We assessed the efficacy of modified Kestenbaum procedure for the correction of abnormal head position in 16 patients with the diagnosis of in fantile nystagmus. Instead of Parks 5-6-7-8mm modified Kestenbaum procedure, we performed 6-7-6-7mm modified Kestenbaum on 11 patients with head turn of 20-30, 20% augmented procedure(7.2-8.4-7.2-8.4mm) on 4 patients with head turn of 30 or more, and-1mm procedure(5-6-5-6mm) on 1 patent with head turn of less than 20. In the average follow-up of 7 months, 10 patients(62.5%) showed head turn of less than 5, in which 14 of 16 patients had less than10 .87.5% of the patients showed satisfactory correction of abnormal head position., 12 prism diopter of exotropia was noted postoperatively in 1 case but the duction was not limited in any case. From the above results, we conclude that 6-7-6-7mm modified Kestenbaum nystagmus.
Diagnosis ; Exotropia ; Follow-Up Studies ; Head ; Humans

We evaluated 38patients with orbital wall fracture, who were repaired surgically after its diagnosis from January 1986 to October 1995. We analysed its clinical symptoms and signs, ocular motlity disturbances and strabismus remaining after reduction. All the aptients showed diplopia due to ocular motility disturbance, it was greater in the patients with large fracture size and inferior wall fracture. The ocular motility disturbance remaining after the reduction was proportional to the fracture size and the time between trauma and its reduction. The exotropia and hypertropia of the fracturd eye were the main types of strabismus remaining after reduction. It was more severe in the patients with large fracture size and upper grade of ocular motility disturbance. The weakening procedure of horizontal and vertical muscle resulted in good correction for the strabismus.
Diagnosis ; Diplopia ; Exotropia ; Humans ; Orbit* ; Strabismus

PURPOSE: The purpose of this study is to provide useful clinical information for proper diagnosis of the superior oblique muscle palsy (SOP) associated with horizontal deviation. METHODS: The records of 186 patients with SOP treated surgically were reviewed. The patients who underwent surgery for horizontal deviation more than 10 PD were classified into SOP associated with horizontal deviation. RESULTS: Of 186 patients with SOP, 96 (51.6%) patients also showed horizontal deviation. In 59 patients (61.5%) of these 96 patients, chief complaint was horizontal deviation only and 24 patients (25.0%) knew their hyperdeviation. Compensatory head-tilt was shown in 52 patients (54.2%), however only 11 (11.5%) patients complained their head-tilt posture. Of 96 patients, 72 (82.3%) had horizontal deviation in the eye contralateral to the paretic eye and amblyopia occurred in the horizontally deviated eye. The frequency of exodeviation was 82.3 % and was more than that of esodeviation. The mean amount of hyperdeviation was 12.6 +/- 6.77 PD, and that of horizontal deviation was 22.9 +/- 8.13 PD in exodeviation and 22.5 +/- 9.17 PD in esodeviation, respectively ninety three patients (96.9%) showed positive Bielschowsky head-tilt test. All 83 patients who had fundus examination showed foveal extorsion. CONCLUSIONS: This study reveals that Bielschowsky head-tilt test and fundus examination for foveal extorsion are needed to diagnose SOP which is masked by prominent horizontal deviation.
Amblyopia ; Diagnosis ; Esotropia ; Exotropia ; Humans ; Masks ; Paralysis ; Posture

A and V patterns are manifest by a horizontal change of alignment of the eyes that occurs on midline upgaze and downgaze as the eyes are moved from the primary position. A and V patterns may be associated with orthophoria, esodeviation, or exodeviation in the primary position. Compensatory head postures are frequently found in patients having A and V patterns. A great deal has been written about the etiology, however, no single etiologic factor can explain all A and V patterns. A and V patterns are revealed by prism and alternate cover midline measurements, comparing 30 degrees upgaze, primary position, and 30 degrees downgaze. A difference of 15 delta between up and down measurements in V patterns and 10 delta in A patterns is necessary for a valid diagnosis. Some surgical methods were described to correct the A and V patterns, only two methods receive widespread acceptance: vertical transposition of the insertions of the horizontal rectus muscles and weakening of the oblique muscles. The authors studied clinically 8 cases of V patterns and 1 case of A pattern in 118 strabismic patients. The results were as follows; 1) The prevalence of A and V patterns was about 8%(9/118). 2) In V patterns, weakening procedures on the inferior oblique muscles with surgery on the horizontal rectus muscles corrected 7 delta to 12 delta between primary position and upgaze. And combining vertical transposition of horizontal rectus muscles corrected an additional 17 delta to 28 delta of V patterns between up and downgaze. 3) In A pattern, resecting inferior rectus muscle with surgery on the horizontal rectus muscles corrected 6 delta of A pattern.
Diagnosis ; Esotropia ; Exotropia ; Head ; Humans ; Muscles ; Posture ; Prevalence

