eMedicine Specialties > Ophthalmology > Extraocular Muscles

Esotropia and Exotropia, V-patterns: Differential Diagnoses & Workup

Author: Neepa Thacker, MBBS, MS, DNB, FRCS, Consulting Staff, Department of Pediatric Ophthalmology and Strabismus, Breach Candy Hospital, Mumbai, India
Coauthor(s): Arthur L Rosenbaum, MD, Chief, Division of Pediatric Ophthalmology, Professor, Vice Chairman, Department of Ophthalmology, University of California at Los Angeles School of Medicine; Frederico G Velez, MD, Assistant Clinical Professor, Department of Ophthalmology, Division of Pediatric Ophthalmology and Strabismus, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: Sep 26, 2006

Differential Diagnoses

Esotropia and Exotropia, A-patterns

Other Problems to Be Considered

Cyclic V-pattern esotropia

Workup

Laboratory Studies

  • Laboratory tests are not required, except for those routinely performed prior to surgery.

Imaging Studies

  • Imaging studies are not required routinely, although they may be beneficial in patients with certain conditions (eg, craniosynostosis) or in patients where abnormalities of the pulley systems are suspected.

More on Esotropia and Exotropia, V-patterns

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

References

  1. Bieder B, Yassur Y. Treatment for A or V patterns by slanting the muscle insertion. In: Lennerstrand G, ed. Update on Strabismus and Pediatric Ophthalmology. Boca Raton, Fla:. CRC press;1995:260.

  2. Boyd TA, Leitch GT, Budd GE. A new treatment for ''A'' and ''V'' patterns in strabismus by slanting muscle insertions. A preliminary report. Can J Ophthalmol. Jul 1971;6(3):170-7. [Medline].

  3. Brown HW. Vertical deviations symposium: Strabismus. Trans Am Acad Ophthalmol Otolaryngol. 1953;57:157.

  4. Caldeira JA. Some clinical characteristics of V-pattern exotropia and surgical outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 22 consecutive patients and a comparison with V-pattern esotropia. Binocul Vis Strabismus Q. 2004;19(3):139-50. [Medline].

  5. Caldeira JA. V-pattern esotropia: a review; and a study of the outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 78 consecutive patients. Binocul Vis Strabismus Q. 2003;18(1):35-48; discussion 49-50. [Medline].

  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. Costenbader FD. Introduction Symposium: The A and V patterns in strabismus. Trans Am Acad Ophthalmol Otolaryngol. 1964;58:354.

  8. Duane A. Isolated paralysis of the ocular muscles. Arch Ophthalmol. 1897;26:317.

  9. Fink WH. The A and V syndromes. Am Orthopt J. 1959;9:105.

  10. Gobin MH. Sagittalization of the oblique muscles as a possible cause for the "A", "V", and "X" phenomena. Br J Ophthalmol. Jan 1968;52(1):13-8. [Medline].

  11. Goldstein JH. Monocular values for the A and V syndromes. Am J Ophthalmol. 1960;50:753.

  12. Helveston EM. A logical scheme for planning of strabismus surgery. In: Surgical Management of Strabismus. An Atlas of Strabismus Surgery. St Louis:. CV Mosby;1993:381.

  13. Jampolsky A. Oblique muscle surgery of the A-V patterns. J Pediatr Ophthalmol. 1965;2:31.

  14. Knapp P. Vertically incomitant horizontal strabismus, the so called A and V syndromes. Trans Am Ophthalmol Soc. 1959;57:666.

  15. Knapp P. A and V patterns. In: Transections of the New Orleans Academy Of Ophthalmology. St Louis:. Mosby-Year Book;1971:242.

  16. Kushner BJ. The role of ocular torsion on the etiology of A and V patterns. J Pediatr Ophthalmol Strabismus. Sep-Oct 1985;22(5):171-9. [Medline].

  17. Miller JE. Vertical recti transplantation in the A and V syndromes. Arch Ophthalmol. 1960;64:175.

  18. Miller M, Folk E. Strabismus associated with craniofacial anomalies. Am Orthopt J. 1975;25:27-37. [Medline].

  19. Minguini N, de Carvalho KM, de Araujo L, Crosta C. Anterior transposition compared to graded recession of the inferior oblique muscle for V-pattern strabismus. Strabismus. Dec 2004;12(4):221-5. [Medline].

