Vertical & horizontal strabismus of uncertain cause OMC Fumitaka Nonaka.
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Transcript of Vertical & horizontal strabismus of uncertain cause OMC Fumitaka Nonaka.
![Page 1: Vertical & horizontal strabismus of uncertain cause OMC Fumitaka Nonaka.](https://reader035.fdocuments.us/reader035/viewer/2022062417/551b5939550346d31b8b546b/html5/thumbnails/1.jpg)
Vertical & horizontal strabismus of uncertain cause
OMCFumitaka Nonaka
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Case 1
• 14yo Female• RE drifting upwards intermittently for some years, no
diplopia• CT: D+N XT with RH• RE poorly reacting to direct light• Other examinations: unremarkable• POH, PMH: nil• CT brain & orbit: normal (not viewed)• TFT: normal
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RXT RH
RIR-
RMR-
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On Examination
VA-0.50 = 6/8 -0.50 = 6/6
Pupil: R>L
12ΔXT RH16Δ
30ΔXT’ RH’12Δ
Distance
Near
-1-3
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MRI
RMR
RIR LIR
LMR
RMR
RIR LIR
LMR
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Palsy of the inferior divisionof the third nerve
Superior division
Inferior division
Levator
SR
MR
IR
IO
Sphincter pupillae
Ciliary muscle
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Case 2
• 16yo Male• Re: worsening head tilt to right• Noticed LE Amblyopia since 2yo• PMH: Developmental delay• PFH: sister with squint
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L Pseudo ptosis
Large LXT, L hypo
Dominant RE can’t depressespecially in R-gaze
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On Examination
s gls6/9 6/28
Pupil: ?some asymmetry reaction L>R
25ΔLXT LHypo 25Δ
Distance
RE can’t depressespecially in R-gaze
L Pseudo ptosis
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CT
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Pre-op Post-op
BSV +
Knapp’s surgical procedure
Treatment Dr Kushner reported the efficacy of “Knapp’s surgical procedure” Simultaneous transposition of
SR toward the insertion of MRLR toward the insertion of IR+ Tenotomy of SO tendon
All 5 patients were free from diplopia in primary position (follow up ranged from 3 to 10 years after surgery)
Surgical Treatment of Paralysis of the Inferior Division of the Oculomotor Nerve. J Kushner, Arch Ophthalmol. 1999;117:485-489
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Two cases of congenital inferior division oculomotor palsy were presented.
This is an important diagnosis to make. It has a
very specific & usually successful treatment.