JUNIPER
PUBLISHERS- JOJ Ophthalmology
Abstract
Objective: To expose the diagnosis of an adult
patient with vertical and unilateral divergent strabismus and to
approach the surgical treatment in order to remove the symptoms of
diplopia and signs of torticollis.
Methods: The measurement of the angle of
deviation, the Lancaster test, the Bielchowsky test and the study of
ocular motility, both in examination room (versions) and in the surgery
room (test of ductions), demonstrated the diagnosis: right eye
hipertropia (HTR) and right eye exotropia (XTR). Surgical intervention
was performed on the right upper rectus muscle and on the right inferior
oblique muscle, with the aim of resolving the deviation of both
directions in only one surgical intervention.
Results: The intervention was satisfactory
for both the patient and the medical team, because we were minimized the
signs and symptoms. After 4 months the residual deviation angle was
minimal and allowed the ability of fusion.
Conclusion: The diagnostic and treatment
protocol performed in this case show the optimal resolution of the
diplopia and torticollis that the patient suffered.
Keywords: Strabismus; Torticollis; Diplopia; Lancaster testIntroduction
We believe that, in some cases, in strabismus surgery
there may be more than one option in the choice of surgical protocol,
and each professional and his experience sets a more personalized
pattern of action. Our objective is showing through this case, for
ophthalmologists and other professionals who visit adult patients with
strabismus, our experience in the surgical treatment of vertical and
divergent deviation with torticollis and an associated diplopia [1-5].
History, Data and Method of Diagnostic Exploration
Patient 41 years old. The patient refers diplopia in
increase for a year and torticollis for years. Tilt the head to the left
shoulder to try to compensate the diplopia. Ocular antecedents: Lasik
refractive surgery (myopia -5.00 both eyes).
Family history: Glaucoma.
Pre-surgery exploration
- Visual acuity without correction right eye = 1
- Visual acuity without correction left eye = 1
- Refraction (cycloplegic) right eye = +1.50-0.50x170°
- Refraction (cycloplegic) left eye = +0.50-0.75x145°
- Corneal topography: Central ablation in both eyes.
- Normal ophthalmic examination.
- . Synoptophore without correction in superaversion = 22Δ XTR / 28 Δ HTR. Primary position of gaze = 17Δ XTR / 28Δ HTR. In Infraversion = 9 Δ XTR / 30Δ HTR.
- Left eye dominance
- Stereopsis test (Titmus / Fly): There is no stereopsis.
Method Surgical
The day of the surgery is performed a tests of duction: right upper oblique muscle (- - -)
Surgical protocol
Backward movement of right upper rectus muscle 3mm. Backward movement of right inferior oblique muscle 6mm.
Post-surgery exploration
The synoptophore after the intervention in the
primary position was 3Δ HTR. There is no existence of stereopsis, but it
can even fusion the images. The patient is subjectively satisfied. It
is proposed, 4 months after the surgery, to begin orthoptic treatment to
strengthen the ability of fusion images [5-10].
Discussion
The deviation of an adult’s strabismus is diagnosed
and resolved the vertical and divergent strabismus in only one surgical
intervention. It was discarded the differential diagnosis of nonocular
torticollis by the examination tests. It was considered, for the good
maintenance of the obtained result and maintenance of the ability of
fusion, to perform an orthoptic treatment after surgery. We consider
that the patient will have more visual quality in their daily life when
resolving their symptoms of diplopia, signs of torticollis and ocular
asymmetry. We emphasize the exploration by the Lancaster test in
patients with diplopia for its ease of use, graphical representation and
its diagnostic ability and the following of the case over time.
Conclusion
The diagnostic and treatment protocol performed in
this case show the optimal resolution of the diplopia and torticollis
that the patient suffered.
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