  20. Mohan K, Saroha V. Cyclic "V" esotropia. J Pediatr Ophthalmol Strabismus. Mar-Apr 2004;41(2):122-5. [Medline].

  21. Monteiro de Carvalho KM, Minguini N, Dantas FJ, et al. Quantification (grading) of inferior oblique muscle recession for V-pattern strabismus. Binocul Vis Strabismus Q. 1998;13(3):181-4. [Medline].

  22. Ohba M, Ohtsuka K, Osanai H. Treatment for A and V strabismus by slanting muscle insertions. Binocul Vis Strabismus Q. 2004;19(1):13-20. [Medline].

  23. Ohba M, Nakagawa T. Treatment for "A" and "V" exotropia by slanting muscle insertions. Jpn J Ophthalmol. Jul-Aug 2000;44(4):433-8. [Medline].

  24. Parks MM, Mitchell PR. A and V patterns. In: Tasman W, Jaeger EA, eds. Duane's Clinical Ophthalmology. Vol 1. Philadelphia:. Lippincott-Raven;1996.

  25. Polati M, Gomi C. Recession and measured, graded anterior transposition of the inferior oblique muscles for V-pattern strabismus: outcome of 44 procedures in 22 typical patients. Binocul Vis Strabismus Q. 2002;17(2):89-94. [Medline].

  26. Pott JW, Godts D, Kerkhof DB, de Faber JT. Cyclic esotropia and the treatment of over-elevation in adduction and V-pattern. Br J Ophthalmol. Jan 2004;88(1):66-8. [Medline].

  27. Saunders RA, Holgate RC. Rectus muscle position in V-pattern strabismus. A study with coronal computed tomography scanning. Graefes Arch Clin Exp Ophthalmol. 1988;226(2):183-6. [Medline].

  28. Scott WE, Drummond GT, Keech RV. Vertical offsets of horizontal recti muscles in the management of A and V pattern strabismus. Aust N Z J Ophthalmol. Aug 1989;17(3):281-8. [Medline].

  29. Stager DR, Parks MM. Inferior oblique weakening procedures. Effect on primary position horizontal alignment. Arch Ophthalmol. Jul 1973;90(1):15-6. [Medline].

  30. Urist MJ. The etiology of the so called A and V syndromes. Am J Ophthalmol. 1958;46:835.

  31. Von Noorden GK. A and V patterns. In: Binocular Vision and Ocular Motility: Theory and Management of Strabismus. 5th ed. St Louis:. Mosby;1996:376.

  32. Wilson J, Spika J, Clarke R, et al. Verocytotoxigenic Escherichia coli infection in dairy farm families. Can Commun Dis Rep. Feb 1 1998;24(3):17-20. [Medline].

Further Reading

Keywords

V-pattern strabismus, vertically incomitant horizontal deviations, A-pattern, V-pattern, horizontal deviation, upgaze, downgaze, angle of deviation, V-pattern esotropia, V-pattern exotropia

Contributor Information and Disclosures

Author

Neepa Thacker, MBBS, MS, DNB, FRCS, Consulting Staff, Department of Pediatric Ophthalmology and Strabismus, Breach Candy Hospital, Mumbai, India
Disclosure: Nothing to disclose.

Coauthor(s)

Arthur L Rosenbaum, MD, Chief, Division of Pediatric Ophthalmology, Professor, Vice Chairman, Department of Ophthalmology, University of California at Los Angeles School of Medicine
Arthur L Rosenbaum, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Frederico G Velez, MD, Assistant Clinical Professor, Department of Ophthalmology, Division of Pediatric Ophthalmology and Strabismus, University of California at Los Angeles School of Medicine
Frederico G Velez, MD is a member of the following medical societies: American Academy of Ophthalmology
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, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

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

Ralph Garzia, OD, Assistant Dean for Clinical Programs, Associate Professor, School of Optometry, University of Missouri at St Louis
Ralph Garzia, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association
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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