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?