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Orbital Causes of Incomitant Strabismus.

Lueder GT - Middle East Afr J Ophthalmol (2015 Jul-Sep)

Bottom Line: Strabismus may result from abnormal innervation, structure, or function of the extraocular muscles.Abnormalities of the orbital bones or masses within the orbit may also cause strabismus due to indirect effects on the extraocular muscles.This paper reviews some disorders of the orbit that are associated with strabismus, including craniofacial malformations, orbital masses, trauma, and anomalous orbital structures.

View Article: PubMed Central - PubMed

Affiliation: Departments of Ophthalmology and Visual Sciences and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.

ABSTRACT
Strabismus may result from abnormal innervation, structure, or function of the extraocular muscles. Abnormalities of the orbital bones or masses within the orbit may also cause strabismus due to indirect effects on the extraocular muscles. This paper reviews some disorders of the orbit that are associated with strabismus, including craniofacial malformations, orbital masses, trauma, and anomalous orbital structures.

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Related in: MedlinePlus

Preferred left head turn with mild left lid fissure narrowing in adduction
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Figure 11: Preferred left head turn with mild left lid fissure narrowing in adduction

Mentions: An otherwise healthy 4-month-old female presented for evaluation of progressive left esotropia. She had a limitation of abduction on the left and lid fissure narrowing in right gaze with a presumed diagnosis of Duane retraction syndrome. By 8 months of age, she had developed a 25° left face turn and esotropia in primary gaze [Figures 9 and 10]. A left medial rectus muscle recession was planned. At the time of surgery, significant restriction in abduction was present in the left eye. The normal-appearing left medial rectus muscle was sutured and disinserted [Figure 11]. As the posterior globe was examined for placement of sutures, an abnormal muscular structure was noted inferiorly and posterior to the medial rectus muscle insertion site [Figure 12]. The structure was isolated and was found to be an accessory muscle distinct from the medial rectus muscle [Figures 13 and 14]. It was approximately half the size of the medial rectus muscle but otherwise appeared normal. The accessory muscle was dissected and clamped 10 mm posterior to its insertion. It was disinserted from the globe, and the muscle anterior to the hemostat was resected. The stump was cauterized and allowed to retract. The left medial rectus muscle was then recessed 4 mm. Pathology of the accessory structure was consistent with an extraocular muscle. Postoperatively the patient improved, but still had moderately limited abduction of the left eye. She was orthophoric in primary gaze. Her head position resolved and vision was normal in both eyes. The contribution of the accessory muscle to the original motility disorder could not be definitively determined, but it is unlikely that the patient would have improved without recognizing and removing the muscle.


Orbital Causes of Incomitant Strabismus.

Lueder GT - Middle East Afr J Ophthalmol (2015 Jul-Sep)

Preferred left head turn with mild left lid fissure narrowing in adduction
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4502170&req=5

Figure 11: Preferred left head turn with mild left lid fissure narrowing in adduction
Mentions: An otherwise healthy 4-month-old female presented for evaluation of progressive left esotropia. She had a limitation of abduction on the left and lid fissure narrowing in right gaze with a presumed diagnosis of Duane retraction syndrome. By 8 months of age, she had developed a 25° left face turn and esotropia in primary gaze [Figures 9 and 10]. A left medial rectus muscle recession was planned. At the time of surgery, significant restriction in abduction was present in the left eye. The normal-appearing left medial rectus muscle was sutured and disinserted [Figure 11]. As the posterior globe was examined for placement of sutures, an abnormal muscular structure was noted inferiorly and posterior to the medial rectus muscle insertion site [Figure 12]. The structure was isolated and was found to be an accessory muscle distinct from the medial rectus muscle [Figures 13 and 14]. It was approximately half the size of the medial rectus muscle but otherwise appeared normal. The accessory muscle was dissected and clamped 10 mm posterior to its insertion. It was disinserted from the globe, and the muscle anterior to the hemostat was resected. The stump was cauterized and allowed to retract. The left medial rectus muscle was then recessed 4 mm. Pathology of the accessory structure was consistent with an extraocular muscle. Postoperatively the patient improved, but still had moderately limited abduction of the left eye. She was orthophoric in primary gaze. Her head position resolved and vision was normal in both eyes. The contribution of the accessory muscle to the original motility disorder could not be definitively determined, but it is unlikely that the patient would have improved without recognizing and removing the muscle.

Bottom Line: Strabismus may result from abnormal innervation, structure, or function of the extraocular muscles.Abnormalities of the orbital bones or masses within the orbit may also cause strabismus due to indirect effects on the extraocular muscles.This paper reviews some disorders of the orbit that are associated with strabismus, including craniofacial malformations, orbital masses, trauma, and anomalous orbital structures.

View Article: PubMed Central - PubMed

Affiliation: Departments of Ophthalmology and Visual Sciences and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.

ABSTRACT
Strabismus may result from abnormal innervation, structure, or function of the extraocular muscles. Abnormalities of the orbital bones or masses within the orbit may also cause strabismus due to indirect effects on the extraocular muscles. This paper reviews some disorders of the orbit that are associated with strabismus, including craniofacial malformations, orbital masses, trauma, and anomalous orbital structures.

Show MeSH
Related in: MedlinePlus