Alphabet Patterns and Oblique Muscle Dysfunctions

Wright, Kenneth W.

doi:10.1007/0-387-27925-3_9

Cited by 4 publications

(7 citation statements)

References 30 publications

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“…They might adopt chin elevation and face turn to compensate for diplopia. Guyton exaggerated forced duction testing will reveal restriction on inward and upward movements, confirming the diagnosis of restrictive strabismus (1).…”

mentioning

confidence: 79%

Brown Syndrome Secondary to SARS-CoV-2

Tezanos¹,

Peralta²

2022

Journal of Neuro-Ophthalmology

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mentioning

confidence: 79%

Brown Syndrome Secondary to SARS-CoV-2

Tezanos¹,

Peralta²

2022

Journal of Neuro-Ophthalmology

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“…Nadiren vasküler nedenler, multipl skleroz, intrakraniyal tümörler ve viral enfeksiyonlar sonucu da SO felci gelişebilmektedir. 1,2 Miyastenia gravis (MG)'te izole SO felci ise çok nadir bildirilmektedir. Bu çalışmada, önce izole tek taraflı, sonra çift taraflı SO felcini taklit eden, sonuçta yeni bulguların gelişmesi ile oküler MG (OMG) tanısı alan bir olgu sunularak, SO felcinin ayırıcı tanısında OMG'ye dikkat çekilmek istenmiştir.…”

Section: Olgu Sunumu Case Reportunclassified

Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy

Koç¹,

Akbalik²

2020

Turkiye Klinikleri J Ophthalmol

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ÖZET Bu çalışmada, sırasıyla tek ve çift taraflı superior oblik felcini taklit eden bir oküler miyastenia gravis olgusu sunularak, superior oblik felcinin ayırıcı tanısında oküler miyastenia gravisın dikkate alınması gerektiği vurgulanmak istenmiştir. Bir yıldır devam eden çift görme şikâyeti olan 53 yaşındaki erkek olgu, sağ superior oblik felci tanısı almış ve cerrahi planlanmıştı. İkinci bir görüş için gelen olguya primer pozisyonda sol intermittan hipertropya ve ekzotropya saptandı ve üç basamak testi ile bilateral superior oblik felci tanısı konuldu. Subjektif torsiyon yoktu, ancak çift Maddox testinde 10°ekstorsiyon saptandı. Takipte, üç ay içinde göz hareketleri tüm yönlerde kısıtlanma ve sağ pitozis gelişti. Pupil tutulumu olmayan hastada bu bulgularla oküler miyastenia gravisten şüphe edildi. Pitozisin buz testi ile tamamen düzelmesi ile oküler miyastenia gravis tanısı konuldu. Superior oblik felci, vertikal şaşılığın en sık izlenen nedenidir. Ancak ayırıcı tanıda oküler miyastenia gravis akılda tutulmalı ve klinik stabilite gözlemlenmeden tedavi planlanmamalıdır. Anah tar Ke li me ler: Diplopi; miyastenia gravis; superior oblik felci ABS TRACT We aimed to draw attention to ocular myasthenia gravis to be considered in the differential diagnosis of superior oblique palsy by presenting a case who mimicked both unilateral and bilateral superior oblique palsy. A 53-year old male patient with a history of double vision for one year was diagnosed as having right superior oblique palsy and was planned for surgery. He came for the second opinion. Left intermittent hypertropia and exotropia was detected in the primary position and bilateral superior oblique palsy was diagnosed with three-step test. There was no subjective torsion, but a 10° extorsion was detected in the double Maddox test. In followup less than three months, eye movements restricted in all directions and right ptosis developed. The patient had no pupil involvement. ocular myasthenia gravis was diagnosed after observing complete resolution of ptosis with ice-pack test. Superior oblique paralysis is the most common cause of vertical strabismus. However, ocular myasthenia gravis should be kept in mind in the differential diagnosis and treatment should not be planned without clinical stability.

