Stereopsis in children with intermittent exotropia and dissociated vertical deviation

Klaehn, Lindsay D.; Kramer, Andrea; Hodge, David O.; Mohney, Brian G.

doi:10.1016/j.jaapos.2021.05.005

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…Three patients had a history of intermittent exotropia with DVD signifying an early onset (Cases 6, 13, and 15). 6 Two patients had a history of acquired nonaccommodative comitant esotropia with diplopia (one presenting at age 4 years [Case 19] and the other presenting at age 7 years [Case 17]). One of these (Case 17) developed esotropia after an acute viral illness but demonstrated MNTA, signifying an infantile origin.…”

Section: Resultsmentioning

confidence: 99%

“…One of these (Case 17) developed esotropia after an acute viral illness but demonstrated MNTA, signifying an infantile origin. 6,7 One patient had a history of partially accommodative esotropia with bilateral inferior oblique muscle overaction (Case 3), and one had a history of acquired esotropia with spontaneous development of secondary exotropia with bilateral inferior oblique overaction (Case 4). Of the 2 cases with no signs of infantile origin, one had partially accommodative esotropia with bilateral inferior oblique overaction (Case 3), and one presented with acquired esotropia followed by spontaneous secondary exotropia (Case 4).…”

Section: Resultsmentioning

confidence: 99%

“…Fifth, OTI may accompany intermittent exotropia with normal stereoacuity when DVD coexists, suggesting an infantile origin for these cases. 6 Finally, there was no control group and therefore no way of determining the sensitivity or specificity of this sign without a larger, prospective study of the general population.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of monocular nasotemporal optokinetic asymmetry (MNTA) was used to establish infantile onset for the strabismus, 5 while the presence of dissociated vertical divergence (DVD) was used to infer an early onset in patients with intermittent exotropia. 6 Noninvasive Heidelberg Spectralis infrared video-imaging of the retinas was used to document the clinical appearance of torsional instability in 2 patients. 7…”

Section: Methodsmentioning

confidence: 99%

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Ocular Torsional Instability—A Neurodiagnostic Sign of Prenuclear Disease

Brodsky¹

2023

Journal of Neuro-Ophthalmology

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Background: Accurate diagnosis of efferent visual system disease in neuro-ophthalmology involves the classification of clinical signs as prenuclear, nuclear, or infranuclear in origin. Over many years, I have come to recognize ocular torsional instability as a clinical sign of prenuclear disease. Methods: Retrospective chart review of patients in whom ocular torsional instability was diagnosed using indirect ophthalmoscopy. Results: Twenty patients were diagnosed as having ocular torsional instability (OTI). Eight had neuro-ophthalmologic disease caused by structural injury to prenuclear ocular motor areas. Six of these had structural lesions primarily involving the cerebellum, one had a midbrain glioma, and one had traumatic encephalomalacia. Eight additional patients had infantile strabismus (esotropia in 7, exotropia in 1) associated with various combinations of monocular nasotemporal optokinetic asymmetry, latent nystagmus, and dissociated vertical divergence (DVD), indicating prenuclear involvement of subcortical visuovestibular pathways within the brain. Three additional patients presented with intermittent exotropia with DVD signifying early onset, while 2 had acquired esotropia that was noninfantile in origin. One had partially accommodative esotropia with bilateral inferior oblique overaction, and one presented with acquired esotropia followed by spontaneous secondary exotropia. Conclusions: OTI provides a useful clinical sign of prenuclear ocular motor dysfunction. When detected in patients without any signs of infantile or early-onset strabismus, OTI signifies the need for neuroimaging to rule out neurovestibular or cerebellar causes of prenuclear disease.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%