Paralytic external deviation of one eye with horizontal immobility of the fellow eye specifies an acute brainstem lesion involving the paramedian pontine reticular formation and the medial longitudinal fasciculus on the side opposite the deviated eye This paralytic pontine exotropia is distinguished from other exotropias The deviated (exotropic) eye shows abductionHeadaches, or abnormal head posture Although the exact cause cannot This Optometric Clinical Practice Guideline for the Care of the Patient with Strabismus describes appropriate examination, diagnosis, treatment, and management to reduce the risk of visual disability from esotropia and exotropia through timely care This Guideline will assist Theories as to neurophysiologic causes of infantile exotropia include (1) deficient development of the convergence system during the vulnerable early period between 2 and 4 months of age;
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Causes of paralytic exotropia
Causes of paralytic exotropia-Diagnosis of paralytic strabismus is almost equal to the diagnosis of isolated or combined ocular motor nerve palsies (oculomotor nerve palsy, trochlear nerve palsy, or abducens nerve palsy) InInjury to the eye;
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Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles Myasthenia most often presents as ptosis with exotropia1) Non paralytic squints common, due to lack of binocular vision caused by refractive error myopia, hyperopia cataract retinoblastoma intraocular occlusion 2) paralytic squints rare caused by nerve palsiesContralateral paralytic pontine exotropia (PPE) and upgaze palsy are unusual features A conglomerate of the above manifestations may pose a diagnostic ambiguity in oneandahalf syndrome This report describes oneandahalf syndrome with contralateral upper motor neuron facial palsy complementing the "crossed" hemiparesis
Strabismus can also be described by its cause The 3 cranial nerves (III, IV, VI) responsible for eye movement can be weak or palsied and cause strabismus Some examples of paralytic strabismus include third nerve palsy and superior oblique palsy Special patterns of strabismus can have unique names such as Brown syndrome, and Duane syndromeParalytic Squint Damage to one or more of the three cranial nerves that supply the eye muscles, as a result of poor blood supply to the nerve, pressure on the nerve or inflammation will cause limited eye movements and strabismus Superior Oblique Palsy Lateral Rectus Palsy IIIrd Nerve Palsy Different Types of Exotropia Sensory Exotropia If a person has sensory exotropia, the eye may suffer from poor vision or blindness It will also turn outward Intermittent Exotropia Congenital Exotropia Alternating Exotropia
Often mislabeled a childhood disease, strabismus can be treated in adults, with visual and psychosocial benefits Strabismus, whether it is newonset or a reappearance of childhood strabismus, can usually be successfully treated in adults Surgical and nonsurgical treatment options are available, and treatment choice is typically based on theParalysis occurs when you're unable to make voluntary muscle movements A nervous system problem causes paralysis Uninjured nerves send signals to muscles Those signals make muscles move When you're paralyzed, or have paralysis, you can't move certain parts of your body Cleveland Clinic is a nonprofit academic medical centerParalytic, muscular or orbital causes (generally incomitant) Supranuclear causes (generally comitant) Most common types of strabismus in children Supranuclear causes Infantile esotropia Accommodative esotropia Sensory esotropia Acquired late esotropia Intermittent exotropia Pattern strabismus Monofixation syndrome
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Intermittent exotropia In this type of strabismus, one eye will fixate (concentrate) on a target while the other eye is pointing outward Symptoms may include double vision, headaches, difficulty reading, eyestrain, and closing one eye when viewing far away objects or when in bright lightCranial nerve palsy is due to partial or complete damage of a cranial nerve These conditions may be genetic, due to trauma, demyelinating conditions, infections, as well as vascular diseases Based on information from MSUNITEDcomCause decompensation of a congenital incomitant strabismus and some health conditions can cause incomitancy, eg thyroid disorders, vascular conditions (diabetes/high blood pressure/high cholesterol), myasthenia gravis and recent trauma Diplopia is often a symptom reported with incomitant strabismus and should be given thorough consideration
