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Complex or Incomitant Strabismus

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Complex, incomitant strabismus may be defined as binocular misalignment that differs in magnitude in distinct directions of gaze. Etiologies include cranial nerve palsies (CN III, IV, and VI), dysinnervation syndromes (Duane and Moebius syndromes), restrictive processes (Graves’ orbitopathy, Brown syndrome), and anatomic (fallen eye syndrome, craniofacial synostosis, blowout fractures). Myasthenia gravis can also present with incomitant strabismus. Obtaining a thorough past medical and surgical history, as well as a history of trauma is critical as is measuring the ductions, versions, and the magnitude of misalignment in each cardinal gaze as well as any ocular torsion. Armed with this information, the etiology can typically be determined. Forced ductions may provide additional clues to the cause and help direct treatment. There is typically more than one way to surgically reduce the various forms of incomitant strabismus, and these are discussed, but all approaches share the goal of creating, or restoring, of a wide field of binocular single vision and stereopsis while minimizing torticollis. Nonsurgical treatment with prisms, botox, or patching provides a practical alternative in some cases.

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References

  1. Engle EC. The genetic basis of complex strabismus. Pediatr Res. 2006;59(3):343–8.

    Article  PubMed  Google Scholar 

  2. Ing EB, Sullivan TJ, Clarke MP, Buncic JR. Oculomotor nerve palsies in children. J Pediatr Ophthalmol Strabismus. 1992;29(6):331–6.

    Article  CAS  PubMed  Google Scholar 

  3. Mudgil AV, Repka MX. Ophthalmologic outcome after third cranial nerve palsy or paresis in childhood. J AAPOS. 1999;3(1):2–8.

    Article  CAS  PubMed  Google Scholar 

  4. O’Hara MA, Anderson RT, Brown D. Magnetic resonance imaging in ophthalmoplegic migraine of children. J AAPOS. 2001;5(5):307–10.

    Article  PubMed  Google Scholar 

  5. Kodsi SR, Younge BR. Acquired oculomotor, trochlear, and abducent cranial nerve palsies in pediatric patients. Am J Ophthalmol. 1992;114(5):568–74.

    Article  CAS  PubMed  Google Scholar 

  6. Trobe JD. Third nerve palsy and the pupil. Footnotes to the rule. Arch Ophthalmol. 1988;106(5):601–2.

    Article  CAS  PubMed  Google Scholar 

  7. Lustbader JM, Miller NR. Painless, pupil-sparing but otherwise complete oculomotor nerve paresis caused by basilar artery aneurysm. Case report. Arch Ophthalmol. 1988;106(5):583–4.

    Article  CAS  PubMed  Google Scholar 

  8. Brodsky M, Baker RS, Hamed LM. Ocular motor nerve palsies in children. In: Brodsky M, Baker RS, Hamed LM, editors. Pediatric neuro-ophthalmology. New York: Springer; 1996. p. 201–40.

    Chapter  Google Scholar 

  9. Tiffin PA, MacEwen CJ, Craig EA, Clayton G. Acquired palsy of the oculomotor, trochlear and abducens nerves. Eye. 1996;10(Pt 3):377–84.

    Article  PubMed  Google Scholar 

  10. Kushner BJ. Surgical treatment of paralysis of the inferior division of the oculomotor nerve. Arch Ophthalmol. 1999;117(4):485–9.

    Article  CAS  PubMed  Google Scholar 

  11. Simons BD. Surgical management of ocular motor cranial nerve palsies. Semin Ophthalmol. 1999;14(2):81–94.

    Article  CAS  PubMed  Google Scholar 

  12. Gottlob I, Catalano RA, Reinecke RD. Surgical management of oculomotor nerve palsy. Am J Ophthalmol. 1991;111(1):71–6.

    Article  CAS  PubMed  Google Scholar 

  13. Harley RD. Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies. Ophthalmology. 1980;87(1):24–43.

    Article  CAS  PubMed  Google Scholar 

  14. Young TL, Conahan BM, Summers CG, Egbert JE. Anterior transposition of the superior oblique tendon in the treatment of oculomotor nerve palsy and its influence on postoperative hypertropia. J Pediatr Ophthalmol Strabismus. 2000;37(3):149–55.

    Article  CAS  PubMed  Google Scholar 

  15. Deutsch JA, Greenwald MJ, Lingua RW, Nelson LB. Surgical approaches to strabismus after third nerve palsy. J Pediatr Ophthalmol Strabismus. 2015;52(6):326–30.

