Normal kittens showed a gradual increase from 17.6% to 25.5% of BLS with aging from the fifth week to the ninth. Young kittens showed significantly less BLS than do adult ones (p < 0.1), There was significant difference of BLS between exotropic and normal kittens or alternating and non-alternating strabismic ones. However, there was a significant diftrence between esotropic and normal ones (p < 0.1). These results suggested that the BLS can be used as a index for the extent of total field from both eyes.
Aging ; Animals ; Cats ; Esotropia/*physiopathology ; Exotropia/*physiopathology ; Photic Stimulation ; Pupil/*physiopathology ; Strabismus/*physiopathology ; Vision, Binocular

The authors report two cases of suddenly deteriorated accommodative esotropia with amblyopia during part-time occlusion therapy. A 7-year-old girl with right accommodative esotropia, which was well controlled, showed marked increase in esodeviation after part-time occlusion and regained orthophoria without occlusion. This phenomenon was repeated. Recession of both medial recti was performed and orthophoria was well maintained at both distant and near targets. Accommodative esotropia of a 9-year-old boy with glasses also showed a striking increase in esodeviation after part-time occlusion. The authors recommended wearing only glasses without occlusion or surgery and he recovered fusion. Three months later, orthophoria was maintained at distant target, with 8PD esophoria at near target with glasses. Although this complication should be considered before occlusion therapy, it must be taken continuously if needed, because an increase of the deviation size with occlusion may simply reflect a true deviation and may not be a poor prognostic sign.
*Accommodation, Ocular ; Amblyopia/physiopathology/therapy ; Child ; Esotropia/*etiology/physiopathology ; Eyeglasses ; Female ; Humans ; Male ; *Sensory Deprivation

We studied the relationship between eye position in the awakened state and in the surgical plane of anesthesia in orthophoric and horizontal strabismus patients. We classified 105 orthophoric and horizontal strabismus patients into 5 groups, measured the eye position at the primary position by photographic measurement of the corneal reflex positions and undertook a quantitative study of eye position. Under general anesthesia, the mean divergence was 39.7 +/- 8 PD for the esotropia group, 36.6 +/- 11.7 PD for exophoria, 27.4 +/- 8.1 PD for orthophoria, and 11.1 +/- 10.2 PD for exotropia I (< or=30 PD). Therefore, the esotropia group had the largest amount of divergence among the groups, but the eye position of the exotropia II (> 30 PD) group was rather convergent at 11.0 +/- 6.5 PD. According to the eye position of the fixating and nonfixating eyes in the esotropia group, both eyes converged with an angle deviation of 14.4 +/- 4.8 PD divergent and 14.1 +/- 4.8 PD divergent, respectively (P=.71). In the exotropia groups (I, II), the fixating eye diverged but the nonfixating eye rather converged. Therefore, the angle deviation was 19.0 +/- 2.1 PD divergent for the fixating eye and 18.2 +/- 6.4 PD divergent for the nonfixating eye (P=.68). In conclusion, under general anesthesia, eye positions in the awakened state and in the surgical plane of anesthesia were convergent or divergent, and showed a tendency to converge into the position of 25-35 PD divergent. Therefore, we could not distinguish fixating eye from nonfixating eye under general anesthesia.
Adolescent ; Adult ; *Anesthesia, General ; Child ; Child, Preschool ; Esotropia/*physiopathology ; Exotropia/*physiopathology ; Eye Movements/*physiology ; Humans ; Photography ; Vision, Binocular/physiology

PURPOSE: To evaluate changes in ocular alignment in partially accommodative esotropic children age ranged from 3 to 8 years during occlusion therapy for amblyopia. METHODS: Angle measurements of twenty-two partially accommodative esotropic patients with moderate amblyopia were evaluated before and at 2 years after occlusion therapy. RESULTS: Mean deviation angle with glasses at the start of occlusion treatment was 19.45+/-5.97 PD and decreased to 12.14+/-12.96 PD at 2 years after occlusion therapy (p<0.01). After occlusion therapy, 9 (41%) cases were indications of surgery for residual deviation but if we had planned surgery before occlusion treatment, 18 (82%) of patients would have had surgery. There was a statistical relationship between increase of visual acuity ratio and decrease of deviation angle (r=-0.479, p=0.024). CONCLUSIONS: There was a significant reduction of deviation angle of partially accommodative esotropic patients at 2 years after occlusion therapy. Our results suggest that occlusion therapy has an influence on ocular alignment in partially accommodative esotropic patients with amblyopia.
*Accommodation, Ocular ; Adult ; Aged ; Amblyopia/*etiology/*physiopathology ; Esotropia/*physiopathology/*therapy ; Female ; Humans ; Male ; Middle Aged ; Occlusive Dressings/adverse effects ; Retrospective Studies ; *Sensory Deprivation ; Treatment Outcome