PURPOSE: To investigate the clinical features associated with hypertropia and report the surgical outcomes of hypertropia coexisting with exotropia. METHODS: We reviewed the medical records of 148 patients with intermittent exotropia coexisting with hypertropia over 4 PD who received exotropia surgery. The cases accompanied by apparent paralytic strabismus such as superior oblique palsy were excluded. Patients were divided into group I(clinically diagnosed hypertropia) and group II (non-specific hypertropia) and the clinical features of coexisting hypertropia and surgical outcomes were analyzed. RESULTS: Among the 148 patients, group Iconsisted of 38 patients (26%) and group II of 110 patients (74%). The average amount of preoperative hypertropia angle in primary gaze was 9.58 +/- 3.89 PD and 6.62 +/- 2.69 PD in group I and II, respectively. Group I included 12 patients with dissociated vertical deviation (DVD), 10 patients with unilateral inferior oblique overaction, 13 patients with asymmetric bilateral inferior oblique overaction and 3 patients with superior oblique overaction. Group II included 19 patients with comitant hypertropia (17%), head tilt positive pattern (simulated superior oblique palsy) was found in 84 patients (76.3%) and variable incomitance was observed. In group I, 29 patients received simultaneous horizontal muscle with hypertropia surgery. Postoperative hypertropia angle in group I was 1.41 +/- 2.93 PD and 4 cases were considered surgical failure. In group II, hypertropia was resolved with horizontal muscle surgery only and the amount of postoperative hypertropia was 0.45 +/- 1.60 PD. CONCLUSIONS: In this study, vertical deviations in intermittent exotropia with concomitant hypertropia related to obvious oblique muscle dysfunction or DVD were corrected effectively by oblique or vertical rectus muscle surgery. Nonspecific hypertropia can be resolved after horizontal muscle surgery alone, however, for precise differential diagnosis, careful examination for variable clinical features is necessary before determining surgery.
Diagnosis, Differential ; Exotropia* ; Head ; Humans ; Medical Records ; Paralysis ; Strabismus*

PURPOSE: The aim of this study was to compare sensory and motor functions in patients with constant and intermittent primary infantile exotropia. METHODS: From March 2010 to November 2015, 58 patients with primary infantile exotropia were divided into a constant group (21 patients) and an intermittent group (37 patients) according to frequency of exodeviation at the first visit. Sex, family history of strabismus, age at diagnosis, spherical equivalent, and presence of amblyopia were compared. Angle of deviation, ocular motor function, and stereopsis were measured. RESULTS: Females were more prevalent (p = 0.027) and the spherical equivalent of the right eye was more myopic (-0.99 D) (p = 0.023) in the constant infantile exotropia group. However, there was no significant difference in family history of strabismus, age at diagnosis, amblyopia, latent nystagmus, or stereopsis between the two groups. There were no significant differences between the two groups in angle of deviation at near or distance (p = 0.598, p = 0.518). Dissociated vertical deviation was accompanied in 2 patients in the constant group and 3 in the intermittent group. Inferior oblique overaction was accompanied in 8 patients in the constant group and 16 in the intermittent group, while vertical deviation was accompanied in 1 patient in the constant group and 3 in the intermittent group. However, there were no significant differences between the groups for any of these findings. CONCLUSIONS: Constancy of exodeviation is insufficient to diagnose primary infantile exotropia. Compared to those in whom exodeviation was intermittent, the patients with constant infantile exotropia showed similar clinical features. Therefore, close observation is recommended in patients with intermittent and constant infantile exotropia.
Amblyopia ; Depth Perception ; Diagnosis ; Exotropia* ; Female ; Humans ; Strabismus

In this study, we reviewed 46 consecutive patients with diagnosis of Duane's retraction syndrome at the Seoul National University Hospital from April, 1987 to October, 1995. The following characteristics were reviewed - sex, laterality, clinical type, primary position alignment, anomalous vertical movements, head turn, fusion and amblyopia. The incidence in each sex showed no difference(male: 54%, female:46%). Ninety-six percent of cases had a unilateral manifestation and 4% of cases had bilaterality. The left eyes were involved in 70% of cases and the right eyes in the 26% of cases. Type I was the most common type(96%) and the esodeviations were the most frequent in primary position. Head turns were observed in 77% of cases and the direction of head turns were toward the involved eyes in esodeviations, and away from the involved eyes in exodeviations regardless of the clinical types. Among 26 patients who underwent the fusion test, seventeen patients(65%) had fusion and that was more common in patients with exodeviation(83%) than others.
Amblyopia ; Diagnosis ; Duane Retraction Syndrome* ; Esotropia ; Exotropia ; Head ; Head Movements ; Humans ; Incidence ; Seoul