    Article  PubMed  Google Scholar 

  16. Velez FG, Thacker N, Britt MT, Alcorn D, Foster RS, Rosenbaum AL. Rectus muscle orbital wall fixation: a reversible profound weakening procedure. J AAPOS. 2004;8(5):473–80.

    Article  PubMed  Google Scholar 

  17. Metz HS, Yee D. Third nerve palsy: superior oblique transposition surgery. Ann Ophthalmol. 1973;5(2):215–8.

    CAS  PubMed  Google Scholar 

  18. Reinecke RD. Surgical results of third cranial nerve palsies. N Y State J Med. 1972;72(11):1255–7.

    CAS  PubMed  Google Scholar 

  19. Villasenor Solares J, Riemann BI, Romanelli Zuazo AC, Riemann CD. Ocular fixation to nasal periosteum with a superior oblique tendon in patients with third nerve palsy. J Pediatr Ophthalmol Strabismus. 2000;37(5):260–5.

    CAS  PubMed  Google Scholar 

  20. Sharma P, Gogoi M, Kedar S, Bhola R. Periosteal fixation in third-nerve palsy. J AAPOS. 2006;10(4):324–7.

    Article  PubMed  Google Scholar 

  21. Shah AS, Prabhu SP, Sadiq MA, Mantagos IS, Hunter DG, Dagi LR. Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy. JAMA Ophthalmol. 2014;132(8):963–9.

    Article  PubMed  Google Scholar 

  22. Yanovitch T, Buckley E. Diagnosis and management of third nerve palsy. Curr Opin Ophthalmol. 2007;18(5):373–8.

    Article  PubMed  Google Scholar 

  23. Patel SV, Mutyala S, Leske DA, Hodge DO, Holmes JM. Incidence, associations, and evaluation of sixth nerve palsy using a population-based method. Ophthalmology. 2004;111(2):369–75.

    Article  PubMed  Google Scholar 

  24. Repka MX, Lam GC, Morrison NA. The efficacy of botulinum neurotoxin A for the treatment of complete and partially recovered chronic sixth nerve palsy. J Pediatr Ophthalmol Strabismus. 1994;31(2):79–83; discussion 84

    Article  CAS  PubMed  Google Scholar 

  25. Laby DM, Rosenbaum AL. Adjustable vertical rectus muscle transposition surgery. J Pediatr Ophthalmol Strabismus. 1994;31(2):75–8.

    Article  CAS  PubMed  Google Scholar 

  26. Foster RS. Vertical muscle transposition augmented with lateral fixation. J AAPOS. 1997;1(1):20–30.

    Article  CAS  PubMed  Google Scholar 

  27. Gunton KB. Vertical rectus transpositions in sixth nerve palsies. Curr Opin Ophthalmol. 2015;26(5):366–70.

    Article  PubMed  Google Scholar 

  28. Mehendale RA, Dagi LR, Wu C, Ledoux D, Johnston S, Hunter DG. Superior rectus transposition and medial rectus recession for Duane syndrome and sixth nerve palsy. Arch Ophthalmol. 2012;130(2):195–201.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rosenbaum AL, Kushner BJ, Kirschen D. Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy. Arch Ophthalmol. 1989;107(6):820–3.

    Article  CAS  PubMed  Google Scholar 

  30. Holmes JM, Leske DA. Long-term outcomes after surgical management of chronic sixth nerve palsy. J AAPOS. 2002;6(5):283–8.

    Article  PubMed  Google Scholar 

  31. Hayreh SS, Scott WE. Fluorescein iris angiography. II. Disturbances in iris circulation following strabismus operation on the various recti. Arch Ophthalmol. 1978;96(8):1390–400.

    Article  CAS  PubMed  Google Scholar 

  32. Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL. Partial rectus muscle-augmented transpositions in abduction deficiency. J AAPOS. 2003;7(5):325–32.

    Article  PubMed  Google Scholar 

  33. Rosenbaum AL. Costenbader Lecture. The efficacy of rectus muscle transposition surgery in esotropic Duane syndrome and VI nerve palsy. J AAPOS. 2004;8(5):409–19.

    Article  PubMed  Google Scholar 

  34. DeRespinis PA, Caputo AR, Wagner RS, Guo S. Duane’s retraction syndrome. Surv Ophthalmol. 1993;38(3):257–88.

    Article  CAS  PubMed  Google Scholar 

  35. Chung M, Stout JT, Borchert MS. Clinical diversity of hereditary Duane’s retraction syndrome. Ophthalmology. 2000;107(3):500–3.

