Managment of IXT
- correct significant hyperopia, myopia, astigmatism
- mild myopia correction could make deviation better
- mild hyperopic correction could make deviation worse (so not typically prescribe)
- moderate hyperopia (>+4.00) needs to be corrected for clarity (improve XT?)
- minus can be added to the correction to stimulate accommodation and stimulate accommodative convergence to control XT
- patching for amblyopia
- VT
Prisms for IXT
When there is no suppression or ARC, can be used to promote fusion, but not long term because it reduces fusional vergence amplitudes
Surgery for XT
When XT gets progressively worse with decreasing stereoacuity and control. Deviation > 50% of the time is concerning
BOtox and IXT
Can be used by needs multiple injections
DVD-dissoaciated vertical deviation (DVD)
- spontaneous upward movement of one or both eyes when tired, fusion is broken or inattentive
- found with infantile strabismus (exo and eso)
- no symptoms
- onset of 2-3 years
- hyper deviation in one or both eyes-the other eye does not have a hypo position
- can be spontaneous (manifest) or when one eye is covered (latent)
- nystagmus can also be present
Treatemtn for DVD
- surgical treatment only if larger or occurs frequently
- but mostly no treatment
- difficult to measure and can be subjective
Inferior oblique overaction
- the eye is elevated in adduction
- present in chidlren with infantile strabismus mainly
- bialteral or unilateral
- little or no deviation in primary
- found in about 2/3 of kids with congenital strab
- surgical treatment only if large
Pattern strab
Present when a horizontal deviation changes in magnitude between upgaze and downgaze
Vertical and non comitant
Can be see in XT or ET
V pattern
Horizontal deviation is more divergent in upgaze than in downgaze (inferior oblique abduction action)
- clinically significant when difference in measurements between upgaze and downs gaze is at least 15PD
- most common
- can be seen in infantile ET
- patient may adopt chin up position
A pattern
Horizontal deviation is more divergent in downgaze than in upgaze (SO abduction action)
- clinically significant when difference in measurement between upgaze and down gaze is at least 10PD. More divergent inferiroly
- seen more in XT
- patient may adopt chin down head posture
- more common in patients with infantile strab assocaited with craniofacial malformations, downs