PURPOSE: To obtain guideline of diagnosis and treatment when hyperdeviation associated with intermittent exotropia shows symptoms similar to superior oblique palsy (SOP). METHODS: We reviewed the charts retrospectively in 27 patients showing simulated SOP in intermittent exotropia, in which hyperdeviation in primary gaze and 10PD or more by Bielschowsky head tilt test were present. Overaction of Inferior oblique, (IOOA) dysfunction of superior oblique, and forveal extorsion more than +2 were excluded including reoperation and head tilt history. All patients were undergone horizontal muscle surgery only. The postoperative changes of deviation were analyzed at postoperative one day, one month, six month, and one year. RESULTS: Average amount of distant horizontal deviation in primary gaze was 32.3+/-9.58PD. Hyperdeviation was 3.8+/-2.52PD. Degree of IOOA averaged +1.18 in hypertropic eye, and +1.06 in hypotropic eye. Only 10 patients (37%) had foveal extorsion less than +2 in degree. Average vertical deviation of hypertropic eye side was 12.7+/-2.93PD on head tilt test. After horizontal surgery only, the amount of hyperdeviation decreased to 1.3PD at 1st day. On head tilt test, hyperdeviation was almost eliminated showing 0.6PD on the hypertropic side and 0.1PD on the contralateral eye at one month. All patients were aligned up to the follow-up of one year. CONCLUSIONS: To differentiate simulated SOP from intermittent exotropia with hyperdeviation, none of head tilt history, mild foveal extorsion, mild oblique dysfunction less than +3, double Maddox rod test, and forced duction test are important guidelines. Horizontal muscle surgery is only needed to remove exodeviation and hyperdeviation.
Diagnosis ; Exotropia* ; Follow-Up Studies ; Head ; Humans ; Paralysis* ; Reoperation ; Retrospective Studies

PURPOSE: To evaluate the clinical course and surgical outcome of infantile exotropia with large and constant angle, as defined by the onset of exotropia before 6 months. METHODS: We reviewed the records of 11 patients who were diagnosed with infantile exotropia and received surgery between July 1987 and December 2003. Age at onset and surgery, visual acuity, refractive error, pre- and post-operative angle of strabismus, and binocular sensory status after surgery were evaluated for each patient. RESULTS: The mean age at onset, diagnosis, and first surgery was 2.3 months (range, birth to 5 months), 14.9 months (range, 4 to 33 months), and 36.3 months (range, 11 to 45 months), respectively. The mean size of preoperative exodeviation was 57.3 prism diopters (PD) (range, 40 to 100 PD). Six patients (54.5%) required reoperation to correct residual or recurred exotropia, oblique dysfunction, and/or DVD. Two (18.2%) of the six required a third operation. Sensory tests including Lang test were performed in seven patients but all failed in Lang test and showed no fusion even with successful surgical treatment. CONCLUSIONS: Infantile exotropia should be observed for a long period and needs proper reoperation because it may be frequently associated with residual or recurred exotropia, oblique dysfunction, and/or DVD after initial operation. However, improvement of binocular function can rarely be expected even with successful surgical alignment.
Diagnosis ; Exotropia* ; Humans ; Parturition ; Refractive Errors ; Reoperation ; Strabismus ; Telescopes ; Visual Acuity

PURPOSE: The purpose of this study is to evaluate the clinical course and surgical outcomes of constant infantile exotopia developed in the first year of life. METHODS: Eighteen patients diagnosed with constant infantile exotropia who underwent surgery between June 1993 and July 2003 were reviewed retrospectively. Age at diagnosis and surgery, refractive error, and preoperative and postoperative prism diopters were evaluated for all patients. RESULTS: The mean age at diagnosis was 7.3+/-2.2 months (2~11 months) and mean deviation was 47.2+/-16.6 prism diopters (PD) (25~90 PD). Inferior oblique muscle overaction was found in 3 (17%) patients. Bilateral lateral rectus muscle recession was performed in all patients and mean amount of recession was 8.0+/-0.9 mm (7.0~9.0 mm). The mean age at surgery was 16.7+/-4.1 months (7~24 months) and the mean postoperative follow-up period was 34.3+/-23.0 months (7~83 months). Thirteen patients (76%) showed stable alignments after the first operation and 3 patients (18%) required reoperation due to undercorrection and recurrence. Among them, one patient (6%) required a third operation. CONCLUSIONS: Early surgical intervention in constant infantile exotropia resulted in good postoperative outcome and stable alignments after the first operation.
Diagnosis ; Exotropia* ; Follow-Up Studies ; Humans ; Recurrence ; Refractive Surgical Procedures ; Reoperation ; Retrospective Studies