strabsyndromes

CASE 6B

A 7 year old patient enters your office. History is positive for esotropia within the first 6 months of life. The mother want to know how cosmesis could be improved. Patient is currently wearing +3.50 DS O.U.

Retinoscopy

O.D.: +3.25 DS

O.S.: +3.00-1.25 X 180

Acuities

20/40 O.D. / O.S. Near and Distance

Cover test (entering)

Alternate ET 25D; Alternate ET' 25D no resistance to occlusion with either eye; unusual head movement noted if target brought off-axis

Cover Test (9 gaze positions)

Significant increase in ET on left or right gaze with little vertical component; patient reluctant to maintain fixation in superior gaze

EOM

Appearance of increased esotropia on abducting eye O.U. (* see movie #4); abducting eye rarely able to go past 10^o of primary position; horizontal angle smaller on primary gaze; no nystagmus noted

RIGHT GAZE -------------------PRIMARY GAZE---------------------LEFT GAZE

1. Any additional tests/observations?

EOM testing

Other

2. Diagnosis?

3. What are some conditions that mimic this Dx?

4. What is the most likely etiology of this Dx?

5. How would this patient perform on a forced duction test?

6. How should you educate the mother? How do you guide her towards or away from the surgical alternative?

Retinoscopy	O.D.: +3.25 DS O.S.: +3.00-1.25 X 180
Acuities	20/40 O.D. / O.S. Near and Distance
Cover test (entering)	Alternate ET 25D; Alternate ET' 25D no resistance to occlusion with either eye; unusual head movement noted if target brought off-axis
Cover Test (9 gaze positions)	Significant increase in ET on left or right gaze with little vertical component; patient reluctant to maintain fixation in superior gaze
EOM	Appearance of increased esotropia on abducting eye O.U. (* see movie #4); abducting eye rarely able to go past 10^o of primary position; horizontal angle smaller on primary gaze; no nystagmus noted