PURPOSE: Duane's retraction syndrome is a congenital eye movement disorder caused by innervational disturbance. It is rare that Duane's retraction syndrome is associated with Goldenhar's syndrome which shows systemic congenital malformations. We report a case of bilateral Duane's retraction syndrome associated with Goldenhar's syndrome, which was treated with strabismus surgery and excision of epibulbar lipodermoid. METHODS: A 14-month-old boy with exotropia showed severe limitation of adduction, mild limitation of abduction, globe retraction and palpabral fissure narrowing on attempted adduction in both eyes. He also had a diffuse small epibulabar mass under the lateral conjunctiva in the left eye. The angle of exodeviation was 45PD on alternate prism cover and uncover test. He had had cleft lip, multiple skin tags on the face and preauricular appendages since birth and undergone an operation for these abnormalities at age of 4 months. Bilateral 7.5mm recession of the lateral recti and excisional biopsy of epibulbar mass of the left eye were performed. RESULTS: A case of Duane's retraction syndrome associated with Goldenhar's syndrome was found. The patient obtained orthophoria in his primary gaze after bilateral recession of lateral recti. The epibulbar mass was consistent with lipodermoid on pathologic examination.
Biopsy ; Cleft Lip ; Conjunctiva ; Duane Retraction Syndrome* ; Exotropia ; Humans ; Infant ; Male ; Ocular Motility Disorders ; Parturition ; Skin ; Strabismus

Of 22 cases of strabismus having surgical operations designed on the basis of A-scan ultrasonography, 19(86%) had less than 10 prism diopters eso-or exodeviation at least 2 months postoperatively; 19 exo-and 3 esodeviations were included in the series. Among 3 cases which had more than 10 prism diopters deviation at final follow up, a true divergence excess type exotropia and a nonaccommodative convergence excess type esotropia were included. With the exception of these 2 cases, 19 among 20 basic tropias(95%) had less than 10 prism diopters deviation. A-scan ultrasonography was done preoperatively to find the diameter and thus the circumference of the globe. This was used with the angle of deviation to estimate the amount of recession and/or resection necessary to correct the deviation. Attention was drawn not to exceed the safe range of recession by considering the oculomotor equator.
Esotropia ; Exotropia ; Follow-Up Studies ; Ocular Motility Disorders ; Strabismus* ; Ultrasonography*

Intermittent exotropia at times is completely controlled by the convergence mechanisms and at other times escapes this control and becomes a manifest exotropia. The treatment of choice is surgical and the treatment is directed at normalization of binocular functions, and recurrence and overcorrection are frequently seen after surgery. Therefore it is important to decide the time and the type of surgery. The author experienced 66 cases of intermittent exotropia in which surgery was done. Surgery was indicated in the cases with deviation of 20 PD or more, deviation of less than 20 PD with asthenopia, exotropia occurred during more than 40% of waking hours, and deterioration of stereoacuity even at early age. Bilateral recession was initial procedure regardless type of intermittent exotropia. In the case with amblyopia, however, R and R was done on the amblyopic eye and in convergence insufficiency type bimedial resection. Lateral Incomitancy was present in 37.9%. The basic type which was shown in 68.2% was the most frequent one. The amount of esodeviation was 15 to 10 PD in 43.9% and 11 to 15 PD in 21.2% on the first postoperative day. The phoria within 10 PD was shown in 95.4% 6 weeks after surgery, in 98.5% 3 months after surgery, and in 93.9% 6 months after surgery. Six months after surgery, 4 cases revealed exodeviation above 16 PD and no case esodeviation. Stereopsis was tested in 54 cases who understood the test before operation and 43 cases(79.6%) showed stereopsis. Nine out of 11 cases who had no stereopsis showed stereopsis after operation. In this study, success rate of first surgery was as high as 93.9% in 6 months follow-up and stereopsis was restored in considerable number of cases in intermittent exotropia compared to other types of strabismus and binocular function could also be restored and improved after surgery.
Amblyopia ; Asthenopia ; Depth Perception ; Esotropia ; Exotropia* ; Follow-Up Studies ; Ocular Motility Disorders ; Recurrence ; Strabismus ; Telescopes ; United Nations