We report a case of surgical treatment for Hallermann-Streiff syndrome in a patient with ocular manifestations of esotropia, entropion, and blepharoptosis. A 54-year-old man visited Yeouido St. Mary's Hospital complaining of ocular discomfort due to cilia touching the corneas of both eyes for several years. He had a bird-like face, pinched nose, hypotrichosis of the scalp, mandibular hypoplasia with forward displacement of the temporomandibular joints, a small mouth, and proportional short stature. His ophthalmic features included sparse eyelashes and eyebrows, microphthalmia, nystagmus, lower lid entropion in the right eye, and upper lid entropion with blepharoptosis in both eyes. There was esodeviation of the eyeball of more than 100 prism diopters at near and distance, and there were limitations in ocular movement on lateral gaze. The capsulopalpebral fascia was repaired to treat the right lower lid entropion, but an additional Quickert suture was required to prevent recurrence. Blepharoplasty and levator palpebrae repair were performed for blepharoptosis and dermatochalasis. Three months after lid surgery, the right medial rectus muscle was recessed 7.5 mm, the left medial rectus was recessed 7.25 mm, and the left lateral rectus muscle was resected 8.0 mm.
Blepharoptosis/physiopathology/*surgery ; Entropion/physiopathology/*surgery ; Esotropia/physiopathology/*surgery ; Eye Movements ; Follow-Up Studies ; Hallermann's Syndrome/*surgery ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*methods

PURPOSE: To evaluate the correlation of the distance Krimsky test and the alternate prism cover test (APCT) for the distance deviation in patients with horizontal strabismus. METHODS: Forty patients with horizontal strabismus (20 esotropia and 20 exotropia) were included in this study. Patients with a variable angle of deviation, vertical angle over 5 prism diopters, impaired binocular vision, or poor cooperation were excluded. We instructed the patient to look a target 6 meters away, and applied a prism over the patient's dominant eye while flashing a light source 33 centimeters from the middle of both eyebrows. When the corneal light reflexes were located on the center of each cornea, we measured the angle of deviation. We defined this method as 'distance Krimsky test,' and the angle measured by this method was compared with the conventional Krimsky test and APCT at distance. We analyzed the accuracy and intra- and inter-observer reliability. RESULTS: The angle of strabismus measured by the distance Krimsky test showed a significant agreement and correlation with the deviation angle measured by the APCT. We elicited the correlation gradient between the angle measured by the distance Krimsky test and the APCT. In addition, the distance Krimsky test showed significant intra- and inter-observer reliabilities. CONCLUSIONS: The distance Krimsky test is expected to be more useful than the Krimsky test in measuring the distance angle of deviation for patients with strabismus in whom it is difficult to measure the angle of deviation using the APCT. The distance Krimsky test can be an accurate and useful test through the improvement of proficiency of examiners and the establishment of individualized normative data.
Adolescent ; Adult ; Child ; Esotropia/*diagnosis/physiopathology ; Exotropia/*diagnosis/physiopathology ; Female ; Humans ; Male ; Observer Variation ; Social Distance ; Strabismus/diagnosis/physiopathology ; Vision Tests/*methods/standards/statistics & numerical data ; Vision, Binocular ; Young Adult

PURPOSE: To investigate the clinical course in patients who underwent surgical correction of consecutive esotropia. METHODS: The medical records of 13 patients who underwent surgical correction of consecutive esotropia were reviewed retrospectively. The authors investigated the deviation and surgical method at the time of exotropia surgery. During the follow up period, the authors also studied incidence of amblyopia development, the effect of occlusion therapy, surgical methods for consecutive esotropia, and postoperative change of deviation. RESULTS: The average exodeviation was 27.1 prism diopter (PD). Bilateral lateral rectus muscle recession was performed in all patients. In all patients, alternate occlusion was tried from 2 weeks after development of consecutive esotropia. However, there was no effect on 7 patients. None of the patients developed amblyopia. Surgery for consecutive esotropia was performed on the average 15.3 months after exotropia surgery. The average esodeviation was 21.1PD. Medial rectus muscle recession was performed in 10 patients and lateral rectus muscle advancement in 3 patients. The average deviation of the subject group immediately after surgery was 1.2PD esodeviation, 0.9PD esodeviation one month after surgery, 2.4PD exodeviation 6 months after surgery, and 4.7PD exodeviation at the last follow up, and it showed a tendency to progress to exodeviation as the follow up period increased. Ten patients (76.9%) showed deviation within 8PD at the last follow up. CONCLUSIONS: The success rate of surgical correction for consecutive esotropia was a favorable outcome. But, careful decisions of the surgical method and amount is needed because the conversion of exodeviation during long-term follow-up is possible.
Adolescent ; Child ; Child, Preschool ; Esotropia/epidemiology/*etiology/physiopathology ; Exotropia/physiopathology/*surgery ; Eye Movements/*physiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Oculomotor Muscles/physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*methods ; Postoperative Complications ; Retrospective Studies ; Time Factors ; Treatment Outcome