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An acquired, slowly progressive third nerve palsy with a meningioma or schwannoma may be associated with aberrant regeneration also Decreased corneal sensitivity in neurofibromatosis type 2 indicates 5 th nerve involvement with the 3 rd nerve palsy 2 Adult acquired 3 rd nerve palsy is bilateral 11% of the time, a complete palsy in 33%, and3,4,6 nerve palsies 12 True strabismus can be associated with what serious pathology?Consecutive exotropia arises after an initial esotropia Most often it results from surgical overcorrection of the initial esotropia It can be addressed with further surgery or with vision therapy;
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Design a decisionmaking scheme for patients with intermittent exotropia Recognize three causes of incomitant exotropia Case 3yo boy presents with "eyes drifting out" per mom No prior specs, injury, surgery Convergence Paralysis Usually part of Parinaud's dorsal midbrain syndrome (limited upgaze, retraction nystagmus, lightnearExotropia is generally a more intermittent and slowly progressive disorder, allowing for observation over time However, a child with any form of strabismus should be seen as soon as possible by an eye specialist to rule out vision loss or a visually dangerous or unexpected cause of the deviation Sometimes esotropia isn't present from birthIn a paralytic squint an eye does not move normally because one or more eye muscles are weak or paralysed This problem may have developed as a result of other health problems, such as damage to cranial nerves, following head injury or as a complication of diabetes or stroke
Paralytic Strabismus
Paralytic Strabismus
8, 9 (3) disruption of binocular vision shortly after birth, altering the development of normal vergence reflexes;Continue Reading There are many causes of exotropia and esotropia In paralytic forms, there is obviously a weak muscle/muscles that is not working properly because of an efferent nervous defect One of the simplest examples is a 6th nerve palsy causing an esotropia because of weakness of the lateral rectusVision loss from any eye disease or injury ;
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Sagging eye syndrome, a connective tissue condition, can cause vertical or horizontal strabismus LoeysDietz syndrome (genetic) puts children at risk for strabismus Conventional Treatment For esotropia or exotropia, depending on the type and severity, treatment may include surgery, glasses, and/or visual trainingIntraocular Intracranial 13 What is a warning sign in a baby for eyes? Childhood Exotropia Symptoms, Causes and Management Childhood exotropia (outward deviation) is a horizontal exodeviation characterised by visual axis forming a divergent angle It usually begins as exophoria Exophoria is a condition in which eyes are straight without deviation when both eyes are open However, eye under cover deviates on
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6 (4) disruption of normal binocular processing in the visual cortex Mental illness Adults who suffer from nonparalytic forms of strabismus face are recorded to have an increased risk of mental illness A casecontrolled study and survey showed that adults with divergence insufficiency and smallangle hypertropia forms of strabismus may be at a higher risk of suffering mental illness and its comorbidities Diabetes (causes a condition known as acquired paralytic strabismus) Graves disease;
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(exotropia) or downward — while the other eye is directed straight ahead Strabismus can also be described by its cause The 3 cranial nerves pigmenti syndrome, Noonan syndrome, Prader(III, IV, VI) responsible for eye movement can be weak or paralyzed and cause strabismus Some examples of paralytic strabismus include third nerveCauses The causes of Strabismus divide it into two major types Paralytic Strabismus and Non Paralytic Strabismus Paralytic Strabismus is caused by the defect in the cranial nerves connecting to the eye This condition is often considered to be indicative of a lesion in the cranial nerveIf exotropia is atleast 15 prism diopter more in up gaze ( 25 degree up) than the down gaze (35 degree) then it called as V pattern exotropia(Fig1,2,3) Causes of Vpattern strabismus Inferior oblique muscle overaction
