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Vertical & horizontal strabismus of uncertain cause OMC Fumitaka Nonaka.

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Presentation on theme: "Vertical & horizontal strabismus of uncertain cause OMC Fumitaka Nonaka."— Presentation transcript:

1 Vertical & horizontal strabismus of uncertain cause OMC Fumitaka Nonaka

2 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

3

4 RXT RH RIR- RMR-

5 On Examination VA-0.50 = 6/8-0.50 = 6/6 Pupil: R>L 12ΔXT RH16Δ 30ΔXT’ RH’12Δ Distance Near -3

6 MRI RMR RIRLIR LMR RMR RIRLIR LMR

7 Palsy of the inferior division of the third nerve Superior division Inferior division Levator SR MR IR IO Sphincter pupillae Ciliary muscle

8 Case 2 16yo Male Re: worsening head tilt to right Noticed LE Amblyopia since 2yo PMH: Developmental delay PFH: sister with squint

9 L Pseudo ptosis Large LXT, L hypo Dominant RE can’t depress especially in R-gaze

10 On Examination s gls6/96/28 Pupil: ?some asymmetry reaction L>R 25ΔLXT LHypo 25Δ Distance RE can’t depress especially in R-gaze L Pseudo ptosis

11 CT

12 Pre-opPost-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 MR LR 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

13 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.


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