PURPOSE: The purpose of this study was to investigate the clinical course of esodeviation after exotropia surgery in older patients (older than 15 years) and to compare it with that in younger patients (15 years or younger). METHODS: The medical records of all surgeries for exodeviation from December 2004 to February 2007 were reviewed and 82 patients were found with consecutive esodeviation. The patients were divided into two groups according to their age: Group A (patients older than 15 years) and Group B (patients age 15 or younger). The clinical course of esodeviation in Group A was compared to that in Group B by means of survival analysis. RESULTS: The median survival times of the esodeviation were 2.0+/-0.1 months in Group A and 1.0+/-0.1 months in Group B (p=0.40). The prevalence of consecutive esotropia at six months was 0% in Group A and 6.1% in Group B (p=0.32). The myopic refractive error, worse sensory condition, and a larger preoperative exodeviation in Group A did not affect the clinical course of the two groups differently. CONCLUSIONS: The postoperative esodeviation of patients older than 15 years after exotropia surgery tended to persist longer during the early postoperative period than that of patients 15 years or younger, however, the difference did not persist at postoperative six months.
Adult ; Age Factors ; Child ; Esotropia/*etiology/physiopathology ; Exotropia/*surgery ; Female ; Humans ; Kaplan-Meiers Estimate ; Male ; Oculomotor Muscles/*surgery ; *Postoperative Complications ; Vision, Binocular/physiology ; Visual Acuity/physiology

PURPOSE: To report the long term results of bifocal treatment in nonrefractive accommodative esotropia and to analyze the changes of accommodative convergence to accommodation (AC/A) ratio. METHODS: Sixteen patients treated with bifocal glasses for at least 5 years were evaluated retrospectively. Angle of deviation at near and distance, refractive error, and AC/A ratio by the lens gradient method were analyzed. The changes of AC/A ratios were also compared after dividing the patients according to continuation or cessation of bifocal therapy. RESULTS: Six patients (38%; bifocal stop group, BSG) were able to stop using bifocal glasses at an average age of 10.8 years (range, 6.5 to 15.4 years) during their follow-up. However, the other ten patients (62%; bifocal continue group, BCG) had to continue using bifocal glasses until the final visit, which was 13.8 years on average (range, 11.3 to 18.5 years). The AC/A ratio decreased from time of bifocal prescription to the last visit in both groups, from 4.4 to 2.7 in the BSG and from 5.9 to 4.5 in the BCG. AC/A ratios were significantly higher (p = 0.03) in the BCG than that of the BSG from the beginning of bifocal treatment and this difference was persistent until the final visit (p = 0.03). CONCLUSIONS: The AC/A ratio decreased with age in both groups but was significantly higher throughout the entire follow-up period in the BCG. AC/A ratio at bifocal prescription could be an important factor in predicting response to bifocal treatment.
Accommodation, Ocular/*physiology ; Adolescent ; Child ; Cyclopentolate/administration & dosage ; Esotropia/*physiopathology/*therapy ; *Eyeglasses ; Female ; Humans ; Male ; Phenylephrine/administration & dosage ; Retrospective Studies ; Statistics, Nonparametric ; Tropicamide/administration & dosage

PURPOSE: To describe the clinical features of Duane's retraction syndrome (DRS) in Korean patients. METHODS: We retrospectively analyzed the 78 DRS cases that presented to our department between 1995 and 2004. The clinical features investigated included sex distribution, laterality, type of presentation, deviation in primary position, anomalous vertical movements, face turn, amblyopia and anisometropia. RESULTS: There were 38 (48.7%) affected males and 40 (51.3%) females. Left eye predominance (83.3%) was observed, as was type I presentation (85.9%). Orthotropia was found to be the most common primary position in 46 cases (59.0%). Face turn in unilateral DRS was noted in 13 patients (17.1%). There were 6 cases (7.7%) with anisometropia and 4 (5.1%) with amblyopia. CONCLUSIONS: The clinical manifestations of DRS in our study were different from those of equivalent Caucasian studies yet similar to those previously reported for Asian groups. Racial and regional differences were noted, for which further research is needed to elaborate the reasons and mechanisms.
Adolescent ; Adult ; *Asian Continental Ancestry Group ; Child ; Child, Preschool ; Duane Retraction Syndrome/*complications/ethnology/*physiopathology ; Esotropia/*complications ; Exotropia/*complications ; Female ; Humans ; Male ; Retrospective Studies