eMedicine Specialties > Ophthalmology > Extraocular Muscles

Esotropia and Exotropia, A-patterns: Follow-up

Author: James L Plotnik, MD, FACS, Consulting Staff, Department of Ophthalmology, Division of Pediatric Ophthalmology, Arizona Pediatric Eye Specialists
Contributor Information and Disclosures

Updated: Dec 18, 2008

Follow-up

Further Outpatient Care

  • Patients should have routine follow-up examinations to determine if the eyes are straight.

Complications

  • If not treated promptly, amblyopia can occur.

Prognosis

  • Prognosis is favorable for cosmetic appearance. The patient's age at the time of treatment determines the success for binocularity.

Patient Education

  • Early detection and prompt referral are important.

Miscellaneous

Medicolegal Pitfalls

  • Prompt detection and treatment is necessary to prevent development of amblyopia.

Special Concerns

  • In patients with good stereoacuity and the ability to fuse preoperatively, even a slight postoperative superior oblique paresis can cause bothersome cyclovertical diplopia by disrupting binocularity and the ability to fuse. Cautiously approach superior oblique tenotomy or tenectomy in these patients.
    • In particular, patients with an intermittent exotropia and an A-pattern tend to have binocular fusion and are at high risk for developing this complication.
    • Additionally, caution should be used when considering superior oblique weakening procedures, such as tenotomy or tenectomy, for A-pattern strabismus in the presence of inferior oblique overaction. Weakening of the superior oblique may result in a postoperative V-pattern.
  • In the aforementioned situations, vertical transposition of the horizontal recti, controlled weakening of the superior oblique using a silicone tendon expander, superior oblique recession, or a posterior superior oblique tenotomy are preferred to decrease the likelihood of inducing symptomatic diplopia postoperatively.
 


More on Esotropia and Exotropia, A-patterns

Overview: Esotropia and Exotropia, A-patterns
Differential Diagnoses & Workup: Esotropia and Exotropia, A-patterns
Treatment & Medication: Esotropia and Exotropia, A-patterns
Follow-up: Esotropia and Exotropia, A-patterns
References
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References

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  2. Breinin GM. Electromyography: a tool in ocular and neurologic diagnosis. II. Muscle palsies. Arch Ophthalmol. 1957;57:165.

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  6. Clark RA, Miller JM, Rosenbaum AL, Demer JL. Heterotopic muscle pulleys or oblique muscle dysfunction?. J AAPOS. Feb 1998;2(1):17-25. [Medline].

  7. Diamond GR, Parks MM. The effect of superior oblique weakening procedures on primary position horizontal alignment. J Pediatr Ophthalmol Strabismus. Jan-Feb 1981;18(1):35-8. [Medline].

  8. Drummond GT, Pearce WG, Astle WF. Recession of the superior oblique tendon in A-pattern strabismus. Can J Ophthalmol. Oct 1990;25(6):301-5. [Medline].

  9. Fierson WM, Boger WP 3rd, Diorio PC, et al. The effect of bilateral superior oblique tenotomy on horizontal deviation in A-pattern strabismus. J Pediatr Ophthalmol Strabismus. Nov-Dec 1980;17(6):364-71. [Medline].

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  16. Parks MM. Commentary on superior oblique tenotomy for A-pattern strabismus in patients with fusion. Binocular Vision. 1988;3:39.

  17. Romano P, Roholt P. Measured graduated recession of the superior oblique muscle. J Pediatr Ophthalmol Strabismus. Jul-Aug 1983;20(4):134-40. [Medline].

  18. Rubin SE, Nelson LB, Harley RD. A complication in weakening the superior oblique muscle in A-pattern exotropia. Ophthalmic Surg. Feb 1984;15(2):134-5. [Medline].

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  21. Shin GS, Elliott RL, Rosenbaum AL. Posterior superior oblique tenectomy at the scleral insertion for collapse of A-pattern strabismus. J Pediatr Ophthalmol Strabismus. Sep-Oct 1996;33(5):211-8. [Medline].

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  24. Wright KW, Min BM, Park C. Comparison of superior oblique tendon expander to superior oblique tenotomy for the management of superior oblique overaction and Brown syndrome. J Pediatr Ophthalmol Strabismus. Mar-Apr 1992;29(2):92-7; discussion 98-9. [Medline].

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Further Reading

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Keywords

A-patterns, A-pattern esotropia, A-pattern exotropia, A-pattern strabismus, alphabet pattern strabismus, vertically incomitant horizontal deviation

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Contributor Information and Disclosures

Author

James L Plotnik, MD, FACS, Consulting Staff, Department of Ophthalmology, Division of Pediatric Ophthalmology, Arizona Pediatric Eye Specialists
James L Plotnik, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology and American Association for Pediatric Ophthalmology and Strabismus
Disclosure: Nothing to disclose.

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American College of Surgeons, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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