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Exotropia is most often intermittent and idiopathic Less often, exotropia is constant and paralytic, as with infantile exotropia or 3rd (oculomotor) cranial nerve palsy Third Cranial (Oculomotor) Nerve Disorders Third cranial nerve disorders can impair ocular motility, pupillary function, or both Symptoms and signs include diplopia, ptosisHowever, a causeandeffect relationship between viral infection and ocular motor palsies is not established Abducens nerve palsy is more common than either oculomotor or trochlear nerve palsies Bilateral involvement is unusual Clinical Features The chief complaint is a painless diplopia Examination reveals a paralytic strabismus Girls are more often affected than are boys and theVideo Transcript This is a type of divergent squint that has arisen due to poor vision in one eye There are many different causes of poor vision including problems with the retina or optic nerve Adults who lose vision in one eye tend to develop a divergent squint rather than a convergent one, whereas the opposite is true of children
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What Causes Cranial Nerve Palsy?Vision therapy has shown promising results if the consecutive exotropia is intermittent, alternating, and of small magnitude (Consecutive exotropia may however also spontaneously Kiyoung, et al, also reported that vascular causes display maximum recovery rate and a short recovery time 15 Conclusion Paralytic strabismus is caused by several reasons First, disease management is either medical or surgical Vascular causes show the highest rate of recovery and the shortest recovery period compared to other factors
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Divergent concomitant squint exotropia Paralytic squint (the usual cause of the symptom of double vision) Synergists and antagonists Increase in the angle of deviation when the paralysed eye is used for fixation The actions of the extraocular eye muscles The abnormal head postureWhat are causes of paralytic strabismus?Symptoms of restrictive or paralytic strabismus are similar to those of other types of strabismus They may occur suddenly if they result from an injury, inflammation or neurologic condition
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Constant exotropiaoften associated with neurological problemsoften poor vision in 1 eye 14 How does paralytic strabismus present?6, 7 (2) monocular defocusing and total deprivation from birth; This type of exotropia is the result of a disease, trauma, or other health condition, particularly those that affect the brain For example, stroke or
Strabismus Ento Key
Strabismus Ento Key
It similarly highlights nonparalytic pontine exotropia and skew deviation as important causes of acute onset acquired strabismus, and transient torsional nystagmus as a rare but relevant localising feature in pontine strokes causing INO Acute onset of this constellation of signs is highly suggestive of pontine infarctionUnlike paralytic squints, the efferent pathways are intact but there is an abnormality in fusion and fixation that is thought to be central there is an exotropia (outer margin for esotropia) Concomitant (nonparalytic) squint management Incomitant (paralytic) squint causes Paralysis of extraocular muscles, usually through damage toMost types of infant and childhood strabismus are comitant Paretic strabismus can be either comitant or noncomitant Incomitant strabismus is almost always caused by a limitation of ocular rotations that is due to a restriction of extraocular eye movement (ocular restriction) or due to extraocular muscle paresis
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Patients not residing in Olmsted County at the time of their diagnosis were excluded Intermittent exotropia was defined in this study as an intermittent distance exodeviation of at least 10 prism diopters (PD) without an underlying or associated neurologic, paralytic, or anatomic disorder Nonaccommodative acquired esotropia includes acute onset esotropia, sensory esotropia (resulting from poor vision in one eye), and consecutive esotropia after a previous surgery to correct exotropia Other causes of esotropia include convergence excess, convergence spasm, and divergence insufficiencyA case with nonparalytic pontine exotropia (NPPE) due to brainstem infarction is reported A 77yearold hypertensive man suddenly developed dizziness, double vision, dysarthria, and right ataxic hemiparesis Oculomotor findings on admission consisted of (1) full right exotropia in
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A family history of strabismus is a risk factor Farsightedness may be a contributing factor, often in children AnyEsotropia, exotropia and hypertropia occur with similar frequency Adultonset strabismus is not associated with amblyopia or decreased vision Instead, it is more likely to be the result of a paralytic disorder or small but troubling deviations with persistent double vision"
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