Restrictive Strabismus: Diagnosis and Management

Flanders, Michael

doi:10.3368/aoj.64.1.54

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…As a result, in these patients underacting directions can be directly linked to the weakness of an individual EOM (figure 2) and overactions, including out of range measurements, can be excluded as these are the result of an underacting muscle of the contralateral eye. For GO, this interpretation cannot be made, as overactions are often the result of swelling and stiffening of the EOM 22 23. Therefore, the translation to the involvement pattern of individual EOM was not made for GO patients.…”

Section: Methodsmentioning

confidence: 99%

Diagnosing myasthenia gravis using orthoptic measurements: assessing extraocular muscle fatiguability

Keene

Nie²,

Brink³

et al. 2022

J Neurol Neurosurg Psychiatry

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IntroductionDiagnosing ocular myasthenia gravis (MG) can be challenging because serum antibodies are often not detected. We aimed to explore whether determining extraocular muscle (EOM) weakness using orthoptic measures, including an adapted Hess chart examination, can aid in diagnosing MG.MethodsWe conducted a prospective study among patients with acetylcholine receptor antibody positive MG (20 recently diagnosed, 19 chronic) and 14 seronegative MG patients. We compared orthoptic measures to 19 healthy and 18 disease controls with Graves orbitopathy, chronic progressive external ophthalmoplegia or oculopharyngeal muscular dystrophy. Maximal eye duction angles were measured using a synoptophore. Gaze deviations between eyes were measured using standard Hess chart examination with addition of 1 min persistent gaze to assess MG-associated fatiguability. Receiver operating characteristics curve analysis was performed.ResultsFor duction angles, the area under the curve (AUC) was 0.73 comparing MG to healthy, and 0.69 comparing to patient controls. For the outer field of the Hess chart, the AUC was 0.89 comparing to healthy and 0.54 to patient controls. For drift, the AUC was 0.93 comparing to healthy and 0.93 to patient controls. The sensitivity and specificity of the presence of drift was 81% and 100%.DiscussionOrthoptic measurements can be used to diagnose MG by quantifying EOM weakness and fatiguability. Drift during persistent gaze on a Hess chart is specific for MG and could be used for diagnostic purposes. The Hess chart examination is widely available, inexpensive and fast. Moreover, orthoptic measurements may be a clinically relevant outcome measure for clinical trials.

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Section: Methodsmentioning

confidence: 99%

Diagnosing myasthenia gravis using orthoptic measurements: assessing extraocular muscle fatiguability

Keene

Nie²,

Brink³

et al. 2022

J Neurol Neurosurg Psychiatry

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“…Patients with congenital restrictive strabismus have a history of limitation of ocular movements since birth. However, acquired progressive restrictive strabismus is very rare in the infants but more common in the adults, usually caused by trauma [2] , tumors [3] , infiltrated inflammation of the ocular muscles such as thyroid disease [2] . Here, we report a case of progressive restrictive strabismus in a 4-month-old infant.…”

Section: Dear Editormentioning

confidence: 99%

Progressive restrictive strabismus in an infant

Yan

2021

Int J Ophthalmol

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“…Anatomik olarak İR kasının maksimum geriletilmesi, nazal bölgenin engellemesi ve globun orbitadaki yerleşiminden dolayı daha güç olabilmektedir (14) . Bunun yanında, başta DRS olmak üzere restriktif şaşılıklar ve yüksek miyopi ET'ye sık eşlik etmektedir (15)(16)(17) . Ağırlıklı olarak bu nedenlerden dolayı Grup 2 olgularının %70'i ET olgularından oluşmaktaydı.…”

Section: Gereç Ve Yöntemunclassified