Internuclear ophthalmoplegia(INO)is a horiwntal ocular motor disturbance caused by a lesion of the medial longitudinal fasciculus. We have experienced a case of bilateral internuclear ophthalmoplegia associated with exotropia, which revealed the symptom of bilateral impairment of adduction and dissociated nystagmus of the abducting eye on horizontal gaze in either direction. No bilateral internuclear ophthalmoplegia caused by trauma has yet been reported in this country. Here we report the case of the trauma-related medial longitudinal fasciculus lesion and its pathophysiology along with a literatural review.
Exotropia ; Nystagmus, Pathologic ; Ocular Motility Disorders*

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with pseudodivergence excess type and convergence insufficiency type of intermittent exotropia [X(T)], and to compare with a normal group. METHODS: A total of 55 subjects were divided into 3 groups: pseudodivergence excess type, convergence insufficiency type, and normal group. Age, gender, and refractive error of patients were examined. The deviation angle was measured at near and distance by using a prism cover test, followed by an interpupillary distance measurement. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: There was no statistically significant difference in age, gender, and the refractive errors among the 3 groups. The mean value of AC/A ratio using the heterophoria method was 9.50 in pseudodivergence excess type patients, 2.59 in convergence insufficiency type patients, and 5.47 in the normal group. Using the gradient method, the mean value of AC/A ratio was 1.47, 0.03, and 2.08 in each group, respectively. There was no statistically significant difference in mean values between patients with pseudodivergence excess type and the normal group, except when obtained using the gradient method (p = 0.43). CONCLUSIONS: A distinct difference in AC/A ratio existed when computed by the heterophoria method between patients with pseudodivergence excess type or convergence insufficiency type and the normal group. In the gradient method, however, the ratios of convergence insufficiency type patients were lower compared to the normal group, indicating the gradient method is more accurate than the heterophoria method.
Exotropia ; Humans ; Ocular Motility Disorders ; Refractive Errors

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with pseudodivergence excess type and convergence insufficiency type of intermittent exotropia [X(T)], and to compare with a normal group. METHODS: A total of 55 subjects were divided into 3 groups: pseudodivergence excess type, convergence insufficiency type, and normal group. Age, gender, and refractive error of patients were examined. The deviation angle was measured at near and distance by using a prism cover test, followed by an interpupillary distance measurement. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: There was no statistically significant difference in age, gender, and the refractive errors among the 3 groups. The mean value of AC/A ratio using the heterophoria method was 9.50 in pseudodivergence excess type patients, 2.59 in convergence insufficiency type patients, and 5.47 in the normal group. Using the gradient method, the mean value of AC/A ratio was 1.47, 0.03, and 2.08 in each group, respectively. There was no statistically significant difference in mean values between patients with pseudodivergence excess type and the normal group, except when obtained using the gradient method (p = 0.43). CONCLUSIONS: A distinct difference in AC/A ratio existed when computed by the heterophoria method between patients with pseudodivergence excess type or convergence insufficiency type and the normal group. In the gradient method, however, the ratios of convergence insufficiency type patients were lower compared to the normal group, indicating the gradient method is more accurate than the heterophoria method.
Exotropia ; Humans ; Ocular Motility Disorders ; Refractive Errors