    Article  CAS  PubMed  Google Scholar 

  36. Miller MT, Stromland K. Ocular motility in thalidomide embryopathy. J Pediatr Ophthalmol Strabismus. 1991;28(1):47–54.

    CAS  PubMed  Google Scholar 

  37. Marshman WE, Schalit G, Jones RB, Lee JP, Matthews TD, McCabe S. Congenital anomalies in patients with Duane retraction syndrome and their relatives. J AAPOS. 2000;4(2):106–9.

    Article  CAS  PubMed  Google Scholar 

  38. Miller NR, Kiel SM, Green WR, Clark AW. Unilateral Duane’s retraction syndrome (Type 1). Arch Ophthalmol. 1982;100(9):1468–72.

    Article  CAS  PubMed  Google Scholar 

  39. Hotchkiss MG, Miller NR, Clark AW, Green WR. Bilateral Duane’s retraction syndrome. A clinical-pathologic case report. Arch Ophthalmol. 1980;98(5):870–4.

    Article  CAS  PubMed  Google Scholar 

  40. Kekunnaya R, Kraft S, Rao VB, Velez FG, Sachdeva V, Hunter DG. Surgical management of strabismus in Duane retraction syndrome. J AAPOS. 2015;19(1):63–9.

    Article  PubMed  Google Scholar 

  41. Pressman SH, Scott WE. Surgical treatment of Duane’s syndrome. Ophthalmology. 1986;93(1):29–38.

    Article  CAS  PubMed  Google Scholar 

  42. Kraft SP. A surgical approach for Duane syndrome. J Pediatr Ophthalmol Strabismus. 1988;25(3):119–30.

    Article  CAS  PubMed  Google Scholar 

  43. Nelson LB. Severe adduction deficiency following a large medial rectus recession in Duane’s retraction syndrome. Arch Ophthalmol. 1986;104(6):859–62.

    Article  CAS  PubMed  Google Scholar 

  44. Saunders RA, Wilson ME, Bluestein EC, Sinatra RB. Surgery on the normal eye in Duane retraction syndrome. J Pediatr Ophthalmol Strabismus. 1994;31(3):162–9; discussion 170-161

    Article  CAS  PubMed  Google Scholar 

  45. Molarte AB, Rosenbaum AL. Vertical rectus muscle transposition surgery for Duane’s syndrome. J Pediatr Ophthalmol Strabismus. 1990;27(4):171–7.

    Article  CAS  PubMed  Google Scholar 

  46. Doyle JJ, Hunter DG. Transposition procedures in Duane retraction syndrome. J AAPOS. 2019;23(1):5–14.

    Article  PubMed  Google Scholar 

  47. Yang S, MacKinnon S, Dagi LR, Hunter DG. Superior rectus transposition vs medial rectus recession for treatment of esotropic Duane syndrome. JAMA Ophthalmol. 2014;132(6):669–75.

    Article  PubMed  Google Scholar 

  48. Velez FG, Foster RS, Rosenbaum AL. Vertical rectus muscle augmented transposition in Duane syndrome. J AAPOS. 2001;5(2):105–13.

    Article  CAS  PubMed  Google Scholar 

  49. Britt MT, Velez FG, Thacker N, Alcorn D, Foster RS, Rosenbaum AL. Surgical management of severe cocontraction, globe retraction, and pseudo-ptosis in Duane syndrome. J AAPOS. 2004;8(4):362–7.

    Article  PubMed  Google Scholar 

  50. Miller MT, Stromland K. The mobius sequence: a relook. J AAPOS. 1999;3(4):199–208.

    Article  CAS  PubMed  Google Scholar 

  51. Verzijl HT, van der Zwaag B, Cruysberg JR, Padberg GW. Mobius syndrome redefined: a syndrome of rhombencephalic maldevelopment. Neurology. 2003;61(3):327–33.

    Article  PubMed  Google Scholar 

  52. MacKinnon S, Oystreck DT, Andrews C, Chan WM, Hunter DG, Engle EC. Diagnostic distinctions and genetic analysis of patients diagnosed with moebius syndrome. Ophthalmology. 2014;121(7):1461–8.

    Article  PubMed  Google Scholar 

  53. McKay VH, Touil LL, Jenkins D, Fattah AY. Managing the child with a diagnosis of Moebius syndrome: more than meets the eye. Arch Dis Child. 2016;101(9):843–6.

