Lateral rectus sag and recurrent esotropia in children

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
Robert A ClarkJoseph L Demer

Abstract

To describe the clinical and intraoperative findings of an anatomic abnormality in children that resembles sagging eye syndrome documented in older adults and that led to recurrent esotropia after surgery. We reviewed records of 4 patients with substantial recurrent esotropia after bilateral medial rectus recession who required subsequent surgery combining lateral rectus resection with correction of the anatomic abnormality affecting the lateral rectus path. Binocular alignment was sequentially analyzed. Three young patients (2-3 years of age) presented with acquired esotropia but minimal cycloplegic refractive error. The fourth patient (14 years of age) initially had moderate hyperopia and partially accommodative esotropia, but subsequently developed marked bilateral overelevation in adduction. In all patients, esotropia recurred within 5Δ of preoperative deviation after bilateral medial rectus recession. Surgical exposure demonstrated that bilateral lateral rectus paths were inferiorly displaced more than one-half tendon width from their normal paths near the globe's equator, despite normal scleral insertions. Equatorial myopexy and lateral rectus resection resulted in stable esotropia correction. Lateral rectus sag in childr...Continue Reading

References

Aug 1, 1997·Archives of Ophthalmology·T H KrzizohH Traupe
Feb 27, 2004·Investigative Ophthalmology & Visual Science·Joseph L Demer
Sep 13, 2006·Archives of Ophthalmology·Burton J Kushner
Nov 27, 2009·American Journal of Ophthalmology·Makoto YamaguchiKunihiko Shiraki
Jan 4, 2018·Strabismus·Zia Chaudhuri, Joseph L Demer

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Citations

Oct 25, 2020·American Journal of Ophthalmology·Brian G Mohney

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