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“…[2][3][4] Incomitance is present in 13% of heterotropia cases but much less common in heterophoria. 2,4 Incomitance in heterotropia is usually secondary to physical damage to muscle tissue; 3,[5][6][7] or muscle dysfunction associated with innervational deficiencies; [8][9][10][11] or congenital due to a developmental anomaly of the motor system. 12 Treatment options for heterotropia include extraocular muscle surgery, yoked vertical prisms (with or without additional base-in horizontal prisms), and visual therapy/vision training.…”

Section: Introductionmentioning

confidence: 99%

“…Although some incomitant heterophorias could be regarded as a normal physiological deviation, A patterns are considered abnormal physiological variants by some, 3 and their existence (physiological or not) can be associated with abnormal head postures 3,7 and/or symptoms. 3 There are other forms of alphabet patterns such as X pattern in which there is increase in divergence in both up-and downgaze; 13 diamond pattern in which there is an increase in convergence in upand downgaze; Y pattern in which there is an increase in divergence on upgaze and no significant difference between the primary position and downgaze; 9 and arrow pattern in which there is an increase in divergence on downgaze and no significant difference between the primary position and upgaze, 11 although these last two forms may be variants of the classic A and V patterns. 11,14 A V pattern is defined as a difference between upgaze and downgaze that is equal or greater than 15 prism diopters (pd), whereas an A pattern is defined as a difference equal or greater than 10 pd.…”

Section: Introductionmentioning

confidence: 99%

“…11,14 A V pattern is defined as a difference between upgaze and downgaze that is equal or greater than 15 prism diopters (pd), whereas an A pattern is defined as a difference equal or greater than 10 pd. 3,11 The higher criterion adopted for the V pattern stems from the fact that there is a physiological tendency for the eyes to diverge in upgaze. 14 It must be noted that these values are arbitrary and in fact it has been suggested that a V pattern exists when the difference is 10 pd in heterophoric 3 and heterotropic 15 patients.…”

Section: Introductionmentioning

confidence: 99%

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<p>Analysis of Alphabet Patterns of Deviations Found in Patients Without Strabismus in Primary Position</p>

Gantz¹,

Millodot²,

Roth³

2020

OPTO

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Aim: To detect alphabet patterns in a group of patients without strabismus and to determine whether they induced any convergence insufficiency type symptoms. Methods: Data on subjective refraction, distance and near heterophoria, distance and near positive fusional vergence (BO), near point of convergence (NPC), measurements of upgaze and downgaze made 45°above and below the primary position with alternate cover test and a prism bar at a distance of 37.5 cm, were collected from participants of two clinics. Symptoms were assessed using the 15-item Convergence Insufficiency Symptoms Survey (CISS) to determine a symptom score. Association between alphabet patterns and the other variables was analyzed using parametric and non-parametric tests. Results: Out of 122 patients, 14 were found to present an alphabet pattern. Defining a V pattern exophoria ≥15-prism dioptre or ≥10-prism dioptre deviation, three patients (2.5%) and 12 patients (9.8%) were identified, respectively. In addition, one case resembled an X pattern and another a diamond pattern. The refraction, distance and near heterophoria, positive fusional vergence and CISS scores were not significantly different in the participants with V pattern compared to those without V pattern. Conclusion: Alphabet patterns, especially V type, were demonstrated in approximately 11.5% of a sample of 122 non-strabismus patients. These alphabet patterns were found not to be associated with convergence insufficiency-like symptoms.

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Alphabet Patterns and Oblique Muscle Dysfunctions

Cited by 4 publications

References 30 publications

Brown Syndrome Secondary to SARS-CoV-2

Brown Syndrome Secondary to SARS-CoV-2

Ocular Myasthenia Gravis Mimicking Superior Oblique Palsy

<p>Analysis of Alphabet Patterns of Deviations Found in Patients Without Strabismus in Primary Position</p>

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