    Article  PubMed  Google Scholar 

  54. Miller MT, Stromland K, Ventura L, Johansson M, Bandim JM, Gillberg C. Autism with ophthalmologic malformations: the plot thickens. Trans Am Ophthalmol Soc. 2004;102:107–20; discussion 120–101

    PubMed  PubMed Central  Google Scholar 

  55. Pastuszak AL, Schuler L, Speck-Martins CE, et al. Use of misoprostol during pregnancy and Mobius’ syndrome in infants. N Engl J Med. 1998;338(26):1881–5.

    Article  CAS  PubMed  Google Scholar 

  56. Stromland K, Miller MT. Thalidomide embryopathy: revisited 27 years later. Acta Ophthalmol. 1993;71(2):238–45.

    Article  CAS  Google Scholar 

  57. Stromland K, Nordin V, Miller M, Akerstrom B, Gillberg C. Autism in thalidomide embryopathy: a population study. Dev Med Child Neurol. 1994;36(4):351–6.

    Article  CAS  PubMed  Google Scholar 

  58. Spierer A, Barak A. Strabismus surgery in children with Mobius syndrome. J AAPOS. 2000;4(1):58–9.

    Article  CAS  PubMed  Google Scholar 

  59. Traboulsi EI, Maumenee IH. Extraocular muscle aplasia in Moebius syndrome. J Pediatr Ophthalmol Strabismus. 1986;23(3):120–2.

    Article  CAS  PubMed  Google Scholar 

  60. Bielschowsky A. Lectures on motor anomalies. Hanover: Dartmouth College Publications; 1940.

    Google Scholar 

  61. Helveston EM, Mora JS, Lipsky SN, et al. Surgical treatment of superior oblique palsy. Trans Am Ophthalmol Soc. 1996;94:315–28; discussion 328–334

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Wallace DK, von Noorden GK. Clinical characteristics and surgical management of congenital absence of the superior oblique tendon. Am J Ophthalmol. 1994;118(1):63–9.

    Article  CAS  PubMed  Google Scholar 

  63. Knapp P. First Annual Richard G. Scobee Memorial Lecture. Diagnosis and surgical treatment of hypertropia. Am Orthopt J. 1971;21:29–37.

    CAS  PubMed  Google Scholar 

  64. Ehrt O, Boergen KP. A concept for the surgical treatment of trochlear palsy. Strabismus. 2004;12(2):75–83.

    Article  CAS  PubMed  Google Scholar 

  65. Cogen MS, Roberts BW. Combined superior oblique tuck and adjustable suture recession of the ipsilateral superior rectus for long-standing superior oblique palsy. J AAPOS. 2003;7(3):195–9.

    Article  PubMed  Google Scholar 

  66. Simons BD, Saunders TG, Siatkowski RM, et al. Outcome of surgical management of superior oblique palsy: a study of 123 cases. Binocul Vis Strabismus Q. 1998;13(4):273–82.

    CAS  PubMed  Google Scholar 

  67. von Noorden GK, Jenkins RH, Chu MW. Horizontal transposition of the vertical rectus muscles for cyclotropia. Am J Ophthalmol. 1996;122(3):325–30.

    Article  Google Scholar 

  68. Nejad M, Thacker N, Velez FG, Rosenbaum AL, Pineles SL. Surgical results of patients with unilateral superior oblique palsy presenting with large hypertropias. J Pediatr Ophthalmol Strabismus. 2013;50(1):44–52.

    Article  PubMed  Google Scholar 

  69. Jampolsky A. Superior oblique tuck surgery in the management of superior oblique palsies: Discussion. J Pediatr Ophthalmol Strabismus. 1992;29(6):347–8.

    Google Scholar 

  70. Deutsch JA, Dotan G, Raab EL, Wagner RS. Surgical management of Brown syndrome. J Pediatr Ophthalmol Strabismus. 2017;54(6):330–1.

    Article  PubMed  Google Scholar 

  71. Lee J. Management of Brown syndrome. Semin Ophthalmol. 2008;23(5):291–3.

    Article  PubMed  Google Scholar 

  72. Wright KW. Superior oblique silicone expander for Brown syndrome and superior oblique overaction. J Pediatr Ophthalmol Strabismus. 1991;28(2):101–7.

