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RSO palsy: motility & Hess test IO SO SR IR MRLR IO SO SR IR MR LR click here to see typical symptoms and clinical test results Change this for F5233 © Bruce Evans, 2001
SO palsy : typical symptoms & test results click here to see explanation & Hess screen again History lCommonly congenital, with head tilt since infancy Symptoms lMay decompensate in adult life lCan be newly acquired, particularly after trauma Cover test lSmall hyper-deviation of affected eye, worse for near fixation Dissociation tests lA cyclo-deviation and positive Bielschowsky test help diagnose SO palsy lSee Appendix 8 © Bruce Evans, 2001
LLR palsy: motility & Hess test IO SO SR IR MRLR IO SO SR IR MR LR click here to see typical symptoms and clinical test results © Bruce Evans, 2001
LR palsy :symptoms & test results of case in video clip click here to see explanation & Hess screen again History lHigh blood pressure, at one time poorly controlled when horizontal diplopia started Symptoms lHorizontal diplopia in distance vision, not at near, worse when looking to affected side. Cover test Distance: 15 left esotropia lNear: orthophoric Comments lA small vertical deviation may be present © Bruce Evans, 2001
Inferior oblique (IO) palsy © Bruce Evans, 2001 An IO palsy is the rarest of all extra-ocular muscle palsies and no video clips were available When the diagnosis of an IO palsy is made it is very often a mis-diagnosis of a Brown’s syndrome Differential diagnosis is discussed in the slides on Brown’s syndrome click here to see Brown’s syndrome
LSR palsy: motility & Hess test IO SO SR IR MRLR IO SO SR IR MR LR click here to see typical symptoms and clinical test results © Bruce Evans, 2001
RSR palsy : motility & Hess test Motility testing suggests right double elevator palsy, but the Hess chart, from some years before, suggests RSR Sometimes, a superior rectus palsy can “spread” in this way © Bruce Evans, 2001 IO SO SR IR MR LR IO SO SR IR MR LR click here to see symptoms and clinical test results 19932001
SR palsy : typical symptoms & test results History lTypically congenital, can be acquired Symptoms lMay be diplopia in upgaze lSometimes with ptosis, especially if congenital Cover test lHypotropia of affected eye, worse for distance fixation, often with small excyclotropia lA SR palsy can sometimes occur as a sequel to a SO palsy in the other eye (see Appendix 8) © Bruce Evans, 2001
Duane’s retraction syndrome Classified in two ways: Huber’s classification Type 1: restricted abduction, adduction minimally affected Type 1: Type 2: restricted adduction, abduction minimally affected Type 2: Type 3: restricted abduction & adduction Type 3: Old classification Type A: restricted abduction, slightly defective adduction Type A: Type B: restricted abduction, normal adduction Type B: Type C: restricted adduction & slightly defective abduction Type C: © Bruce Evans, 2001
Brown’s syndrome Previously known as superior oblique tendon sheath syndrome The syndrome has the appearance of an inferior oblique (IO) palsy. For differential diagnosis, consider: IO palsy is exceptionally rare. Brown’s syndrome is, relatively speaking, much more common An incyclodeviation will be present in the primary position in IO palsy, not in Brown’s syndrome Parks three step is positive in IO palsy, not in Brown’s syndrome Secondary sequelae (overaction of: ipsilateral SO and contralateral SR) will be present in long-standing IO palsy, not Brown’s © Bruce Evans, 2001
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