PMID: 18427617Apr 23, 2008Paper

Dissociated horizontal deviation: clinical spectrum, pathogenesis, evolutionary underpinnings, diagnosis, treatment, and potential role in the development of infantile esotropia (an American Ophthalmological Society thesis).

Transactions of the American Ophthalmological Society
Michael C Brodsky

Abstract

To elucidate the pathophysiology of dissociated horizontal deviation. The reversed fixation test was performed prospectively in 28 patients who developed consecutive exotropia following horizontal extraocular muscle surgery for infantile esotropia. All patients were assessed for the presence of adduction weakness, latent nystagmus, dissociated vertical divergence, and neurologic disease. A positive reversed fixation test, indicating the presence of dissociated horizontal deviation, was found in 14 of 28 patients (50%) with consecutive exotropia. In patients with dissociated horizontal deviation, the exodeviation was usually smaller with the nonpreferred eye fixating than with the preferred eye fixating, and smaller with the preferred eye fixating than during periods of visual inattention or under general anesthesia. Dissociated horizontal deviation correlated with the findings of dissociated vertical divergence, but not with asymmetric adduction weakness, latent nystagmus, or neurologic disease. Using reversed fixation testing, dissociated horizontal deviation can be detected in 50% of patients who develop consecutive exotropia following surgery for infantile esotropia. In this setting, monocular fixation with either eye superi...Continue Reading

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