Here are two cases that we will be discussing during a webinar session 2/15/13. Both cases have had surgery for their strabismus. Your assignment is to review the clinical history and images, develop a surgical plan, and post your plan and reasoning in the comments section. You don't need to worry about specific surgical dosages, but should indicate which muscle you plan to work on, and whether you will weaken, strengthen, transpose, or otherwise modify the muscle.
I will moderate the comments and "publish" them after our session with a summary of our discussion. Please separate your comments into Case 1 and Case 2.
5y/o boy, history of shaken baby syndrome and optic atrophy OD>OS.
Va 20/200 OD, 20/40 OS. + RAPD OD
20ft: XT 40
13in: XT 35
Strongly prefers fixing with OS. Full versions. Mom wants his right eye to be straight before he enters kindergarten.
Q1.1 What is your surgical plan?
7y/o girl brought in by mother because "eyes look funny". No prior injuries or surgery. Mom notes that patient has always tilted her head to the right.
Va 20/20 OU
Rotations: 2-3+ LIOOA
Primary: LH(T) 12
R gaze: LHT 15; L gaze: LHT 4
Down: LHT 6
Q2.1 What measurements would you expect on head tilt to the right and left?
Q2.2 What would you expect with double Maddox rod testing?
Q2.3 What is your surgical plan?