    Article  CAS  PubMed  Google Scholar 

  73. Stager DR Jr, Parks MM, Stager DR Sr, Pesheva M. Long-term results of silicone expander for moderate and severe Brown syndrome (Brown syndrome “plus”). J AAPOS. 1999;3(6):328–32.

    Article  PubMed  Google Scholar 

  74. Sharma M, MacKinnon S, Zurakowski D, Dagi LR. Consecutive superior oblique palsy after adjustable suture spacer surgery for Brown syndrome: incidence and predicting risk. J AAPOS. 2018;22(5):335–339 e332.

    Article  PubMed  Google Scholar 

  75. Suh DW, Guyton DL, Hunter DG. An adjustable superior oblique tendon spacer with the use of nonabsorbable suture. J AAPOS. 2001;5(3):164–71.

    Article  CAS  PubMed  Google Scholar 

  76. Parks MM, Eustis HS. Simultaneous superior oblique tenotomy and inferior oblique recession in Brown’s syndrome. Ophthalmology. 1987;94(8):1043–8.

    Article  CAS  PubMed  Google Scholar 

  77. Parks MM. Doyne Memorial Lecture, 1977. The superior oblique tendon. Trans Ophthalmol Soc UK. 1977;97(2):288–304.

    CAS  PubMed  Google Scholar 

  78. Bagolini B, Tamburrelli C, Dickmann A, Colosimo C. Convergent strabismus fixus in high myopic patients. Doc Ophthalmol Adv Ophthalmol. 1990;74(4):309–20.

    Article  CAS  Google Scholar 

  79. Demer JL, Von Noorden GK. High myopia as an unusual cause of restrictive motility disturbance. Surv Ophthalmol. 1989;33(4):281–4.

    Article  CAS  PubMed  Google Scholar 

  80. Hayashi T, Iwashige H, Maruo T. Clinical features and surgery for acquired progressive esotropia associated with severe myopia. Acta Ophthalmol Scand. 1999;77(1):66–71.

    Article  CAS  PubMed  Google Scholar 

  81. Ward DM. The heavy eye phenomenon. Trans Ophthalmol Soc UK. 1967;87:717–26.

    CAS  PubMed  Google Scholar 

  82. Kowal L, Troski M, Gilford E. MRI in the heavy eye phenomenon. Aust N Z J Ophthalmol. 1994;22(2):125–6.

    Article  CAS  PubMed  Google Scholar 

  83. Krzizok TH, Kaufmann H, Traupe H. New approach in strabismus surgery in high myopia. Br J Ophthalmol. 1997;81(8):625–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Krzizoh TH, Kaufmann H, Traupe H. Elucidation of restrictive motility in high myopia by magnetic resonance imaging. Arch Ophthalmol. 1997;115(8):1019–27.

    Article  CAS  PubMed  Google Scholar 

  85. Aoki Y, Nishida Y, Hayashi O, et al. Magnetic resonance imaging measurements of extraocular muscle path shift and posterior eyeball prolapse from the muscle cone in acquired esotropia with high myopia. Am J Ophthalmol. 2003;136(3):482–9.

    Article  PubMed  Google Scholar 

  86. Demer JL. Muscle paths matter in strabismus associated with axial high myopia. Am J Ophthalmol. 2010;149(2):184–186 e181.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Miller JM, Demer JL, Rosenbaum AL. Effect of transposition surgery on rectus muscle paths by magnetic resonance imaging. Ophthalmology. 1993;100(4):475–87.

    Article  CAS  PubMed  Google Scholar 

  88. Wong I, Leo SW, Khoo BK. Loop myopexy for treatment of myopic strabismus fixus. J AAPOS. 2005;9(6):589–91.

    Article  PubMed  Google Scholar 

  89. Yamaguchi M, Yokoyama T, Shiraki K. Surgical procedure for correcting globe dislocation in highly myopic strabismus. Am J Ophthalmol. 2010;149(2):341–346 e342.

    Article  PubMed  Google Scholar 

  90. Ranka MP, Steele MA. Esotropia associated with high myopia. Curr Opin Ophthalmol. 2015;26(5):362–5.

    Article  PubMed  Google Scholar 

  91. Morax S, Pascal D, Barraco P. Significance of the “V” syndrome with double “up shoot”. Insufficiency of the two superior oblique muscles in craniofacial malformations. J Fr Ophtalmol. 1983;6(3):295–310.

