Monofixation Syndrome Treatment & Management

  • Author: Balaji K Gupta, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 8, 2012
 

Medical Care

  • Monofixation syndrome is often the desired result of strabismus surgery.
    • If a manifest strabismus is present, it is small and cosmetically acceptable.
    • Monofixation syndrome allows for a higher likelihood of diplopia-free long-term alignment.
    • Monofixation syndrome with esotropia of less than 8 prism diopters is more stable than monofixation syndrome with exotropia of less than 8 prism diopters.
  • Treatment is given for any associated amblyopia in accordance with standard ophthalmic principles.
    • Amblyopia in children should be treated with appropriate spectacle correction. A careful cycloplegic refraction should be performed to check for anisometropia.
    • Occlusive patching or optical penalization should be considered as the clinical situation warrants. The amount of occlusive patching is dependent upon many factors, including age, density of amblyopia, and underlying etiology. In cases of mild amblyopia secondary to anisometropia, part-time occlusion may be all that is needed.
    • Optical penalization is a method of amblyopia treatment. Optical penalization relies on optically blurring the image of the preferred eye. The most common method relies on using atropine 1% ophthalmic solution in the preferred eye.
  • Older patients with monofixation syndrome may develop double vision if their fusional status decreases. This is termed decompensated monofixation syndrome.
    • This is less likely in patients treated earlier in childhood, those with no manifest strabismus, and patients with monofixation due to anisometropia.
    • In symptomatic patients, treatment ranges from correcting refraction, orthoptic exercises, prisms, and strabismus surgery. The majority of patients can be successfully returned to a monofixation state.
Next

Surgical Care

  • Heterotropia is cosmetically acceptable, so patients rarely need surgery. Monofixation syndrome tends to stabilize the alignment, thereby decreasing the need for further surgery.[6]
Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Balaji K Gupta, MD  Clinical Assistant Professor, Department of Ophthalmology and Visual Sciences, University of Chicago

Balaji K Gupta, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus

Disclosure: Nothing to disclose.

Specialty Editor Board

Gerhard W Cibis, MD  Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas School of Medicine

Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

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.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

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.

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.

References

  1. Tychsen L. Can ophthalmologists repair the brain in infantile esotropia? Early surgery, stereopsis, monofixation syndrome, and the legacy of Marshall Parks. J AAPOS. Dec 2005;9(6):510-21. [Medline].

  2. Botet RV, Calhoun JH, Harley RD. Development of monofixation syndrome in congenital esotropia. J Pediatr Ophthalmol Strabismus. Mar-Apr 1981;18(2):49-51. [Medline].

  3. Kushner BJ. The Occurrence of Monofixational Exotropia After Exotropia Surgery. Am J Ophthal. Mar 13 2009;[Medline].

  4. Scott MH, Noble AG, Raymond WR 4th, Parks MM. Prevalence of primary monofixation syndrome in parents of children with congenital esotropia. J Pediatr Ophthalmol Strabismus. Sep-Oct 1994;31(5):298-301; discussion 302. [Medline].

  5. Cibis GW. Video vision development assessment in diagnosis and documentation of microtropia. Binocul Vis Strabismus Q. 2005;20(3):151-8. [Medline].

  6. Arthur BW, Smith JT, Scott WE. Long-term stability of alignment in the monofixation syndrome. J Pediatr Ophthalmol Strabismus. Sep-Oct 1989;26(5):224-31. [Medline].

  7. Hunt MG, Keech RV. Characteristics and course of patients with deteriorated monofixation syndrome. J AAPOS. Dec 2005;9(6):533-6. [Medline].

  8. Choi DG, Isenberg SJ. Vertical strabismus in monofixation syndrome. J AAPOS. Feb 2001;5(1):5-8. [Medline].

  9. Parks MM. The monofixation syndrome. Trans Am Ophthalmol Soc. 1969;67:609-57. [Medline].

  10. Siatkowski RM. The decompensated monofixation syndrome (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. Dec 2011;109:232-50. [Medline]. [Full Text].

  11. Tomac S. Monofixation syndrome and anisometropia. Ophthalmology. Jan 2002;109(1):3-4. [Medline].

  12. Wright K. Visual development, amblyopia, and sensory adaptations. In: Pediatric Ophthalmology and Strabismus. St Louis, Mo: Mosby; 1995:119-138.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.