Wednesday, October 8, 2014

October 2014 Strabismus Rounds

So this is our 2nd strabismus rounds of the year- same rules as last time. Pick a case, devise a rational surgical plan, submit your plan in the comments section, and then go to the wet lab and show me what you can do.

Case 1: This 18 year old girl has had double vision since suffering a head injury in a car accident 6 months ago:

She has an inability to abduct the right eye past midline and has an otherwise normal ocular exam. She measures ET 35 in primary, ET 50+ in right gaze, and ET 10 in left gaze. (Top photo is left gaze, bottom photo is attempted right gaze.)

What is your surgical plan?

Case 2: This 15 year old boy has had double vision since suffering a concussion in a football game last year.

He had a left inferior oblique recession by a trusted colleague 3 months ago, but has persistent diplopia, especially in primary and right gaze. He has LHT 8 in primary, LHT 20 in right, orthotropia in left gaze, and LHT 8 in downgaze. Double Maddox Rod testing shows minimal (2 degrees) of excyclotorsion.

What is your surgical plan? (Hint- let's not mess with the obliques in the wet lab yet.)

Case 3: A 25 year old woman seeks your care for correction of her strabismus. She notes that she tends to adopt a chin-up head position.

You note XT25 in primary, increasing to XT 40 in upgaze, and XT 8 in downgaze. There is no inferior oblique or superior oblique dysfunction, and her ocular exam is normal. Of note, she was diagnosed with plagiocephly as an infant, but is otherwise healthy.

What is your surgical plan?

Thursday, July 31, 2014

August 2014 Strabismus Rounds

This is our first strabismus rounds for the year. I'll present 3 recent cases that have gone to the OR, and your job is to come up with a surgical plan for each and submit it in the comments section. The new twist for this year: you will demonstrate your ability to perform the surgery in the wet lab. So prior to the session, pick a case and a few friends, go to the wet lab, and record your surgical correction with the appropriate model.

Case 1: This is a 10 month old boy who has had crossed eyes since birth.

He cross-fixates, and does not object to occluding either eye. His ocular exam is otherwise normal, and his cycloplegic refraction is +1D in both eyes. His alignment is stable from his initial exam 2 months ago. You estimate he is ET 40 by Krimsky. What is your surgical plan?

Case 2: This is a 12 year old girl who has been concerned about her friends noticing her eye drifting.

You find her acuity to be 20/20 in both eyes without correction. Her X(T) measures 45PD, she becomes tropic spontaneously, and will often remain tropic through a blink. Her stereoacuity has decreased over the past 6 months from 40 sec to 200 sec. What is your surgical plan?

Case 3: This is a 7 year old girl, who had surgery for esotropia when she was 8 months old. For the past year, she has been turning her face to the right, and sometimes adopting a small tilt to the right.

Her acuity is 20/20 in both eyes without correction. You measure LHT 6 in forced primary gaze, LHT 15 in right gaze, Ortho in left gaze and downgaze. Her LHT increases on left head tilt. What is your surgical plan?