    CAS  PubMed  Google Scholar 

  92. Robb RM, Boger WP 3rd. Vertical strabismus associated with plagiocephaly. J Pediatr Ophthalmol Strabismus. 1983;20(2):58–62.

    Article  CAS  PubMed  Google Scholar 

  93. Morax S. Oculo-motor disorders in craniofacial malformations. J Maxillofac Surg. 1984;12(1):1–10.

    Article  CAS  PubMed  Google Scholar 

  94. Rosenberg JB, Tepper OM, Medow NB. Strabismus in craniosynostosis. J Pediatr Ophthalmol Strabismus. 2013;50(3):140–8.

    Article  PubMed  Google Scholar 

  95. Bagolini B, Campos EC, Chiesi C. Plagiocephaly causing superior oblique deficiency and ocular torticollis. A new clinical entity. Arch Ophthalmol. 1982;100(7):1093–6.

    Article  CAS  PubMed  Google Scholar 

  96. Ortiz-Monasterio F, Fuente del Campo A, Limon-Brown E. Mechanism and correction of V syndrome in craniofacial dysostosis. In: Tessier P, editor. Symposium on plastic surgery in the orbital region. Saint Louis: Mosby; 1976. p. 247–54.

    Google Scholar 

  97. Denis D, Genitori L, Bolufer A, Lena G, Saracco JB, Choux M. Refractive error and ocular motility in plagiocephaly. Childs Nerv Syst. 1994;10(4):210–6.

    Article  CAS  PubMed  Google Scholar 

  98. Cheng H, Burdon MA, Shun-Shin GA, Czypionka S. Dissociated eye movements in craniosynostosis: a hypothesis revived. Br J Ophthalmol. 1993;77(9):563–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. Dagi LR, MacKinnon S, Zurakowski D, Prabhu SP. Rectus muscle excyclorotation and V-pattern strabismus: a quantitative appraisal of clinical relevance in syndromic craniosynostosis. Br J Ophthalmol. 2017;101(11):1560–5.

    Article  PubMed  Google Scholar 

  100. Weinstock FJ, Hardesty HH. Absence of superior recti in craniofacial dysostosis. Arch Ophthalmol. 1965;74:152–3.

    Article  CAS  PubMed  Google Scholar 

  101. Cuttone JM, Brazis PT, Miller MT, Folk ER. Absence of the superior rectus muscle in Apert’s syndrome. J Pediatr Ophthalmol Strabismus. 1979;16(6):349–54.

    Article  CAS  PubMed  Google Scholar 

  102. Diamond GR, Katowitz JA, Whitaker LA, Quinn GE, Schaffer DB. Variations in extraocular muscle number and structure in craniofacial dysostosis. Am J Ophthalmol. 1980;90(3):416–8.

    Article  CAS  PubMed  Google Scholar 

  103. Greenberg MF, Pollard ZF. Absence of multiple extraocular muscles in craniosynostosis. J AAPOS. 1998;2(5):307–9.

    Article  CAS  PubMed  Google Scholar 

  104. Hertle RW, Quinn GE, Minguini N, Katowitz JA. Visual loss in patients with craniofacial synostosis. J Pediatr Ophthalmol Strabismus. 1991;28(6):344–9.

    Article  CAS  PubMed  Google Scholar 

  105. Ganesh A, Edmond J, Forbes B, et al. An update of ophthalmic management in craniosynostosis. J AAPOS. 2019;23(2):66–76.

    Article  PubMed  Google Scholar 

  106. Nguyen JQN, Resnick CM, Chang YH, et al. Impact of obstructive sleep apnea on optic nerve function in patients with craniosynostosis and recurrent intracranial hypertension. Am J Ophthalmol. 2019;207:356–362.

    Google Scholar 

  107. Diamond GR, Whitaker L. Ocular motility in craniofacial reconstruction. Plast Reconstr Surg. 1984;73(1):31–7.

    Article  CAS  PubMed  Google Scholar 

  108. Buncic JR. Discussion: Ocular motility in craniofacial reconstruction. Plast Reconstr Surg. 1984;73:36–7.

    Article  Google Scholar 

  109. Elhusseiny AM, Mackinnon S, Zurakowski D, Huynh EM and Dagi LR. Long-term ophthalmic outcomes in 120 children with unilateral coronal synostosis: A 20-year retrospective review. J AAPOS. 2021;S1091–8531(21)00053-7.