PURPOSE: To evaluate the effects of converted intermittent exotropia type with part-time occlusion therapy on final postoperative outcomes. METHODS: The present study included 140 consecutive intermittent exotropia patients. On the patient's first visit, the type of intermittent exotropia was determined according to the deviation angle. After preoperative part-time occlusion therapy, the type of intermittent exotropia was reevaluated. The surgical success rates of each group was compared retrospectively according to the converted type. RESULTS: At the first visit, the basic type was the most prevalent (n = 112), followed by convergence insufficiency type (n = 18) and pseudo-divergence excess type (n = 10). Mean deviation angle on the first visit was 25.42 +/- 6.05 PD at distance and 26.19 +/- 8.20 PD at near. There were significant changes in near deviation angle after part-time occlusion in patients with the basic and convergence insufficiency types (p = 0.045, 0.03, respectively). Twenty-seven patients who had converted from basic type to pseudo-divergence excess type and from convergence insufficiency type to basic type showed better surgical success rate (89%) than other patients (69%) (p = 0.033). CONCLUSIONS: Part-time occlusion therapy converts the type of intermittent exotropia by reducing near deviation angle and is related to a better surgical success rate.
Exotropia ; Humans ; Ocular Motility Disorders ; Retrospective Studies

Intermittent exotropia occurs commonly in Korea and its clinical characteristics are relatively well known. We analyzed the clinical characteristics of intermittent exotropia and studied the relationship among them. We examined 229 patients(92 males and 137 females( who first visited three strabismic clinics. The age of onset, frequency, family history and symptoms of intermittent exotropia were examined. The angle and type of deviation were studied and sensory tests were done. The mean age of onset was 32.4 months and frequency ws 39.1% and family history was 8.7%. Photophobia was the most common symptom of intermittent exotropia. The distant angle of deviation was 26.7 prism diopters in average and the near angle was 25.3 prism diopters in average. The most common type of intermittent exotropia was basic type. followed by simulated divergence excess type, convergence insufficiency type, and divergence excess type. In statistical study, there was no significant relationship among clinical characteristics of intermittent exotroia.
Age of Onset ; Exotropia* ; Humans ; Korea ; Male ; Ocular Motility Disorders ; Photophobia ; Statistics as Topic ; Strabismus

A 31-years-old female presented with left eyelid, canalicular, and conjunctival lacerations after struck by a glass bottle.She had left hypertropia and limitation of depression.Primary repairs of left eyelid, canalicular, and conjunctival laceration were performed that day.After two weeks, the explorative operation was done because of the inability of depression of left eye. We identified the transection of inferior rectus muscle, and repaired it.Three months after second operation, there were 12 prism diopters of left hyper-tropia, 12 prism diopters of left exotropia in the primary position, and 20 prism diopters of left hypertropia in left down gaze.Double Maddox rod testing revealed 6degrees of left incyclotropia, and she presented head tilt to the left. Four months after second operation, 5 mm recession of left superior rectus muscle was done.Postoperatively, she had nearly orthotropia in primary position, but 10 prism diopters in left downgaze.She had only 2 degrees of left incyclotropia, and showed the improvement of ocular torticollis.
Depression ; Exotropia ; Eyelids ; Female ; Glass ; Head ; Humans ; Lacerations ; Ocular Motility Disorders* ; Strabismus

To investigate whether the slanted medial rectus recession can correct excess esotropia at near without overcorrection at distance and reduce the distance-near deviation difference, we examined 11 convergence excess esotropia patients who had deviation at near exceeding distance esotropia by 15PD or more, and underwent this operation. They composed of 7 partially accommodative esotropia with high AC/A ratio and 4 nonaccommdodative convergence excess esotropia. The surgical procedure consisted of bilateral, symmetrical slanted recession of the medial rectus muscle. The amount of recession of the upper and lower margins were calculated so as to correct the esotropia with correction at distance, and near respectively. The preoperative mean near and distance deviation were 33.8PD and 15PD, and each decreased to 9.2PD and 4.3PD postoperatively. The preoperative mean distance-near deviation difference were 18.8PD, and decreased to 5.4PD postoperatively. The 3 patients decreased over 10PD in the distancenear deviation difference. In conclusion, the surgical procedure, as bilateral slanted medial rectus recession, can correct excess esotropia at near without overcorrection at distance and reduce the distance-near deviation difference. Therefore, the bilateral slanted medial rectus recession may be used as the method of surgical treatment in convergence excess esotropia.
Esotropia* ; Humans ; Ocular Motility Disorders*