark RA, Demer JL: Effect of aging on human rectus extraocular muscle paths demonstrated by magnetic resonance imaging. Am J Ophthalmol 2002; 134: 872–878.[CrossRef][Medline]
  15. Christoff A, Christiansen SP: Spasm of the near reflex: Treatment with miotics revisited. Am Orthopt J 1992; 42: 110–113.
  16. Kaczmarek BB, Dawson ELM, Lee JP: Convergence spasm treated with botulinum toxin. Poster presented at the 2008 AAPOS meeting, Washington, DC.
  17. Roper-Hall G: The "Worth" of the Worth 4-Dot test. Am Orthopt J 2004; 54: 112–119.[CrossRef]
  18. Roper-Hall G: Optical management in strabismus: Simple, advanced and unconventional techniques. Am Orthopt J 2005; 55: 144–157.[CrossRef]




This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Roper-Hall, G.
Right arrow Search for Related Content

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS

Copyright 2008 by The Board of Regents of the University of Wisconsin System