    Google Scholar 

  110. Isaac KV, MacKinnon S, Dagi LR, Rogers GF, Meara JG, Proctor MR. Nonsyndromic unilateral coronal synostosis: a comparison of fronto-orbital advancement and endoscopic suturectomy. Plast Reconstr Surg. 2019;143(3):838–48.

    Article  CAS  PubMed  Google Scholar 

  111. Coats DK, Paysse EA, Stager DR. Surgical management of V-pattern strabismus and oblique dysfunction in craniofacial dysostosis. J AAPOS. 2000;4(6):338–42.

    Article  CAS  PubMed  Google Scholar 

  112. Kushner BJ. Restriction of elevation in abduction after inferior oblique anteriorization. J AAPOS. 1997;1(1):55–62.

    Article  CAS  PubMed  Google Scholar 

  113. Elhusseiny AM, Huynh EM and Dagi LR. Evaluation and management of V-pattern strabismus in craniosynostosis. J Binocul Vis Ocul Motil. 2020;70(1):40–45.

    Google Scholar 

  114. Hussein MA, Stager DR Sr, Beauchamp GR, Stager DR Jr, Felius J. Anterior and nasal transposition of the inferior oblique muscles in patients with missing superior oblique tendons. J AAPOS. 2007;11(1):29–33.

    Article  PubMed  Google Scholar 

  115. Cruz OA. Restricted motility for vertical strabismus in Graves’ ophthalmopathy. Ophthalmology. 2001;108(2):242–3.

    Article  CAS  PubMed  Google Scholar 

  116. Buckley EG. Restrictive strabismus. In: Plager DA, editor. Strabismus surgery: basic and advanced strategies. Oxford: Oxford University Press; 2004. p. 117–54.

    Google Scholar 

  117. Coats DK, Paysse EA, Plager DA, Wallace DK. Early strabismus surgery for thyroid ophthalmopathy. Ophthalmology. 1999;106(2):324–9.

    Article  CAS  PubMed  Google Scholar 

  118. Bartalena L, Baldeschi L, Boboridis K, et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J. 2016;5(1):9–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  119. Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves’ orbitopathy. N Engl J Med. 2011;364(20):1920–31.

    Article  CAS  PubMed  Google Scholar 

  120. Gair EJ, Lee JP, Khoo BK, Maurino V. What is the role of botulinum toxin in the treatment of dysthyroid strabismus? J AAPOS. 1999;3(5):272–4.

    Article  CAS  PubMed  Google Scholar 

  121. Granet DB, Hodgson N, Godfrey KJ, et al. Chemodenervation of extraocular muscles with botulinum toxin in thyroid eye disease. Graefes Arch Clin Exp Ophthalmol. 2016;254(5):999–1003.

    Article  CAS  PubMed  Google Scholar 

  122. Ruttum MS. Effect of prior orbital decompression on outcome of strabismus surgery in patients with thyroid ophthalmopathy. J AAPOS. 2000;4(2):102–5.

    Article  CAS  PubMed  Google Scholar 

  123. Trokel S, Kazim M, Moore S. Orbital fat removal. Decompression for Graves orbitopathy. Ophthalmology. 1993;100(5):674–82.

    Article  CAS  PubMed  Google Scholar 

  124. Ellis EM, Kinori M, Robbins SL, Granet DB. Pulled-in-two syndrome: a multicenter survey of risk factors, management and outcomes. J AAPOS. 2016;20(5):387–91.

    Article  PubMed  Google Scholar 

  125. Wright KW. Late overcorrection after inferior rectus recession. Ophthalmology. 1996;103(9):1503–7.

    Article  CAS  PubMed  Google Scholar 

  126. Hudson HL, Feldon SE. Late overcorrection of hypotropia in Graves ophthalmopathy. Predictive factors. Ophthalmology. 1992;99(3):356–60.

    Article  CAS  PubMed  Google Scholar 

  127. Sprunger DT, Helveston EM. Progressive overcorrection after inferior rectus recession. J Pediatr Ophthalmol Strabismus. 1993;30(3):145–8.

    Article  CAS  PubMed  Google Scholar 

  128. Dagi LR. Management of graves myopathy. Understanding and managing vertical strabismus from thyroid eye disease. J AAPOS. 2018;22(4):252–5.

    Article  PubMed  Google Scholar 

  129. Cruz OA, Davitt BV. Bilateral inferior rectus muscle recession for correction of hypotropia in dysthyroid ophthalmopathy. J AAPOS. 1999;3(3):157–9.

    Article  CAS  PubMed  Google Scholar 

  130. Nguyen VT, Park DJ, Levin L, Feldon SE. Correction of restricted extraocular muscle motility in surgical management of strabismus in Graves’ ophthalmopathy. Ophthalmology. 2002;109(2):384–8.

    Article  PubMed  Google Scholar 

  131. Dagi LR, Elliott AT, Roper-Hall G, Cruz OA. Thyroid eye disease: honing your skills to improve outcomes. J AAPOS. 2010;14(5):425–31.

    Article  PubMed  Google Scholar 

  132. Del Monte MA. An ocular odyssey: lessons learned from 25 years of surgical treatment for graves eye disease. Am Ortho J. 2001;52:40–57. 2002

    Article  Google Scholar 

  133. Holmes JM, Hatt SR, Bradley EA. Identifying masked superior oblique involvement in thyroid eye disease to avoid postoperative A-pattern exotropia and intorsion. J AAPOS. 2012;16(3):280–5.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Hatton MP, Watkins LM, Rubin PA. Orbital fractures in children. Ophthal Plast Reconstr Surg. 2001;17(3):174–9.

    Article  CAS  PubMed  Google Scholar 

  135. Sires BS, Stanley RB Jr, Levine LM. Oculocardiac reflex caused by orbital floor trapdoor fracture: an indication for urgent repair. Arch Ophthalmol. 1998;116(7):955–6.

    CAS  PubMed  Google Scholar 

  136. Jordan DR, Allen LH, White J, Harvey J, Pashby R, Esmaeli B. Intervention within days for some orbital floor fractures: the white-eyed blowout. Ophthal Plast Reconstr Surg. 1998;14(6):379–90.

    Article  CAS  PubMed  Google Scholar 

  137. Bansagi ZC, Meyer DR. Internal orbital fractures in the pediatric age group: characterization and management. Ophthalmology. 2000;107(5):829–36.

    Article  CAS  PubMed  Google Scholar 

  138. Ludwig IH, Brown MS. Strabismus due to flap tear of a rectus muscle. Trans Am Ophthalmol Soc. 2001;99:53–62; discussion 62–53

    CAS  PubMed  PubMed Central  Google Scholar 

  139. Ortube MC, Rosenbaum AL, Goldberg RA, Demer JL. Orbital imaging demonstrates occult blow out fracture in complex strabismus. J AAPOS. 2004;8(3):264–73.

    Article  PubMed  Google Scholar 

  140. Chatzistefanou KI, Kouris T, Iliakis E, et al. The ice pack test in the differential diagnosis of myasthenic diplopia. Ophthalmology. 2009;116(11):2236–43.

    Article  PubMed  Google Scholar 

  141. Kubis KC, Danesh-Meyer HV, Savino PJ, Sergott RC. The ice test versus the rest test in myasthenia gravis. Ophthalmology. 2000;107(11):1995–8.

    Article  CAS  PubMed  Google Scholar 

  142. Gilhus NE, Verschuuren JJ. Myasthenia gravis: subgroup classification and therapeutic strategies. Lancet Neurol. 2015;14(10):1023–36.

    Article  CAS  PubMed  Google Scholar 

  143. Bentley CR, Dawson E, Lee JP. Active management in patients with ocular manifestations of myasthenia gravis. Eye. 2001;15(Pt 1):18–22.

    Article  CAS  PubMed  Google Scholar 

  144. McCreery KM, Hussein MA, Lee AG, Paysse EA, Chandran R, Coats DK. Major review: the clinical spectrum of pediatric myasthenia gravis: blepharoptosis, ophthalmoplegia and strabismus. A report of 14 cases. Binocul Vis Strabismus Q. 2002;17(3):181–6.

    PubMed  Google Scholar 

  145. Peragallo JH, Velez FG, Demer JL, Pineles SL. Long-term follow-up of strabismus surgery for patients with ocular myasthenia gravis. J Neuroophthalmol. 2013;33(1):40–4.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Linda R. Dagi & Yoon-Hee Chang

  2. Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA

    Evan Silverstein

Authors
  1. Linda R. Dagi
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  2. Yoon-Hee Chang
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  3. Evan Silverstein
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Corresponding author

Correspondence to Linda R. Dagi .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

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  1. No affiliation provided

    Michael Chiang

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Dagi, L.R., Chang, YH., Silverstein, E. (2022). Complex or Incomitant Strabismus. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_290

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  • DOI: https://doi.org/10.1007/978-3-030-42634-7_290

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